Self creation and the limitless void of dissociation: the 'as if' personality

The concept of the 'as if' personality has been used variously in analytic literature without having formed part of a clinically based theoretical development over time. The author discusses the bases of her notion of the 'as if' personality, as observed across a number of patients and supervised patients in intensive, long term analytic treatment. In this composite clinical picture, a grouping of elements that form a particular kind of defence of the self is identified in certain patients with an exceptional capacity for creative engagement in the world, surpassing expectations given their background. The picture includes the presence of physical breakdown and illness, as psychic suffering arising from early narcissistic wounding and from a physical, emotional and/or sexual abusive familial environment, was held for too long in bodily memory but not in mind. A distinction is made between the 'as if' personality, the persona and the false self. The 'as if' personality concerns the action of defensive dissociation deriving from very early experiences of internalizing the presence of an absent object, creating the sense of an internal void at the core of the self. At the same time, the self is capable of acts of self creation through a succession of identifications and internalizations with other sources of environmental nourishment, which substitute for, and are constructed around, the original sense of internal emptiness. Thus are restored, but only up to a point, the resources of the originally diminished self. Until these resources have been used up, the self is often able to excel in activities to an exceptional degree. The countertransference is shown to be the means of both useful but often perilously obtained clinical experience and information, supporting the work along the hazardous analytic journey.     

Establishing ethics in an organization by using principles

Laws, codes, and rules are essential for any community, public or private, to operate in an orderly and productive fashion. Without laws and codes, anarchy and chaos abound and the purpose and role of the organization is lost. However, danger is significant, and damage serious and far-reaching when individuals or organizations become so focused on rules, laws, and specifications that basic principles are ignored. This paper discusses the purpose of laws, rules, and codes, to help understand basic principles. With such an understanding an increase in the level of ethical and moral behavior can be obtained without imposing detailed rules. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Category-specific effects on the identification of non-manipulable objects

Theories of category-specific effects on visual object identification predict easier identification of non-living than living objects. The Sensory-Functional theory credits greater representational weighting of the visual properties of living objects independent of greater weighting of the functional properties of non-living objects. It predicts a lost or reversed non-living advantage for non-manipulable objects. Normal participants matched pictures of non-manipulable objects with words describing three levels of identity while visual object similarity, and concept familiarity were controlled. Consistent with the Sensory-Functional theory, living objects were matched faster than non-living objects. Concept familiarity facilitated subordinate matches. Visual similarity hampered subordinate matches and facilitated basic matches.     

Ethical Issues in Cancer Genetics: 1) Whose Information Is It?

This article presents and discusses four clinical cases that exemplify the complexity of ethical dilemmas concerning the provider's obligation to disclose or withhold genetic information from patients. Case 1: What is the responsibility of the cancer genetics provider to ensure that a positive test results is shared with distant relatives? Case 2: To ensure that results go to at-risk relatives, do we have the right to ignore the wishes of the designated next-of-kin? Case 3: Do we have the right to reveal a familial BRCA1 mutation to a patient's relative, who is at 50% risk? Case 4: Do we have an obligation to reveal that a patient is not a blood relative and therefore, not at risk to have inherited a familial mutation? These cases form the basis for discussing the provider's dual obligations to keeping patient confidentiality and informing patients and families about risk (i.e. duty to warn). We also provide a summary of consensus points and additional discussion questions for each case.     

A network approach for distinguishing ethical issues in research and development

In this paper we report on our experiences with using network analysis to discern and analyse ethical issues in research into, and the development of, a new wastewater treatment technology. Using network analysis, we preliminarily interpreted some of our observations in a Group Decision Room (GDR) session where we invited important stakeholders to think about the risks of this new technology. We show how a network approach is useful for understanding the observations, and suggests some relevant ethical issues. We argue that a network approach is also useful for ethical analysis of issues in other fields of research and development. The abandoning of the overarching rationality assumption, which is central to network approaches, does not have to lead to ethical relativism.     

A survey of genetic counselors' strategies for addressing ethical and professional challenges in practice

There is limited research about ethical and professional dilemmas that genetic counselors encounter in their practice and their strategies for addressing them. In this study, 454 genetic counselors rated the frequency with which they encounter each of 16 ethical/professional challenges identified and categorized previously (McCarthy Veach P, Bartels DM, LeRoy BS (2001) J Genet Couns 10(2):97–119). Over 40% indicated these issues occurred frequently: patient emotions, diversity, financial constraints, uncertainty, and colleague error. Two hundred and fifty-five respondents provided personal anecdotes describing exceptionally challenging situations and recommended strategies for addressing them. Most of their anecdotes involved informed consent, value conflicts, confidentiality, colleague error, withholding information, and resource allocation. The most frequently recommended strategies were further discussion with patient, consultation with other professionals, and referral to other health sources. Thirty-five respondents were unable to/did not offer strategies. Respondent demographics were not related to frequency of issues, type of anecdote, or recommended strategies. Practice, policy, and research implications are discussed.     

