Clinical interpretation: The hermeneutics of medicine

I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a novel, the judge asked to apply a law, must arrive at a coherent reading of their respective texts. Similarly, the physician interprets the text of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the experiential text of illness as lived out by the patient; the narrative text constituted during history-taking; the physical text of the patient's body as objectively examined; the instrumental text constructed by diagnostic technologies. I further suggest that certain flaws in modern medicine arise from its refusal of a hermeneutic self-understanding. In seeking to escape all interpretive subjectivity, medicine has threatened to expunge its primary subject — the living, experiencing patient.     

The crane's foot: The rise of the pedigree in human genetics

The standard pedigree used by geneticists is intimately connected to the history of genetics. Pedigrees drawn today are based on standards established in the early decades of the twentieth century. Those standards were established by geneticists who pursued an active interest in eugenics. The slightly different standards followed in America vs. England to some extent followed the stronger support of Mendelism by the Americans, as well as the individual preferences of the leading human geneticists in those countries.     

The myth of science education

It is argued that the manner in which we teach science in the high schools represents an outdated positivistic conception of science. The standard presentation of a year of each of chemistry, biology and physics should be replaced by an integrated science plus history, philosophy, and sociology of science which would take a total of three years to complete. A proper appreciation for the true nature of science is essential to the continued health of the scientific enterprise.     

EFFECTS OF REINFORCEMENT HISTORY AND INSTRUCTIONS ON THE PERSISTENCE OF STUDENT ENGAGEMENT

We examined the effects of three reinforcement histories on the persistence of task engagement by 2 fourth-grade students using a partially counterbalanced ABCDBCD design. In each condition, an experimenter made four student contacts during the first 2 min of each session (reinforcement baseline), followed by an 8-min extinction period. The reinforcement history that contained an instructional control component produced the greatest persistence in student engagement. The applied relevance of instructional control is discussed.     

Response to John Beebe

This paper briefly describes the history of the professional interaction between psychoanalysts and analytical psychologists in the United States. There has been little public contact between the two groups since the personal feud between Freud and Jung has beer carried forth to the present generation of analysts. The relationship between Otto Rank and Freud and his circle demonstrated many of the same dynamics that were activated between Freud and Jung, who had broken off their relationship ten years earlier; this paper highlights the similarities between Jung's, then Rank's, exile from the psychoanalytic group, Jung's interest in spiritual matters, including his interest in the nature of religious experience, and his questionable dealing with the Nazis during the 1930s have been the stated reason for the taboo set against Jung's writings. Presently there seems to be a growing realization that there are large areas of mutual interest, and both the similarities and differences between the schools need further exploration.     

Effects of a variable-ratio conditioning history on sensitivity to fixed-interval contingencies in rats.

We investigated the possibility that human-like fixed-interval performances would appear in rats given a variable-ratio history (Wanchisen, Tatham, & Mooney, 1989). Nine rats were trained under single or compound variable-ratio schedules and then under a fixed-interval 30-s schedule. The histories produced high fixed-interval rates that declined slowly over 90 sessions; differences as a function of the particular history were absent. Nine control animals given only fixed-interval training responded at lower levels initially, but rates increased with training. Despite differences in absolute rates, rates within the intervals and postreinforcement pauses indicated equivalent development of the accelerated response patterns suggestive of sensitivity to fixed-interval contingencies. The finding that the histories elevated rates without retarding development of differentiated patterns suggests that the effective response unit was a burst of several lever presses and that the fixed-interval contingencies acted on these units in the same way as for single responses. Regardless of history, the rats did not manifest the persistent, undifferentiated responding reported for humans under comparable schedules. We concluded that the shortcomings of animal models of human fixed-interval performances cannot be easily remedied by including a variable-ratio conditioning history within the model.     

Trustworthy research—An editorial introduction

She is guest editor for this special issue ofScience and Engineering Ethics on “Trustworthy Research”.     

Human performance on conjunctive fixed-interval fixed-ratio schedules

Eighteen young adults performed a lever-pulling task for money. Subjects were initially exposed to a fixed-interval 80-second schedule and subsequently to one of three conjunctive schedules in which the added fixed-ratio requirement was set at either 10, 80, or 120 responses. Three fixed-interval response patterns emerged: high constant rate, intermediate rate, or low rate, with most subjects displaying the last. Conjunctive performance was related to the subjects' prior fixed-interval patterns and the conjunctive ratio requirements. Low-rate subjects tended to optimize reinforcement (maximum reinforcers for minimum responses) on conjunctive schedules. Response rate was directly related to ratio requirements. Subjects' performance closely corresponded to their verbal statements of the contingencies.     

Positive reinforcement and the elimination of reinforced responses

Key pecking was maintained on a fixed-interval schedule while either a differential-reinforcement-of-not-responding or a fixed-time schedule was imposed simultaneously. The lower the time parameter of the not-responding schedule, the lower was the response rate. Similar effects occurred with the fixed-time schedule, if the pigeons had experience with reinforcement for not responding. Otherwise the effects were less orderly, to the extent that rate could reach maximum with the lowest-valued fixed-time schedule. The not-responding and the response-independent schedules had similar effects on rate in experienced pigeons only when the time parameter or nominal frequency of food presentation was considered. When considered in terms of obtained frequency of food presentation, reinforcement of not responding produced larger decrements in rate than did the fixed-time schedule.     

Doing history that matters: Going public and activating voices as a form of historical activism

For many of us academics, doing community‐engaged research means coming to terms with the significant gaps in experience, privilege, and power, and overall access to knowledge. We are trained to learn through texts, not through direct experience. In some ways, we are even conditioned to tune out experience, or anecdote, to dilute personal subjectivities in favor of a critical analysis informed by a combination of methods and sources, and a reliance on text‐based forms of evidence. Whereas for most community members, evidence is experiential. This dynamic also underscores the tremendous power and responsibility we have as historians to shape identities and legacies through the stories we tell. In the end, I believe the risks are worth the rewards.