Boundaries of reasoning in cases: The visual psychoanalysis of René Spitz

2020 ◽  
Vol 33 (3-4) ◽  
pp. 66-84
Author(s):  
Rachel Weitzenkorn

This article argues that the foundational separation between psychoanalysis and experimental psychology was challenged in important ways by psychoanalytic infant researchers. Through a close examination of American psychoanalyst René Spitz (1887–1974), it extends John Forrester’s conception of reasoning in cases outside classic psychoanalytic practices. Specifically, the article interrogates the foundations of reasoning in cases—the individual, language, and the doctor–patient relationship—to show how these are reimagined in relation to the structures of American developmental psychology. The article argues that the staunch separation of experimental psychology and psychoanalysis, reiterated by philosophers and historians of psychology, is flimsy at best—and, conversely, that the maintenance of these boundaries enabled the production of a cinematic case study. Spitz created films that used little language and took place outside the consulting room with institutionalized infants. Yet key aspects of the psychoanalytic case, as put forth by John Forrester, were depicted visually. These visual displays of transference, failure, and interpersonal emotions highlight the foundations of what Forrester means by reasoning in cases. The article concludes that Spitz failed at creating classic psychoanalytic evidence, but in so doing stretched the epistemology of the case.

Author(s):  
Mani Shutzberg

AbstractThe commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms of solidarity between comrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice.


2013 ◽  
Vol 3 (4) ◽  
pp. 84-88
Author(s):  
Ranjana Srivastava

Reflective writing helps people to explore the larger context, the meaning, and the implications of an experience and action. When used well, it promotes the growth of the individual (William, 2002). Just as personal illness narratives help patients understand their illnesses and help in healing similarly reflective writing by physicians can help them see and understand illness, pain and loss from a larger perspective. At the same time reflection on one's lapses or inadequacies can help in one's own healing. They also help people evolve into more empathic and self-aware practitioners (Sayatani, 2004). Here are two case studies which can be used to make future generation of doctors more human. The first raises the issue of the inadequate training and courage to admit one's mistakes. Whenever this happens people are the first casualty for one carries the burden for years when simple disclosure would have helped in the healing and helped in improving the doctor patient relationship by making doctors appear more human. The second advises struggling students and residents trying to find answers and develop reactions to deal with a situation when they can do nothing for patients (Lisa, 2011)—the answer is communication: engage with patients, simply listen to their stories and keep learning by listening.


1972 ◽  
Vol 3 (4) ◽  
pp. 343-355 ◽  
Author(s):  
Max B. Clyne

Diagnosis is possible on a number of levels. Traditional, overall, and interrelationship types of diagnosis are differentiated. The effectiveness of the traditional diagnosis, which is used to indicate etiology of disease, to assess the effect of the disorder on structure and function, and to classify the illness, is questioned, since it usually leads to a general prognosis based on statistical probability rather than to a unique prognosis indicating specific predictions and treatments for the individual patient. The doctor, when making this kind of diagnosis, acts as an objective observer and assesses an abstract concept, the illness rather than a person, so that the traditional diagnosis is illness-centered. By including features of the patient's personality and his relationships with others, the overall diagnosis provides a more embracing overview of the individual's physical and emotional conditions. It has greater ongoing validity in description and of usefulness for treatment by centering upon the patient as an individual whose conflicts and sufferings are felt and understood. It may require lengthy interviewing, but this may be shortened in practice by focusing upon the particular aspect of the patient's world which seems central to the pathology. This focal area is often determined spontaneously through a “flash,” the mutual intuitive recognition of an important understanding between doctor and patient, leading to further diagnostic and therapeutic work. The flash establishes a climate of high emotional charge and involves both patient and doctor intrinsically in the diagnostic process and its outcome. It is one of the means by which an interrelationship diagnosis, centered on the doctor-patient relationship, may be arrived at. Truly successful treatment in general practice, and perhaps in most branches of medicine, is probably based on some form of interrelationship diagnosis, even though this diagnosis may not have been verbalized or properly conceptualized by the doctor. Case material illustrates the effectiveness of each type of diagnosis for the physician and for his patient.


2020 ◽  
Vol 12 (17) ◽  
pp. 7015
Author(s):  
Rafael Hologa ◽  
Nils Riach

Information on individual hazard perception while cycling and the associated feeling of safety are key aspects to foster sustainable urban cycling mobility. Although cyclist’s perceptions must also be critically reviewed, such crowdsourced Volunteered Geographic Information (VGI) provides wide-ranging insights on diverse hazard categories in cycling. In this case study in the city of Freiburg, Germany, hazard perceptions, information about lane types, and the underlying routes were crowdsourced via an open source smartphone application by a small group with the aim of providing cyclists with effective solutions. By dealing with levels of reliability, we show that even a small group of laypersons can generate an extensive and valuable set of VGI consisting of comprehensive hazard categories. We demonstrate that (1) certain hazards are interlinked to specific lane types, and (2) the individual hazard perceptions and objective parameters, i.e., accident data, are often congruent spatially; consequently, (3) dangerous hot spots can be derived. By considering cyclists’ needs, this approach outlines how a people-based perspective can supplement regional planning on the local scale.


