Genetic counseling for deaf adults: Communication/language and cultural considerations

It has been estimated that at least 50% of congenital or early onset deafness loss has a genetic etiology. Genetic services have traditionally been utilized by hearing parents of deaf children. Deaf adults could also greatly benefit from genetic counseling services. However, many deaf adults do not seek genetic services due in part to the communication/language and cultural differences of this group. Deaf people communicate in various ways including the use of sign language, oral communication, writing, or a combination of these modes. Also, while some deaf individuals are part of the hearing culture, others are part of the Deaf culture which has its own language, values, and traditions. Culturally Deaf individuals do not see themselves as handicapped or disabled. The genetic professional's awareness of the communication/language and cultural needs of this group, as well as their agency's responsibilities under section 504 of the Rehabilitation Act of 1973, may increase the accessibility of genetic services and contribute to the provision of successful genetic counseling for deaf adults.Throughout this paper, the term deaf will be used to denote a person who audiologically has a hearing loss which may range from mild to profound and may be sensorineural, conductive, or mixed. However, the term Deaf is used to denote cultural deafness.     

The family void: treatment and theoretical aspects of the synchronous family paradigm

The synchronous paradigm is a model of families whose members remain uninvolved and disconnected from each other yet somehow maintain relatively unvarying or even rigid patterns of behavior. In the synchronous paradigm, calm agreement and harmonious unity of action are valued above all. The concept of synchronous operation was first formulated by Constantine to solve certain theoretical problems growing out of the work of Kantor and Lehr. The theory has been elaborated upon through linkages established with other clinical and theoretical models of family dysfunction. Clinical experience in treating synchronous families has now contributed more detailed and practical understanding. Clinically, disabled synchronous families may present as bland, boring, or even death-like. They may have considerable difficulty accommodating to necessary developmental changes or to the demands of life crises, employing a variety of strategies to maintain the appearance of synchrony at the expense of adaptation. Their ability to ignore change and to absorb interventions can tax the abilities of even the most creative and energetic therapist. On the other hand, the quiet efficiency of the family and the social sensitivity of its members can be strong assets. Awareness of their strengths and special vulnerabilities can help the family therapist work more effectively with synchronous families.     

“Marital trap analysis”—incompetence,complementarity, and success traps: Identifying potential future dysfunctions based on a couple's current collusive agreements

This paper describes three types of traps or collusive marital agreements-incompetence traps, complementarity traps, and success traps-in which the mates renounce or forgo competent functioning in vital areas of marital roles and experience. It is suggested that responsible clinical work with the couple should include a careful evaluation of such traps and the potential breakdown or dysfunction inherent in each one, and a decision as to whether or not to attempt therapeutic penetration into such collusive agreements even before the couple complain directly about their arrangement.     

Suicide and rurality in urban society

Recent findings suggest that suicide increases with rurality, but research on rural suicide leaves many questions unanswered. This study specifies problems of community organization as a reason for expecting a positive effect of rurality on the suicide rate. A multiple regression analysis of county data shows that rurality has a substantial positive effect and is, in fact, the best predictor of the suicide rate among several variables selected from the previous literature. Additional research is needed to test the interpretation that rurality contributes to an incomplete, fragmented form of community organization which influences the suicide rate by disrupting primary relationships.     

To commit or not commit to human life: Children of victims and victimizers—All

The author discusses the impact of the Holocaust on both the children of victims and victimizers and reports on empirical researches conducted among Israeli student health professionals and others as to how ready they, the people of the victims, are to approve of and to participate in various programs and events which take the lives of helpless others, and reports disturbing results. He concludes that making a commitment to human life is the single most important task for all of us.     

What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).     

Pictorial encoding reduces false recognition of semantic associates

High levels of false recognition can be observed after people study lists of semantic associates that all converge on a nonpresented lure word. To test the idea that encoding distinctive perceptual information would help to reduce false recognition, we presented a line drawing representing each associated word during study list presentation and later tested recognition of studied words and lure words. Two experiments revealed marked reductions in false recognition after pictorial encoding, relative after to word encoding. Results suggest that people reject related and unrelated lures because these items lack the distinctive qualities associated with remembered pictures.     

CROSS-CULTURAL DIFFERENCES IN DIRECTIONALITY*

The assumption that the directions of writing single letters and series of letters in a given language affect the directional preferences for reproducing single and multiple stimuli, respectively, was tested on three groups of subjects with different reading and writing habits; English readers, Hebrew readers, and Arabic readers. The subjects were presented with single stimuli and with series of stimuli for reproduction, and the horizontal directions of their responses were recorded. Confirming the hypothesis, the data pointed to the complexities of the effects of reading and writing habits on directional preferences among readers of different languages.     

Mental pain and its relationship to suicidality and life meaning

Shneidman (1996) proposed that intense mental pain is related to suicide. Relatedly, Frankl (1963) argued that the loss of life's meaning is related to intense mental pain. The first goal of this research was to test Shneidman's proposition by comparing the mental pain of suicidal and nonsuicidal individuals. Meaning in life and optimism are the polar opposites of suicidality and hopelessness, and the examination of these variables in relation to mental pain was undertaken to provide a test of Frankl's proposition. In two studies, a relationship between a newly developed measure of mental pain--the Orbach & Mikulincer Mental Pain Scale, 2002 (OMMP; see also Orbach, Mikulincer, Sirota & Gilboa-Schechtman, 2002)--and suicidal behavior and life meaning were examined. Results confirmed both propositions. Implications for the study of mental pain and suicide are discussed.     

Dissociation,Physical Pain,and Suicide: A Hypothesis

The hypothesis of this paper states that at least some suicidal individuals are characterized by a disposition toward dissociation manifested in relative insensitivity to physical pain and indifference to their bodies. Three main topics are discussed: dissociation and suicide, psychological aspects of pain, and pain and suicide. Various theoretical and experimental studies suggest that certain stress conditions lead to the development of dissociative tendencies, and that once these tendencies are established, they become an integral part of suicidal behavior. Psychological variables that affect pain tolerance are presented and they include perception, motivation, emotions, and behavioral and cognitive strategies of pain control. These can increase tolerance of pain in suicidal individuals, making the suicidal act possible. The specific relationships of pain and suicide are then introduced through an examination of pain analgesia in the phenomenon of self-harm. The integration of the material suggests that early and continuous stress lead to the simultaneous development of dissociative tendencies (including indifference to the body and pain) and heightened vulnerability to stress. These dispositions may facilitate suicidal behavior in the face of mounting intolerable stress, helplessness, and hopelessness. Preliminary empirical support for the present hypothesis is cited. This hypothesis shifts the focus of attention from the question of what causes suicide to what facilitates suicide, and in so doing suggests new directions for research and therapy.