Reflective Capacity: An Antidote to Structural Racism Cultivated Through Mental Health Consultation

Effecting a paradigm shift from “reproductive health” to “reproductive justice” within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant-Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use-of-self in patient–provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well-being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.     

学制——我国医学教育的困惑与出路

目前我国医学教育层次繁多,学制较为混乱,已成为阻碍医学教育改革的重要因素。在《本科医学教育全球标准》及我国住院医师规划化培训均已启动和实施的背景下,医学教育国际化和住院医师规范化培训均对我国医学教育提出了更高要求。逐步统一医学教育学制,是继续深化医学教育变革的出路之一。     

The functional role of consciousness: A phenomenological approach

In this paper, a theoretical account of the functional role of consciousness in the cognitive system of normal subjects is developed. The account is based upon an approach to consciousness that is drawn from the phenomenological tradition. On this approach, consciousness is essentially peripheral self-awareness, in a sense to be duly explained. It will be argued that the functional role of consciousness, so construed, is to provide the subject with just enough information about her ongoing experience to make it possible for her to easily obtain as much information as she may need. The argument for this account of consciousness' functional role will proceed in three main stages. First, the phenomenological approach to consciousness as peripheral self-awareness will be expounded and endorsed. Second, an account of the functional role of peripheral perceptual awareness will be offered. Finally, the account of the functional role of peripheral self-awareness will be obtained by straightforward extension from the functional role of peripheral perceptual awareness. This revised version was published online in June 2006 with corrections to the Cover Date.     

Embracing the other: Revisiting the epistemological foundations of family systems therapy

Family systems therapy originated in the 1960s, 1970s, and 1980s through the work of innovative thinkers and clinicians. However, despite the creative contributions of the mentioned colleagues and of later innovations in family therapy theory and practice, it seems as though the dominant culture of establishment psychiatry in the United States (and in most Western countries) to this day has not seriously incorporated relationships, social context, or community connectedness into the treatment of individuals with psychiatric diagnoses. For the “psychiatric” patients diagnosed according to the DSM-5, the dominant underlying epistemological perspective is the medical “scientific” paradigm. Within this approach there is a dearth of reflections about the truthfulness of so-called “empirical facts” and a lack of skepticism about the techniques of “measurement” of the psychiatric illness. The alternative, relationship-oriented, context-sensitive, and community-connected thinking paradigm is highlighted here in contrast to the “psychiatric” foundation. This paradigm consists of (a) the awareness that all human Subjects (including “psychiatric” clients) are constituted as such by their relational connection to others; (b) the awareness of our sensitivity to and embeddedness in a socio-economic, cultural, and racial context; and (c) the awareness of our involvement in and connectedness with many kinds of communities.     

认知控制子成分与客观风险对信任行为的影响

研究通过三个实验,在控制客观风险高低的同时,分别对刺激—反应一致性、任务转换和工作记忆负载进行操纵。结果发现,抑制控制在反应时上表现出差异,刺激—反应一致条件下被试做出信任的反应时更快;认知灵活性和工作记忆刷新在信任率上表现出差异,不转换条件和低工作记忆负载条件下被试的信任率更高。结果表明,抑制控制主要影响反应组织过程,认知灵活性和工作记忆刷新则会影响个体的信任决策过程。此外,客观风险对信任行为的影响表现出跨情境一致性,低风险条件下信任率更高。     

An account of consciousness in physical and functional terms: A target for research in the neurosciences

The neurophysiology of mental events cannot be fully understood unless that of consciousness is understood. As the first step in a top-down approach to that problem, one needs to find an account of consciousness as a property of the biological organism that can be clearly defined as such. However, if it is to deliver what must be expected of it, it should address what is commonly meant by the wordconsciousness. Unless the last condition is satisfied, the theory will fail to deliver what must ultimately be expected of it. Although current interest lies mainly in the higher functions of consciousness, such as its role in language and social relationships, the common usage of the word relates to modes of awareness that are not denied to creatures lacking language or social relationships. The basic features to be covered include awareness of the surrounding world, of the self, and of one’s thoughts and feelings; the subjective qualities of phenomenal experience (qualia); the conditions a brain event must satisfy to enter consciousness; and the main divisions of mental events, such as sensations, feelings, perceptions, desires, volitions, and mental images.     

Transference, the transcendent function, and transcendence

People in analysis come into direct contact with the transcendent – that which surpasses not only our ego consciousness but the whole psyche – through the transcendent function working in the transference–countertransference field. Reductive and synthetic methods of interpretation of transference, in both objective and subjective levels of meaning, inaugurate moving the ego out of center stage into the process of relating to the Self. The transcendent function is the means of enlarging psychic space in the transference field to make room for coinciding opposites and a 'creative solution' that arises from their conversation. That solution, or set of symbols, addresses us with such compelling authority that Jung likens it to 'the voice of God', A clinical case illustrates the connection of transference, the transcendent function, and the experience of the transcendent which, I believe, we must identify as such in order to go on relating to it.     

Cognitive assessment: A multibehavior-multimethod-multiperspective approach

Clarifying methodological and assessment issues is fundamental to the further development of cognitive-behavioral approaches. The present work examines potential method confounds in several cognitive assessment techniques (e.g., self-statement inventories, postperformance videotape reconstruction) in light of social psychological research on objective self-awareness. On the basis of this analysis, a conceptual framework is proposed to organize research on the assessment of clinical cognition.     

Metamemory Experiments in Neurological Populations: A Review

Metamemory refers to knowledge about one's memory capabilities and strategies that can aid memory, as well as the processes involved in memory self-monitoring. Although metamemory has been studied in cognitive psychology for several decades, there have been fewer studies investigating the neuropsychology of metamemory. In recent years, a growing number of studies of neurological patient groups have been conducted in order to investigate the neural correlates of metamemory. In this review, we examine the neuropsychological evidence that the frontal lobes are critically involved in monitoring and control processes, which are the central components of metamemory. The following conclusions are drawn from this literature: (1) There is a strong correlation between indices of frontal lobe function or structural integrity and metamemory accuracy (2) The combination of frontal lobe dysfunction and poor memory severely impairs metamemorial processes (3) Metamemory tasks vary in subject performance levels, and quite likely, in the underlying processes these different tasks measure, and (4) Metamemory, as measured by experimental tasks, may dissociate from basic memory retrieval processes and from global judgments of memory.