Psychosocial adjustment along the HIV disease continuum

Abstract

Evidence suggests that certain indices of stage of HIV disease are determinants of psychological distress, although information is lacking on how disease stage impacts on multiple domains of adjustment. The present study aimed: (1) to explore differences among clinical stages of HIV on measures of psychosocial adjustment, and (2) to explore the relationship between indices of psychosocial adjustment to HIV and self-report measures of physical health. Ninety six HIV-infected persons and 33 HIV seronegative comparison group participants were interviewed and completed self-administered scales. Participants were divided into four groups (the independent variable): a comparison group and three HIV groups, representing the three clinical indices of illness stage (asymptomatic, early symptomatic and AIDS). Three subjective health indices included number of HIV-related symptoms, global health rating, and T4 count. The dependent variables included 5 psychosocial adjustment measures. Results indicated that social and instrumental domains of adjustment were significantly associated with both clinical stage and all 3 subjective health indices. Levels of psychological distress were associated with number of physical symptoms and global health rating, but were unrelated to clinical stage and T4 count. Emotional and existential concerns were unrelated to all indices of illness stage.     

Book review

A hermeneutic of everyday life

Schrag, C.O. Radical Reflection and the Origin of the Human Sciences. West LaFayette, Indiana: Purdue University Press, 1980, 134 pp., $4.95.

Humanistic psychology: past, present and future

Tageson, C. William. Humanistic Psychology: A Synthesis. Home‐wood, Illinois: The Dorsey Press, 1982, 286 pp.

Recent books by division members

Giorgi, Amedeo (Ed.). Phenomenology and Psychological Research. Pittsburgh: Duquesne University Press, 1985, 216 pp., $12.50.

Aanstoos, Christopher M. (Ed.). Exploring the Lived World: Readings in Phenomenological Psychology. West Georgia College Studies in the Social Sciences, Volume 23, 1984, 150 pp., $4.00.

Mahrer, Alvin R. Psychotherapeutic Change: An Alternative Approach to Meaning and Measurement. New York: W .W. Norton & Co., 1985, 208 pp., $22.95.

Klee, James. Points of Departure: Aspects of the Tao. South Bend, Indiana: and books, 1982, 325 pp., $8.95.     

Being a Social Worker as an Existential Commitment: From Vulnerability to Meaningful Purpose

One's personal and professional dimensions complement each other in the practice of social work. In plying their trade, social workers construct a personal narrative that gives a sense of meaning to their commitment to clients who face suffering and distress. The study is based on in-depth interviews of twenty-five experienced female social workers. Two themes were identified: The first theme focuses on the construction of an existential vulnerability in the family-of-origin, which drives the choice of a helping profession. The interviewees perceived these difficulties as contributing to their sensitivity toward the suffering and turmoil of others, connecting them with clients, and giving them a sense of purpose, commitment, and meaning in their work. The second theme relates to the special meaning assigned to social values, such as giving and committing to others, in the family-of-origin and the profound effect of this socialization process on professional choices and practice. The discussion of the findings is from an existential perspective and has implications for the professional development of social workers and other helping professionals.     

The Zen Doctrine of “No-Method”

The case is made for a spectrum of methods in Western psychology transcending the normal dichotomy between the categories of quantitative versus qualitative methodology. Although the quantitative–qualitative continuum may be a sufficient representation of methods in the discussion of methodology within the reductionistic sciences, it fails to account for the phenomenology of the science-making process, itself, as a problem of consciousness within the developing human sciences, and also has little relevance for the way non-Western cultures view the problem of the relation of method to theory. A case in point is the problem of method as discussed in Zen Psychology. The act of freeing attention from its attachment to objective thought through the cultivation of wu, or no-thing-ness, is considered in Zen meditation and then applied to an analysis of the method of the koan, or nonrational riddle, which is designed to shock consciousness into a state of release through immediate intuitive insight. The conclusion is that possibly through such means psychologists in the West could free themselves from the overly rigid and narcissistic focus on methods of reductionistic empiricism as the only alleged standard for defining reality.     

