Cognitive Factors in Fibromyalgia: The Role of Self-Concept and Identity Related Conflicts
Fibromyalgia is a syndrome characterized by the presence of diffuse and chronic musculoskeletal pain of unknown etiology. Clinical diagnosis and the merely palliative treatments considerably affect the patient's experience and the chronic course of the disease. Therefore, several authors have emphasized the need to explore issues related to self in these patients. The repertory grid technique (RGT), derived from personal construct theory, is a method designed to assess the patient's construction of self and others. A group of women with fibromyalgia (n = 30) and a control group (n = 30) were assessed using RGT. Women with fibromyalgia also completed the Fibromyalgia Impact Questionnaire and a visualanalogue scale for pain, and painful tender points were explored. Results suggest that these women had a higher present self-ideal self discrepancy and a lower perceived adequacy of others, and it was more likely to find implicative dilemmas among them compared to controls. These dilemmas are a type of cognitive conflict in which the symptom is construed as "enmeshed" with positive characteristics of the self. Finally, implications of these results for the psychological treatment of fibromyalgia are suggested to give a more central role to self-identity issues and to the related cognitive conflicts.
Viewing Cognitive Conflicts as Dilemmas: Implications for Mental Health
The idea that internal conflicts play a significant role in mental health has been extensively addressed in various psychological traditions, including personal construct theory. In the context of the latter, several measures of conflict have been operationalized using the Repertory Grid Technique (RGT). All of them capture the notion that change, although desirable from the viewpoint of a given set of constructs, becomes undesirable from the perspective of other constructs. The goal of this study is to explore the presence of cognitive conflicts in a clinical sample (n = 284) and compare it to a control sample (n = 322). It is also meant to clarify which among the different types of conflict studied provides a greater clinical value and to investigate its relationship to symptom severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas were the only ones to discriminate between clinical and nonclinical samples. These dilemmas were found in 34% of the nonclinical sample and in 53% of the clinical sample. Participants with implicative dilemmas showed higher symptom severity, and those from the clinical sample displayed a higher frequency of dilemmas than those from the nonclinical sample.
Meaning-Making in the Face of Intersecting Catastrophes: COVID-19 and the Plague of Inequality
Beyond the enormous toll in illness and death, the COVID-19 pandemic unleashed multiple additional problems (job loss, evictions, hunger) that are disproportionately borne by those who were already vulnerable. In this essay, I reflect about these , which I see as undermining the capacities of many to live meaningful and fulfilling lives. Symptoms of these problems are growing "deaths of despair" due to suicide, drug and alcohol addictions. Drawing on multidisciplinary science, I suggest that these widespread problems cannot be ministered to by focusing only at the individual level. Structural factors, including unfair distributions of resources and opportunities demand attention as well because they are fueling growing disparities between the privileged and the disadvantaged segments of contemporary societies. I examine what meanings and emotions are relevant responses to these troubled times, giving emphasis to the legitimacy of anger and outrage in the face of suffering and injustice. Further insight is sought in historical accounts of longstanding tensions between self-interest and the social contract. Going forward, I suggest that these turbulent times call for greater engagement with and scientific understanding of the arts and humanities in activating the deepest corners of our humanity. Examples from past and current art dealing with human suffering, inequality, and plagues illustrate their possible role in nurturing human capacities to understand, to care, and to act.