Oh death,where is thy sting? Reflections on dealing with dying patients

This paper examines the reactions of physicians and other health-professionals when they become involved in decisions about the death of their patients. The way people understand the condition of death has a profound influence on attitudes towards death and dying issues. Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.     

Psychoanalytic ecumenism and varieties of psychoanalytic experience.

Using the metaphor of ecumenism, the current status of psychoanalysis and the American Psychoanalytic Association is examined. The dialectical tendencies to oppose and to unify are noted in psychoanalytic theory, technique, and practice, as well as in the administrative and political life of our organization. Fostering tolerance for new hypotheses without sacrificing empirical discrimination, and promoting broad participation without lowering standards confront us as major tasks demanding continuing vigilance and effort.     

"Existential" therapists and their group therapy practices.

Existential philosophical thought insists that human behavior is indeterminate and subject only to the individual's will. It is, therefore, skeptical of all dynamic psychologies based as they are on Freudian determinism. Group therapists imbued with this philosophy stop short of its extreme. Their existential position, however, does greatly modify treatment, and yet they preserve both the form and goals of therapy. They place properly selected and prepared patients in a group where their individuality and authenticity are highly valued. Finding most technical procedures irrelevant, the therapists themselves, that is, their evolving personalities are central. The key to patient change is the spontaneous meeting of members and the therapist which the therapist orchestrates. Instead of the usual interpretation, members are encouraged to confront the paradoxes in their lives, their humanness, and especially their finitude. Patients are to be brought up to the threshold of their self-knowledge so they can choose. Choice, therefore, along with action coupled with responsibility are frequent themes. Unless the individual is incompetent, decisions made for him or her by the therapist or by group consensus are thought to be nontherapeutic.     

Stability/Instability of Cognitive Strategies Across Tasks Determine Whether Stress Will Affect Judgmental Processes'

Previous research indicates that individuals employ various cognitive heuristics and decision modes in making decisions and judgmental tasks that do not follow an expected value model. It further indicates that several cognitive faculties are affected by stress. The purpose of this study was twofold: first, to examine whether individual differences exist in the use of cognitive heuristics and risk-assessment decision modes; second, to examine whether stress would affect the use of these cognitive strategies. Three versions of a questionnaire measuring the representativeness and availability heuristics, and risk-seeking and risk-aversion decision modes were administered to three different groups of subjects. Consistent individual differences were only observed in the subscales measuring risk-seeking and risk-aversion modes, but not in the use of the heuristics. In a different group of subjects, exposure to noise and task overload stress increased the use of the representativeness heuristic, but did not alter the use of risk-seeking and risk-aversion decision modes. These results indicate that the existence of individual differences in cognitive strategies may determine, in part, whether stress will modify judgmental processes.     

Repression at encoding: discrete appraisals of emotional stimuli.

In previous research, the emotions associated with repressors' memorial representations were found to be more discrete than those associated with nonrepressors'. In each of the 3 experiments reported here, repressive discreteness was apparent in repressors' appraisals of emotional stimuli at the time they were encoded. In 1 experiment, Ss appraised individual facial expressions of emotion. Repressors judged the dominant emotions in these faces as no less intense than did nonrepressors, but they appraised the blend of nondominant emotions as less intense than did nonrepressors. In the remaining 2 experiments, Ss appraised crowds of emotional faces as well as crowds of geometric shapes. In both crowd experiments, the repressive discreteness was evident in appraisals of crowds of emotional faces but not in appraisals of crowds of geometric shapes. The repressive discreteness effect did not appear to reflect a general repressor-nonrepressor difference in the appraisal of stimulus features. Rather, the results suggested that repressive discreteness may be constrained to appraisals of emotions.     

Classification of adult attachment: an integrative taxonomy from attachment and psychoanalytic theories.

Developmental and psychoanalytic theorists have focused increasingly on empirically determined early childhood antecedents of adult attachments, with several resulting taxonomic models. This article suggests a theoretically based and clinically based model of attachment consistent with both psychoanalytic and attachment theories, resulting in an integrative taxonomy of four adult attachment styles: dependent, avoidant, hostile, and resistant-ambivalent. These styles reflect behavioral manifestations of dependence and anger, as derived from the interaction of primitive relational drives, defenses, and interpersonal experience. In addition to theoretical construction, brief clinical examples are presented to facilitate discussion of the model.     

The development of reactions of the public to warning and emergency situations in France, Greece, and the Netherlands.

This article describes the different reactions to emergency warning messages among residents living within a 3-km radius of a hazardous chemical complex and by people living at least 10 km from an industrial site in France, Greece, and the Netherlands. Belief in warning, primary and secondary appraisal, emotional response, and adherence to normal routine were assessed by conducting face-to-face interviews in which a four-phase scenario simulating a credible industrial accident was presented. The results showed that respondents who did not reside in the neighborhood of the hazardous site were, in general, more inclined to trust the warning messages than respondents who resided in the neighborhood were. With the exception of primary appraisal, the warning phases evoked very distinct reactions in the respondents from all three countries with regard to warning belief, secondary appraisal, emotional response, and adherence to normal routine.