Compromising health

The Health Services Since the War, Vol. 1, Problems of Health Care: The National Health Service Before 1957, by Charles Webster, HMSO, 1988, 479 pages, hb £27.50.     

Publications Received

SUMMARY

In this paper clinical examples are used to illustrate the view that transference to the diagnostician (and the institution) exists from the start of the process of assessment. It is also suggested that providing an analytic setting during an assessment will facilitate the emergence of both transference and counter-transference. Sensitivity to these can add greatly to the depth and richness of understanding of the object relationships and early situations being transferred, and hence add to the understanding of the character structure and psychopathology of the child. The deeper the understanding that can be reached in an assessment, the more likely it is that any diagnostic formulation will have validity and value in generating hypotheses and in directing any further intervention. An assessment not making use of these concepts would seem to be ignoring an important dimension which psycho-analytic theory and technique can offer.     

Mobilizing self through short-term dynamic interpersonal psychotherapy: a preliminary report

Background: The key features of short-term dynamic interpersonal psychotherapy (STDIP) are outlined along with the background of its development. Preliminary data demonstrating functional improvement in a small case series of patients is presented.

Methods: Nineteen patients were evaluated at commencement and end of therapy in a pilot study. Instruments used were the Childhood Trauma Questionnaire (CTQ); Beck Depression Inventory (BDI); Brief Symptom Inventory (BSI); COPE (Coping Style Questionnaire); Relationship Styles Questionnaire (RSQ) and Social Adjustment Scale-Self Report (SAS-SR).

Results: This cohort had significantly elevated scores on the CTQ. They demonstrated substantial improvement on measures including the BDI, and several subscales of BSI, COPE, RSQ and SAS-SR.

Conclusions: The small numbers and naturalistic design preclude firm conclusions however the results suggest that STDIP can be used to successfully treat patients, notwithstanding a history of childhood trauma.     

Relationships among Facial,Prosodic, and Lexical Channels of Emotional Perceptual Processing

This study was designed to address the issue of whether there is a general processor for the perception of emotion or whether there are separate processors. We examined the relationships among three channels of emotional communication in 100 healthy right-handed adult males and females. The channels were facial, prosodic/intonational, and lexical/verbal; both identification and discrimination tasks of emotional perception were utilised. Statistical analyses controlled for nonemotional perceptual factors and subject characteristics (i.e. demographic and general cognitive). For identification, multiple significant correlations were found among the channels. For discrimination, fewer correlations were significant. Overall, these results provide support for the notion of a general processor for emotional perceptual identification in normal adult subjects.     

The bystander effect in an N-person dictator game

Dozens of studies show that bystanders are less likely to help victims as bystander number increases. However, these studies model one particular situation, in which victims need only one helper. Using a multi-player dictator game, we study a different but common situation, in which a recipient’s welfare increases with the amount of help, and donors can share the burden of helping. We find that dictators transfer less when there are more dictators, and recipients earn less when there are multiple dictators. This effect persisted despite mechanisms eliminating uncertainty about other dictators’ behavior (a strategy method and communication). In a typical public goods game, people seem to transform the situation into an assurance game, willing to contribute if certain others will too. Despite similarities, people do not treat a recipient’s welfare like a public good. Instead, people seem to transform the situation into a prisoner’s dilemma, refusing to help whatever others do.     

The stability of structural measures derived from repertory grids

Although the use of repertory grids in psychological research has proliferated, studies of their psychometric properties are relatively rare. For this reason, we studied the reliability and convergence of several measures of cognitive structure derived from grids, including intensity, percentage of variance accounted for by the first component, cognitive complexity, ordination, extremity of ratings, self-ideal discrepancy, and self-other discrepancy, as well two measures of rating stability, construct consistency and factor loading consistency. Eighty-two Spanish (Catalan) and American participants completed small and large grids on each of four occasions, which enabled exploratory analyses of the impact of grid size and subject characteristics on the structural scores obtained. Results indicated that the majority of scores showed impressive test-relest reliability (modal r = .85 for periods up to 1 month), but also suggested a gradual tightening effect across subsequent administrations. In general, scores intercorrelated in theoretically anticipated ways, converging on the assessment of cognitive differentiation and discrimination of elements within construct dimensions. The results have implications for the reactivity of structural scores to variations in grid format, as well as for use of grids in the study of sex differences and cross-cultural comparisons.     

No Moral Absolutes

In search of a potential problem with cloning, I investigate the phenomenon of telomere shortening which is caused by cell replication; clones created from somatic cells will have shortened telomeres and therefore reach a state of senescence more rapidly. While genetic intervention might fix this problem at some point in the future, I ask whether, absent technological advances, this biological phenomenon undermines the moral permissibility of cloning.     

Structural-functional correlations between hippocampal volume and cortico-limbic emotional responses in depressed children

Although hippocampal atrophy and altered functional brain responses to emotional stimuli have been found in major depressive disorder (MDD), the relationship between the two is not yet well understood. The present study focused on children with and without a history of preschool onset MDD (PO-MDD) and directly examined the relations between hippocampal volume and functional brain activation to affect-eliciting stimuli. Children completed annual diagnostic assessments starting at preschool. When children were school-aged, high-resolution structural MRI and task-related functional MRI data were acquired from N = 64 nonmedicated children. During fMRI, subjects were shown emotional faces. Results from the total sample indicated that smaller bilateral hippocampal volumes were associated with greater cortico-limbic (e.g., amygdala, hippocampus, dorsolateral prefrontal cortex) activation to sad or negative faces versus neutral faces. Left hippocampal volume was negatively associated with the cortico-limbic activation in both the PO-MDD and healthy children. Right hippocampal volume was negatively correlated with amygdala responses in the PO-MDD group, but not in the healthy comparison group. These findings suggest that there may be important interrelationships between reduced hippocampal volume and hyperactivation of brain responses in children, both those with and those without a history of PO-MDD.     

Effects of Stimulus Color,Pattern, and Practice on Sex Differences in Mental Rotations Task Performance

Redundant color information improved performance for both sexes on the Shepard Mental Rotations Task (MRT; Shepard & Metzler, 1971). Absolute score gains for women were larger than those for men; therefore, relative improvement was greater. Substantial practice effects, also favoring women, were apparent in both studies. Study 1 showed that redundant color improved performance by 0.25 SD. Study 2 demonstrated that redundant black-and-white pattern information did not have any effect; a second visuospatial channel, redundant color, was a critical factor in improving scores of men and women on difficult mental rotations tasks.