Illness representations in patients with multimorbid long-term conditions: Qualitative study

Most research on illness representations explores how patients view single conditions, but many patients report more than one long-term condition (known as multimorbidity). It is not known how multimorbidity impacts on patient illness representations. This exploratory qualitative study examined patients’ representations of multimorbid long-term conditions and sought to assess how models of illness representation might need modification in the presence of multimorbidity. We explored two major issues: (1) the impact of multimorbidity on patient representations of their individual conditions and (2) the representation of multimorbidity itself. Twenty eight adults with at least two long-term conditions (mean of 4) were interviewed. The presence of multimorbidity impacted on patient illness representations in relation to the dimensions of identity, perceived cause, coherence and consequences. Representations of multimorbidity itself concerned representations of the burden of medication and perceived priorities among conditions and synergies and antagonisms between conditions and their management. The results have implications for the measurement of multimorbidity (through scales such as the Illness Perception Questionnaire) and the use of illness representations in the design and delivery of interventions to improve health behaviour and outcomes of patients with multiple long-term conditions.     

An Eye‐Tracking Study of Exploitations of Spatial Constraints in Diagrammatic Reasoning

Semantic studies on diagrammatic notations (Barwise & Etchemendy, 1990 ; Shimojima, 1995 ; Stenning & Lemon, 2001 ) have revealed that the “non‐deductive,” “emergent,” or “perceptual” effects of diagrams (Chandrasekaran, Kurup, Banerjee, Josephson, & Winkler, 2004 ; Kulpa, 2003 ; Larkin & Simon, 1987 ; Lindsay, 1988 ) are all rooted in the exploitation of spatial constraints on graphical structures. Thus, theoretically, this process is a key factor in inference with diagrams, explaining the frequently observed reduction of inferential load. The purpose of this study was to examine the empirical basis for this theoretical suggestion, focusing on the reality of the constraint‐exploitation strategy in actual practices of diagrammatic reasoning. Eye movements were recorded while participants used simple position diagrams to solve three‐ or four‐term transitive inference problems. Our experiments revealed that the participants could exploit spatial constraints on graphical structures even when (a) they were not in the position of actually manipulating diagrams, (b) the semantic rule for the provided diagrams did not match their preferences, and (c) the constraint‐exploitation strategy invited a partly adverse effect. These findings indicate that the hypothesized process is in fact robust, with the potential to broadly account for the inferential advantage of diagrams.     

临终关怀与内隐自尊的修复:现象、机制及意义

内隐自尊是自发的、自动的、无意识地自我评价系统.临终关怀系统与临终个体的心理健康、生活幸福感密切相关,人文社会科学已渗透临终关怀研究领域.通过回顾临终关怀与内隐自尊系统的社会表征及研究的现状,并从中揭示出临终关怀与内隐自尊的修复可能的机制及意义.     

Peasants' Social Representation of Politicians in a Clientelist Rural Context

In Latin America, political clientelism is one of the main obstacles to the process of sustaining truly democratic practices. Thus, this article proposes to study peasants from the Province of Formosa, Argentina's social representation of politicians, in hopes of shedding light on the relationship between said representations and clientelist practices, with the objective of making a contribution to the development of alternative means towards democratization in the area. The results of this case study show that, at the center of the peasants' social representation of politicians, there lies a tendency to place their expectations for receiving assistance within a context of a personalized and hierarchical relationship framework. Nevertheless, the majority of these farmers consider the assistance received to be insufficient and inadequate, stating that politicians actually look to satisfy their own interests and not those of the general public. In conclusion, the peasants' social representation of politicians favors clientelist practices, even though these small farmers do not identify, via their culture or their expectations, with these practices. Copyright © 2012 John Wiley & Sons, Ltd.     

