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.     

The physician's influence on patients' choices

Although the traditional physician ethic sees nothing objectionable about the doctor's influence over patients, superficial conceptions of the patient's right to self-determination imply that this influence may be manipulative. On the contrary, there are several different lines of argument which can reconcile self-determination with the physician's influence. Nevertheless, drawing the boundaries between legitimate methods of persuasion, and manipulation or coercion sometimes proves difficult.     

The electronic chalkboard

The present paper describes “the electronic chalkboard” (TEC), a teaching innovation made possible by the recent development, under a FIPSE grant to CONDUIT, of specialized instructional software. The instructional power of TEC casts the computer in the role of catalyst in the student-teacher dyad and leads to the emergence of the more powerful student-computer-teacher triad. Relevant educational principles and CAI techniques that should ensure the intelligent use of TEC are discussed.     

Typicality ratings for 893 exemplars of 93 categories

Although the typicality effect has been much studied in the semantic memory literature, typicality ratings exist for exemplars from only a very limited number of categories. This lack of ratings frequently limits the range of stimuli that can be used in investigations of the typicality effect. As an aid in stimulus construction, this paper reports typicality ratings of 893 exemplars from 93 different categories.     

Postnatal development of respiratory and vocal responses during aversive classical conditioning in cats

Respiratory rate, respiration amplitude, and vocal responses were recorded in cats of different ages during classic conditioning. Vocal responses to the conditional stimulus (CS) appeared first in 8-week-old kittens, and became prominent at older ages. An increase in respiration rate occurred after the onset of the CS in cats of all ages. Similarly, the decrease of respiration amplitude was observed at all ages, but only in 8-week-old and older subjects did this response resemble an adult pattern. In 4-week-old kittens the response was characterized by an early and brief peak, suggesting an alpha conditional response (CR). Clear and significant discrimination between a warning and a safety signal was present in both respiratory and vocal responses after the age of 8 weeks.     

A word’s meaning affects the decision in lexical decision

The influence of an isolated word’s meaning on lexical decision reaction time (RT) was demonstrated through four experiments. Subjects in two experiments made lexical decision judgments, those in a third experiment pronounced the words used in the lexical decision task, and those in a fourth experiment quickly pronounced their first associative response to the words. Differences in lexical access time for the words were measured with the pronunciation task, and differences in meaning were assessed with the association task. Multiple regression analyses of lexical decision RT were conducted using associative RT, pronunciation RT, and other target word properties (printed frequency, length, instance dominance, and number of dictionary meanings) as predictor variables. These analyses revealed a relationship between lexical decision RT and associative RT after the effects of other variables had been partialed out. In addition, word frequency continued to have a significant relationship to lexical decision RT beyond that shared with pronunciation RT and the other variables. The results of these experiments indicate that at least some of the effect of word meaning and word frequency in lexical decision is attributable to a decision stage following lexical access.     

The hierarchy of consistency: A review and model of longitudinal findings on adult individual differences in intelligence,personality and self-opinion

When viewed in the aggregate, studies of the longitudinal consistency of intelligence, personality traits and self-opinion (self-esteem, life satisfaction etc.) show a hierarchy of consistency. Uncorrected retest coefficients over periods of 6 months to 50 yr are analyzed as the product of period-free reliability (R) and the true stability of the construct (sⁿ, where s is the coefficient of annual stability and n the number of years of the retest interval). The annual stabilities of intelligence, personality traits and self-opinions are estimated as 0.99, 0.98 and 0.94, respectively. While intelligence and personality may be regarded as relatively stable characteristics over the length of the adult lifespan, self-opinion has little stability over periods of more than 10 yr. The hierarchy of consistency should be taken into account in causal models of human development. Although self-opinion is not a longitudinally-stable characteristics, it may still be predicted over long periods of time by higher-order constructs such as personality traits and intelligence.     

Cognitive dysfunction in compulsive checkers: Further explorations

Recent evidence suggests a relationship between certain memory deficits and compulsive-checking behavior. The present study explores this relationship in the context of several additional memory capacities not yet investigated. Using the Maudsley Obsessional-Compulsive Inventory and the Everyday Checking Behavior Scale four groups of Ss were identified: (1) frequent checkers, (2) occasional checkers, (3) infrequent checkers and (4) noncheckers. Consistent with previous research, a memory-for-actions task indicated a deficit among compulsive checkers. Furthermore, checking status was found to be negatively related to memory functioning as measured by the Wechsler Memory Scale (WMS) and the Cognitive Failures Questionnaire (CFQ). This memory deficit was most pronounced on the Logical Memory subtest of the WMS. Checkers appear to have difficulty recalling details of meaningfully linked sequences, either presented in narrative form or engaged in personally. Although the reasons for these checking-related deficits are not clear, a complete understanding of checking phenomena will involve an appreciation of the role played by memory deficits.     

Physiological and psychological effects of acute intentional hyperventilation

Research is reviewed which suggests that hyperventilation syndrome is an underdiagnosed disorder for the presentation of many patients experiencing apparent anxiety states. In a test of this hypothesis, 21 normal individuals (9 female) underwent a 2 min period of intentional hyperventilation following a 10 min baseline phase. Hyperventilation was accompanied by increased subjective anxiety and tachycardia, and indications of peripheral vasoconstriction. Following hyperventilation, Ss experienced increased levels of state anxiety and perceived autonomic arousal, as indexed by self-report instruments. These results support the hypothesis that undiagnosed hyperventilatory phenomena may be etiologically implicated in states of pathologic anxiety.