Yearning for certainty and the critique of medicine as “science”

A debate has simmered concerning the nature of clinical reasoning, especially diagnostic reasoning: Is it a “science” or an “art”? The trend since the seventeenth century has been to regard medical reasoning as scientific reasoning, and the most advanced clinical reasoning is the most scientific. However, in recent years, several scholars have argued that clinical reasoning is clearly not “science” reasoning, but is in fact a species of narratival or hermeneutical reasoning. The study reviews this dispute, and argues that in a theoretical sense, the dispute rests upon a naïve—but very popular—caricature of what constitutes “science reasoning.” But, if the dispute rests upon just such a caricature, why is it so persistent? The study concludes by suggesting that we, as patients and as physicians, have deep psychological tendencies that incline us to adopt the very naïve “science” concept/model of diagnostic reasoning, even if (or when) we understand its inaptness.     

Wisdom in clinical reasoning and medical practice

Exploring informal components of clinical reasoning, we argue that they need to be understood via the analysis of professional wisdom. Wise decisions are needed where action or insight is vital, but neither everyday nor expert knowledge provides solutions. Wisdom combines experiential, intellectual, ethical, emotional and practical capacities; we contend that it is also more strongly social than is usually appreciated. But many accounts of reasoning specifically rule out such features as irrational. Seeking to illuminate how wisdom operates, we therefore build on Aristotle’s work on informal reasoning. His account of rhetorical communication shows how non-formal components can play active parts in reasoning, retaining, or even enhancing its reasonableness. We extend this account, applying it to forms of healthcare-related reasoning which are characterised by the need for wise decision-making. We then go on to explore some of what clinical wise reasoning may mean, concluding with a case taken from psychotherapeutic practice.

Measuring Meaning in Life

The present studies addressed the need for a comprehensive, economical, and psychometrically adequate measure of existential meaning. In Study 1, principal-axis factor analysis of participants’ responses to popular meaning measures identified five latent constructs underlying them, labelled purposeful life, principled life, valued life, exciting life, and accomplished life. These dimensions resonate with the meaning in life concept as understood by Frankl (1963. Man’s search for meaning. (Revised Ed.) London: Hodder & Stoughton) and the panoply of subsequent theoretical definitions (e.g. Battista and Almond. (1973). Psychiatry, 36, 409–427; 2000. Exploring existential meaning: Optimising human development across the life span (pp. 39–55). USA: Sage; 1998. The human quest for meaning: A handbook of psychological research and clinical applications (pp. 11–140). Mahwah: Lawrence Erlbaum). Study 2 used these results as a foundation for developing a psychometrically satisfactory self-report questionnaire of each of these aspects of meaning in life. Confirmatory factor analysis (CFA) validated a five-factor structure, with each factor loading on a common second-order factor. Study 3 provided evidence for this new measure’s convergent validity and economic property. The final Meaningful Life Measure is reported and provides comprehensive but differentiated measurement of the meaning in life construct.     

灾区民众的公正观与幸福感及其与非灾区的比较

作为公德的社会公正与作为私情的个人幸福,是个体作为社会成员的两个方面,二者在逻辑上是统一的,以往的心理学研究也证实了这一点,但在低标准下,二者却可能出现分离。本研究探讨了灾区民众的公正观和幸福感及其与非灾区的对比,以及中国本土文化背景下二者的关系。本研究发现,与非灾区相比,处在灾区的民众持有更高的公正观与更平和的情感状态,男性尤其如此,并且其情感幸福对公正观有微弱的正向预测（主要是积极情感）,但八个月后随着公正观与幸福感的回落,这种关联变得不显著。民众的情感幸福与公正观在常态下表现为分离的关系,但生活满意度这一幸福感的认知因素却与公正观一直有正向的关联。总之,情感幸福、认知幸福与社会认知的矛盾、变换关系,暗示了建立在私情基础之上的、在灾难中不断强化的中国人特定的情感与理性诉求。     

Publication trends in individual DSM personality disorders: 1971–2015

Growth in personality disorder research has been documented by previous authors up to 1995. The aim of the present study was to extend this by examining publications rates for individual DSM personality disorders over the period 1971–2005, and making projections to 2015 based on these data. It was found that personality disorder research has grown in absolute terms, and as a proportion of overall psychopathology research. Research output is dominated by borderline personality disorder, with strong publication rates in other conditions such as antisocial and schizotypal personality disorders. In contrast, several personality disorders such as schizoid and paranoid personality disorder have failed to attract research interest. Based on current projections, there is expected to be no research output in 2015 for schizoid personality disorder. It was found that the rate of publications for personality disorders was not influenced by the publication of the last three revisions of the DSM diagnostic criteria. Several potential explanations such as the difficulty in conducting certain types of personality disorder research, and the validity of the current DSM diagnostic taxonomy are discussed.     

