A study of the foundations of ethical decision making of clinical medical ethicists

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values.     

Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

The Humanizing Brain: An Introduction

The rediscovery of the sacred needs to take into account the neural underpinnings of faith and meaning and also draw on the insights of the emerging discipline of complexity studies, which explore a tendency toward adaptive self-organization that seemingly is inherent in the universe. Both neuroscience and complexity studies contribute to our understanding of the brain's activity as it transforms raw stimuli into recognizable patterns, and thus "humanizes" all our perceptions and understandings. The brain is our physical anchor in the natural environment— and its human capacities orbit us into the emerging world of culture (including religion), which provides a template for the brain's function of making sense of an ambiguous reality. The humanizing brain holds together scientific causality and religious meaning, working both bottom-up (linking the physical and the experiential) and top-down (beginning with the whole of things, or God). These processes we know as "mind" (experienced as intentionality, subjective consciousness, empathy, imagination, memory, adaptability). We maintain that such processes are not only subjective but built into "the way things really are." Thus, they carry the most privileged information about the nature of reality to which we human beings have access. For not only are we humans observers and logicians, but we are embedded in the larger reality; and as we strive to make sense of it all, we become both Homo sapiens and Homo religiosus .     

The relevance of attachment theory to a contemporary Jungian view of the internal world: internal working models, implicit memory and internal objects

In this paper I examine the various meanings of the term 'internal object' and the differences between various theoretical models for the formation of internal objects. I suggest that the idea in attachment theory of 'internal working models' emphasizes the internal world as one consisting of unconscious internalized patterns of emotional relationships. The term 'internal object' lacks this clarity and the different meanings it carries within differing theoretical frameworks are a source of confusion. I describe the role implicit memory plays in the formation of 'internal working model's and suggest that these offer us an alternative explanation for unconscious fantasy and for object relationships to that of instinctual drives. This model is then brought to bear on contemporary Jungian concepts of the internal world, with a suggestion that, seen in this light, Jung's formulation of the concept of the complex has many features in common with the 'internal working model' of attachment theory.     

Betrayal And Paranoia: The Psychotherapist's Function as an Intermediary

We present an approach to the problem of structuring a therapeutic alliance with patients presenting paranoid symptoms, using both psychoanalytical and cognitive techniques. Initially, we focused on one of the main aspects of the paranoid worldview: the fear of being betrayed and the tendency to betray. This is a defense maneuver, through which patients deny their passivity, and the impotence in the relationship with their own internal needs and with the significant people in the external world, including the therapist. In our experience to build up a working relationship, both a psychoanalytical interpretation of unconscious conflicts and the cognitive analysis of dysfunctional beliefs are needed. Often, in more serious cases, the role of nonqualified object must be accepted at the beginning, due to the patient's need to be in control of the situation. Only then can a therapeutic phase begin, in most cases, through an integrated approach that includes pharmacological, psychodynamic, and cognitive modalities.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

Milestones in the development of infant numeracy

This article deals with the development of numeracy among young children of the four to seven year age group. The research investigation described had two aims: to see how early numeracy develops in children of different ages; and to see whether there are fixed points which might serve as milestones in the development of infant numeracy. The results of this investigation involving 96 children indicate a strong development of numeracy skills during this period. With reference to the literature, it is also shown that certain items of a test previously developed for this purpose may be taken as core items that do indeed represent milestones in the development of infant numeracy.     

论学习的基本类型与教学设计──学习双机制理论的教学模式

本文阐述了学习的双机制理论关于学习的基本机制的观点,根据该学习理论对知识分类进行了新的划分,并分析了不同类型知识学习的信息加工过程与特点,然后提出了课堂学习与教学的“七阶段模型”及相应的教学设计。     

Unification of models for choice between delayed reinforcers.

Two models for choice between delayed reinforcers, Fantino's delay-reduction theory and Killeen's incentive theory, are reviewed. Incentive theory is amended to incorporate the effects of arousal on alternate types of behavior that might block the reinforcement of the target behavior. This amended version is shown to differ from the delay-reduction theory in a term that is an exponential in incentive theory and a difference in delay-reduction theory. A power series approximation to the exponential generates a model that is formally identical with delay-reduction theory. Correlations between delay-reduction theory and the amended incentive theory show excellent congruence over a range of experimental conditions. Although the assumptions that gave rise to delay-reduction theory and incentive theory remain different and testable, the models deriving from the theories are unlikely to be discriminable by parametric experimental tests. This congruence of the models is recognized by naming the common model the delayed reinforcement model, which is then compared with other models of choice such as Killeen and Fetterman's (1988) behavioral theory of timing, Mazur's (1984) equivalence rule, and Vaughan's (1985) melioration theory.     

Analyzing sequential categorical data: Individual variation in markov chains

Markov chains are probabilistic models for sequences of categorical events, with applications throughout scientific psychology. This paper provides a method for anlayzing data consisting of event sequences and covariate observations. It is assumed that each sequence is a Markov process characterized by a distinct transition probability matrix. The objective is to use the covariate data to explain differences between individuals in the transition probability matrices characterizing their sequential data. The elements of the transition probability matrices are written as functions of a vector of latent variables, with variation in the latent variables explained through a multivariate regression on the covariates. The regression is estimated using the EM algorithm, and requires the numerical calculation of a multivariate integral. An example using simulated cognitive developmental data is presented, which shows that the estimation of individual variation in the parameters of a probability model may have substantial theoretical importance, even when individual differences are not the focus of the investigator's concerns.Research contributing to this article was supported by B.R.S. Subgrant 5-35345 from the University of Virginia. I thank the DADA Group, Bill Fabricius, Don Hartmann, William Griffin, Jack McArdle, Ivo Molenaar, Ronald Schoenberg, Simon Tavaré, and several anonymous reviewers for their discussion of these points.