Additional Thoughts on Rethinking Research Ethics

Recently, bioethics has become interested in engaging with narrative, but in this engagement, narrative is usually viewed as a mere helpmate to philosophy. In this precis to his book The Fiction of Bioethics, Tod Chambers argues that narrative theory should not be simply a helpful addition to medical ethics but instead should be thought of as being as vital and important to the discipline as moral theory itself. The reason we need to rethink the relationship of medical ethics to narrative is that ethicists test their ideas by applying them to cases, and cases are a narrative genre. Recognizing the importance that cases have for the way medical ethicists do ethics is essential in order to appreciate the field as a form of applied philosophy. Like other forms of representation, narrative has distinct and defining features, which ethicists, in order to understand the data of their field, must learn to recognize and differentiate. Ethicists need to attend to the way decisions about the discourse of a narrative influences the kind of moral theories judged relevant to it. The author briefly examines six features of narrative discourse that rhetorically condition the way we understand medical ethics cases: filter, reportability, closure, characters, chronotope, and gender.     

'Poor girl': a case of active psychosis

The paper provides a structural account of a clinical case of psychosis based on a two-year analysis conducted from a Lacanian perspective. It illustrates the Lacanian theoretical and clinical approach to psychosis through discussing the different phases of the analytic work with the particular analysand from her gradual stabilization to her breakdown and hospitalization. Following through the development of the analysis in a chronological order enables a presentation of the different modalities of psychotic transference at different points in the work as well as a discussion of the mechanisms responsible for stabilization and, conversely, psychotic breakdown. The paper discusses the use of language in psychosis as well as the strategies of binding jouissance that the analysand developed as a means of preventing psychotic crises and maintaining a functional relation to the world. Finally,issues are raised about the aim and direction of psychoanalytic treatment of psychosis.     

Applying Cluster Analysis to Define a Typology of Chronic Fatigue Syndrome in a Medically-Evaluated,Random Community Sample

This study involved a randomly selected, medically-evaluated, community-based sample of 166 individuals with chronic fatigue. Participants diagnosed with chronic fatigue syndrome and medically-explained chronic fatigue reported significantly more severe fatigue following exertion than the idiopathic chronic fatigue group, and participants with medically-explained chronic fatigue also reported significantly more severe fatigue following exertion than the psychiatrically-explained chronic fatigue group. A cluster analysis was performed to define a typology of chronic fatigue symptomatology for participants diagnosed with chronic fatigue syndrome. Three clusters emerged. Cluster 1 contained only one participant with chronic fatigue syndrome and was characterized by relatively low post-exertional fatigue. Cluster 2 contained a small proportion of individuals with chronic fatigue syndrome and was characterized by most severe post-exertional fatigue and most improvement in fatigue following rest. Cluster 3 contained the highest proportion of individuals with chronic fatigue syndrome, and was characterized by high post-exertional fatigue and fatigue not alleviated by rest.     

When hoarding is a symptom of OCD: A case series and implications for DSM-V

Hoarding, the excessive collection and failure to discard objects of apparently little value, can represent a serious psychiatric problem and pose a threat to public health. Hoarding has traditionally been considered a symptom (or symptom dimension) of Obsessive-Compulsive Disorder (OCD), but its nosological status has recently been debated. Mounting evidence suggests that, once other primary causes are ruled out, hoarding may be a discrete diagnostic entity, recently named Hoarding Disorder. However, hoarding can sometimes be a genuine OCD symptom. This can be confusing and clinicians may sometimes struggle making the differential diagnosis. To illustrate this, we describe 10 OCD patients with severe hoarding behavior that is better conceptualized as a symptom of OCD. We focus on the motivations for hoarding and the overlapping of hoarding with other obsessive-compulsive symptom dimensions. We estimate that this clinical presentation is relatively rare and accounts for a minority of severe hoarding cases. We discuss the unique characteristics of hoarding as a symptom of OCD and the implications for DSM-V.     

