Ethical Challenges for Jewish Long Term Care Providers

ABSTRACT

This article discusses the particular ethical challenges and opportunities facing Jewish long term care providers. The discussion begins with background on Jewish healthcare ethics generally and then notes several problems in applying traditional principles in concrete situations today. Specific ethical dilemmas characterizing long term care are described, and their implications for practice within Jewish facilities are explicated. Finally, suggestions are offered regarding special contributions that can be made to both the Jewish community and the larger society by bringing the perspective of Jewish healthcare ethics to the arena of long term care provision and policy-making for aging citizens.     

A Review of Reviews Examining Neurological Processes Relevant to Impact of Parental PTSD on Military Children: Implications for Supporting Resilience

In this study, 10 recent meta-analytic and systematic review studies were synthesized on the neurological underpinnings of stress and trauma with implications for the impact of parental post-traumatic stress disorder (PTSD) and resilience among military children. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) group guidelines and utilizing a validated quality assessment tool, this systematic review of reviews incorporated results from more than 35,971 individuals with stress exposures, effects, or disorders and healthy controls. This synthesis found support for important gene, physiology, and environment correlations and interactions that predict increased risk for stressful life events and PTSD, but not direct transmission, among military children. Future research is needed to determine if these constitute indirect pathways of intergenerational transmission in military children.     

Intergenerational studies of parenting and the transfer of risk from parent to child

This review describes a recent approach to studying the intergenerational processes that place families and children at risk for a broad variety of social, behavioral, and health problems. Intergenerational studies typically involve two (or more) generations of participants, observed over time. These projects are utilized to study the origins and early determinants of parenting behavior and of other environmental, health, and social conditions that place young offspring at risk for continuing behavioral, cognitive, and health problems. Convergent findings, across a broad range of research populations in several countries, suggest that problematic parenting develops in part through learning the behavior modeled by one's own parents. In addition, problematic parenting seems to be an extension of an individual's early style of aggressive and problematic social behavior. Parents with a history of childhood aggression, in particular, tend to have continuing social, behavioral, and health difficulties, as do their offspring. Conversely, parental involvement, cognitive stimulation, warmth, and nurturance appear to have important protective effects for offspring. Finally, educational achievement appears to be a powerful buffer against problematic parenting and a wide variety of difficult family circumstances, protecting families against the transfer of risk between generations.     

Intergenerational Transmission of Trauma-Related Distress: Maternal Betrayal Trauma,Parenting Attitudes,and Behaviors

The purpose of this study was to elucidate mechanisms involved in the intergenerational transmission of trauma-related distress. This study investigated whether betrayal trauma (BT; abuse by a person close to the victim) and specific parenting attitudes and behaviors among mothers with child abuse histories predicted internalizing and externalizing symptoms in their children. Mothers and children (ages 7–11) were recruited for a project on parenting and stress (N = 72). Maternal betrayal trauma predicted both internalizing (β = 0.33, p < .01) and externalizing symptoms (β = 0.25, p < .05) even when controlling for mothers’ trauma-related symptoms. Negative attitudes toward limit setting predicted externalizing symptoms (β = ?0.33, p < .05). Poorer communication (β = ?0.39, p < .05) but higher parenting satisfaction (β = 0.38, p < .01) predicted internalizing symptoms. These findings demonstrate the importance of assessing maternal trauma and parenting characteristics as part of interventions with symptomatic children.     

Phantom narratives and the uncanny in cultural life: psychic presences and their shadows

Abstract

In this paper the author explores the emotional factors that are activated at the level of the cultural unconscious, that produce experiences of the uncanny that are expressed through Phantom Narratives. Phantom Narratives as a hybridized term is the author’s way of linking personal and social activity of unconscious story formation through psychic presences (images). Phantom Narratives are expressions of the unconscious at the level of the group that shows the psyche’s way of narrating its relationship to the group, through the expressions of cultural, social, and political issues. The uncanny, at the level of the social, is seen as those disturbances of feelings that alienate us from the familiar social world of others. What is uncanny about Phantom Narratives is how group emotional dynamics are represented as psychic presences. Making use of the author’s own subjectivity (i.e. psychoanalytic literary genre) he uses an approach from analytic psychology (Jungian) called amplification, which allows for the elaboration of symbolic processes, to create a meaningful (semantic) context for exploration.     

‘It’s silly these doors don’t open’: a six-year-old girl emerges from a chronic state of emotional withdrawal

This clinical paper explores the way in which the first two years of a long-term psychotherapy helped six-year-old Anna to lessen her retreat into a chronic withdrawn emotional state. Over the course of the first year she would occasionally pick up the fridge from the doll’s house and try to open the doors, but because the fridge was actually a block of wood the doors could not open. In treatment, this inquiry came to represent the difficulties of engaging and making contact with a baby who found it very hard to feed. The author describes how, as Anna entered into a therapeutic relationship, it slowly became clear that there was an inner world jam-packed with persecutory anxieties and a family history of unmourned loss and trauma. Through fear Anna slammed the doors to her mind – to knowing herself – and by not feeding, Anna starved herself of opportunities for mental growth. It took some time for her to state, “it’s silly these doors don’t open, they should”. In the discussion of this clinical material the author draws on the work of Francis Tustin, Alessandra Piontelli and Marguerite Reid to consider the link between intergenerational and prenatal trauma and subsequent emotional disturbance in the child.     

Impact of maternal adverse childhood experiences on child socioemotional function in rural Kenya: Mediating role of maternal mental health

Mothers in low‐ and middle‐income countries (LMIC) suffer heightened vulnerability for adverse childhood experiences (ACEs), which is exacerbated by the multitude of risk factors associated with poverty and may lead to increased risk of psychiatric disorder. The constellation of complex, co‐occurring biological, environmental, social, economic and psychological risk factors are in turn transmitted to her child, conferring vulnerability for adverse development. This study examines the association between maternal intra‐ and extra‐familial ACEs, maternal education and the mental health of her child, mediated by maternal mental health. Mother‐child dyads (n = 121) in Machakos, Kenya were examined cross‐sectionally using self‐report measures of ACEs, maternal mental health and child internalizing and externalizing mental health problems. The four models proposed to examine the relationship between intra‐ and extra‐familial maternal ACEs and child internalizing and externalizing problems demonstrated indirect pathways through maternal mental health. These effects were found to be conditional on levels of maternal education, which served as a protective factor at lower levels of maternal ACEs. These models demonstrate how the impact of ACEs persists across the lifespan resulting in a negative impact on maternal mental health and conferring further risk to subsequent generations. Elucidating the association between ACEs and subsequent intergenerational sequelae, especially in LMIC where risk is heightened, may improve targeted caregiver mental health programs for prevention and intervention.     

Slavery in the White Psyche

This article was born out of the hypothesis that slavery—as historical reality, signifier, and symbol—has deep psychological implications for contemporary white Americans. Using data collected in an exploratory, qualitative study, my participants’ responses serve to illuminate the psychic structure of whiteness, which functions as a distortion that gets passed down intergenerationally (and horizontally) through a white collective unconscious. Housed in individual psyches, I suggest that this distorted structure of self actively resists and prevents white Americans (as a collective) from making contact with the racialized realities, both past and present, that would potentially lead to opportunities for choice, reparation, and transformation.