Reply to Commentaries

Each discussant approached my paper on embedded levels of illusion from a different perspective, representing schools as diverse as those derived from Jung and Bion. It is interesting that, although my paper was not primarily about dreams or how to interpret them, but rather about the way in which multiple levels of illusion may open a potential space in treatment, each discussant centered his comments around a dream that I had reported in one of my cases. In this reply, I compare the discussants' approaches to the dream with mine. I also wonder whether the dream itself represents an embedded level of illusion within my paper. If so, it may function as a transitional space in which we may entertain different viewpoints around not only the nature of dream work, but also around questions including the nature of the mind and the therapeutic process.     

The Needlessness of Adverbialism,Attributeism and its Compatibilty with Cognitive Science

Although adverbialism is not given much attention in current discussions of phenomenal states, it remains of interest to philosophers who reject the representationalist view of such states, in suggesting an alternative to a problematic ‘act-property’ conception. We discuss adverbialism and the formalization Tye once offered for it, and criticize the semantics he proposed for this formalization. Our central claim is that Tye’s ontological purposes could have been met by a more minimal view, which we dub “attributeism”. We then show that there is no incompatibility between the ontology of attributeism and the postulation of pictorial representations in the brain.     

The development of numerical estimation: evidence against a representational shift

How do our mental representations of number change over development? The dominant view holds that children (and adults) possess multiple representations of number, and that age and experience lead to a shift from greater reliance upon logarithmically organized number representations to greater reliance upon more accurate, linear representations. Here we present a new theoretically motivated and empirically supported account of the development of numerical estimation, based on the idea that number‐line estimation tasks entail judgments of proportion. We extend existing models of perceptual proportion judgment to the case of abstract numerical magnitude. Two experiments provide support for these models; three likely sources of developmental change in children’s estimation performance are identified and discussed. This work demonstrates that proportion‐judgment models provide a unified account of estimation patterns that have previously been explained in terms of a developmental shift from logarithmic to linear representations of number.     

Anesthesia Awareness: Narrative Review of Psychological Sequelae,Treatment, and Incidence

Awareness during general anesthesia occurs when patients recall events or sensations during their surgeries, although the patients should have been unconscious at the time. Anesthesiologists are cognizant of this phenomenon, but few discussions occur outside the discipline. This narrative review summarizes the patient recollections, psychological sequelae, treatment and follow-up of psychological consequences, as well as incidence and etiology of awareness during general anesthesia. Recalled memories include noises, conversations, images, mental processes, feelings of pain and/or paralysis. Psychological consequences include anxiety, flashbacks, and posttraumatic stress disorder diagnosis. Limited discussion for therapeutic treatment after an anesthesia awareness experience exists. The incidence of anesthesia awareness ranges from 0.1 to 0.2% (e.g., 1–2/1000 patients). Increased recognition of awareness during general anesthesia within the psychological/counseling community, with additional research focusing on optimal therapeutic treatment, will improve the care of these patients.     

Racism in the consulting room: myth or reality?

This paper explores ways in which issues of race might impact on, and/or be ignored within, the practice of psychotherapy. Racial difference, that is being white as well as being black, taps into ingrained patterns of binary thinking that create hierarchies of "otherness." This generates anxiety which leads some therapists to avoid seeing race or naming its resonance in the therapeutic alliance. The origins of this splitting may lie in the unconscious, from whence it can be subtly nudged into more conscious awareness, as a seminal paper by Andrew Curry, published in this journal, suggested some forty-five years ago. Other modalities bring these dynamics more directly into the therapeutic space by exploring the patient's familial history or their daily lived experiences of racial (dis)advantage from an explicitly empowering standpoint. But whatever route is taken, racism is not an animal that can, or should, be left sleeping in the corner of the consulting room.     

Psychological and Social Characteristics Associated with Religiosity in Women’s Health Initiative Participants

Measures of religiosity are linked to health outcomes, possibly indicating mediating effects of associated psychological and social factors. We examined cross-sectional data from 92,539 postmenopausal participants of the Women’s Health Initiative Observational Study who responded to questions on religious service attendance, psychological characteristics, and social support domains. We present odds ratios from multiple logistic regressions controlling for covariates. Women attending services weekly during the past month, compared with those not attending at all in the past month, were less likely to be depressed [OR = 0.78; CI = 0.74–0.83] or characterized by cynical hostility [OR = 0.94; CI = 0.90–0.98], and more likely to be optimistic [OR = 1.22; CI = 1.17–1.26]. They were also more likely to report overall positive social support [OR = 1.28; CI = 1.24–1.33], as well as social support of four subtypes (emotional/informational support, affection support, tangible support, and positive social interaction), and were less likely to report social strain [OR = 0.91; CI = 0.88–0.94]. However, those attending more or less than weekly were not less likely to be characterized by cynical hostility, nor were they less likely to report social strain, compared to those not attending during the past month.