Oh death,where is thy sting? Reflections on dealing with dying patients

This paper examines the reactions of physicians and other health-professionals when they become involved in decisions about the death of their patients. The way people understand the condition of death has a profound influence on attitudes towards death and dying issues. Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.     

Medical ethics in Norway: Modern medicine — Traditional morality

In Norway, by tradition a Lutheran country, the puritan ethics of a “moral minority” has a strong influence on the development and manifestations of medical ethics. Those who exert this influence are found primarily among politicians, the clergy, and, last but certainly not least, among nurses and doctors. The focus of interest is not so much on problems of bioethical moral theory or the teaching of bioethics to students, but very much on attitudes and policies with regard to substantive issues traditionally regarded in Norway as burning bioethical issues, such as: medical research ethics, abortion, prenatal diagnosis, euthanasia, definitions of death, and reproductive technologies.     

Maternal handling and motor development: an intracultural study

Citing a distinction between informal and formal routines used by mothers in handling their infants, we examined formal handling routines, in which the caregiver acts in a pedagogical manner; these routines are widespread in many non-Western countries. We hypothesised that formal handling serves to facilitate gross motor development during early infancy. To examine this hypothesis, the effects of a Jamaican formal handling routine on a broad range of developmental outcomes was examined. Results showed that the effects were specific to early gross motor development and in particular to postural control along the vertical axis of the body. Information is also provided on other aspects of Jamaican child care. It seems that the handling routine forms part of a folk (developmental) medicine system and may serve not only to promote child health but also as a sort of developmental neurological examination.     

Individual differences in afterimage persistence: relationships to hypnotic susceptibility and visuospatial skills.

To investigate the moderating role of individual differences in hypnotic susceptibility and visuospatial skills on afterimage persistence, we presented a codable (cross) flash of light to 40 men and 46 women who had been dark adapted for 20 min. In an unrelated classroom setting, subjects had previously been given two standardized scales of hypnotic susceptibility (Harvard Group Scale of Hypnotic Susceptibility, Shor & Orne, 1962; Group Stanford Hypnotic Susceptibility Scale, Form C, Crawford & Allen, 1982) and the Mental Rotations Test (Vandenberg & Kuse, 1978). The first afterimage interval and the afterimage duration correlated significantly with hypnotic responsiveness, supporting Wallace (1979), but did not show the anticipated relationships with mental rotation visuospatial skills. Individuals in the high hypnotizable group had (a) significantly longer afterimage intervals between its first appearance and first disappearance than did those in medium or low groups, as well as (b) significantly longer afterimages between the first appearance and the final disappearance than did those in low groups, but those in medium groups did not differ significantly from the other groups. Discriminant analysis using the afterimage persistence measures classified correctly 65.2% of high hypnotizables, 37.5% of medium hypnotizables, and 54.8% of low hypnotizables. Hypothesized cognitive skills that assist in the maintenance of afterimages and underlie hypnotic susceptibility include abilities to maintain focused attention and resist distractions over time and to maintain vivid visual images.     

Psychoanalytic ecumenism and varieties of psychoanalytic experience.

Using the metaphor of ecumenism, the current status of psychoanalysis and the American Psychoanalytic Association is examined. The dialectical tendencies to oppose and to unify are noted in psychoanalytic theory, technique, and practice, as well as in the administrative and political life of our organization. Fostering tolerance for new hypotheses without sacrificing empirical discrimination, and promoting broad participation without lowering standards confront us as major tasks demanding continuing vigilance and effort.     

Neutrality, interpretation, and therapeutic intent.

Neutrality is a central concept within the theory of psychoanalytic technique. We spell out the major controversies in which the concept has become embroiled, and provide a definition that we believe coincides with actual psychoanalytic practice. We discuss its merits and weaknesses, noting also the negative consequences of relying on older definitions. We relate neutrality to the interpretive process, indicating ways interpretation protects neutrality and is made more effective by it. We discuss the complex and controversial relation between neutrality and the analyst's therapeutic intent.     

Malevolent object representations in borderline personality disorder and major depression.

To study malevolent representations, earliest memories were reliably coded on scales of affect tone. Ss were diagnosed with borderline personality disorder: 31 without and 30 with concurrent major depression. Nonborderline comparison subjects had either major depressive disorder (n = 26) or no psychiatric diagnosis (n = 30). Borderline subjects were discriminated from comparison subjects by their more malevolent representations; they more frequently produced memories involving deliberate injury; and they portrayed potential helpers as less helpful. Results suggest the diagnostic significance of malevolent representations, which need to be explained by any theory of borderline personality disorder.