Richard Zaner’s Phenomenology of the Clinical Encounter

The clinical ethics propounded by Richard Zaner is unique. Partly because of his phenomenological orientation and partly because of his own daily practice as a clinical ethicist in a large university hospital, Zaner focuses on the particular concrete situations in which patients and their families confront illness and injury and struggle toward workable ways for dealing with them. He locates ethical reality in the clinical encounter. This encounter encompasses not only patient and physician but also the patients family and friends and indeed the entire lifeworld in which the patient is still striving to live. In order to illuminate the central moral constituents of such human predicaments, Zaner discusses the often-overlooked features of disruption and crisis, the changed self, the patients dependence and the physicians power, the violation of personal boundaries and their necessary reconfiguring, and the art of listening.     

Prescribing conventional antipsychotics at two Veterans Administration hospitals: are there geographical differences?

The medical records of 110 patients receiving conventional antipsychotics at two geographically distinct Veterans Administration hospitals (Syracuse, New York, and Omaha, Nebraska) were reviewed. The most common reasons for continuation of conventional antipsychotics were good response and patient or physician choice. Frequently, physicians did not discuss the reasons for continuing conventional antipsychotics or the availability of alternative therapies with their patients. Geographic differences in physicians' prescribing practices of conventional antipsychotics were apparent.     

Lesions in the Central Nucleus of the Amygdala: Discriminative Avoidance Learning, Discriminative Approach Learning, and Cingulothalamic Training-Induced Neuronal Activity

The amygdala is critically involved in discriminative avoidance learning. Large lesions of the amygdala block discriminative avoidance learning and abolish cingulothalamic training-induced neuronal activity. These results indicated that amygdalar processing is critical for cingulothalamic plasticity. The larger lesions did not allow differentiation of the specific functioning of various amygdalar nuclei. Anatomical analysis showed that damage in the central (CE) nucleus of the amygdala was correlated with the severity of the behavioral deficit. The present study was carried out to determine whether smaller lesions, centered in the CE nucleus, would impair discriminative avoidance learning and block cingulothalamic plasticity. In addition, the possible role of the CE nucleus in appetitively motivated discriminative approach learning was examined for the first time. New Zealand White rabbits with CE nuclear lesions were first trained in the discriminative approach task. After attaining asymptotic performance, discriminative avoidance training sessions were alternated with continuing approach training sessions, one session each day. The rabbits with lesions were severely impaired in avoidance learning but showed no impairment of approach learning. Surprisingly, the attenuating effects of the lesions on cingulothalamic training-induced neuronal activity were more prevalent during approach learning than during avoidance learning. These results indicated that avoidance learning can be impaired by lesions centered in the CE nucleus that leave cingulothalamic plasticity largely intact and that the CE nucleus is involved in extra-cingulothalamic learning processes.     

Stress Induced Oral Behaviors and Facial Pain

Facial pain is frequently associated with environmental stress and emotional distress. One hypothetical mechanism by which stress is translated into pain is through stress induced motor function (e.g., teeth clenching, grinding, nail biting). Existent data partially supports these stress-hyperactivity models although they have also come under theoretical and empirical attack. The purpose of this study was to examine the relationship between oral behaviors and pain in an analog sample of facial pain sufferers and student controls. Subjects engaged in a controlled clenching task and reported on subjective facial pain intensity and unpleasantness at 5 specified times over the subsequent 48 hours. A one-way ANCOVA indicated group differences in self reported oral habits (p < .05) with the facial pain group reporting great frequency of oral habits. Two repeated measures ANCOVAs (i.e., pain intensity and pain unpleasantness), controlling for baseline pain ratings, indicated a between groups effect with facial pain sufferers experiencing significantly greater pain over the 48 hours postexperiment (p < .05). This study supports a hyperactivity model of facial pain and provides clues about relevant factors in facial pain development.     

Adult attachment orientations: Relation to affiliation motivation

This study examines the multifaceted relationship between attachment and affiliation motivation. In a sample of 322 participants differences were found between attachment styles or dimensions and affiliation motivation. Anxious attachment was positively related to seeking attention from others, social comparison, and positive stimulation as motivations for affiliation. Avoidant attachment was negatively related to emotional support and positive stimulation as motivations for affiliation. Also, results indicated that individuals with a dismissing attachment style scored lower on several dimensions of affiliation motivation than individuals characterized by secure, fearful, or preoccupied attachment styles. Implications for the impact of attachment on motivation to seek social support and counseling are discussed.     

Ethnic identity and acculturation in Hispanic early adolescents: mediated relationships to academic grades, prosocial behaviors, and externalizing symptoms

This study examined acculturative stress and self-esteem as mediators of the association of ethnic identity and acculturation with psychosocial outcomes. The study sample consisted of 347 Hispanic adolescents in a "new" immigrant-receiving community in the Midwest. The authors expected acculturation to influence psychosocial adjustment through acculturative stress and ethnic identity to influence psychosocial adjustment through self-esteem. Results indicated that relationships of ethnic identity to academic grades and to externalizing symptoms were mediated by self-esteem and that both U.S. and Hispanic acculturation orientations were directly associated with prosocial behavior. The relationships of U.S. cultural orientation to academic grades and to behavior problems were mediated through acculturative stress and self-esteem. Implications of these findings for the study of Hispanics in more monocultural receiving communities are discussed.     

"Leaky" Rationality: How Research on Behavioral Decision Making Challenges Normative Standards of Rationality

ABSTRACT— For more than 30 years, decision-making research has documented that people often violate various principles of rationality, some of which are so fundamental that theorists of rationality rarely bother to state them. We take these characteristics of decision making as a given but argue that it is problematic to conclude that they typically represent departures from rationality. The very psychological processes that lead to "irrational" decisions (e.g., framing, mental accounting) continue to exert their influence when one experiences the results of the decisions. That is, psychological processes that affect decisions may be said also to "leak" into one's experience. The implication is that formal principles of rationality do not provide a good enough normative standard against which to assess decision making. Instead, what is needed is a substantive theory of rationality—one that takes subjective experience seriously, considers both direct and indirect consequences of particular decisions, considers how particular decisions fit into life as a whole, and considers the effects of decisions on others. Formal principles may play a role as approximations of the substantive theory that can be used by theorists and decision makers in cases in which the formal principles can capture most of the relevant considerations and leakage into experience is negligible.     

Remembering the forgotten: psychotherapy groups for the nursing home resident

The mental health needs of the long-term nursing home resident receive little attention. It is especially difficult for the more cognitively intact resident to obtain psychological help. An integrated group psychotherapy model that incorporates developmental, cognitive-behavioral, and psychodynamic approaches is described, based on the author's clinical experience in developing and co-leading four groups in three long-term care facilities over a period of ten years. The technical and countertransference challenges of working with this unique population and in this format are described, along with clinical material to illustrate common themes. The success of the groups in improving the morale, sense of community, and quality of life for group members is demonstrated.