Attending to what matters: Flexibility in adults’ and infants’ action perception

Action perception is selective in that observers attend to and encode certain dimensions of action over others. But how flexible is action perception in its selection of perceptual information? One possibility is that observers consistently attend to particular dimensions of action over others across different contexts. Another possibility, tested here, is that observers flexibly vary their attention to different dimensions of action based on the context in which action occurs. We investigated 9.5-month-old infants’ and adults’ ability to attend to drop height under varying contexts—aiming to drop an object into a narrow container versus a wide container. We predicted differential attention to increases in aiming height for the narrow container versus the wide container because an increase in aiming height has a differential effect on success (i.e., getting the object into the container) depending on the width of the container. Both adults and infants showed an asymmetry in their attention to aiming height as a function of context; in the wide container condition increases and decreases in aiming height were equally detectable, whereas in the narrow container condition observers more readily discriminated increases over decreases in aiming height. These results indicate that action perception is both selective and flexible according to context, aiding in action prediction and infants’ social–cognitive development more broadly.     

'Gonnae no' dae that!'1 the internal and external worlds of the delinquent adolescent

In understanding delinquency in adolescence the key theoretical papers on the role of oedipal resolution and superego development remain essential and are summarized. To this we need to add our knowledge of trauma and of developmental deficit if we are to offer appropriate strategies for young delinquents and to be able to select those for whom therapy, intervention with the network or containment are appropriate. The defence of activity, commonplace in adolescence, becomes too easily enacted in the network around the delinquent and in the public domain, and thoughts are given on this process and on the roles open to the psychotherapist.

Afin de mieux cerner la délinquance chez l'adolescent, l'auteur passe en revue certains textes théoriques fondamentaux et toujours d'actualité sur l'importance de la dissolution du complexe d'?dipe et de la mise en place du Surmoi. À ces thèmes il convient d'ajouter ce que nous connaissons de l'impact des traumatismes et des défaillances développementales si nous voulons offrir au jeune délinquant des stratégies adéquates et identifier ceux pour qui une modalité particulière d'intervention - thérapie, prise en charge en réseau, structure contenante - semble la mieux indiquée. La défense par mise en acte, fréquente À l'adolescence, trouve trop facilement un écho dans le réseau d'intervenants autour de l'adolescent et dans le champ social ; l'auteur développe ses réflexions À ce sujet et explore les rôles que le thérapeute peut être amené À jouer.     

So many options,so little control: Abstract representations can reduce selection demands to increase children’s self-directed flexibility

Children often struggle to behave flexibly when they must use self-directed goals (e.g., doing homework without prompting) rather than externally driven goals (e.g., cleaning up when told). Such struggles may reflect the demands of selecting among many potential options, as required for self-directed control. The current study tested whether (a) 6-year-old children show difficulty in selecting among competing semantic representations, (b) providing category labels designed to reduce selection demands improves performance, and (c) such benefits transfer to self-directed flexibility. Selection was measured using the blocked cyclic naming task for the first time with children. Pictures were named repeatedly in either homogeneous blocks from the same category (e.g., all animals), which create high selection demands due to spreading semantic activation and engage effortful cognitive control, or mixed blocks with each picture from a different category. Children showed robust difficulty in selecting among options, as indexed by response time (RT) differences between homogeneous and mixed blocks. Providing subcategory labels designed to reduce selection demands by distinguishing among same-category items (e.g., “A cow is a farm animal. A cat is a pet.”) improved selection. Providing superordinate categories (e.g., “A cow is an animal. A cat is an animal.”) also improved selection, but these benefits were less robust, and subcategory labels led to greater benefits than superordinate category labels on a subsequent verbal fluency task. These results support a role for subcategory representations in reducing selection demands to aid self-directed flexibility while suggesting that some children may use superordinate category labels to activate subcategory representations on their own.     

Book Reviews

Abstract

There are many brief, demanding, aborted cases that no one ever writes about. The typical psychoanalyst or psychoanalytic psychotherapist, however, has many outpatient cases that are shortlived, intense encounters with very disturbed patients. Rather than ignore these encounters as non-analytic or non-instructive, I think these cases add to our knowledge about the mind and its functions. In addition, it is unrealistic to think we can always help a very anxious and disturbed person to enter the treatment process with immediate success. It is more instructive to apply the analytic method and offer the patient what we can and have both analyst and patient learn as much as they can in the time they are able to stay together. Using case material, I show the Kleinian approach to working analytically with these difficult patients. Whether focusing on transference or extra-transference material, the analyst interprets the patient's internal phantasies and anxieties regarding the self and the self's important objects. This analytic stance tends to relieve the immediate anxiety and set the stage for potential self-reflection and the start of basic working-through processes.