Anesthesia Awareness: Narrative Review of Psychological Sequelae,Treatment, and Incidence

Awareness during general anesthesia occurs when patients recall events or sensations during their surgeries, although the patients should have been unconscious at the time. Anesthesiologists are cognizant of this phenomenon, but few discussions occur outside the discipline. This narrative review summarizes the patient recollections, psychological sequelae, treatment and follow-up of psychological consequences, as well as incidence and etiology of awareness during general anesthesia. Recalled memories include noises, conversations, images, mental processes, feelings of pain and/or paralysis. Psychological consequences include anxiety, flashbacks, and posttraumatic stress disorder diagnosis. Limited discussion for therapeutic treatment after an anesthesia awareness experience exists. The incidence of anesthesia awareness ranges from 0.1 to 0.2% (e.g., 1–2/1000 patients). Increased recognition of awareness during general anesthesia within the psychological/counseling community, with additional research focusing on optimal therapeutic treatment, will improve the care of these patients.     

The contribution of social rank and attachment theory to depression in a non clinical sample of adolescents

This study explores the relative contribution of the overall quality of attachment to the mother, to the father and to peers (Inventory of Parent and Peer Attachment scales), the style of attachment towards peers (Attachment Questionnaire for Children scale), the social rank variables (submissive behavior and social comparison), and sex and age variables in predicting the depression score (Center of Epidemiological Studies Depression Scale) on a non-psychiatric sample of 13-18 year old adolescents (n = 225). Results of our integrated model (adjusted R-Square of .50) show that attachment variables (overall quality of attachment to the father and to the mother), social rank variables (social comparison and submissive behavior), age and sex are important in predicting depressive symptoms during adolescence. Moreover, the attachment to peers variables (quality of attachment to peers, secure and ambivalent style of attachment) and sex are mediated by the social rank variables (social comparison and submissive behavior).     

Personal and intergenerational narratives in relation to adolescents' well-being

Narratives of the self are embedded within families in which narrative interaction is a common practice. Especially in adolescence, when issues of identity and emotional regulation become key, narratives provide frameworks for understating self and emotion. The authors' research on family narratives suggests that adolescents' personal narratives are at least partly shaped by intergenerational narratives about their parents' childhoods. Both personal and intergenerational narratives emerge frequently in typical family dinner conversations, and these narratives reflect gendered ways of being in the world. Adolescents who tell intergenerational narratives that are rich in intergenerational connections and perspective-taking show higher levels of well-being. These findings suggest that individual narrative selves are created within families and across generations.     

EUTHYPHRO AND THE GOODNESS OF GOD INCARNATE

A familiar problem is here viewed from an unfamiliar angle. The familiar problem is the Euthyphro dilemma: if God wills something because it is good, then goodness is independent of God, so God becomes, morally speaking, de trop. On the other hand, if something is good because God wills it, then, given the absence of constraint on what God may will, moral truths are – counterintuitively – contingent. An examination of the kinds of necessity and possibility at work in this conundrum leads us to the most promising solution: there is a metaphysical connection between God and goodness. What he wills is an expression of his nature. But (and this is the unfamiliar angle), that solution now poses an acute problem for an understanding of the Incarnation. For if God is constitutive of goodness, and Christ is God incarnate, then Christ is constitutive of goodness. But Christ, as a human, is subject to external moral evaluation and obligation, which entails that he is not constitutive of goodness. This metaethical difficulty is not easily met by the usual strategies by which Christ is understood to have two natures. Reflection on our moral relations to our past selves, however, suggests a way forward.     

Like a Fish Out of Water: Reconsidering Disaster Recovery and the Role of Place and Social Capital in Community Disaster Resilience

In this paper we draw on the findings of a critical, multi-sited ethnographic study of two rural communities affected by a wildfire in British Columbia, Canada to examine the salience of place, identity, and social capital to the disaster recovery process and community disaster resilience. We argue that a reconfiguration of disaster recovery is required that more meaningfully considers the role of place in the disaster recovery process and opens up the space for a more reflective and intentional consideration of the disorientation and disruption associated with disasters and our organized response to that disorientation. We describe a social-psychological process, reorientation, in which affected individuals and communities navigate the psychological, social and emotional responses to the symbolic and material changes to social and geographic place that result from the fire's destruction. The reorientation process emphasizes the critical importance of place not only as an orienting framework in recovery but also as the ground upon which social capital and community disaster resilience are built. This approach to understanding and responding to the disorientation of disasters has implications for community psychologists and other service providers engaged in supporting disaster survivors. This includes the need to consider the complex dynamic of contextual and cultural factors that influence the disaster recovery process.