Between Wonder and Doubt: Psychoanalysis in the Goal-Free Zone

This paper examines the experiential dimensions of wonder and doubt as one way to articulate the creative and growth-promoting tensions between the medical/scientific model and the spiritual/mystical model. Both forms of experience, it is argued, function as necessary elements in a psychotherapy that integrates psychoanalysis and spiritual praxes. Fundamental differences between the medical/scientific model and the spiritual/mystical models are examined. The notion of the gap serves to illustrate these diametrically opposed, albeit compatible and necessary, points of view. The multifaceted layers of movement between Buddhism and psychoanalysis typify interacting dynamics between the two disciplines and provide a focal point for discussion. The paper then explores parallels between the Zen Buddhist notion of Satori as explicated in the writings of D. T. Suzuki and Wilfred Bion's notion of O. Theoretical aspects of the discussion provide a backdrop for exploring clinical experience regarding the relationship between acceptance and change, the clinical relevance of the Buddhist notions of gaining idea and basic goodness. The author also explores relationships between presence as actuality and ideal; knowing and not knowing; wonder and doubt. Clinical material supports the theoretical aspects of the discussion.     

Treating a Chronically Depressed Adolescent Female Using the Cognitive Behavioral Analysis System of Psychotherapy: A Case Study

A case is presented of an adolescent female with double depression who was treated using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is designed to teach a social problem-solving procedure called Situational Analysis (SA). Generalized treatment effects were measured through monitoring of diagnostic status, two administrations of the Minnesota Multiphasic Personality Inventory-Adolescent, weekly administrations of the Child Depression Inventory, and acquisition performance ratings on the SA task. The results showed that CBASP appeared to be an effective treatment. The double depressive disorder remitted, and the patient learned to identify behavioral consequences as well as target and attain her interpersonal goals. CBASP can be effective for adolescents, although modifications of the adult form of the therapy may be necessary.     

From agape to organs: religious difference between Japan and America in judging the ethics of transplant

This essay argues that Japan's resistance to the practice of transplanting organs from persons deemed "brain dead" may not be the result, as some claim, of that society's religions being not yet sufficiently expressive of love and altruism. The violence to the body necessary for the excision of transplantable organs seems to have been made acceptable to American Christians at a unique historical "window of opportunity" for acceptance of that new form of medical technology. Traditional reserve about corpse mutilation had weakened and, especially as presented by the theologian Joseph Fletcher, organ donation was touted as both expressive of agape and a way of "updating" Christianity via the ethics of Utilitarianism. Many Japanese, largely Buddhist and Confucian in their orientation, view these changed valorizations as neither necessary nor patently more ethical than those of their own traditions.     

The Late Life Reconstruction of Selfhood Analyzed in Peter Hall's Film She's Been Away

The film She's Been Away tells the story of an old woman who had been locked in a mental asylum while a teenager, for willfully violating repressive sexual codes. Sixty years later her ward is closed and she moves in with her nephew and his wife. Faced with what appears to be a hopeless situation, she manages to forge a sense of a meaningful closure to a misspent life. Through narrative, story structure, and characterization the film throws into focus coping mechanisms and ego strategies deployed by a triple disadvantaged person (woman, old, and mad) in her ascent to a reconstructed selfhood. As the protagonist ties both ends of her life, and faces the abyss in between she makes genuine adaptive use of so-called regressive, late-life development assets (available to a lesser degree to elderly people in normal life circumstances), primarily the abolition of linear time. Through this abolition she makes reminiscing an actual reality while still maintaining a functional separation between the real and the remembered. Her portrayal is a valuable document for gerontologists as it explores, through artistic imagination and intuition, the workings of an aging mind in search for a meaningful sense of closure.     

Psychopathy in Children and Adolescents: The Need for a Developmental Perspective

The current paper introduces the special issue on research attempting to extend the construct of psychopathy to child and adolescent samples. Past special sections and reviews have typically focused on the implications of this research for forensic research and practice. The current special issue focuses on topics relevant for integrating this research within the broader literature on childhood psychopathology. Papers included in this special issue focus on the structure of psychopathic traits in youth, the relation of these traits to other important psychopathological and personality constructs in children and adolescents, and the utility of these traits for identifying a distinct subgroup of antisocial youth who differ on important cognitive processes and on the severity and stability of their problem behavior. These empirical works are followed by commentary provided by two prominent scholars who outline the potential importance of the construct for advancing our understanding of childhood psychopathology. In addition, these scholars provide a discussion of important directions for future research.     

Doctor's Expertise and Managing Discrepant Information from Other Sources in Genetic Counseling: A Conversation Analytic Perspective

The study examines a recurrent interactional pattern in genetic counseling. It describes clinical geneticists' responses in situations in which clients have presented information from other sources that is potentially discrepant with information given by the doctor. The data consists of 12 video-recorded sessions of genetic counseling in Finland, and the method is conversation analysis. There are two primary ways the doctors respond: either they accept the client's information as such, but show that it is not discrepant with the doctor's information, or they reject the client's information. In the latter case they mitigate the ‘wrongness’ of the client's information. The clinical geneticists seem to be working with a dilemma: they need to find a balance between ensuring correct understanding of the information and showing respect for the expertise of others. A particularly complex case is also analyzed and reflected on.     

Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program

Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing the power of genetics discourse has implications for our collective understanding of the operations of the care of the self and the uses of genetic information that we propose.     

Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

Government Subsidized Academic Research: Economic and Ethical Conflicts

Justification for public funding of academic research is based on the linear model of technological advance first proposed by Francis Bacon. The model hypothesizes that government subsidized science generates new technology which creates new wealth. Mainstream economics supports Bacons model by arguing that academic research is a public good. The Bayh–Dole Act allows universities to privatize federally funded research and development (R&D) which is in direct conflict with the public good argument. Diminishing returns to university R&D, challenges to Bacons linear model and the labor exploitation of young scientists by research universities suggest that policy makers may want to reconsider the system for allocating federal R&D to universities and colleges.     

Towards a research programme for ethics and technology

In this editorial contribution, two issues relevant to the question, what should be at the top of the research agenda for ethics and technology, are identified and discussed. Firstly: can, and do, engineers make a difference to the degree to which technology leads to morally desirable outcomes? What role does professional autonomy play here, and what are its limits? And secondly, what should be the scope of engineers' responsibility; that is to say, on which issues are they, as engineers, morally obliged to reflect? The research agendas proposed by the authors contributing to this special section, implicitly, give different answers to these questions. We suggest that an explicit discussion of these issues would greatly help in constructing a common research agenda.