Relational suffering and the moral authority of love and care

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.

     

Normative data for the selective reminding test: a random digit dialing sample

Healthy control participants (46 women, M age=44.3 yr., SD=7.6; 29 men) were recruited to undergo a comprehensive neuropsychological battery and serve as a comparison group in a study of cognitive functioning in patients with Lyme isease. Participants were selected using Mitofsky-Waksberg random digit dialing. The Buschke 12-word, six-trial Selective Reminding Test was administered as part of the neuropsychological battery and normative data are presented stratified by age and sex. Performance on alternate forms of this measure were examined. Mean education, intelligence quotient, and Wide Range Achievement Test-3 Reading scores are reported.     

Perceptions of physical and psychological aggression in close relationships: A review

This review of the literature examines the effect of contextual variables (i.e., characteristics of the perpetrator and victims, observer characteristics) on perceptions of physical and psychological aggression in close relationships. Observers view physical aggression as more serious, harmful, abusive, and more deserving of punishment than psychological aggression, male aggression as more serious than female aggression, and aggression in committed, exclusive relationships as more serious than aggression in casual ones. Victims of psychological aggression, however, perceive it as more harmful than physical aggression and consider the effects to be longer-lasting. The disparity between observer and victim perceptions of physical and psychological aggression extends to mental health professionals, who tend to judge the severity of aggressive behaviors based on frequency and duration of the actions instead of perpetrator intent. This difference of opinion may influence the reporting of and intervention in physically or psychologically aggressive situations, and how these types of aggression are treated by legal professionals, especially if those legal professionals are informed about aggressive romantic relationships by third-party observers whose opinions of the situation differ from those of the victims.     

Low diversity and low frequency of participation in leisure activities compromise working memory efficiency in young adults

People perform leisure activities (LA) every day; pursuits that entail applying cognitive, physical and social abilities. As in old age, doing LA during early and middle adulthood is related to a reduced risk of dementias, probably by generating a cognitive reserve. As it is possible that a relation between doing LA and working memory (WM) efficiency exists in young adults, we assessed whether the diversity and frequency of LA are related to WM efficiency in this population. Ninety-three healthy young subjects solved the n-back task at two levels of difficulty (2, 3), and answered an LA questionnaire on the activities in which they had participated in the month prior to the experiment. Subjects were classified separately on their scores for (1) diversity (high/low) and (2) frequency (high/low) in order to test the relation between each variable and WM efficiency. Though no differences were found, a subsequent analysis of the average of diversity and frequency ratios of LA performance taken together-the diversity/frequency index-showed that low diversity plus low frequency was significantly associated with reduced WM efficiency at this age; results that suggest that frequent participation in diverse LA during youth is related to WM efficiency.     

The effects of modifying interpretation bias on worry in generalized anxiety disorder

This study investigated whether facilitating a benign interpretive bias decreases negative thought intrusions in generalized anxiety disorder (GAD). Clients were randomly allocated to an interpretation modification condition in which they repeatedly accessed benign meanings of emotionally ambiguous homographs and scenarios, or to a control condition in which they accessed threat and benign meanings with equal frequency. Worry frequency was assessed using a breathing focus task that involved categorising the valence of thought intrusions before and after an instructed worry period. Interpretation bias was assessed during the modification tasks, and on a different measure of interpretation bias (sentence completion) following a period of worry. The experimental procedure modified interpretations made during training, and in the later sentence completion task. Furthermore, compared to the control group, the benign group showed fewer negative thought intrusions during breathing focus (as rated by both participants and an assessor). These findings show that it is possible to induce a more benign interpretive bias in GAD clients and that this reduces negative thought intrusions.     

The effect of attention modification with explicit vs. minimal instructions on worry

In this experiment we investigated the effect of different instructions on the modification of attentional biases, and subsequently on worry persistence. Participants without excessive worry completed a modified dot-probe task, designed to train attention either to threat or neutral words. Half of each group was given explicit instructions regarding the relationship between word valence and target location, and half were given the more usual minimal instructions. Impact on worry persistence was assessed by categorizing the valence of thought intrusions before and after a period of instructed worry. Response latencies to test items on the dot-probe task showed that attention had been successfully manipulated in the expected direction, and explicit instructions led to more effective attention modification. Moreover, participants in the attend-threat group who received explicit instructions reported significantly more negative thought intrusions following instructed worry, as rated by an assessor, whereas participants in the attend-neutral group did not. These findings suggest that an attentional bias towards threatening information plays a role in worry persistence, and that explicit instructions may be helpful in modifying this bias.     

Backward recall and benchmark effects of working memory

Working memory was designed to explain four benchmark memory effects: the word length effect, the irrelevant speech effect, the acoustic confusion effect, and the concurrent articulation effect. However, almost all research thus far has used tests that emphasize forward recall. In four experiments, we examine whether each effect is observable when the items are recalled in reverse order. Subjects did not know which recall direction would be required until the time of test, ensuring that encoding processes would be identical for both recall directions. Contrary to predictions of both the primacy model and the feature model, the benchmark memory effect was either absent or greatly attenuated with backward recall, despite being present with forward recall. Direction of recall had no effect on the more difficult conditions (e.g., long words, similar-sounding items, items presented with irrelevant speech, and items studied with concurrent articulation). Several factors not considered by the primacy and feature models are noted, and a possible explanation within the framework of the SIMPLE model is briefly presented.     

Is spoken duration a sufficient explanation of the word length effect?

The word length effect is one of the cornerstones of trace decay plus rehearsal models (TDR) of memory. Words of long spoken duration take longer to rehearse than words of short spoken duration and as such suffer more decay and are thus less well recalled. The current experiment manipulates both syllable length and spoken duration within words of fixed syllable length in an aim to test the assumptions of the TDR model. Our procedures produced robust effects of both syllable length and spoken duration in four measures of the time it takes to pronounce the different types of words. Serial recall for the same materials produced robust syllable effects, but no duration effects.