The relationship of appraisal and coping to chronic illness adjustment

There is evidence that adaptation to chronic illness may be affected by psychological factors, especially how patients appraise and cope with the stress of their illness. The purpose of the present study was to examine the relationship of stress appraisal and coping responses to multiple behavioral indices of illness adjustment among patients with diverse chronic medical conditions. One hundred and one patients admitted to a multidisciplinary medicine/psychiatry unit completed measures of functional impairment, depression, symptom severity, and the Ways of Coping Checklist--Revised. Hierarchical regression analyses indicated that emotion-focused coping was positively related to poor psychosocial adjustment and depression after controlling for physician rated disease severity. Appraising chronic illness as holding one back predicted greater emotion-focused coping responses and poorer adjustment to illness. The use of problem-focused coping strategies was generally unrelated to illness adjustment. These findings suggest the presence of an emotion-focused coping triad consisting of wishful thinking, self blame, and avoidance, all of which appear to be maladaptive strategies when coping with chronic medical conditions. Implications for coping skills training and the need for longitudinal research is discussed.     

Pessimistic explanatory style and response to illness

Previous studies have shown that a pessimistic explanatory style is a risk factor for illness, but the factors linking explanatory style and illness are unknown. One's characteristic response to poor health may mediate this relationship. Perhaps pessimistic individuals act helplessly in the face of their symptoms, thereby exacerbating disease. In the present study, we investigated this possibility by asking 96 young adults to complete measures of explanatory style, habitual response to illness, and ways of coping during their most recent episode of illness. Subjects who explain bad events pessimistically (with internal, stable, and global causes) reported more frequent illnesses during the past year and rated their overall health more poorly than those who habitually favor external, unstable, and specific explanations. When ill, the pessimistic subjects were less likely than their optimistic counterparts to take active steps to combat their illness. Our results suggest that one pathway leading from pessimistic explanatory style to poor health is mundane: passivity in the face of disease.     

Transformations of unconscious fantasy in art

Unconscious fantasy is conceptualized as a representation for drive-related, conflict-laden, wish-fulfilling views of human experience. These are usually related to sexuality, and refer to birth, intrauterine existence, primal scene, castration, and seduction. Unconscious fantasy may be transformed into works of art through a variety of artistic means. The employment of formal means for the representation of fantasy may be the product of an endopsychic perception. Thus, structural attributes of the psyche may also find representation. An example is used from the creative process in the construction of a novel by Henry James, The Spoils of Poynton. In the process of fulfilling artistic purposes in the construction of his plot, the author made use of derivatives of unconscious fantasy which surface in the process of creation. The work of art is the integration of unconscious derivatives which become transformed into artistic structure.     

Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

The old homeless and the new homelessness in historical perspective

In the 1950s and 1960s homelessness declined to the point that researchers were predicting its virtual disappearance in the 1970s. Instead, in the 1980s, homelessness increased rapidly and drastically changed in composition. The "old homeless" of the 1950s were mainly old men living in cheap hotels on skid rows. The new homeless were much younger, more likely to be minority group members, suffering from greater poverty, and with access to poorer sleeping quarters. In addition, homeless women and families appeared in significant numbers. However, there were also points of similarity, especially high levels of mental illness and substance abuse.     

Processing distinctions between stems and affixes: evidence from a non-fluent aphasic patient

In this paper, we study the ability of a non-fluent aphasic patient, BN, to comprehend morphologically complex words when they appear in utterance contexts. We first establish that he is insensitive to the contextual appropriateness of both derived and inflected words. In a further experiment we show that he has no difficulty processing the stems of complex words and conclude that his problem is with the bound morphemes themselves. We then ask whether this problem is due to his inability to access either the phonological form of a morphologically complex word or its semantic and/or syntactic content. We find that only the access of semantic and syntactic content is impaired. We conclude from these six studies that: (a) BN presents a counter-example to the claim that non-fluent patients have particular difficulty with those aspects of morphology which have a syntactic function; (b) BN processes both derived and inflected words by mapping the sensory input onto the entire full-form of a complex word, but the semantic and syntactic content of the stem alone is accessed and integrated into the context. The semantic and syntactic implications of the suffix are never evaluated. This implies separate representation of the stems and suffixes of some types of morphologically complex words.     

Towards a theory of algorithm-determined cognitive test construction

A rationale for, and data from, a trial of a theory of item generation by algorithms whose origins are cognitive models of task performance are presented. Since Spearman (1904), intelligence has been operationally defined and assessed in human subjects by administering identical test items whose content and order have been fixed only after empirical iterations. In our approach, intelligence is ostensively defined by theoretically determined algorithms used for item construction and presentation. Knowledge of what cognitive factors limit human performance makes it possible to vary within tightly specified parameters those features of the tasks that contribute to difficulty, which we call radicals, to let those components of the tasks that do not contribute to difficulty vary randomly, and to counterbalance aspects of answer production that might induce biases of response. Empirical data are based on the generation of five different short tests demanding only functional literacy as a prerequisite for their execution. Four parallel forms of each test were administered to young male Army recruits whose scores were collated with their Army Entrance Test results, which were not previously known to us. Results show that the parallel, algorithm-generated item sets are statistically invariant, which item generation theory demands; and that the individual tests differentially predict Army Entrance Test scores. We conclude that IQ test performances are parsimoniously explained by individual differences in encoding, comparison and reconstructive memory processes.     

ASSESSING FOOD PREFERENCES AMONG PERSONS WITH PROFOUND MENTAL RETARDATION: PROVIDING OPPORTUNITIES TO MAKE CHOICES

Increased attention has been directed recently to assisting persons with severe handicaps to express preferences concerning events in their lives. We evaluated a program for assessing choice-making skills to provide opportunities for persons with profound mental retardation to express food and drink preferences. In Experiment 1, the assessment procedure involving repeated, paired-item presentations resulted in active choice making and the identification of preferences for all 5 participants. Results also indicated that caregiver opinion was not predictive of participant food and drink preferences. A survey of service providers supported the importance of meal-related choices in this population. In Experiment 2, the practicality of the assessment procedure was supported by demonstrating that (a) routine caregivers could apply the procedure with appropriate supervision to provide choice opportunities, and (b) results of the procedure were predictive of participant choices when a less structured and more normal opportunity to express a preference was provided during regular mealtimes. Results are discussed in terms of extending the developing technology of preference and reinforcer identification to other important areas for persons with severe disabilities.     

EFFECTS OF CHOSEN VERSUS ASSIGNED JOBS ON THE WORK PERFORMANCE OF PERSONS WITH SEVERE HANDICAPS

We evaluated the effects of several choice-related variables on the work performance of adults with severe handicaps. After assessing client work preferences, three choice-related situations were presented: (a) providing clients with the opportunity to choose a work task, (b) assigning a preferred task, and (c) assigning a nonpreferred task. Results indicated that clients attended to work tasks almost twice as much when they chose their tasks and when assigned to work on preferred tasks versus when assigned to work on nonpreferred tasks. Results are discussed regarding the need to assess systematically the effects of choice-related variables.