More focused attention upon relationship; another call for paradigm shift in psychiatry

Much of what are understood as ‘mental health difficulties’ reflects shortcomings in the ability to develop and sustain healthy relationships. Many of those embarking upon life as someone with a psychiatric diagnosis are people whose difficulties can be traced to adolescence, or even earlier in life. Unsatisfactory relational experiences during childhood are acknowledged contributors to subsequent psychological vulnerability. Numerous studies identify associations between other forms of relational disturbance, and the onset and maintenance of psychological difficulties. Some eighty years’ psychotherapy research has repeatedly suggested that the quality of therapeutic relationship is a major determinant of outcome. Sophisticated analyses of large databases now confirm this beyond doubt. All concur that social exclusion and stigma are the most disabling consequences of living as someone with a psychiatric diagnosis. None of these facts are disputed but there is continuing resistance to broad acknowledgement of their implications. This has many parallels with other examples of paradigm shift, as so clearly outlined by Thomas Kuhn. Uncertainties about the value of medical psychiatry and growing recognition of the role relationships play in the genesis and relief of mental health difficulties suggest that psychiatry can be seen in similar terms. This paper develops that thesis.     

Why are some people’s names easier to learn than others? The effects of face similarity on memory for face-name associations

Using synthetic faces that varied along four perceptual dimensions (Wilson, Loffler, & Wilkinson, 2002), we examined the effects of face similarity on memory for face-name associations. The nature of these stimuli allowed us to go beyond the categorical similarity manipulations used in previous verbal associative memory studies to trace out the parametric relation between similarity and various performance measures. In Experiment 1, we found that recall performance diminished as a function of how many studied faces were in the vicinity of the cue face in similarity space. Also, incorrect recalls were more likely to come from nearby positions in face space. Experiments 2 and 3, respectively, demonstrated analogous effects with a set of more distinguishable, photorealistic faces, and in an associative recognition task. These results highlight the similarity between associative recall and associative recognition, and between face-name association and other domains of associative memory.     

Patients taking the lead. A naturalistic investigation of a patient led approach to treatment in primary care

In an earlier paper (Carey, T. A. (2005). Can patients specify treatment parameters? A preliminary investigation. Clinical Psychology and Psychotherapy, 12, 326–335) an approach to treatment delivery was examined in which the duration and frequency of the appointments was scheduled by patients. Results of this approach were encouraging but the generalizability of the results was constrained because only one clinician trialed the approach and no standardized assessment measures were used. In the present study there are two clinicians involved and the Depression Anxiety Stress Scale (DASS) was used. The approach was introduced at one GP practice and monitored over a six-month period. Results suggest that this approach might be an effective way of promoting patient access to, and involvement in, service delivery as well as reducing waiting times.     

Recognition memory for realistic synthetic faces

A series of experiments examined short-term recognition memory for trios of briefly presented, synthetic human faces derived from three real human faces. The stimuli were a graded series of faces, which differed by varying known amounts from the face of the average female. Faces based on each of the three real faces were transformed so as to lie along orthogonal axes in a 3-D face space. Experiment 1 showed that the synthetic faces' perceptual similarity structure strongly influenced recognition memory. Results were fit by a noisy exemplar model (NEMO) of perceptual recognition memory. The fits revealed thatrecognition memory was influenced both by the similarity of the probe to the series items and by the similarities among the series items themselves. Nonmetric multidimensional scaling (MDS) showed that the faces' perceptual representations largely preserved the 3-D space in which the face stimuli were arrayed. NEMO gave a better account of the results when similarity was defined as perceptual MDS similarity, rather than as the physical proximity of one face to another. Experiment 2 confirmed the importance of within-list homogeneity directly, without mediation of a model. We discuss the affinities and differences between visual memory for synthetic faces and memory for simpler stimuli.     

Ethics and the sexual countertransference

In this paper I shall suggest that, in addition to 'conscience', the archetype of Eros plays an important part in 'benign relatedness' and that this is what constitutes an ethical attitude. I also propose that the idea of 'benign relatedness' can provide us with a workable concept for those serving on Ethics Committees especially when our Code of Ethics is unclear or limited. I attempt to show that the analytic attitude is essentially ethical and define what I see as the analytic attitude as a way of demonstrating this. By discussing the neurotic sexual countertransference and unconscious identity I hope to clarify the main reasons for unethical enactments. I use examples of ethical problems, including a personal experience, to illustrate the kinds that occur and lastly I discuss how mourning plays an important part in the resolution and avoidance of these problems.     

The Role of Cognitive Control in Cocaine Dependence

While hedonic and reward-related processes are central to drug use and dependence, this article focuses on the contribution that cognitive processes may make to addiction. In particular, attention is drawn to those processes involved in exercising control over behavior as drug dependence is characterized by risky, impulsive behavior. Functional neuroimaging implicates prefrontal deficits in cocaine dependence with an emerging picture of cocaine users having attentional biases towards drug-related stimuli, poor performance in laboratory tests of inhibitory control, and compromised monitoring and evaluation of their behavior. Combined, these deficits may contribute to the continuation of use in dependent individuals and may qualify as important targets for therapeutic interventions.     

Spare the rod: The figure of the dominatrix in the literary canon

The commonly cited maxim, “Spare the rod and spoil the child” is often traced incorrectly back to the biblical book of Proverbs when its point of origin lies instead first in Langland’s Piers Plowman and then, in the highly satirical and sexualized text of Samuel Butler’s Hudibras. Thus, from a religious origin, it has metamorphosed into a woman-man relationship. Indeed to follow the evolution of this phrase is to uncover the extent to which the disciplining impulses of religious rhetoric are eroticized in one Western European literary theme, that of feminine dominance, from the tenth century when the word Dominatrix appeared in the writings of Hroswitha of Gandersheim. The period leading up to the 1650s, when Butler turned the phrase into one line of a heroic iambic couplet in the middle of a stanza on an amorous jaileress, was also a time when medical research on human and animal anatomy and physiology had unravelled the pathways of libido-lifting buttock-beating. Far from demonizing woman the literary image of the whip-wielding mistress did not degrade the female sex but instead apotheosized the dominatrix as a major erotic image of the twentieth century.     

Wittgenstein on the Resurrection

Wittgenstein probably did not believe in Christ's Resurrection (as an historical event), but he may well have believed that if he had achieved a higher level of devoutness he would believe it. His view seems to have been that devout Christians are right in holding onto this belief tenaciously even though, in fact, it's false. It's historical falsity, is compatible with its religious validity, so to speak. So far as I can see, he did not think that devout Christians should believe that it doesn't really matter whether or not that alleged historical event occurred.