Oh death,where is thy sting? Reflections on dealing with dying patients

This paper examines the reactions of physicians and other health-professionals when they become involved in decisions about the death of their patients. The way people understand the condition of death has a profound influence on attitudes towards death and dying issues. Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.     

Developmental versus sensory deficit effects on perceptual processing in the reading disabled

Thirty children and 5 adults participated in two experiments designed to compare visual processing in normal and reading disabled children. The children were aged 8, 10, and 12 years. In Experiment 1, subjects were asked to detect the temporal order of two briefly presented stimuli. In Experiment 2, subjects sorted cards containing bracket stimuli that did or did not produce perceptual grouping effects. Poor readers required more time to make accurate temporal order judgments and showed stronger perceptual grouping effects. For both good and poor readers, the amount of time necessary to make a correct temporal order judgment decreased, and perceptual grouping effects became weaker with age. However, the magnitude of the difference between the groups did not lessen with age. These results suggest that there are visual processing differences between good and poor readers that do not appear to correct by age 12.     

Individual differences in afterimage persistence: relationships to hypnotic susceptibility and visuospatial skills.

To investigate the moderating role of individual differences in hypnotic susceptibility and visuospatial skills on afterimage persistence, we presented a codable (cross) flash of light to 40 men and 46 women who had been dark adapted for 20 min. In an unrelated classroom setting, subjects had previously been given two standardized scales of hypnotic susceptibility (Harvard Group Scale of Hypnotic Susceptibility, Shor & Orne, 1962; Group Stanford Hypnotic Susceptibility Scale, Form C, Crawford & Allen, 1982) and the Mental Rotations Test (Vandenberg & Kuse, 1978). The first afterimage interval and the afterimage duration correlated significantly with hypnotic responsiveness, supporting Wallace (1979), but did not show the anticipated relationships with mental rotation visuospatial skills. Individuals in the high hypnotizable group had (a) significantly longer afterimage intervals between its first appearance and first disappearance than did those in medium or low groups, as well as (b) significantly longer afterimages between the first appearance and the final disappearance than did those in low groups, but those in medium groups did not differ significantly from the other groups. Discriminant analysis using the afterimage persistence measures classified correctly 65.2% of high hypnotizables, 37.5% of medium hypnotizables, and 54.8% of low hypnotizables. Hypothesized cognitive skills that assist in the maintenance of afterimages and underlie hypnotic susceptibility include abilities to maintain focused attention and resist distractions over time and to maintain vivid visual images.     

Psychoanalytic ecumenism and varieties of psychoanalytic experience.

Using the metaphor of ecumenism, the current status of psychoanalysis and the American Psychoanalytic Association is examined. The dialectical tendencies to oppose and to unify are noted in psychoanalytic theory, technique, and practice, as well as in the administrative and political life of our organization. Fostering tolerance for new hypotheses without sacrificing empirical discrimination, and promoting broad participation without lowering standards confront us as major tasks demanding continuing vigilance and effort.     

Depression and social problem solving.

Twenty depressed patients with major depressive disorder, 20 nondepressed matched control subjects, and 17 patients with anxiety disorders were compared in different measures of social problem solving. Problem solving was assessed with the Means-Ends Problem-Solving Test (Study 1), the solution of personal problems, and a problem-solving questionnaire (Study 2). Results showed that, as predicted, depressed subjects suffered from a deficit in problem solving in all three measures. The majority of these deficits were also displayed by the clinical control group rather than being specific to a diagnosis of depression. However, depressed subjects produced less effective solutions than did normal and clinical control subjects. The results suggest that depressed and anxious patients may have difficulties at different stages of the problem-solving process.     

Hypnotically created pseudomemories: further investigation into the "memory distortion or response bias" question.

In order to study whether pseudomemories represent actual memory distortions or are a result of response bias, 60 highly hypnotizable subjects and subjects from the general population were divided into 4 experimental groups and were tested for pseudomemory manifestation after receiving a false suggestion. Of the 4 groups of subjects, 3 were offered a monetary reward as a motivation to distinguish false suggestion from actual occurrence. Pseudomemory manifestation was found to be significantly higher among subjects not offered a reward than among subjects who were offered such an reward. The implications of these findings are discussed.     

"Existential" therapists and their group therapy practices.

Existential philosophical thought insists that human behavior is indeterminate and subject only to the individual's will. It is, therefore, skeptical of all dynamic psychologies based as they are on Freudian determinism. Group therapists imbued with this philosophy stop short of its extreme. Their existential position, however, does greatly modify treatment, and yet they preserve both the form and goals of therapy. They place properly selected and prepared patients in a group where their individuality and authenticity are highly valued. Finding most technical procedures irrelevant, the therapists themselves, that is, their evolving personalities are central. The key to patient change is the spontaneous meeting of members and the therapist which the therapist orchestrates. Instead of the usual interpretation, members are encouraged to confront the paradoxes in their lives, their humanness, and especially their finitude. Patients are to be brought up to the threshold of their self-knowledge so they can choose. Choice, therefore, along with action coupled with responsibility are frequent themes. Unless the individual is incompetent, decisions made for him or her by the therapist or by group consensus are thought to be nontherapeutic.