Medical Decision-Making: An Argument for Narrative and Metaphor

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual's prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts'the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed.     

Richard Zaner’s “Troubled” Voice In <Emphasis Type="Italic">Troubled Voices</Emphasis>: Poseur,Posing, <Emphasis Type="Italic">Possibilizing</Emphasis>?

This essay considers Richard Zaner’s storytelling in Troubled Voices as a form of possibilizing which uses the stories to exemplify important moral themes such as contingency and freedom. Distinguishing between activities of moral discovery through the telling of a story and “posing” in the sense of writing to tell the “moral” of the story, I suggest that something crucial goes on for Zaner in his own tellings. Several of the more insistent implications Zaner reveals about the moral relationships encountered in the activity of clinical ethics consultation are examined in that light, especially regarding this question: is it more beneficial, or harmful, to articulate elements of core meanings and values that are entailed in individual viewpoints, which, prior to an ethics consultant’s participation, may have remained unspoken and possibly unacknowledged?     

On the development of Husserl’s transcendental phenomenology of imagination and its use for interdisciplinary research

In this paper I trace Husserl’s transformation of his notion of phantasy from its strong leanings towards empiricism into a transcendental phenomenology of imagination. Rejecting the view that this account is only more incompatible with contemporary neuroscientific research, I instead claim that the transcendental suspension of naturalistic (or scientific) pretensions precisely enables cooperation between the two distinct realms of phenomenology and science. In particular, a transcendental account of phantasy can disclose the specific accomplishments of imagination without prematurely deciding upon a particular scientific paradigm for its experimental investigation; a decision that is best left to the sciences themselves.You will find a more extensive version of the first sections of this paper in Rudolf Bernet, Donn Welton, Gina Zavota (eds), in press. Husserl: Critical Assessments (5 vol.). London: Routledge.     

6～14岁儿童对想象物的文字与图画描述

本研究采用开放式问卷法,通过调查810名6-14岁儿童头脑中想象物的文字与图画描述,考察了儿童想象发展的特点。结果发现：(1)儿童对想象物的文字与图画描述可以分划分为3种水平：表象的记忆水平、表象的再造水平和表象创造水平。其中,对想象物的文字描述水平,年龄发展趋势明显,从小学一至二年级之间和四到五年级之间的发展变化最大;而对想象物的图画描述水平,年龄发展趋势不明显。(2)根据儿童对想象物的文字描述和图画描述的发展的匹配程度,可以把儿童的想象发展分为3种类型：文字与图形符号均衡发展型、文字符号型和图形符号型。     

概化理论中的模型选择、数据解释和指标比较——评刘远我等的两篇论文

对刘远我等在1998年《心理学报》和1999年《心理科学》上发表的两篇慨化理论(GT)的应用研究论文．提出了对GT的一些主要问题的不同理解。这些问题包括模型选择、方差分量解释、一致性指标比较等。     

中国老年人身体自我问卷编制及特点初探

该研究以293名年龄在60-97岁老人为研究对象,通过开放式问卷和探索性因素分析得到老年人的身体自我量表,包含六个因素:运动特征、相貌特征、功能特征、身材特征,性特征,行为特征。检验了量表内部一致性系数和严格平行模型的信度系数及两个效标,发现该量表具有较好的信度和效度。对老年人身体自我特征分析表明,研究中,老年人在总体上对身体较满意,且不存在性别、年龄和体型指数的差异。但在身材特征上,存在性别和年龄的交互作用,性别和体形指数的交互作用,性别、年龄和体形指数三者的交互作用。其它五个维度均不存在性别、年龄和体形指数的差异。     

Countertransference as active imagination: imaginative experiences of the analyst

Active imagination is at the heart of Jung's elucidation of depth psychology. Yet, in the discourse of present day analytical psychology theory it is not always given the serious attention accorded to some other Jungian concepts. Active imagination emerges spontaneously within the 'third' area--the imaginal or dynamic field--in-between patient and analyst. It is commonly regarded as the patient's experience but I am proposing that, looked upon as the analyst's experience as well, active imagination offers a distinctly Jungian way of understanding some forms of countertransference. I am describing what I think many present-day analytical psychologists already do in their clinical practice but, as far as I know, it has not been theorized in quite this way before. The intention is to exploit the unique contribution of our Jungian heritage by reframing certain profoundly symbolic countertransference-generated imagery as active imagination. In this article these are differentiated from other less complex forms of imaginative countertransference through examples from clinical practice. The point is that such countertransference experiences may activate the symbolic function in the analyst and thus contribute to the mediation of emergent consciousness in the analysand.     

Impulsivity mediates the association between borderline personality pathology and body mass index

Borderline personality disorder (BPD) is associated with obesity, a major risk factor for a number of chronic illnesses (e.g., cardiovascular disease). We examined whether impulsivity and affective instability mediate the association between BPD pathology and body mass index (BMI). Participants were a community sample of adults ages 55–64 and their informants. The Structured Interview for DSM-IV Personality measured BPD symptoms and the Revised NEO Personality Inventory measured self- and informant-report impulsivity and affective instability. Mediation analyses demonstrated that only higher self-report impulsivity significantly mediated the association between greater BPD pathology and higher BMI. A subsequent model revealed that higher scores on the impulsiveness (lack of inhibitory control) and deliberation (planning) facets of impulsivity mediated the BPD–BMI association, with impulsiveness exerting a stronger mediation effect than deliberation. Obesity interventions that improve inhibitory control may be most effective for individuals with BPD pathology.     

术前右美托咪定滴鼻对全麻诱导期的影响

观察新型α2肾上腺素受体激动剂右美托咪定(Dex)对全麻诱导期NTI及应激反应的影响.择期全麻手术患者40例,ASA Ⅰ级～Ⅱ级,随机分为两组,D组(n=20):患者入室后Dex1μg/kg滴鼻;C组(n=20)作为对照组,滴入相同容积的生理盐水.30min后进行诱导,观察NTI、改良清醒镇静评分(MOAA/S)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),记录给药前(T0),给药后10min(T1),给药后20min(T2),给药后30min(T3),插管前(T4),插管即刻(T5)各项值变化.D组T1～T3与T0比较,NTI值、MOAA/S逐渐降低(P＜0.05)且显著低于C组(P＜0.05);D组T2、T3与T0比较,HR明显减慢(P＜0.05);麻醉诱导期间,C组T5与T4比较,MAP、HR均显著升高(P＜0.05),D组T5与T4比较,MAP、HR虽有所升高,但差异无统计学意义(P＞0.05).Dex以1μg/kg滴鼻可明显镇静,使NTI值降低,诱导期血流动力学更加稳定,减少插管时应激反应.