Applied ethics in mental health in Cuba: part II--power differentials,dilemmas, resources,and limitations

This article is the second one in a series dealing with mental health ethics in Cuba. It reports on ethical dilemmas, resources and limitations to their resolution, and recommendations for action. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans experience dilemmas related to (a) the interests of clients, (b) their personal interests, and (c) the interests of the state. These conflicts are related to power differentials among (a) clients and professionals, (b) professionals from different disciplines, and (c) professionals and organizational authorities. Resources to solve ethical dilemmas include government support, ethics committees, and collegial dialogue. Limitations include minimal training in ethics, lack of safe space to discuss professional disagreements, and little tolerance for criticism. Recommendations to address ethical dilemmas include better training, implementation of a code of ethics, and provision of safe space to discuss ethical dilemmas. The findings are discussed in light of the role of power in applied ethics.     

Applied ethics in mental health in Cuba: part I--guiding concepts and values

As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mental health professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by a set of professional values but by a set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America.     

Awareness and working memory in strategy adaptivity

To further the understanding of the mechanisms of strategy choice, in three experiments, we investigate the role of explicit awareness and working memory in strategy adaptivity. Experiment 1 provided correlational evidence that individual differences in strategy adaptivity to changing base rates are related to individual differences in awareness of those changes but appear not to be related to individual differences in working memory capacity. Experiment 2 replicated the role of awareness, and the results suggest that awareness at the time of the base-rate change, rather than afterwards, is related to increased strategy adaptivity. Experiment 3 measured working memory capacity using a different procedure and manipulated working memory load with a dual-task procedure; again, no apparent role of working memory capacity in strategy adaptivity was found. This juxtaposition of findings presents a challenge for existing models of strategy choice.     

A Role for Cognitive Rehabilitation in Increasing the Effectiveness of Treatment for Alcohol Use Disorders

Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.     

Freud and the Psychoanalysis of Telepathy: Commentary on Claudie Massicotte’s “Psychical Transmissions”

Freud was interested in and eventually accepted the diverse forms of telepathic communication as psychoanalytic rather than occult phenomena, particularly as manifested in dreams. Massicotte revisits the topic of Freud and his interest in the occult in a manner that invites serious reconsideration of this aspect of his work, long the subject of intense controversy in the history of psychoanalysis. In my response to Massicotte’s paper I argue that Freud’s interest in telepathy or thought transference belongs to his psychoanalytic theories of the unconscious and transference. His approach to telepathy parallels his approach to religious beliefs: He accounts for both as creations of the human mind as individuals attempt to make sense and meaning of their real experiences. What Freud meant by telepathy is what contemporary psychoanalysis refers to as unconscious communication, and the strange, often inexplicable forms it takes in clinical contexts. For Freud, instances of telepathy or unconscious communication are to be understood contextually and relationally, revealing important data about the nature of affectively charged human relationships.     

The Short-Form of the Coparenting Across Family Structures Scale (CoPAFS-27): A Confirmatory Factor Analysis

Journal of Child and Family Studies - To further refine the measurement of coparenting across family dynamics, this article presents data from 2 separately collected samples, the first consisting...     

Counseling Muslim Women: Navigating Cultural and Religious Challenges

In this article, the authors consider strategies for counseling female Muslim clients. First, they review general beliefs and practices of Muslims in the United States. Through the use of a case study, they illustrate a collaborative method of counseling Muslim women that is based on a trusting client‐counselor relationship.     

Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.     

Cortisol response to behavior problems in FMR1 premutation mothers of adolescents and adults with fragile X syndrome: A diathesis-stress model

Mothers of adolescents and adults with fragile X syndrome (FXS) are faced with high levels of parenting stress. The extent to which mothers are negatively impacted by this stress, however, may be influenced by their own genetic status. The present study uses a diathesis-stress model to examine the ways in which a genetic vulnerability in mothers with the premutation of the FMR1 gene interacts with child-related environmental stress to predict their morning cortisol levels. Seventy-six mothers of an adolescent or adult with FXS participated in an 8-day telephone diary study in which they reported on the behavior problems of their son or daughter with FXS each day. We analyzed salivary cortisol collected from mothers at awakening and 30 minutes after awakening on 4 of these days. The results indicated that mothers with greater genetic vulnerability had a lower level of cortisol on mornings following days when their son or daughter with FXS manifested more episodes of behavior problems, whereas mothers with less genetic risk evinced the opposite pattern of higher morning cortisol in response to their child's behavior problems. This finding contributes to our understanding of gene-by-environment interactions and highlights the importance of interventions to alleviate parenting stress in mothers raising children with FXS.