COGNITIVE DISABILITY IN A SOCIETY OF EQUALS

Abstract: This essay considers the range of possible policy options that are available if we wish to attempt to treat people with cognitive disabilities as equal members of society. It suggests that the goal of policy should be to allow each disabled person to establish a worthwhile place in the world and sets out four policy options: cash compensation, personal enhancement, status enhancement, and targeted resource enhancement. The essay argues for the social policy of targeted resource enhancement for individuals with cognitive disabilities, in the form of providing cash, with some limits on its use. Taking the example from the United Kingdom of "self-directed support," it argues that such policies can be cost-effective and advance the autonomy of people with cognitive disabilities, especially when compared with current policies of centrally provided services.     

RESPECTING HUMAN DIGNITY: CONTRACT VERSUS CAPABILITIES

Abstract: There appears to be a tension between two commitments in liberalism. The first is that citizens, as rational agents possessing dignity, are owed a justification for principles of justice. The second is that members of society who do not meet the requirements of rational agency are owed justice. These notions conflict because the first commitment is often expressed through the device of the social contract, which seems to confine the scope of justice to rational agents. So, contractarianism seems to ignore the justice claims of the severely cognitively impaired. To solve this problem, Martha Nussbaum proposes the capabilities approach. The justifiability condition, on this approach, is met by the idea of overlapping consensus. This essay argues that overlapping consensus cannot meet liberalism's justifiability condition, nor is it more inclusive of the cognitively impaired. Therefore, we have reason to retain the contract device and look for another way to ensure that liberalism respects the justice claims of all.     

The development and validation of the pictorial motivation scale in physical activity

The purpose of the present research was to report the validation of the pictorial motivation scale in English. This scale is designed for adolescents and adults with an intellectual disability who are unable to independently read a questionnaire. The scale has a picture and phrase depicting 16 items related to participation in sport and physical activity; four for each of the following subscales, intrinsic motivation, self-determined extrinsic motivation, non self-determined extrinsic motivation, and amotivation. Phase 1 of the research describes the formal translation of the scale from French to English. Results from three studies conducted with Special Olympians (Phase 2) and adolescents in a special school (Phases 3 and 4) provided support for the internal consistency, test–retest reliability, and factorial and construct validity of the scale. Overall, the scale would appear to be sufficiently reliable and valid to warrant its continued use and further development.

Excess disability and malignant social psychology: A case study of Alzheimer's disease

An in-depth case study was undertaken to assess the effects of what Kitwood has termed ‘malignant social psychology’ on the observed behaviour of an Alzheimer's disease sufferer. Interviews were conducted with the spouse and observations were made in an adult day-care centre, where staff members were also interviewed. Abilities that the spouse reported to be absent at home were readily observed at the day-care centre, lending support to Brody's idea of excess disability, i.e. disability not due to disease alone. Furthermore, forms of malignant social psychology existed in the home environment but did not exist in the day-care centre. Excess disability and its absence coincided with the presence and absence of aspects of malignant social psychology. The sufferer's behaviour was found to be affected not only by the extant neuropathology, but also by social relationships.     

The Effectiveness of Audiovisual Self-Instructional Materials in Teaching Child-Care Skills to Parents with Intellectual Disabilities

Children of parents with intellectual disabilities are at risk for neglectful care due to parenting skill deficiencies. Previous studies have shown that parents with intellectual disabilities can improve child-care skills with intensive behavioral training, but self-instruction has not been explored. We evaluated the efficacy of self-instructional pictorial child-care manuals with and without accompanying audiotaped instruction using a multielement design with 13 parents with intellectual disabilities. The self-instructional materials were effective in teaching 22 of 26 skills to levels seen in parents without intellectual disabilities. Eighty-one percent of the skills maintained over a 1-15 month follow-up period and self-learning effects were replicated when the parents received self-instructional materials for the original no-training control skill. Despite the low literacy skills of the parents, for most of them no advantage was found in adding the audiotape to the illustrations. Three parents only reached criterion after an audiotape was added to the manual alone skill. Consumer satisfaction ratings were uniformly high and those parents who stated a preference, preferred the pictorial manuals without, as opposed to with, the audiotape. These findings suggest that a majority of parents with intellectual disabilities may improve their parenting skills with low cost, low tech, self-instructional materials.     

精神分裂症病人对成人面部表情的辨别

本文对比研究了精神分裂症病人和正常人对成人面部表情辨别的水平,发现精神分裂症病人存在着表情辨别障碍。病程长、以阴性症状为主的病人易出现这种障碍。表情辨别障碍是一种情绪障碍,属阴性症状。     

Forensic neuropsychology: The art of practicing a science that does not yet exist

Despite its future promise, neuropsychological evidence generally lacks scientifically demonstrated value for resolving legal issues, and thus, if admitted into court, should be accorded little or no weight. In support of this contention, examples of problems and limits in forensic neuropsychology are described. These include contrasts between the clinical and forensic context; the base-rate problem; lack of standardized practices; problems assessing credibility or malingering; difficulties determining prior functioning, limits in the capacity to integrate complex data; and the lack of relation between judgmental accuracy and education, experience, or credentials. Some possible counterarguments are also addressed.     

Treating the “Wise Baby”

In a previous examination of Ferenczis concept of the Wise Baby (1996), I had noted both its applications and its limitations in the analytic treatment of an unusually intelligent adult. Ferenczis concepts of the origin of intellect in trauma and of the wise baby have often left the indistinct impression of being interrelated phenomena. In this paper, I regard as arguable the notion that very high intelligence is pathological when it is precocious. This return visit to the territory of the wise baby extends Ferenczis ideas about the origin and use of the intellect to include a consideration of what may constitute effective treatment for those who suffer from giftedness.Judith E. Vida, M.D. edits On the Arts for this journal. She is a Founding Member and Faculty of the Institute of Contemporary Psychoanalysis in Los Angeles, CA, a member of both American and International Psychoanalytic Associations, and of the Sándor Ferenczi Society of Budapest. Her private practice is in Pasadena, CA.Address correspondence to Judith E. Vida, 301 S. Fair Oaks Ave., Suite 406A, Pasadena, CA 91105, USA; e-mail: jvida@spence.net     

Broad-Perspective Perceptual Disorder of the Right Hemisphere

Traditional accounts of right-posterior brain injury describe a syndrome of low-level perceptual sequelae producing marked acute dependency and transient safety concerns. The syndrome is also held to spare cognition and to carry a generally favorable long-term prognosis. The present paper reviews publications and anecdotal data that challenge this picture. Recent theoretical expositions and empirical studies stipulate three major cognitive functions of the right posterior association cortex: processing novel input, guiding reactions to emergencies, and anticipating consequences. Appearing benign after acute recovery, the impairment of these processes produces vocational, social and marital dysfunctions that increase as a function of chronicity, ultimately becoming more broadly disabling than focal injuries in other cortical loci. The unique symptom picture and serious implications suggest that the long-term syndrome should be labeled (Broad-Perspective Perceptual Disorder) and incorporated in future clinical taxonomies, underscoring the need for extraordinary long-term assistance and specialized therapeutics. Procedures for assessment and differential diagnosis are outlined.