Research report: A preliminary analysis of medical futility decisionmaking: law and professional attitudes

Judicial decisions reviewed in this article indicate that courts have taken two disparate approaches to disputes over futility of treatment. To explore whether a consensus on medical futility is developing among hospitals, the authors conducted a nationwide survey of health care professionals at hospitals. Respondents assigned importance ratings to factors used in recent futility decisions made at their institutions. The resulting importance ratings showed significant variation by characteristics of the institution (comparing respondents from for-profit, not-for-profit, and government hospitals) and by profession of the respondent (comparing physicians and nurses). The respondents' judgments endorsed three distinct strategies for making futility decisions (i.e., emphasis on the patient's decision preferences, providing for the patient and family, and adhering to objective medical and social norms). © 1998 John Wiley & Sons, Ltd.     

Increased response time of primed associates following an “episodic” hypnotic amnesia suggestion: A case of unconscious volition

Following a hypnotic amnesia suggestion, highly hypnotically suggestible subjects may experience amnesia for events. Is there a failure to retrieve the material concerned from autobiographical (episodic) memory, or is it retrieved but blocked from consciousness? Highly hypnotically suggestible subjects produced free-associates to a list of concrete nouns. They were then given an amnesia suggestion for that episode followed by another free association list, which included 15 critical words that had been previously presented. If episodic retrieval for the first trial had been blocked, the responses on the second trial should still have been at least as fast as for the first trial. With semantic priming, they should be faster. In fact, they were on average half a second slower. This suggests that the material had been retrieved but blocked from consciousness. A goal-oriented information processing framework is outlined to interpret these and related data.     

The Prevention of Suicidal Behaviors: An Overview

The authors discuss the development of the concept of prevention as it has evolved from the public health and mental health fields. Concepts of epidemiology, treatment, and community mental health are defined in terms of their contributions to the evolution of prevention thinking. Four models of prevention are presented and critiqued: the public health model, the operational model, the antecedent conditions model, and the injury control model. Essential ingredients for implementing effective preventive interventions are presented, as well as examples of practical preventive interventions.     

How do we get there? Effects of cognitive aging on route memory

Research into the effects of cognitive aging on route navigation usually focuses on differences in learning performance. In contrast, we investigated age-related differences in route knowledge after successful route learning. One young and two groups of older adults categorized using different cut-off scores on the Montreal Cognitive Assessment (MoCA), were trained until they could correctly recall short routes. During the test phase, they were asked to recall the sequence in which landmarks were encountered (Landmark Sequence Task), the sequence of turns (Direction Sequence Task), the direction of turn at each landmark (Landmark Direction Task), and to identify the learned routes from a map perspective (Perspective Taking Task). Comparing the young participant group with the older group that scored high on the MoCA, we found effects of typical aging in learning performance and in the Direction Sequence Task. Comparing the two older groups, we found effects of early signs of atypical aging in the Landmark Direction and the Perspective Taking Tasks. We found no differences between groups in the Landmark Sequence Task. Given that participants were able to recall routes after training, these results suggest that typical and early signs of atypical aging result in differential memory deficits for aspects of route knowledge.     

Use of Groups in Various Modalities of Hospital Treatment

The authors provide a comprehensive survey of the research literature on pretherapy training for group psychotherapy. The twenty studies identified during the twenty-five-year period 1962–1987 were fraught with various methodological and design inadequacies. Despite the widespread positive endorsement found in the clinical literature, the research evidence for the benefit of pretherapy training is not particularly impressive. While there is evidence of certain immediate effects (e.g., improved attendance), results concerning process and outcome effects are, at best, only suggestive. In the face of the disappointing findings, the authors are nonetheless optimistic regarding the potential value of pretherapy training.     

Problems in Integrating Traditional Group Therapies with New Group Forms

The authors describe a range of critical issues that are common within homogeneously composed groups for patients suffering from Acquired Immunodeficiency Syndrome (AIDS) and AIDS Related Complex (ARC). They examine the need for these patients to understand their physical symptomatology, to reconsider life's priorities, and to confront their ethical and moral dilemmas. The authors also highlight special affects, unique group atmosphere and process, and the nature of the group contract that is essential for these patients.     

The Evaluation of Culpability for Rape: A Model of Legal Decision Making

An analogy was borrowed from the law to develop a legal model of the attribution of responsibility for rape. According to the model, judgments of physical and psychological causality of an alleged rapist are combined into overall evaluations of attacker responsibility. An experimental test of the model was conducted with college students. Results showed that witness identification information influenced judgments of physical causality (i.e., extent to which the situation was perceived as rape), and information about the relationship between the alleged attacker and victim influenced judgments of psychological causality (i.e., intention to rape). Judgments of physical and psychological causality interacted significantly with overall attributions of attacker responsibility.     

The Developmental Trajectory from Amodal Perception to Empathy and Communication: The Role of Mirror Neurons in This Process

In a recent paper entitled “Mirror Neurons. Procedural Learning and the Positive New Experience” (Wolf et al., 2000), data were presented about a special type of neuron, the mirror neuron, originally located by Rizzolatti and his colleagues (1995). These neurons were discussed as they related to a particular developmental view of psychoanalysis, developmental systems self psychology (Shane, Shane, and Gales. 1997).

In this paper, we focus on how this mirror neuron system might contribute to the development of communicative abilities in humans. First we summarize the research findings about mirror neurons and how they apply to humans. We then attempt to demonstrate how the mirror neuron system might be involved in a developmental sequence hypothesized by Kohut (1984), Stern (1985), and others to begin in infancy. We postulate that this trajectory starts with the onset of “amodal perception” (Stern, 1985) and then proceeds to affect resonance, joint attention, and ultimately to symbolization of language. In this paper, we attempt to integrate these concepts with a formulation of empathy and demonstrate what might go awry in developmental disorders when the normative sequence of development described above does not take place.     

Psychoanalysis Unbound: A Contextual Consideration of Boundaries From a Developmental Systems Self Psychology Perspective

Each individual analyst has a unique way of evolving and developing over the years, in theory and in style of working with analysands. Different environmental conditions as well as one's personal inner life are significant influences. My analytic journey started in 1950 in Los Angeles and the turmoil of the psychoanalytic institutes had a significant impact on me. Often difficulties in the institutes were said to be about theory and ideas in psychoanalysis, but power issues were always present. The American Psychoanalytic Association was also involved in these matters with their attitude on “correct” theory. This paper discusses the interplay of these events and other aspects of my own evolution—from ego to self.