Relational suffering and the moral authority of love and care

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.

     

Idiographic network analysis of discrete mood states prior to treatment

Idiographic network models based on time‐series data have received recent attention for their ability to model relationships among symptoms and behaviours as they unfold in time within a single individual (cf. Epskamp, Borsboom, & Fried, 2018; Fisher, Medaglia, & Jeronimus, 2018). Rather than examine the correlational relationships between variables in a sample of individuals, an idiographic network examines correlations within a single person, averaged over many time points. Because the approach averages over time, the data must be stationary (i.e. relatively consistent over time). If individuals experience varying states over time—different mixtures of symptoms and behaviours in one moment or another—then averaging over categorically different moments may undermine model accuracy. Fisher and Bosley (2019) address these concerns via the application of Gaussian finite mixture modelling to identify latent classes of time points in intraindividual time‐series data from a sample of adults with major depressive disorder and/or generalised anxiety disorder (n = 45). The present paper outlines an extension of this work, wherein network analysis is used to model within‐class covariation of symptoms. To illustrate this approach, network models were constructed for each intraindividual class identified by Fisher and Bosley (137 networks across the 45 participants, mean classes/person = ~3, range = 2–4 classes/person). We examine the relative consistency in symptom organisation between each individual's multiple mood state networks and assess emergent group‐level patterns. We highlight opportunities for enhanced treatment personalisation and review nomothetic patterns relevant to transdiagnostic conceptualisations of psychopathology. We address opportunities for integrating this approach into clinical practice and outline potential shortcomings.     

Assessment of dysfunctional beliefs in borderline personality disorder

This study had two aims: to test the hypothesis that borderline personality disorder (BPD) patients hold numerous dysfunctional beliefs associated with a variety of Axis II disorders, and to construct a BPD belief scale which captures these beliefs. Beliefs were measured using the Personality Belief Questionnaire (PBQ) which is designed to assess beliefs associated with various personality disorders, although not specifically BPD. Eighty-four BPD patients and 204 patients with other personality disorders (OPD) were randomly split into two study samples. Fourteen PBQ items were found to discriminate BPD from OPD patients in both samples. These items came from the PBQ Dependent, Paranoid, Avoidant, and Histrionic scales and reflect themes of dependency, helplessness, distrust, fears of rejection/abandonment/losing emotional control, and extreme attention-seeking behavior. A BPD beliefs scale constructed from these items showed good internal consistency and diagnostic validity among the 288 study patients. The scale may be used to assist in diagnosis and cognitive therapy of BPD.     

Perceptions of another person's heavy drinking as a function of one's relationship to the drinker a pilot study

Of 301 participants in a telephone survey, 201 could identify a problem drinker within their social networks. In 67 cases the drinker was a partner, in 45 another family member, in 61 a friend, and in 28 a work colleague. Another person's heavy drinking was reported as most disrupting to one's life when that person was a partner or other family member or if one was living in the same residence as the drinker. The exception to this was that reported disruption to respondents' work life was greatest when the drinker was a work colleague. While there appear to be problems for friends and work colleagues, partners and other family members appear to report the most disruption so providing services to family members seems appropriate.     

Background beliefs in Bayesian inference

We report five experiments in which the role of background beliefs in social judgments of posterior probability was investigated. From a Bayesian perspective, people should combine prior probabilities (or base rates) and diagnostic evidence with equal weighting, although previous research shows that base rates are often underweighted. These experiments were designed so that either piece of information was supplied either by personal beliefs or by presented statistics, and regression analyses were performed on individual participants to assess the relative influence of information. We found that both prior probabilities and diagnostic information significantly influenced judgments, whether supplied by beliefs or by statistical information, but that belief-based information tended to dominate the judgments made.     

The acquisition of bimanual coordination is mediated by anisotropic coupling between the hands

The present study was designed to test two predictions from the coupled oscillator model of multifrequency coordination. First, it was predicted that multifrequency tasks that match the inherent manual asymmetry (i.e., the preferred hand assigned to the faster tempo) would be easier to learn than tasks that do not match the inherent dynamics (i.e., the non-preferred hand assigned to the faster tempo). Second, in the latter case acquisition of the multifrequency coordination would involve a reorganisation of the coupling dynamics such that the faster hand would exert a greater influence on the slower hand than vice versa. Sixteen right-handed volunteers received extensive training on a 2:1 coordination pattern involving a bimanual forearm pronation-supination task. Participants were randomly assigned to one of two groups: 1L:2R in which the preferred right hand performed the higher frequency, or 2L:1R in which the non-preferred left hand performed the higher frequency. The dynamic stability of the patterns was assessed by the ability of participants to maintain the coordination pattern as movement frequency was increased. Changes in the directional coupling between the hands was assessed by transition pathways and lead-lag relationship evident in a 1:1 anti-phase frequency-scaled coordination task performed prior to and following three practice sessions of the 2:1 task. The predicted differential stability between the multifrequency patterns was evident in the initial acquisition sessions but by the end of training the two patterns evidenced equivalent stability. Unexpectedly, for both groups the fast hand displayed greater variability in amplitude and movement frequency than the slow hand perhaps reflecting anchoring afforded to the slow hand by synchronising movement endpoints with the auditory pacing metronome. Analysis of pre- to post-training changes to the coupling dynamics in the 1:1 anti-phase task support the hypothesis that acquisition of the 2L:1R pattern involved reorganisation of the inherent dynamics.     

The pursuit of Leonardo's constraint

Leonardo da Vinci (1452-1519) identified two stimulus situations that cannot be painted faithfully on a canvas: (a) when two objects are located in the same direction with respect to the painter's head, and (b) when parts of a surface are visible to one eye, but occluded from the other eye. He analysed these situations in terms of rays being emitted from the two eyes and, aside from the origin of the rays, the projective geometry he used was correct. His analyses showed that what can be seen from two vantage points cannot be represented on a canvas, because a 'correct' painting must be created from a single 'station point'. He was struck by the consequence of this fact that the depth seen on a canvas cannot match that of viewing the scene with two eyes. Subsequent visual scientists focused on Leonardo's observation about the lack of vivid depth in a picture. We argue that a complete understanding of what we see in the two stimulus situations requires consideration of visual direction in addition to visual depth. More specifically, we argue that the visual directions of the two objects, (a) above, and the visual direction of the monocular areas, (b) above, are dependent upon the constraint that two opaque objects cannot be represented in the same direction. Demonstrations that readers can perform, and that support this argument, are provided on the Perception website at http://www.perceptionweb.com/perc0102/ono.html.     

The rattling sound of rattlesnakes (Crotalus viridis) as a communicative resource for ground squirrels (Spermophilus beecheyi) and burrowing owls (Athene cunicularia)

Animal communication involves very dynamic processes that can generate new uses and functions for established communicative activities. In this article, the authors describe how an aposematic signal, the rattling sound of rattlesnakes (Crotalus viridis), has been exploited by 2 ecological associates of rattlesnakes: (a) California ground squirrels (Spermophilus beecheyi) use incidental acoustic cues in rattling sounds to assess the danger posed by the rattling snake, and (b) burrowing owls (Athene cunicularia) defend themselves against mammalian predators by mimicking the sound of rattling. The remarkable similarity between the burrowing owl's defensive hiss and the rattlesnake's rattling reflects both exaptation and adaptation. Such exploitation of the rattling sound has favored alternations in both the structure and the deployment of rattling by rattlesnakes.