Narrative unity and clinical judgment

Alasdair MacIntyre's recent thinking both about the concept of a practice and the existence of narrative unity in human life raises important questions about how we should view clinical medicine today. Is it possible for clinical medicine to pursue patient well-being in a society (allegedly) afflicted with what he calls ‘modernity’? Here it is argued that MacIntyre's pessimistic view of the individual in contemporary society makes his call for patient autonomy in the clinical setting pointless. Finally, recent work in gerontology is cited to make three points: first, MacIntyre's pessimism about us is too extreme; second, the concept of a ‘fictionalized’ personal history is closer to reality than either MacIntyre's notion of narrative unity or the ideas of his imagined opponent (Sartre); and finally, we should not expect clinical medicine to produce patient well-being, when this is understood narratively.     

Childhood fantasy play relates to adult socio-emotional competence

Childhood fantasy play and creation of imaginary companions are thought to confer socio-emotional benefits in children, but little is known about how they relate to socio-emotional competence in adulthood. A total of 341 adults (81 males) aged 18 and above (M = 31.47, SD = 12.62) completed an online survey examining their fantasy play as a child, their childhood imaginary companion status, and their adult socio-emotional competence. Adults who reported higher levels of childhood fantasy play were found to be significantly more prosocial, empathetic, and emotionally intelligent than their counterparts after controlling for demographic factors. Recall of a childhood imaginary companion, however, was significantly related only to higher scores for perspective-taking and did not explain unique variance in any adult competence measure. Findings suggest that engagement in fantasy play during childhood may be a precursor to later socio-emotional competence, while benefits previously associated with imaginary companions specifically may not extend into adulthood.     

Dispositional Optimism/Pessimism and Coping Strategies: Predictors of Psychosocial Adjustment of Rheumatoid and Osteoarthritis Patients1

Because rheumatoid arthritis (RA) has a more unpredictable course than osteoarthritis (OA), we hypothesized that generalized expectancies (optimistic/ pessimistic) influence the psychosocial adjustment of RA patients, whereas disease severity influences the adjustment of OA patients. Path analysis (LISREL VI) revealed that pessimistic RA patients (N= 107) and the more physically disabled OA patients (N= 108) reported poorer adjustment. The hypothesized mediating role of coping was supported for the RA but not the OA sample; that is, pessimism was associated with poor adjustment through greater use of wishful thinking coping. Unexpectedly, problem-solving coping was not found to mediate the optimism adjustment relationship.     

The impact of short-term counselling on general health questionnaire scores

An evaluation was conducted of short-term counselling in a higher education setting. The main objective was to measure client scores on a shortened version of the General Health Questionnaire (GHQ-12) pre- and post- counselling. Forty-five matched pairs of GHQ-12 scores were compared. There was a highly significant reduction in scores post-counselling. The evidence suggests that the 'great pretender' evaluation can be challenged using standard quantitative measures such as the GHQ-12. It is concluded that counselling in higher education may be addressing long-standing distress in members of the student population.     

Adaptation effects and reversible figures: A comment on Horlitz and O’Leary

In a recent article, Horlitz and O’Leary (1993) offer a reinterpretation of the results of several studies over the past 40 years that have employed the prolonged-inspection technique in the investigation of reversible figures. Specifically, they contend that, contrary to the favored interpretation of neural adaptation effects, the results of these studies reveal the combined influence of such topdown processes as attention and perceptual learning as well as such methodological difficulties as unwanted demand characteristics. In this note, we examine their analysis of the literature, their alternative theoretical model, and the supporting conclusions they draw from their two experiments. We argue that there is considerable evidence from a variety of studies for the joint role of bottom-up and top-down processes in reversible figures. Moreover, we propose that Horlitz and O’Leary’s own research, rather than eliminating the possibility of neural-adaptation effects, is best conceptualized as providing additional evidence for the role of higher-order processes in these phenomena.     

AUGMENTING SIMPLIFIED HABIT REVERSAL WITH AN AWARENESS ENHANCEMENT DEVICE: PRELIMINARY FINDINGS

The chronic hair pulling of a 36-year-old woman with moderate mental retardation was initially treated with a simplified habit-reversal (SHR) procedure that consisted of awareness training, competing response training, and social support. When SHR did not produce large and sustained reductions in hair pulling, an awareness enhancement device was added, and it reduced hair pulling to near-zero levels in two settings. The results are discussed, and directions for future research with this device are provided.     

The contribution of visual persistence to the perceived duration of brief targets

Two experiments were conducted to examine the role of sensory persistence on tasks of perceived duration employing very brief visual stimuli. Using a standard temporal judgment task, the first experiment replicated both the “size effect” and “empty-filled” illusion reported by previous investigators. However, entirely comparable results were also found with a probematching task, which theoretically assesses the degree of persistence exhibited by a stimulus. The second experiment examined the effect of target luminance on perceived duration. Consistent with a sensory persistence interpretation, judgments of duration increased with increasing luminance. The results from the two experiments were discussed in terms of varying degrees of retinal persistence produced by different stimuli. This view was contrasted with currently dominant interpretations that postulate changes in perceived duration to reflect different information-processing requirements across stimulus conditions.