2018 ◽  
Vol 94 (1116) ◽  
pp. 596-600 ◽  
Author(s):  
Jennifer L H Peterson

There is a premium placed on the maintenance of our privacy and confidentiality as individuals in society. For a productive and functional doctor–patient relationship, there needs to be a belief that details divulged in confidence to the doctor will be kept confidential and not disclosed to the wider public. However, where the information disclosed to the doctor could have implications for the safety of the wider public, for example disclosures with potential criminal implications, or have serious consequences for another individual, as is the case in genetic medicine, should doctors feel confident about breaching confidentiality? This essay firstly explores the legal rulings regarding cases in which confidentiality has been breached where there was risk of significant harm to others following the patient’s disclosure, and secondly, focusing on the evolving legal position with regard to confidentiality in contexts where information sharing would be beneficial to others, for example the evolving case of the implications of genetic diagnosis on families (eg, ABC v St George’s Healthcare NHS Trust; 2017).


1995 ◽  
Vol 25 (4) ◽  
pp. 319-329 ◽  
Author(s):  
Peter Salmon ◽  
Carl R. May

Objective: Extensive empirical data and theory describe the inequality of power in relations between doctors and their patients. However, the focus has been on the ways in which doctors control the doctor-patient relationship. This has meant that the extent to which patients influence the consultation, and the ways in which they do this, have been neglected. Methods: In this article, we use a single case to identify and illustrate distinct ways in which patients exert power to determine the outcome of consultations. Conclusion: This analysis leads to a more powerful explanation than is presently available to understand the somatization of psychological needs. According to this, the patient organizes strategies, which include the presentation of emotional and social distress, around a biomedical model. Because of their prior decisions as to their role, doctors permit themselves to be trapped in this model.


1993 ◽  
Vol 1 (1) ◽  
pp. 33-56
Author(s):  
Paul Robertshaw ◽  
Rajeev Thacker

In this article we examine a particular aspect of the doctor-patient relationship — that of consent to treatment procedures — from three perspectives: ethics, sociology of medicine, and the Common Law. The legal deliberation and judgments are considered within the first two perspectives. Ethics provide us with ideal standards such as personal autonomy or the sanctity of life, whereas the sociological perspective focuses on the actuality of the doctor-patient relationship in terms of knowledge and mystification or power and dependence. In our analysis of the cases, including a spate of recent decisions, we note how the rhetoric of patient autonomy in the leading House of Lords cases has not followed through into the later crisis-handling judgments. We argue that the practical model for these decisions is not the rhetoric of autonomy but the prerogative jurisdiction of wardship: the infantilised patient. We argue that there is an aspect of professional collusion here between lawyers and doctors, which exemplifies much of the sociological literature as well as the individual constituted as subject, rather than citizen, in English jurisprudence. We suggest a number of reforms for the situation we have criticised.


Author(s):  
Mariana Barstad Castro Neves ◽  
Rafaela Oliveira Grillo ◽  
Flavia Sollero-De-Campos

Although more frequent and intense on infancy, the attachment system can be triggered across the lifespan, from "the cradle to the grave." In adulthood, whenever the individual's internal working model does not have enough resources to sustain his/her insecurity, one seeks support from an attachment figure. Illness may trigger the attachment system, obliging the individual to pursue the proximity of an attachment figure. In our research on how the doctor's attachment style affects the doctor-patient relationship (Barstad-Castro Neves, 2018), we assessed the doctor's attachment style and correlated with a semi-structured interview script. One of the categories highlighted in our research was how physicians cared for their patients. The present article aims to explore, expand, and clarify the category mentioned. It is essential to discuss how the car ing and concerning doctor acts towards his/her patient, and how the caregiving system, from the lens of attachment theory, has a function in that matter. Our research may contribute to the discussion of strategies to improve the doctor-patient relationship, therefore refining patient adherence and compliance to treatment. Besides, it can also shed light on how to give support to medical professionals, starting from medical school.


2020 ◽  
Vol 163 (1) ◽  
pp. 63-64 ◽  
Author(s):  
Norman D. Hogikyan ◽  
Andrew G. Shuman

The COVID-19 pandemic has forced otolaryngologists and their patients to confront issues that they have rarely if ever previously faced. Prominent among these is the need to put the collective good ahead of the interests of individual patients with otolaryngologic disorders. We argue that the individual doctor-patient relationship remains paramount even at a time when public health principles mandate systems-level thinking.


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