“Violence” in medicine: necessary and unnecessary,intentional and unintentional

We are more used to thinking of medicine in relation to the ways that it alleviates the effects of violence. Yet an important thread in the academic literature acknowledges that medicine can also be responsible for perpetuating violence, albeit unintentionally, against the very individuals it intends to help. In this essay, I discuss definitions of violence, emphasizing the importance of understanding the term not only as a physical perpetration but as an act of power of one person over another. I next explore the paradox of a healing profession that is permeated with violence sometimes necessary, often unintentional, and almost always unrecognized. Identifying the construct of “physician arrogance” as contributory to violence, I go on to identify different manifestations of violence in a medical context, including violence to the body; structural violence; metaphoric violence; and the practice of speaking to or about patients (and others in the healthcare system in ways that minimize or disrespect their full humanity. I further suggest possible explanations for the origins of these kinds of violence in physicians, including the fear of suffering and death in relation to vicarious trauma and the consequent concept of “killing suffering”; as well as why patients might be willing to accept such violence directed toward them. I conclude with brief recommendations for attending to root causes of violence, both within societal and institutional structures, and within ourselves, offering the model of the wounded healer.     

Better Together: A Review and Recommendations to Optimize Research on Family Involvement in CBT for Anxiety and Related Disorders

Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to “enhance” treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equivocal. The present paper (a) identifies methodological considerations for explaining inconsistent outcomes among CBT for ARDs with family involvement, and (b) reviews factors that affect outcomes of CBT for ARDs with family involvement including levels of involvement in treatment (e.g., number, duration, and spacing of sessions) and characteristics of who is involved in treatment (e.g., family member cognitions and cultural factors). Limitations of the literature and recommendations for future research are discussed. Researchers should focus on conducting studies that can test not whether but for whom and how family involvement can contribute to improved outcomes above and beyond individual CBT for ARDs.     

Worn out relationship? The role of expectations in judgments of relational boredom

This study examined the role of growth and security expectations in shaping people's judgments of relational boredom and conflict (for discriminant validity). In Studies 1 and 2, the type of expectation gaps (growth vs. security) in hypothetical relationships (as well as the occurrence of a gap in Study 2) was manipulated, and people's judgments of relational boredom and conflict were assessed; Study 3 assessed these associations in people's own relationships. Across all studies, people were more likely to diagnose boredom in other people's relationships (Studies 1 and 2) and their own relationship (Study 3) if the expectation gap for growth (vs. security) was greater. People reported more conflict in their own relationship if the expectation gap for security (vs. growth) was greater.     

The Relationship Between Agentic and Communal Personality Traits and Psychosocial Adjustment to Breast Cancer

Agency, communion, unmitigated agency (UA), and unmitigated communion (UC) are related to psychosocial health outcomes in nonclinical and medical populations. This study examined the relationship between these personality traits and emotional and interpersonal well-being, as up to 50% of women experience difficulties in psychosocial adjustment after being diagnosed with breast cancer. Seventy-four women newly diagnosed with breast cancer completed baseline assessment measures within 2 weeks prior to their first chemotherapy treatment or at the beginning of their hormonal therapy. Findings indicate that (1) agency and UA are important correlates of emotional and interpersonal adjustment and should be considered when attempting to identify women at high risk for psychosocial distress, and (2) UC deserves increased attention in behavioral medicine research, given its strong relationship with emotional distress in a breast cancer population. Thus, evidence continues to accumulate regarding the important relationship of these personality traits to psychosocial outcomes in medical populations.     

The role of awareness in human conditioning

The cognitive view of human classical conditioning is that Ss are active in thinking about the pattern of stimulus events which occurs, the demands of the situation, and the kind of responses which they give. A question crucially central to conditioning theory is whether these thoughts and expectations determine conditional responding. This paper reports on two conditioning and personality experiments, employing the standard procedure of a single cue CS-UCS schedule and masking task, which assess awareness of stimulus contingencies and demand characteristics by means of a postexperimental questionnaire. Results were quite clear in showing no significant relationship between measures of awareness and eyelid conditioning.     

Accuracy of memories from childhood and adolescence related to growth and size

The ability of middle-aged adults to recall their body size and events occurring up to 40 years earlier was assessed. Ninety-one subjects recalled their relative height, weight, and fatness during childhood, early adolescence and late adolescence. Accuracy of these memories was compared with the accuracy of current reports. The ability to accurately date benchmarks of their maturation such as menarche and year of maximal growth in height was also examined. Accuracy of reports did not decline uniformly over time. In general, reports of childhood physical characteristics were at least as accurate as reports of current characteristics; that is, they did not differ significantly from current reports. Males were less accurate in their reports of relative height and fatness during early adolescence and childhood. This project has been funded at least in part with federal funds from the U.S. Department of Agriculture, Agricultural Research Service under contract number 53-3K06-5-10. The contents of this article do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.