Relational suffering and the moral authority of love and care

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.

     

Psychiatric correlates of childhood shyness in a nationally representative sample

Relations between adult anxiety and mood disorders and retrospective reports of excessive childhood shyness were investigated in the US National Comorbidity, Survey (n=5877). Results indicated that 26% of women and 19% of men described themselves as 'very shy' when they were growing up. Of these shy individuals, 53% of women and 40% of men met criteria for a lifetime diagnosis of one or more anxiety or mood disorders. Relations between excessive shyness and each of the anxiety and mood disorders were examined after adjusting for elevated neuroticism, self-criticism, and low maternal care. The largest odds ratios were found for social phobia in both men and women, particularly for the complex subtype of this disorder. Significant associations also emerged for posttraumatic stress disorder in women and for major depressive disorder in men. Childhood shyness remained significantly associated with a lifetime history of social phobia when individuals with current (past year) social phobia were excluded from the analysis. The results of this study suggest that childhood shyness is strongly related to the complex subtype of social phobia in the general population. Excessive shyness does not appear to be strongly associated with other anxiety and mood disorders when related psychosocial and developmental dimensions are statistically controlled. Finally, many individuals who report excessive childhood shyness do not meet criteria for any anxiety or mood disorder. In a similar fashion, approximately 50% of individuals with a lifetime history of complex social phobia did not view themselves as very shy when growing up.     

Can we really do without self-esteem? Comment on Crocker and Park (2004)

Because self-esteem plays a central role in managing anxiety and provides a superordinate goal that organizes much human behavior, the authors conclude that it would be extremely difficult and probably impossible for people to stop pursuing self-esteem. Although they agree that investment in others' welfare may circumvent some of the negative consequences of self-esteem pursuit, the authors argue that the self-esteem implications of other-oriented behavior will inevitably be a powerful motivating force. Finally, the authors propose that self-esteem derived from self-determined standards of value may reduce defensiveness, closed-mindedness, and indifference to others, as well as promote personal growth, but they acknowledge the daunting barriers to the attainment of such self-determined bases of self-worth.     

Perfectionism and depression symptom severity in major depressive disorder.

In recent years it has been recognized that perfectionism is a multidimensional construct and two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation [Frost, R.O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P.L., & Flett, G.L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470]. The present study sought to evaluate the association between various dimensions of perfectionism, higher-order personality dimensions, and self and observer rated depressive symptoms in a group of 145 patients with major depressive disorder. Only three of ten perfectionism dimensions (socially prescribed perfectionism, concern over mistakes and self-criticism) displayed medium to large correlations with depressive symptoms, especially self-report symptoms reflecting depressive cognitive distortions. The results are discussed in relation to the specificity of perfectionism dimensions to depression, adaptive versus maladaptive aspects of perfectionism, and in the context of previous research, much of which has relied on college student samples.     

Temporal dynamics of anxiety-related attentional bias: is affective context a missing piece of the puzzle?

Previous research has demonstrated that anxious individuals attend to negative emotional information at the expense of other information. This is commonly referred to as attentional bias. The field has historically conceived of this process as relatively static; however, research by [Zvielli, A., Bernstein, A., &; Koster, E. H. W. (2014). Dynamics of attentional bias to threat in anxious adults: Bias towards and/or away? PLoS ONE, 9(8), e104025; Zvielli, A., Bernstein, A., &; Koster, E. H. W. (2015). Temporal dynamics of attentional bias. Clinical Psychological Science, 3(5), 772–788.], and others, challenges this assumption by demonstrating considerable temporal variability in attentional bias amongst anxious individuals. Still, the mechanisms driving these temporal dynamics are less well known. Using a modified dot-probe task, the present study examined the impact of two relevant contextual variables- affective valence and trial repetition. Affective context was instantiated by the presentation of negative versus neutral pictures before each trial, while repetition context was achieved via the presentation of the valenced pictures in either a blocked- or mixed-trial design. Results indicate that individuals with higher trait-anxiety levels were significantly more influenced by blocked presentations of negative affective information, leading to greater temporal fluctuations in attentional bias. Furthermore, our findings provide additional evidence that attentional bias is best conceptualised as dynamic and variable, and that an individual’s affective experience is one factor that regulates attentional bias dynamics. Implications relating to theoretical and methodological factors are discussed.     

Maternal parenting as a mediator of the relationship between intimate partner violence and effortful control

The current study examined the relationship between intimate partner violence (IPV), maternal parenting behaviors, and child effortful control in a diverse sample of 705 families living in predominantly low-income, rural communities. Using structural equation modeling, the authors simultaneously tested whether observed sensitive parenting and/or harsh-intrusive parenting over the toddler years mediated the relationship between early IPV and later effortful control. Results suggest that parenting behaviors fully mediate this relationship. Although higher levels of IPV were associated with both higher levels of harsh-intrusive parenting and lower levels of sensitive supportive parenting, only sensitive supportive parenting was associated with later effortful control when both parenting indices were considered in the same model.     

Commentary on “Mediation analysis and categorical variables: The final frontier” by Dawn Iacobucci

The commentary discusses several topics in Dr. Iacobucci's article on mediation analysis with categorical variables including the lack of equivalency of mediated effect measures, ab, and c–c′, that are algebraically equivalent in ordinary least squares regression models. The commentary raises the issue of correlated mediation coefficients and presents formulas to include the correlation in the test of significance. References to new developments in causal mediation analysis for categorical variables are given and the importance of programs of research to establish a mediation theory is emphasized.