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Current research on developmental aspects of aging
Published in Peter G. Coleman, Ann O’Hanlon, Aging and Development, 2017
Peter G. Coleman, Ann O’Hanlon
Temporal coherence describes the manner in which remembered experiences are temporally related to one another and to external historical events. Cultural coherence refers to the normative cultural facts and events that define conventional life phases (e.g. births, marriages and deaths). Causal and thematic coherence on the other hand refer to the evaluative and meaning-making components of the life story. For example, when causal links are not established, life appears to have been determined by chance and will be experienced as meaningless. However, it is possible to work with people on ‘restorying’ their lives (Kenyon and Randall, 1997) so that negative experiences become opportunities for development and acquisition of wisdom (Randall and Kenyon, 2001; Kenyon et al., 2011). Even emotionally disturbing events can become an occasion for transformation. The term ‘post-traumatic growth’, first coined by Tedeschi and Calhoun (1995), has come to be accepted over the last twenty years as an integral part of the science of ‘positive psychology’ (Snyder and Lopez, 2002).
Family Systems and Chronic Illness: A Typological Model
Published in Froma Walsh, Carol Anderson, Chronic Disorders and the Family, 2014
The typology facilitates the development of various patient support or psycho-educational groups for families. For example, groups could be designed to meet the needs of patients dealing with: progressive, life-threatening diseases; relapsing disorders; acute onset, incapacitating illnesses; or the chronic phase of constant course diseases. Sometimes there are not enough families involved with any particular disease to form such groups. This is particularly relevant in more rural settings or for less common illnesses. Thinking about group-oriented services in terms of illness types helps to overcome these obstacles while maintaining the groups' thematic coherence. Also, packaging brief psycho-educational "modules" timed for critical phases of particular "types" of diseases, encourages families to accept and digest manageable portions of a long-term coping process. Each module could be tailored to the particular phase of the illness life cycle and family coping skills necessary to confront disease-related demands. This would provide a cost-effective preventive service that could also aid in the detection of families at high risk for maladaptation to chronic illness.
Life writing at the limits
Published in Rebecca A. Bitenc, Reconsidering Dementia Narratives, 2019
Although a referential relationship to ‘life’ is central to autobiography studies (Eakin 1992, Lejeune 1988), the criterion of referentiality may recede into the background in collaborative dementia life writing—without, however, dropping out of the picture entirely. Recent work on confabulation in dementia illuminates how even confabulatory stories are used to make identity claims. To recognise these claims, however, we need to expand the notion of narrative coherence. Maria Medved and Jens Brockmeier’s view of narrative as ‘primarily a communicative activity’ (Medved and Brockmeier 2010: 25) opens the door for recuperating relevance in fragmented and possibly confabulatory autobiographical narratives. They underscore how the narratives told by a brain-injured person may be psychologically coherent, by highlighting a central pre-morbid personality trait. Other authors have stressed the relevance of ‘emotional,’ ‘metaphorical,’ or ‘thematic’ coherence in confabulatory stories by people with dementia (Crisp 1995, McLean 2006). Jane Crisp (1995) proposes a framework in which the relevant criteria for evaluating stories by people in advanced stages of dementia ‘would no longer be the literal truth or falsity of the details,’ but among other things, ‘the overall point of the story—the underlying message or thematic and metaphoric meaning it suggests’ (135). Crisp underscores that it is important to note ‘the qualities to which the storyteller [of confabulatory stories] is laying claim’: Sometimes these are fantasized qualities of strength, activity, resourcefulness and power, which serve to compensate for an actual position of weakness and dependency. … Less positive stories may present the teller as ill-treated, trapped, confused and miserable; qualities that make a direct claim on the listener’s sympathy, reassurance and aid.(139)
Assessing Competence: Narrative Coherence or Practical Reasoning?
Published in AJOB Neuroscience, 2020
Guy Widdershoven, Andrea Ruissen, Gerben Meynen
Goldberg (2020) argues that the four criteria for competence assessment as defined by Appelbaum and Grisso (1988) are not sufficient to determine whether a patient has the ability to make decisions. As an alternative, he presents the notion of narrative coherence. He states that self-governance entails decision-making that is coherent with one’s narrative. Coherence is further defined in terms of both causal and thematic coherence. Narratives describe an order of events and relate them to a core theme, embodying the narrator’s worldview and self-knowledge. After determining cognitive capacity, the physician examining competence should ask the patient to explain how the decision which is about to be made is related to self-defining themes in the patient’s story. If the patient shows cognitive capacity, but is unable to explain how the decision fits in with the larger story of their life, this indicates that the patient lacks competence.
Thematic Coherence Within Narratives: A Feature or a Bug?
Published in AJOB Neuroscience, 2020
Noam Goldberg, Vidhura Malkowsky, Talya Ohana, Dov Greenbaum
Goldberg (2020), in describing a method to assess this mental state of the patient regarding treatment decisions, elected to put substantial reliance in the patient’s narrative to assess their ability to make decisions to knowingly put themselves in harm’s way. Goldberg further suggests that it is the coherence of this narrative—especially thematic coherence—that is an important and useful indicator of rationality required for respecting patient autonomy. As Goldberg describes it, thematic coherence is displayed by “particular themes that are implied or explicitly affirmed by the narrator. His example: a “patient who begins her explanation about why she’s come to the doctor by stating, “Bad things always come in threes” (12).
Measuring discourse coherence in anomic aphasia using Rhetorical Structure Theory
Published in International Journal of Speech-Language Pathology, 2018
Anthony Pak-Hin Kong, Anastasia Linnik, Sam-Po Law, Waisa Wai-Man Shum
There is a lack of consensus on whether discourse coherence is impaired for people with aphasia (PWA). For example, a number of studies demonstrated a significantly reduced degree of discourse coherence and/or pathological coherence in aphasia (e.g. Andreetta et al., 2012; Andreetta & Marini, 2015; Christiansen, 1995; Coelho & Flewellyn, 2003; Wright & Capilouto, 2012a, 2012b), whereas other researchers have provided evidence to it being within normal limits (Glosser & Deser, 1991; Ulatowska et al., 1981, 2013). Further disparities are related to the more global question about the origins of coherence. It has been suggested that impaired micro-linguistic skills lead to macro-linguistic processing difficulties. For example, poor cohesion, often caused by morphosyntactic deficits, was found to be correlated with global coherence (e.g. Armstrong, 1987). Contrary to this idea, several studies demonstrated that thematic coherence in oral discourse can remain relatively intact despite PWA’s micro-linguistic deficits (e.g. Coelho & Flewellyn, 2003; Glosser & Deser, 1991; Ulatowska et al., 1981; Ulatowska, Weiss-Doyell, Freedman-Stern, & Macaluso-Haynes, 1983). This indicates that micro- and macro-level of discourse may be organised independently. The techniques discussed above are valuable for assessment and therapy outcomes evaluation as they reliably estimate the level of coherence in discourse; nevertheless, they do not provide an insight on the reasons behind coherence impairment or preservation. As a solution to this problem, a number of multi-level approaches have been developed and implemented to explore the relationship between the micro- and macro-linguistic abilities of PWA (e.g. Marini, Andreetta, del Tin, & Carlomagno, 2011; Sherratt, 2007; Wright & Capilouto, 2012a, 2012b).