“And yet it moves” or why grammar overrides frequency: a reply to Kempen and Harbusch

We show that Kempen and Harbusch's (Cognition (2003) this issue) arguments against our claims cannot be upheld. On the one hand, their alternative account of our data that is based on the availability of constructions with object-experiencer verbs is not compatible with the literature on the processing of these types of sentences in German. Moreover, their allegation that we failed to conduct an accurate corpus count is simply a misreading of our paper. Insofar, the commentary in no way casts doubt on our claim that grammatical regularities override frequency during online comprehension.     

Multidisciplinary creativity: the case of Herbert A. Simon

In the twentieth century, no person epitomized more dramatically the “Renaissance mind” than Herbert A. Simon (1916–2001). In aworking life spanning over 60 years, Simon made seminal contributions to administrative theory, axiomatic foundations of physics, economics, sociology, econometrics, cognitive psychology, logic of scientific discovery, and artificial intelligence. Simon's life of the mind, thus, affords nothing less than a “laboratory” in which to observe and examine at close quarters the phenomenon of multidisciplinary creativity. In this paper, we attempt to shed some light on the nature of Simon's creativity and the nature of his particular Renaissance mind. In particular, we have attempted here to articulate the cognitive style underlying Simon's multidisciplinary creativity.     

Chickens or eggs? A follow‐up case study exploring links between physical and psychological impact of Tourette's syndrome and sexual abuse

This follow‐up case study highlights the complex relationship when working at the interface between physical and psychological symptoms. The paper draws upon conversations between an ex‐client and myself, held seven years after the end of our six year therapeutic relationship. Conversational interviews, based upon social constructionist beliefs, led to an unexpected exploration of the client's subsequent diagnosis of Tourette's syndrome (given several years after the end of therapy) and evolved into a struggle to reach a shared understanding of how she now makes connection between her problem with eating in public, her neck and facial tics, and childhood sexual abuse. Our research relationship provided both of us with a rare opportunity to reflect upon how she had made meaning of her counselling and its outcomes. The paper draws attention to the impact of counselling and therapy discourses concerning sexual abuse on the work we did at the time and asks how that work might be different today. It also helps us understand the layers of complexity and ambiguity contained within the client's stories. This multi‐layered case study represents the overlap and ‘messiness’ that mirrors the ‘lived experience’ of the persons involved, and provides an example of how co‐constructed research conversations can evoke stories that create meaning as they are told.     

A critical boundary to the left-hemisphere advantage in visual-word processing

Two experiments explored boundary conditions for the ubiquitous left-hemisphere advantage in visual-word recognition. Subjects perceptually identified words presented directly to the left or right hemisphere. Strong left-hemisphere advantages were observed for UPPERCASE and lowercase words. However, only a weak effect was observed for AlTeRnAtInG-cAsE words, and a numerical reversal of the typical left-hemisphere advantage was observed for words in a visual prototype font (a very unfamiliar word format). Results support the theory that dissociable abstract and specific neural subsystems underlie visual-form recognition and fail to support the theory that a visual lexicon operates in the left hemisphere.     

Operational efficiency and the growth of short-term memory span

Four studies are reported which link developmental increases in memory span with developmental increases in operational speed or efficiency. In the first, a linear relationship is demonstrated between increases in word span and increases in speed of word repetition. In the second, adults and 6-year-olds are equated on speed of word repetition, by manipulating word familiarity. It is shown that their word spans are no longer different under these conditions. Similar findings are then reported for a test of M space called “Counting Span.” First, a linear relationship is demonstrated between increases in Counting Span and increases in speed of counting. Next, adults and 6-year-olds are equated on speed of counting, by forcing adults to count in an unfamiliar language. It is shown that their counting spans are no longer different under these conditions. The conclusion is that developmental increases in memory span do not result from increases in total processing space. Rather, with development, basic operations become faster and more efficient. This means that they require less processing space, and that more space becomes available for storage as a result.