Creative Writing as a Medical Instrument

Listening and responding to patients’ stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn’t work on the wrong story, and the stories patients tell sometimes feel like first drafts—vital and fragile works-in-progress. Increasingly complex health challenges compounded by social, financial, and psychological burdens make for stories that are difficult to articulate and comprehend. In this essay, I argue that healthcare providers need to think like creative writers and the skills and sensitivities necessary to story construction deserve a vital space in medical education. A thorough understanding of story anatomy and the imaginative flexibility to work stories into open spaces serve as antidotes to the reductive nature of clinical decision making and have implications as patient safety and risk management strategies. The examples that I have selected demonstrate how thinking like a creative writer functions at the bedside, providing tools for clinical excellence and empathy. This approach asks that we re-imagine the importance of story in clinical care: from a vehicle to a diagnosis to its place as a critical destination.     

Offsets and prioritizing the selection of new elements in search displays: More evidence for attentional capture in the preview effect

The preview effect refers to the finding that new elements in a search display are prioritized over old elements. Donk and Theeuwes (2001) suggest that this prioritization is due to bottom-up attentional capture, as new elements that abruptly appear with increases in luminance produce a preview effect whereas new elements that are equiluminant to the background do not. The present study extends this research by examining if new elements that appear from offsets, with and without luminance changes, yield similar findings to onsets. This was indeed the case, as equiluminant offsets did not produce a preview effect but offsets with corresponding increases or decreases in luminance did show the prioritization of new elements over old elements. These findings show that the prioritization of new elements is sensitive to changes in luminance but not to the direction of such changes.     

Prior experience and patterning in a prisoner's dilemma game

Female college students first played a pseudo-prisoner's dilemma (PPD) game with the experimenter, who followed a fixed strategy. In the first experiment the experimenter's strategies for different groups of subjects were: (a) play tit-for-tat; (b) play randomly; (c) always cooperate; (d) always defect (‘cooperation’ and ‘defection’, defined as in an actual prisoner's dilemma game). Only the tit-for-tat group increased cooperation over trials; other groups decreased cooperation. After playing the PPD with the experimenter, subjects played an actual prisoner's dilemma (PD) game with each other. In the PD game, subjects began cooperating moderately but cooperation deteriorated regardless of what the experimenter's strategy had been in the earlier (PPD) game. In a second experiment, subjects again played a PPD game with the experimenter and then played a PD game with each other. Half played one trial at a time as in the first experiment while half played in patterns of four trials at a time. In the PD game, patterning of trials retarded the development of mutual defection regardless of previous experience. The cooperation-preserving effect of patterning of trials in this social task is compared with similar effects on individual tasks involving self-control and risk-aversion. © 1998 John Wiley & Sons, Ltd.     

Research misconduct—Have we reached the turning point at last?

The laissez-faire attitude towards dishonesty in research has simply created an environment for widespread escalation of the problem. Can we now believe anything we read? Why should we have confidence in an author because of his eminence? Should we automatically accept that clinical trials are always conducted with total integrity? Why have we been afraid to tackle this crisis head-on?     

Integrative problem-centered metaframeworks therapy I: core concepts and hypothesizing

Over the last 20 years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders. That trend will increase. Psychotherapists will increasingly be exhorted and ultimately required to integrate empirical data and multicultural competence into their practice. Additionally, individual psychotherapy's default dominance of psychotherapeutic discourse needs to integrate and come to theoretical and clinical terms with the implications of the growing body of research demonstrating the validity and value of a multisystemic perspective. This article (and its companion article) presents a comprehensive, integrative, multisystemic, and empirically informed psychotherapeutic perspective to help therapists and psychotherapy trainers successfully address these challenges-Integrative Problem Centered Metaframeworks (IPCM) Therapy. This first article presents and illustrates IPCM's theoretical foundation, core concepts, and "case formulating" components. It delineates a Blueprint for the practice and teaching of 21st century psychotherapists who can meld science and art into best practice.     

Growing older does not always mean moving slower: examining aging and the saccadic motor system

Although humans typically move more slowly as they age, one exception may be the saccadic motor system. To fully determine whether the execution of saccades is affected by age, the authors examined detailed kinematics of vertical and horizontal saccades across a range of saccadic amplitudes (4 degrees, 8 degrees, and 12 degrees). Ten younger and 20 older adults participated in each experiment. Whereas in the 1st experiment, the authors assessed volitionally generated saccades, in the 2nd experiment, they evaluated reflexively generated saccades. The results of those experiments showed that the saccadic motor system is relatively impervious to the effects of aging; in fact, the differences between vertical and horizontal saccades were more evident than were differences between saccades produced by younger and older adults. The authors discuss possible reasons for that relative resistance to aging.     

The gap effect for eye and hand movements

A temporal gap between fixation point offset and stimulus onset typically yields shorter saccadic latencies to the stimulus than if the fixation stimulus remained on. Several researchers have explored the extent to which this gap also reduces latencies of other responses but have failed to find a gap effect isolated from general warning effects. Experiment 1, however, showed a robust gap effect for aimed hand movements (which required determination of a precise spatial location), regardless of whether the hand moved alone or was accompanied by a saccadic eye movement. Experiment 2 replicated this aimed hand gap effect and also showed a smaller effect for choice manual keypress responses (which required determination of the direction of response only). Experiment 3 showed no gap effect for simple manual keypress responses (which required no spatial determination). The results are consistent with an interpretation of the gap effect in terms of facilitation of spatially oriented responses.     

Joyce's Argument with Himself/Or, Reading Joyce's Inside Narrative

James Joyce's argument with himself about where he should practice his art and with what literary tradition he should identify—Irish, British, or European—is represented by several of the characters and episodes in his short story The Dead.In the main character, Gabriel Conroy, Joyce represented the conflicts that he himself experienced. But in many of the minor characters Joyce also reflected parts of his own wishes and fears.In this story, Joyce rejects the possibilities of artistic identification with Ireland and England, and, in the dynamics of the tale, arrives at the understanding that to fulfill his artistic aspirations, he must make an identification with the great European tradition, and also live in Europe; if he stays in Ireland or attempts to be an English author, he will be, as he portrays Gabriel to be, paralyzed, imitative, and a failure as an artist. Joyce himself took the decisive path that Gabriel could not choose.