A personal reaction to freud's paper ‘on beginning the treatment’

Abstract

Sometimes, when reading Freud, I imagine I hear the sound of far-off warning bells tolling their alarm somewhere deep in my mind. I feel as if I am experiencing a great sense of danger, as if I am a child being led by the hand into a confusing, directionless, murky wood by an adult who appears to know the way, yet whom I do not quite trust to keep hold of my hand. It is as if, although I read the decrepit, over-grown sign at the edge as we advanced under the eaves: proceed with caution: at risk of losing touch with reality, I was hurried quickly past by the firm grip of the Omnipotent Adult who plunged straight in, and whose knowledge I do not altogether credit. So, for me, reading some of Freud's papers has a distinctly nightmarish quality, an atmosphere of being slightly out-of-control, an unnerving feeling of being in severe danger of being sucked in.     

Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder

Understanding the onset and course of sudden gains in treatment provides clinical information to the patient and clinician, and encourages clinicians to strive for these sudden clinical gains with their patients. This study characterizes the occurrence of sudden gains with Behavioral Activation (BA; Martell, Addis, & Jacobson, 2001), and the extent to which pre-treatment dysfunctional depressive thinking predicts sudden gains during treatment. We enrolled a sample of adults (n = 42) between ages 18-65 diagnosed with primary Major Depressive Disorder. All participants completed a 16-week course of BA, with clinical and self-report assessments at pre-, mid- and post-treatment. Results indicated that sudden gain and non-sudden gain participants showed differential improvement across treatment. No significant effects emerged for the dysfunctional cognitive style as a predictor of sudden gain status. Sudden gains may result from interaction of non-specific factors with the BA techniques implemented during early phases of therapy.     

Is priming during anesthesia unconscious?

General anesthesia provides an alternative to typical laboratory paradigms for investigating implicit learning. We assess the evidence that a simple type of learning--priming--can occur without consciousness. Although priming has been shown to be a small but persistent phenomenon in surgical patients (Merikle & Daneman, 1996) there is reason to question whether it occurs implicitly due to problems in detecting awareness using typical clinical signs. This paper reviews the published studies on priming during anesthesia that have included a measure of awareness or of anesthetic depth. We conclude that perceptual priming, but not conceptual priming, takes place in the absence of conscious awareness.     

Additive similarity trees

Similarity data can be represented by additive trees. In this model, objects are represented by the external nodes of a tree, and the dissimilarity between objects is the length of the path joining them. The additive tree is less restrictive than the ultrametric tree, commonly known as the hierarchical clustering scheme. The two representations are characterized and compared. A computer program, ADDTREE, for the construction of additive trees is described and applied to several sets of data. A comparison of these results to the results of multidimensional scaling illustrates some empirical and theoretical advantages of tree representations over spatial representations of proximity data.We thank Nancy Henley and Vered Kraus for providing us with data, and Jan deLeeuw for calling our attention to relevant literature. The work of the first author was supported in part by the Psychology Unit of the Israel Defense Forces.     

Pascal’s Wager: a Reason to Hesitate

Philosophia - One version of Pascal’s Wager says we should commit to, or cultivate belief in, whatever religion we think is most likely to bring us eternal joy. I pose a reductio for this...     

Death, organ transplantation and medical practice

A series of papers in Philosophy, Ethics and Humanities in Medicine (PEHM) have recently disputed whether non-heart beating organ donors are alive and whether non-heart beating organ donation (NHBD) contravenes the dead donor rule. Several authors who argue that NHBD involves harvesting organs from live patients appeal to "strong irreversibility" (death beyond the reach of resuscitative efforts to restore life) as a necessary criterion that patients must meet before physicians can declare them to be dead. Sam Shemie, who defends our current practice of NHBD, holds that in fact physicians consider patients to be dead or not according to physician intention to resuscitate or not. We suggest that criteria for a concept are not necessarily truth conditions for assertions involving the concept. Hence, non-heart beating donors may be declared dead without meeting the criterion of strong irreversibility even though strong irreversibility is implied by the concept of death. Our perception that a concept applies in a given case is determined not by the concept itself but by our necessary skill and judgment when using it. In the case of deciding that a patient is dead, such judgment is learned by physicians as they learn the practice of medicine and may vary according to circumstances. Current practice of NHBD can therefore be defended without abandoning death as an empirical concept, as Shemie appears to do. We conclude that the dead donor rule continues to be viable and ought to be retained so as to guarantee what the public most cares about as regards organ donation: that physicians can be trusted to make determinations of eligibility for organ donation in the interests of patients and not for other purposes such as increasing the availability of organs.     

The sense-making approach for audience assessment of adolescents

The purpose of the research was to test the methodology used to identify how adolescents approach their nutrition concerns and questions. The methodology was based on Dervin's sense-making theory. Using a time-line interview technique, 305 adolescents 14 to 16 years of age detailed a situation involving their most important nutrition concerns. Other pertinent information was obtained. Cluster analysis was chosen as the appropriate analysis to identify groups of adolescents who responded similarly to the technique. Discriminant analysis was then used to determine which variables maximally separated the groups. Four groups were identified, two of which described action-oriented approaches to dealing with nutrition situations and differed in terms of how much outside help they wanted. The remaining two groups perceived barriers to dealing with situations and also differed in how much help they wanted. A fifth group indicated no nutrition concerns or questions. The results will be used to develop and test the effectiveness of nutrition education when it is focused on the different approaches.