Relational suffering and the moral authority of love and care

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.

     

The relationship between STD locus of control and STD acquisition among adolescent girls

This longitudinal study examined adolescent girls' perception of control over sexually transmitted disease (STD) acquisition. Participants were asked questions regarding their perception of their STD locus of control (internal control; control by parents, partners, peers, and health care providers; and chance) at two waves of data collection. Of the 116 participants (mean age = 17 years), 82% were African-American and 18% were Caucasian. Responses to the measure of locus of control were significantly correlated across a 6-month interval. The responses regarding internal control, control by partner, and chance were not related to the acquisition of an STD in the next 6 months. Further, they were not influenced by an STD in the preceding 6 months. These results indicate that responses to a locus of control measure were stable over a 6-month period, and internal, partner, and chance locus of control perceptions seem to be neither determined by STD experience nor directly related to future STD acquisition. However, understanding an individual's locus of control may be helpful in providing appropriate counseling. Future research could examine how adolescent girls form their perceptions of control over STD acquisition.     

Rich interpretation vs. deflationary accounts in cognitive development: the case of means-end skills in 7-month-old infants

Seven-month-old infants appear to learn means-end skills, such as pushing a button to retrieve a distant toy (Psychological Review 104 (1997) 686). The present studies tested whether such apparent means-end behaviors are genuine, or simply the repetition of trained behaviors under conditions of greatest arousal, as suggested by a dynamic systems reinterpretation. When infants were trained to repeat behaviors that did not serve as means to retrieving toys (pushing a button to light a set of distant lights), their button-pushing differed significantly from infants for whom button-pushing served as a means for retrieving toys. Further, infants demonstrated means-end skills with behaviors that they had not been trained to repeat. Implications for early means-end abilities and for debates surrounding the interpretation of infant behavior are discussed.     

Do boys with attention-deficit/hyperactivity disorder have positive illusory self-concepts?

One hundred ninety-five boys with attention-deficit/hyperactivity disorder (ADHD) were compared with 73 comparison boys (M = 9.83 years, SD = 1.30) on self-perceptions relative to a teacher-rated criterion. Emphasis was placed on ADHD subgroup comparisons according to level of aggression, academic achievement, and depression compared with control boys. Consistent with the authors' prediction, ADHD boys overestimated relative to teacher report, more than did controls, in the scholastic competence, social acceptance, and behavioral conduct domains. Examination of discrepancy scores (child rating - teacher rating) by comorbidity subgroups suggested that aggressive and low-achieving ADHD boys tended to overestimate their competence the most in the domains in which they were the most impaired. Results are discussed in terms of prior literature on "positive illusions" in ADHD children.     

A comparison of multiple reinforcer assessments to identify the function of maladaptive behavior

Functional analysis results indicated that maladaptive behaviors displayed by a 25-year-old man with profound mental retardation were maintained by attention from caregivers and possibly, to a lesser degree, by access to tangible items. A concurrent-schedules procedure was then used to study the relative reinforcing value for maladaptive behavior of attention versus tangible items. Results of the concurrent-schedules assessment and subsequent functional communication training indicated that preference for attention versus access to a tangible object varied.     

Why do non-color words interfere with color naming?

In the non-color-word Stroop task, university students' response latencies were longer for low-frequency than for higher frequency target words. Visual identity primes facilitated color naming in groups reading the prime silently or processing it semantically (Experiment 1) but did not when participants generated a rhyme of the prime (Experiment 3). With auditory identity primes, generating an associate or a rhyme of the prime produced interference (Experiments 2 and 3). Color-naming latencies were longer for nonwords than for words (Experiment 4). There was a small long-term repetition benefit in color naming for low-frequency words that had been presented in the lexical decision task (Experiment 5). Facilitation of word recognition speeds color naming except when phonological activation of the base word increases response competition.     

The accuracy of abstracts in psychology journals

This article provides an empirically supported reminder of the importance of accuracy in scientific communication. The authors identify common types of inaccuracies in research abstracts and offer suggestions to improve abstract-article agreement. Abstracts accompanying 13% of a random sample of 400 research articles published in 8 American Psychological Association journals during 1997 and 1998 contained data or claims inconsistent with or missing from the body of the article. Error rates ranged from 8% to 18%, although between-journal differences were not significant. Many errors (63%) were unlikely to cause substantive misinterpretations. Unfortunately, 37% of errors found could be seriously misleading with respect to the data or claims presented in the associated article. Although deficient abstracts may be less common in psychology journals than in major medical journals (R. M. Pitkin, M. A. Branagan, & L. F. Burmeister, 1999), there is still cause for concern and need for improvement.     

The effects of praise on children's intrinsic motivation: a review and synthesis

The authors argue against a purely behavioral definition of praise as verbal reinforcement in favor of the view that praise may serve to undermine, enhance, or have no effect on children's intrinsic motivation, depending on a set of conceptual variables. Provided that praise is perceived as sincere, it is particularly beneficial to motivation when it encourages performance attributions to controllable causes, promotes autonomy, enhances competence without an overreliance on social comparisons, and conveys attainable standards and expectations. The motivational consequences of praise also can be moderated by characteristics of the recipient, such as age, gender, and culture. Methodological considerations, such as including appropriate control groups and measuring postfailure outcomes, are stressed, and directions for future research are highlighted.     

Legal and ethical issues in neuroimaging research: human subjects protection,medical privacy,and the public communication of research results

Humans subjects research entails significant legal and ethical obligations. Neuroimaging researchers must be familiar with the requirements of human subjects protection, including evolving standards for the protection of privacy and the disclosure of risk in "non-therapeutic" research. Techniques for creating veridical surface renderings from volumetric anatomical imaging data raise new privacy concerns, particularly under the federal medical privacy regulation. Additionally, neuroimaging researchers must consider their obligation to communicate research results responsibly. The emerging field of neuroethics should strive to raise awareness of these issues and to involve neuroimaging researchers in the legal, ethical, and policy debates that currently surround human subjects research.