Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program

Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing the power of genetics discourse has implications for our collective understanding of the operations of the care of the self and the uses of genetic information that we propose.     

自我面孔识别的独特性

与识别他人的面孔相比,自我面孔识别在行为反应、种系发生、个体发展以及脑机制等方面都具有很大的独特性。行为指标方面,自我面孔识别在速度上快于识别他人的面孔;种系发生方面,只有人类和大猩猩等高级灵长类动物才具有识别自己面孔的能力;个体发展方面,儿童出生后不久即能识别他人面孔,但要在18个月左右才能表现出自我面孔识别能力;脑机制方面,神经心理学和脑成像研究结果表明自我面孔识别可能主要是右脑的功能。该领域的研究进展将为深入了解自我的形成机理提供一个新的探视“窗口”。     

内隐联想测验中他人重要性对自我心理表征的影响

联合采用联想匹配任务和内隐联想测验（IAT）任务,考察了自我—他人分类中的他人重要性对自我—高奖赏相似性的影响。研究将中性的几何图形与自我、不同重要性的他人（实验一为陌生人,实验二为朋友）建立联结,并将自我（暂时建立联结的图形）高奖赏联合任务与自我低奖赏联合任务下的反应差异（即IAT值）作为自我—高奖赏相似性的指标,结果表明：（1）联想匹配任务中自我和朋友以及自我和陌生人之间都存在显著的自我优势效应;（2）IAT任务中,自我和高奖赏只在他人为朋友的自我—他人分类判断时才具有相似性,而他人为陌生人时二者不具有相似性。这说明他人重要性改变了自我的心理表征。     

Identity, narcissism and the emotional core

This paper describes the course of an analysis which demonstrates how borderline and narcissistic functioning can be understood in terms of a struggle with issues of identity. It shows how such functioning can come to exert a profound hold on the individual and why it seems, at times, a matter of life and death to the patient to avoid states of separation from the analyst. The paper suggests that these complex phenomena can be understood, perhaps surprisingly, in the simple terms of the nature of affect itself. The concept of the emotional core is introduced to embody and highlight that which lies beneath both Jungian and Freudian models (offering a potential bridge between the two models)--namely the psyche's essentially affective nature. It is suggested that the emotional core can serve as an organ of perception giving the individual both their primary relation to reality and an emotional attachment to others. This emotional core is understood to function in a narcissistic manner to preference experiences of sameness and in aversion to experiences of difference--a view consonant with Stern's understanding of infant development where the infant is able to distinguish self from other from the beginning of life (as Fordham also held); taking up Stern's terminology, it gives the individual a 'core' sense of being. There is, however, no stable, on-going sense of 'I' associated with this form of functioning as the individual is immersed in the latest affect to enter consciousness (as in the borderline state of mind) and consequently the individual comes to rely intensely on the other to determine their sense of being (the other becomes a self-regulating other in Stern's terms). The development of ego-functioning gives a more stable and on-going sense of 'I' to the individual, giving contact with the broader personality, allowing the individual to be less reliant on the other and orientating them to reality in a way more fitting to their overall needs. The paper describes how consciousness, which is not seen as identical with the ego, moves between the mode of functioning of the ego and that of the emotional core, i.e., shifting in and out of states where projective identification predominates. It elaborates the range of self-experience encompassing spiritual experience and states of disintegration (which are understood to have a similar structure) on one side, to ego-based experience (which can itself be defensive and rigid at times) on the other. It explores the consequences of such a view for analytic technique and relates it to the Jungian view of the self and the Freudian unconscious.     

Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury

We evaluated the effects of systematic application and removal of protective equipment on three topographies of self-injurious behavior (SIB) exhibited by a girl who had been diagnosed with autism. Results showed that when protective equipment was applied, SIB decreased to near-zero levels. In addition, withdrawal of protective equipment for specific topographies of SIB (by removing only the corresponding padding) increased rates of SIB only for that topography of SIB. Next, a functional analysis of hand SIB showed that protective equipment suppressed this behavior in all conditions and that the behavior was maintained by automatic reinforcement when padding was removed. Results are discussed in terms of sensory extinction as a possible mechanism responsible for response suppression.     

Functional analysis and treatment of self-injurious behavior in young children a summary of 30 cases

The assessment and treatment of self-injurious behavior (SIB) has received much attention in the literature; however, few studies have focused on early intervention for this behavior. In the current study, functional analyses with developmentally appropriate modifications were conducted in an outpatient clinic with 30 children (aged 10 months to 4 years 11 months) to assess SIB and problem behavior in its early stages. The reported mean age of SIB onset was 17 months, and head banging was the most prevalent topography. Functional analyses identified sources of reinforcement for SIB in 62.1% of cases; with the inclusion of all forms of problem behavior, sources of reinforcement were identified for 87.5% of cases. Function-based treatments were developed for 24 cases, with functional communication training prescribed most often (70.8% of cases). Implications of these findings for the development of early intervention programs for SIB are discussed.     

Effects of teacher-directed versus student-directed instruction on self-management of young children with disabilities

In this study, students worked independently by setting goals, selecting assignments, and recording and evaluating their results after receiving one of two different types of self-management training. During teacher-directed training, the teacher set goals, assigned work, and recorded and evaluated results for students. During student-directed training, students performed those tasks themselves. The results indicated that students engaged in the self-management behaviors more frequently during independent work following student-directed instruction than following teacher-directed instruction.     

Self Psychology, Dreams and Group Psychotherapy: Working in the Playspace

This paper presents one leadership style within a self-psychological approach to working with dreams in group psychotherapy. It stresses an empathic attunement, the creation of safety, and an experience-near playful relationship. Playful is not used lightly here. It is used in the spirit of Winnicott's intermediate space where a mother suspends questions of what is real or not real and what is me and not me. Freud's analogy to a playspace forms a metaphor for the creation of a special atmosphere in a group, or for that matter in individual work as well, that encourages exploration, risk taking, and vulnerability. Working with dreams in this playspace deepens the curative process, not only for the dreamer, but for the entire group.     

The Embodiment of Birth

This paper rejects dualism between mind and body toview the self as an embodied biological entity. Rather thanseeing the body operating by passive mechanisms as Descartesargues, it holds it actively moves in and even defines its world. Carrying this perspective to medicine presents an attempt toincorporate or work with internal processes of the body; it issensitive to how patients identify with their bodies. Thecurrent discussion over the extent to which women should try tohave natural childbirths provides a concrete example of thedifferences between mechanistic and embodied approaches tomedicine.     

中国古代的自主学习思想探析

从自主学习的价值、自主学习的原则、自主学习的教学等方面探讨了中国古代的自主学习思想。中国古代学者强凋为学贵在自求自得。注重立志、学思结合、知疑善间、自我省察、相互切磋等自主学习原则。主张遵循启发式的、少而精的教学原则来培养学生的自主学习能力。