To stay or to go, to speak or stay silent, to act or not to act: moral distress as experienced by psychologists

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes. They described dealing with the resulting moral distress by such means as silence, taking a stance, acting secretively, sustaining themselves through work with clients, seeking support from colleagues, and exiting. Recognizing moral distress can lead to a significant shift in the way we perceive moral choices and understand the moral context of practice.     

Reflections on public bioethics: a view from the trenches

For many reasons, and more than its predecessors, the President's Council on Bioethics has been the subject of much public attention and heated controversy. But little of that attention and controversy has been informed by knowledge of the Council's mission, its ways of working, and, most importantly, its actual work. This essay describes the Council's mission, discusses its public ways of working, and reviews the five major works produced during the Council's first term. In all its activities, the Council has sought to develop a richer bioethics, one that recognizes and tries to do justice to the deep issues of our humanity raised by the age of biotechnology. Believing that these issues are properly matters to be discussed and governed by the polity as a whole, the Council also has sought to contribute to a genuinely public or political bioethics, beyond the rule of "experts," scientific and bioethical.     

Group psychotherapy and Parkinson's disease: when members and therapist share the diagnosis

This report describes a psychosocial therapy group for Parkinson's patients, focusing on the therapeutic processes arising when group members and therapist share the diagnosis of Parkinson's disease. The paper explores the question, "What is the therapeutic effect on the group when the therapist suffers and displays the same illness as members of the group"? Countertransference issues are described.     

Neuropsychological executive functioning in children at elevated risk for alcoholism: findings in early adolescence

One component of individual risk for alcoholism may involve cognitive vulnerabilities prodromal to alcoholism onset. This prospective study of 198 boys followed between 3 and 14 years of age evaluated neurocognitive functioning across three groups who varied in familial risk for future alcoholism. Measures of intelligence, reward-response, and a battery of neuropsychological executive and cognitive inhibitory measures were used. Executive functioning weaknesses were greater in families with alcoholism but no antisocial comorbidity. IQ and reward-response weaknesses were associated with familial antisocial alcoholism. Executive function effects were clearest for response inhibition, response speed, and symbol-digit modalities. Results suggest that executive deficits are not part of the highest risk, antisocial pathway to alcoholism but that some executive function weaknesses may contribute to a secondary risk pathway.     

Mothers' ambivalence with their babies and toddlers: manifestations of conflicts with aggression

In this paper the author continues his study of conflicts over aggression in women, discussing the implications for contemporary theories of feminine psychology of observations of mothers in parent/child groups with their infants and toddlers. Many mothers experience conflicts over aggression (both in themselves and in their children) and become intolerant of their ambivalence toward their children. The author suggests that this observation provides an avenue that allows an integration of psychoanalytic ideas about maternity and childrearing with psychoanalytic understandings of women's conflicts about achievement in the social realm outside the home. In both roles, difficulties mastering conflicts with aggression may cause women to struggle profoundly, and to experience problems, in successfully negotiating their important life goals, whether the goals refer to their roles as effective mothers or their roles as effective individuals in the social sphere outside the home. Some women may demonstrate these difficulties in one sphere or the other, some in both, and others in neither. The author suggests on the one hand that we need to eliminate the concept of normality when considering the activities of women, and on the other hand that we need to normalize the omnipresence of ambivalence in the psychology of women.     

On the Value and Scope of Freedom

We have a practical, not merely theoretical interest in freedom. The question that is considered in this paper, is what it is that we value about freedom. It is proposed that what we value is being able to get what we most want (or value), because that is what we most want (or value). This account is compatible with determinism. Certain accounts opposed to determinism are considered and rejected. On these accounts freedom requires either a particular sort of indeterminism, or requires a special form of causation, agent-causation, or requires that the agent be a certain sort of self-constituting entity. It is argued that even if these accounts were less metaphysically problematic than they are, they would not give us a 'freedom' that we would value, nor would they secure conditions under which an action would be praise – or blameworthy. It is also argued, that a certain sort of capacity to control ourselves is not a precondition for freedom, though such a capacity would add to the scope of our freedom     

The Relation of Lifetime Cognitive Activity and Lifetime Access to Resources to Late-life Cognitive Function in Older African Americans

ABSTRACT

Research in older Caucasians has demonstrated that cognitive activity is related to cognitive function in late adulthood. Knowledge of this association is limited in older minority populations. We examined the relation of cognitive activity and access to cognitive resources, with cognitive function in a group of 108 older African Americans. We constructed two scales to measure the frequency of cognitive activity and the presence of resources that promote cognitive activity during early and late life. Both measures had high internal consistency and the cognitive activity scale had adequate temporal stability over a 4-week interval. In analyses that controlled for age and education, more frequent lifetime cognitive activity was related to current cognitive function, but lifetime cognitive resources only approached significance. The results suggest that both measures are psychometrically sound in a minority population and that lifetime cognitive activity may contribute to current cognitive function in African Americans.