Transformations in dreaming and characters in the psychoanalytic field1,2

Having reviewed certain similarities and differences between the various psychoanalytic models (historical reconstruction/development of the container and of the mind's metabolic and transformational function; the significance to be attributed to dream‐type material; reality gradients of narrations; tolerability of truth/lies as polar opposites; and the form in which characters are understood in a psychoanalytic session), the author uses clinical material to demonstrate his conception of a session as a virtual reality in which the central operation is transformation in dreaming (de‐construction, de‐concretization, and re‐dreaming), accompanied in particular by the development of this attitude in both patient and analyst as an antidote to the operations of transformation in hallucinosis that bear witness to the failure of the functions of meaning generation. The theoretical roots of this model are traced in the concept of the field and its developments as a constantly expanding oneiric holographic field; in the developments of Bion's ideas (waking dream thought and its derivatives, and the patient as signaller of the movements of the field); and in the contributions of narratology (narrative transformations and the transformations of characters and screenplays). Stress is also laid on the transition from a psychoanalysis directed predominantly towards contents to a psychoanalysis that emphasizes the development of the instruments for dreaming, feeling, and thinking. An extensive case history and a session reported in its entirety are presented so as to convey a living impression of the ongoing process, in the consulting room, of the unsaturated co‐construction of an emotional reality in the throes of continuous transformation. The author also describes the technical implications of this model in terms of forms of interpretation, the countertransference, reveries, and, in particular, how the analyst listens to the patient's communications. The paper ends with an exploration of the concepts of grasping (in the sense of clinging to the known) and casting (in relation to what is as yet undefined but seeking representation and transformation) as a further oscillation of the minds of the analyst and the patient in addition to those familiar from classical psychoanalysis.     

BRAND PLACEMENT AND CONSUMER CHOICE: AN IN‐STORE EXPERIMENT

An in‐store experiment was performed to investigate the effects of shelf placement (high, middle, low) on consumers' purchases of potato chips. Placement of potato chips on the middle shelf was associated with the highest percentage of purchases. The results confirm the importance of item placement as a factor in consumers' buying behavior.     

What Revolution Would You Like to See In the Field of Psychotherapy? Introduction

Contributors to a theme issue were invited to address two questions: (a) What revolution would you like to see in the field of psychotherapy? (b) What makes it revolutionary? That is, how and why is it revolutionary? In a spirit of helping contributors do their job, an attempt is made to clarify the meaning of a revolutionary new idea in the field of psychotherapy by identifying components that do not especially belong, and by proposing components that can be thought of as defining the proposed meaning.     

The effects of justice motivation on memory for self- and other-relevant events

We examined whether people might distort and selectively remember the past in ways that enable them to sustain a belief in a just world (BJW; Lerner, M. J. (1980). The belief in a just world: A fundamental delusion. New York: Plenum Press). In Study 1, recall of a lottery prize reflected participants’ justice concerns, such that the average lottery amount recalled was lowest when a “bad” versus “good” person won. In Study 2, an unrelated experience of just world threat (versus affirmation) enhanced biased recall of the lottery prize when the winner was undeserving. In Study 3, participants who experienced a fortuitous bad break selectively remembered more bad deeds from their recent past, whereas participants who experienced a good break selectively remembered more good deeds. Study 4 demonstrates that such selective memory biases specifically serve to portray chance outcomes as more fair. Taken together, these findings offer support for the notion that reconstructing and selectively recalling the past can serve to sustain a BJW.     

When vaccinating against information reduction works and when it does not work

Practice not only affects how information is processed, but also which information is processed. The Information-Reduction Hypothesis (i.e. Haider & Frensch, 1996) holds that — with practice — irrelevant task information (i.e. information that is not logically needed to correctly perform the task) is discarded from processing. Recently, Gaschler and Frensch (2007) have demonstrated that Information Reduction is not affected by the frequency with which individual task configurations are presented: well-practiced and little-practiced irrelevant task configurations are discarded at the same point in time during practice; Information Reduction is thus an item-general phenomenon. These findings suggest that Information Reduction is at least in part a consequence of top-down, voluntary control. In the present research, we ask how tasks can be constructed such that Information Reduction is avoided. Our results show that item-general Information Reduction is observed even when it leads to severe processing costs (i.e. errors). On the whole, the present results are in line with models of skill acquisition incorporating top-down modulation (e.g. Haider & Frensch, 2002) and are incompatible with purely data-driven accounts of skill acquisition (e.g. Logan, 1988; Nosofski & Palmeri, 1997; Palmeri, 1997; Rickard, 2004).