Some Must Die

The transplantation and procurement of human organs has become almost routine in American society. Yet, organ transplantation raises difficult ethical and psychosocial issues in the context of “controlled” death, including the blurring of boundaries between life and death, self and other, healing and harming, and killing and letting die. These issues are explored in the context of the actual experiences of organ donors and recipients, brain death, the introduction of non‐heartbeating donor protocols, and the increasing reliance on living donors. The author draws on a thematic analysis of the way that organ transplantation is presented in the media, films, and science fiction and on his clinical experience as a psychiatrist working with transplant patients, their families, and the nurses and physicians who care for them.     

Service in the Gulf War and Significant Health Problems: Focus on the Central Nervous System

The consensus of several studies on health among Gulf War (GW)-deployed veterans is that they have elevated symptom complaints. Central nervous system (CNS) symptoms among these veterans have been assessed in several investigations. Studies have disagreed as to whether there are neuropsychological deficits in GW-deployed veterans relative to controls. When differences between these groups have been found, they have often been attributed to stress or psychiatric factors, although exposures to neurotoxic substances present in the GW theatre have also been indicted as possible explanations. A review of the existing literature as well as the 5 papers contained in this issue of Journal of Psychopathology and Behavioral Assessment suggests that the neuropsychological and health symptom sequelae of GW zone service are multidetermined and cannot easily be explained on the basis of simplistic models of causation. Psychological, historical, and exposure parameters must be considered in the scientific evaluation of this problem.     

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

Using a between-subject 3 × 3 design of an experimentally manipulated realistic case vignette of Black, White, and Hispanic youth in a survey mailed to 1540 experienced psychologists, psychiatrists, and social workers, the authors examined if clinicians alter their judgments about treatment for antisocially behaving youth based on the symptom’s social context (e.g., life circumstances) and the youth’s race or ethnicity, even among youth who are otherwise identical in terms of behavioral symptoms. Vignettes describe behaviors meeting DSM-IV criteria for conduct disorder, but contain contextual information suggesting either internal dysfunction (ID) or a normal response to a difficult environment [i.e., environmental-reaction (ER)]. Comparison was symptom-only (SO). Judgments of effectiveness of 14 treatments for youth exhibiting antisocial behavior were examined. Frequencies and median scores of perceived effectiveness level (1–9, Likert) were compared in bivariate analyses, stratifying context and youth’s race or ethnicity. The context of the behavior was associated significantly with differences in effectiveness judgments in 13 of 14 treatments. Within ID and ER contexts, clinicians judged three different treatments as effective (median ≥ 7 of 9). In the SO condition, clinicians were less selective, judging six as effective. In the ID context, psychiatric medications, systems oriented family therapy, and residential care were judged more effective for White than for Black or Hispanic youth. Evidence-based practice research may be hampered by inattention to the social context of behavioral symptoms. Context may activate implicit racial assumptions about treatment effectiveness. Implications are for clinical training to improve service delivery, and future clinical research.     

Psychopathy and Functions of Aggression in Emerging Adulthood: Moderation by Anger Rumination and Gender

Psychopathy has been previously identified as a risk factor for aggression (Porter and Woodworth 2006). However, few studies have considered specific relationships with functional subtypes of aggression, or how gender and anger rumination affect these relationships in emerging adulthood. We hypothesized that primary psychopathy would be uniquely related to proactive aggression (PA) and secondary psychopathy to reactive aggression (RA), and that these relationships would be amplified by anger rumination, and potentially influenced further by gender. Undergraduate students (N = 610; 73.3 % female) ages 18–20 completed self-report measures of anger rumination, psychopathy, and aggression, and hypotheses were tested using hierarchical regression. As predicted, anger rumination enhanced the association between secondary psychopathy and RA. It also amplified the relationship between primary psychopathy and PA, but only at very high levels of anger rumination. Gender moderated interactions between primary and secondary psychopathy on aggression. For men, primary psychopathy attenuated the secondary psychopathy – RA relationship, but not for women. These findings fill an important gap in the literature by demonstrating how tendencies to ruminate on anger and psychopathic traits interact to influence functional subtypes of aggression in young men versus women.     

Consumer Trust and Advice Acceptance: The Moderating Roles of Benevolence,Expertise, and Negative Emotions

I explored advice acceptance for high‐stakes decisions (i.e., those with subjectively important and risky outcomes), focusing on the relative influence of two components of consumer trust—benevolence and expertise—as well as perceived emotional decision difficulty. Participants solicited advice from experts when their decisions were low in perceived emotional difficulty but favored the advice of predominantly benevolent providers when making highly emotionally difficult decisions. Although consumers who faced emotionally difficult decisions were willing to trade off expertise for benevolence, they did not perceive this non‐normative trade‐off to influence decision quality. Instead, the results support a “stress buffering” effect whereby consumers were more confident in the accuracy of predominantly benevolent providers’ advice.     

Social capital and identity politics among Asian Buddhists in Toronto

Asian Buddhist identities in Toronto are based on a proliferation of interconnected criteria ranging from shared language, culture, ethnicity, and notions of homeland to distinct doctrinal interpretations and practices. Each identity referent is given a wide variety of meanings and interpretations according to the social context, structures of power and inequality, and relevance of, or ability to, articulate collective self-definition and action. The authors of this article contend that the degree to which Asian Buddhists in Toronto can effectively use the politics of representation depends on the degree of social capital in their communities and/or with individuals associated with, or acting on behalf of, an identifiable group. A specific example of identity politics is examined in the case of the Lao refugees as they faced opposition to their establishing a temple. Local land-use disputes or neighbourhood tensions over places of worship reveal the importance of social capital for effective identity representation to counter negative stereotypes toward religious and racial minorities. The Lao example illustrates how ideal notions of pluralism and multiculturalism advocated by Canadian social policy are not necessarily equated in practice with diversity and acceptance of the other.     

Understanding Gerotranscendence in Older Adults: A New Perspective for Counselors

The author describes gerotranscendence as a process that occurs when older adults shift from a rational focus on the present‐day, material world to a more universal and transcendent perspective. Accompanying this shift is a desire to move toward the end of life with a sense of integrity and acceptance of one's choices. By gaining an understanding of gerotranscendence, counselors can better meet the needs of their aging clients. Using existing gerotranscendence literature as a guideline, suggestions are made for appropriate counseling interventions.