Histrionic Managers Wreak Havoc in the Workplace: Identifying the Phenomenon

Histrionic thinking and behavior derive more from emotion than from reason, creating a condition that causes problems for both those who display this emotional style and those they interact with. When histrionic people “manage” others in the workplace, a destructive dynamic often supervenes as employee and manager pursue the goals of work, frequently at cross purposes. In a naturalistic study, three incidents from my experience with histrionic managers are described and the underlying phenomenon of the histrionic manager is identified. This phenomenon is postulated to be universal, which is to say that managers with a histrionic style will be found wherever work is done.     

Margaret Cavendish on Gender,Nature, and Freedom

Some scholars have argued that Margaret Cavendish was ambivalent about women's roles and capabilities, for she seems sometimes to hold that women are naturally inferior to men, but sometimes that this inferiority is due to inferior education. I argue that attention to Cavendish's natural philosophy can illuminate her views on gender. In section II I consider the implications of Cavendish's natural philosophy for her views on male and female nature, arguing that Cavendish thought that such natures were not fixed. However, I argue that although Cavendish thought women needed to be better educated, and could change if they had such an education, she also thought their education should reinforce the feminine virtues. Section III examines Cavendish's notorious “Preface to the Reader” (from The Worlds Olio), where Cavendish claims that women are naturally inferior in strength and intelligence to men. Section IV addresses another notorious Cavendish text, “Female Orations,” arguing that its message is similar to that of the “Preface to the Reader.” Nonetheless, although Cavendish held conventional views about male and female nature and appropriate gender roles, she also recognized how social institutions could limit women's freedom; section V explores the complexities of Cavendish's critique of one such institution, patriarchal marriage.     

Learning to think in a ‘war zone’

This paper describes an experimental investigation of Winnicott's set situation as described by him in 1941. Three groups of South African infants, 7 to 9 months old, selected from white, black and institutionalized samples were tested three times in the set situation to validate Winnicott's findings and explore new ways of extending the usefulness of the set situation. The study also attempts to explore phantasy in infancy. The results show no significant differences between the black and white infants in the standard presentation, validating Winnicott's observations across different ethnic groups. However, significant differences in the institutionalized group were found, revealing considerable deviations and disturbances. In the second testing, where frustration was introduced, there were, however, significant differences in response to frustration between the black and white infants. Individual examples reveal the uniqueness of the responses to the situation. The situation provides a semi-structured infant observation which can be used as a diagnostic thermometer by professionals in the field of mental health.     

Concreteness and word production

Two experiments are reported that investigated the effect of concreteness on the ability to generate words to fit sentence contexts. When participants attempted to retrieve words from dictionary definitions in Experiment 1, abstract words were associated with more omissions and more alternates than were concrete words. These findings are consistent with the view that the semantic–lexical weights in the word production system are weaker for abstract than for concrete words. We found no evidence that greater competition from semantic neighbors was an additional reason why abstract words were harder to produce. Participants also reported more positive tip-of-the-tongue states (TOTs) when attempting to produce abstract words from their definitions, consistent with more phonological retrieval problems for abstract than for concrete words. In Experiment 2, participants attempted to generate words to fit into a sentence that described a specific event. The difference between the numbers of abstract and concrete words recalled was significantly smaller in the event condition than in the definition condition, and evidence no longer emerged of greater phonological retrieval failure for abstract words. Overall, the results are consistent with the view that the semantic–lexical weights, but not the lexical–phonological weights, are weaker for abstract than for concrete words in the word production system.     

Body Image Disturbance in Schizophrenia: A Study of Arms and Feet

This study investigated the significance of omitting arms/hands and legs/feet on the Draw-A-Person Test (DAP) in 128 hospitalized schizophrenic and 104 normally functioning adult males. The DAP was administered according to Machover's instructions, and the data were analyzed by chi-square tests. It was found that schizophrenics demonstrated significantly more omissions of arms/hands and legs/feet than the normals. These findings were interpreted to indicate body image disturbance in schizophrenia and were related to Schilder's and Federn's theories of the disorder emphasizing an impairment of ego boundaries.