Erikson's General and Adult Developmental Revisions of Freudian Thought: “Outward,Forward, Upward”

In this paper I explore Erik Erikson's revisions of Freudian thought and reasons for his conceptual departure. I show Erikson as the second stage psychoanalytic theorist who shifted thought upward in consciousness, outward to the social world, and forward throughout the complete life span. I explore Erikson's dispute of Freud's reductionism and predeterminism, and illustrate Erikson's movement afield of a model of mental illness, fragmentation, and negation. I explore Erikson's view that the social world is both inside and outside the psyche, rather than solely external to the person as Freud had held. Addressed is Erikson's conversion of Freud's notions of adult morality to a developmental view of the adult as a potentially moral–ethical person, and Erikson's revision of Freud's concepts of the potentially rational adult to a view of the adult with rational and emotional attributes. These words are Erikson's (1975, p. 39) terms for his theoretical focus. Erikson said that he had felt compelled to alter Freudian views, for the second stage psychoanalytic thought in which he participated required a focus on healthy development instead of attention to deviations from health. Such thought also required analysis of the importance of consciousness and of engagement in the social world, as well as a theory of adult development that extends throughout the mature years to chart the person's psychosocial growth and the development of principled behavior. To Erikson, Freud's views were reductionistic due, in part, to their placement within Newtonian and Darwinian thought. Further, Freud's thought was based on the assumption of an invariably moral person, and of the human who would eventually rise above the irrational powers that he found to govern the self. In this paper, I take up these points. I look to Erikson's revisions of Freudian thought, emphasizing the ways in which he made us think differently about psychological life and about adults in their ongoing development. This synthesis adheres to the points Erikson himself made about his departure from Freud, thoughts that appear in Erikson's (1987b) Harvard notes and marginalia, in his audiotapes, and in portions of his published writings.     

Teaching ethical analysis in environmental management decisions: A process-oriented approach

The general public and environmental policy makers often perceive management actions of environmental managers as “science,” when such actions are, in fact, value judgments about when to intervene in natural processes. The choice of action requires ethical as well as scientific analysis because managers must choose a normative outcome to direct their intervention. I examine a management case study involving prescribed burning of sagebrush (Artemisia tridentata) communities in south-central Montana (USA) to illustrate how to teach students to ethically evaluate a management action by precisely identifying: 1) the proposed management action, 2) the deficiency of the system to be remedied by the action, 3) the stakeholders affected by the action, and 4) the category and type of values affirmed in the management action. Through such analysis, students are taught to recognize implicit and explicit value judgments associated with management actions, identify stakeholders to whom managers have legitimate ethical obligations, and practice a general method of ethical analysis applicable to many forms of environmental management. An earlier version of this paper was presented at the Fourteenth Annual Meeting, Association for Practical and Professional Ethics, February 24–27, 2005.     

Common-Sense Virtue Ethics and Moral Luck

Moral luck poses a problem for out conception of responsibility because it highlights a tension between morality and lack of control. Michael Slote’s common-sense virtue ethics claims to avoid this problem. However there are a number of objections to this claim. Firstly, it is not clear that Slote fully appreciates the problem posed by moral luck. Secondly, Slote’s move from the moral to the ethical is problematic. Thirdly it is not clear why we should want to abandon judgements of moral blame in favour of judgements of ethical deplorability. Finally this paper defends an alternative solution to the problem of moral luck, which focuses on judgements of probability, but which has been rejected by Slote.     

A memory span of one? Object identification in 6.5-month-old infants

Infants' abilities to identify objects based on their perceptual features develop gradually during the first year and possibly beyond. Earlier we reported [Káldy, Z., & Leslie, A. M. (2003). Identification of objects in 9-month-old infants: Integrating 'what' and 'where' information. Developmental Science, 6, 360-373] that infants at 9 months of age are able to use shape information to identify two objects and follow their spatiotemporal trajectories behind occlusion. On the other hand, another recent study suggests that infants at 4-5 months of age cannot identify objects by features and bind them to locations [Mareschal, D., & Johnson, M. H. (2003). The "what" and "where" of object representations in infancy. Cognition, 88, 259-276]. In the current study, we investigated the developmental steps between these two benchmark ages by testing 6.5-month-old infants. Experiment 1 and 2 adapted the paradigm used in our previous studies with 9-month-olds that involves two objects hidden sequentially behind separate occluders. This technique allows us to address object identification and to examine whether only one or both object identities are being tracked. Results of experiment 1 showed that 6.5-month-old infants could identify at least one of two objects based on shape and experiment 2 found that this ability holds for only one, the last object hidden. We propose that at this age, infants' working memory capacity is limited to one occluded object if there is a second intervening hiding. If their attention is distracted by an intervening object during the memory maintenance period, the memory of the first object identity appears to be lost. Results of experiment 3 supported this hypothesis with a simpler one-screen setup. Finally, results of experiment 4 show that temporal decay of the memory trace (without an intervening hiding) by itself cannot explain the observed pattern of results. Taken together, our findings suggest that at six months of age infants can store but a single object representation with bound shape information, most likely in the ventral stream. The memory span of one may be due to immaturity of the neural structures underlying working memory such that intervening items overwrite the existing storage.