Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

An ethical excursion through labeling the mentally retarded

Review of a representative body of research data concerning the effects of the “mentally retarded” (MR) label on parents, teachers, college students, nonretarded children, communities, and persons labeled fails to support the extravagant claim of some investigators that the labeling process has psychologically damaging effects upon the individuals labeled as well as society. Negative reactions to labels could be minimized by extensive public education and counseling. Labels should be retained as formal instruments essential to establishing the eligibility of the retarded for special assistance, and for maintenance of communication within and between disciplines, without which contemporary society could not operate. An argument for the judicious use of labels is fashioned, recommending replacement of the MR label by “AD” (adaptively deficient), in keeping with the modern view of mental retardation as a psychosocial challenge deemphasizing IQ and requiring adjustment of the whole personality to demands of a complex environment (e.g., coping skill, motivation). Parents, teachers, friends, employers, and public officials could support the AD's struggle to effectively participate in community life by promoting the perennial values of respect for human dignity, fairness, equality, autonomy, and compassion. As a result of monitoring the success of such programs in all settings, public policy administrators could formulate rational approaches to improvement of service programs in the national interest.     

Cross-modal and intra-modal binding between identity and location in spatial working memory: The identity of objects does not help recalling their locations

In this study we tested incidental feature-to-location binding in a spatial task, both in unimodal and cross-modal conditions. In Experiment 1 we administered a computerised version of the Corsi Block-Tapping Task (CBTT) in three different conditions: the first one analogous to the original CBTT test; the second one in which locations were associated with unfamiliar images; the third one in which locations were associated with non-verbal sounds. Results showed no effect on performance by the addition of identity information. In Experiment 2, locations on the screen were associated with pitched sounds in two different conditions: one in which different pitches were randomly associated with locations and the other in which pitches were assigned to match the vertical position of the CBTT squares congruently with their frequencies. In Experiment 2 we found marginal evidence of a pitch facilitation effect in the spatial memory task. We ran a third experiment to test the same conditions of Experiment 2 with a within-subject design. Results of Experiment 3 did not confirm the pitch–location facilitation effect. We concluded that the identity of objects does not affect recalling their locations. We discuss our results within the framework of the debate about the mechanisms of “what” and “where” feature binding in working memory.     

Ferenczi's Clinical and Theoretical Conception of Trauma: A Brief Introductory Map

In this paper, I am going to limit myself to tracing a map of the principal points in Ferenczi's thinking concerning trauma. Ferenczi's contribution to trauma theory is fundamental, even though up to today--in spite of the recent "Ferenczian Renaissance"--it still remains for many psychoanalysts simply not acknowledged and not considered and, when it is acknowledged and considered, it is frequently misunderstood or reported only in part. Perhaps this is because passages of his theory are extrapolated without knowing his entire clinical theoretical way or because he is quoted through others without the authors having personally read his work. These last ones are typical habits, as we know, to project one's own ideas, especially our prejudices.