Neural underpinnings of ethical decisions in life and death dilemmas in naïve and expert firefighters.

When a single choice impacts on life outcomes, faculties to make ethical judgments come into play. Here we studied decisions in a real-life setting involving life-and-death outcomes that affect others and the decision-maker as well. We chose a genuine situation where prior training and expertise play a role: firefighting in life-threatening situations. By studying the neural correlates of dilemmas involving life-saving decisions, using realistic firefighting situations, allowed us to go beyond previously used hypothetical dilemmas, while addressing the role of expertise and the use of coping strategies (n = 47). We asked the question whether the neural underpinnings of deontologically based decisions are affected by expertise. These realistic life-saving dilemmas activate the same core reward and affective processing network, in particular the ventromedial prefrontal cortex, nucleus accumbens and amygdala, irrespective of prior expertise, thereby supporting general domain theories of ethical decision-making. We found that brain activity in the hippocampus and insula parametrically increased as the risk increased. Connectivity analysis showed a larger directed influence of the insula on circuits related to action selection in non-experts, which were slower than experts in non rescuing decisions. Relative neural activity related to the decision to rescue or not, in the caudate nucleus, insula and anterior cingulate cortex was negatively associated with coping strategies, in experts (firefighters) suggesting practice-based learning. This shows an association between activity and expert-related usage of coping strategies. Expertise enables salience network activation as a function of behavioural coping dimensions, with a distinct connectivity profile when facing life-rescuing dilemmas.

Mental health and post-traumatic stress disorder in firefighters: an integrated analysis from an action research study.

Introduction: The presence of post-traumatic stress disorder (PTSD) symptomatology in firefighters is an ever-pressing issue that requires close attention for adequate interventions. The present study investigated PTSD and global psychopathology prevalence in a sample of highly risk-exposed Portuguese firefighters, collected after the widespread deadly wildfires in 2017 that ravaged the country. Following an action research approach, the aim of this study was to depict this sample and examine the impact of cumulative adverse experiences on their mental health, which is a phenomenon worth attention. Method: From an initial sample of 283 firefighters who manifested interest in participating, a total of 139 firefighters from the Coimbra District, of whom 130 unequivocally experienced a potentially traumatic/adverse event as a firefighter, completed BSI (to obtain indicators on psychopathology), QEPAT (an inventory of adverse events possibly experienced as a firefighter), and PCL-5 (a measure of PTSD symptomatology) through an online survey during the year 2018 by the Regional Medical Organization, as proposed and supervised by the local Centre for Prevention and Treatment of Psychological Trauma (CPTTP). Results: We found a global prevalence of 8.6% of possible PTSD and 14.4% of possible psychopathology (n = 139). When considering only firefighters who unequivocally reported a potentially traumatic/adverse event as a firefighter (n = 130), 9.2% present possible PTSD, and 13.8% present possible global psychopathology. This sample experienced a mean of 28 adverse events during firefighting work. Linear regressions (n = 118) demonstrated that the perceived severity of the most traumatic event reported and the experience of more adverse events were both related to an increase in PTSD symptomatology. Global psychopathology was associated with PCL-5 scores, with an emphasis on paranoid ideation, hostility, depression, anxiety, and phobic anxiety. Discussion: The severe wildfires of 2017 did not impact PTSD scores in this sample (collected the year after), suggesting that cumulative adverse events are more important than particular episodes. However, the number of reported events was related to PTSD scores. These results can be used to develop interventions that target all firefighters by addressing risk and protective factors. This action research study motivated specialized aid for firefighters involved in this study.

A constituição do self a partir das relações familiares abusivas: um enfoque winnicottiano / Self organization and abusive familiar relations: an approach to Winnicott’s theory

A violência intrafamiliar é um problema milenar e complexo, que ocorre ao longo do ciclo vital, em todas as regiões do mundo, sem distinção de classe social, grupo racial, nível económico, educacional ou religião. Constitui uma violação dos direitos humanos fundamentais e uma ofensa à dignidade humana, limitando o reconhecimento e exercício de tais direitos. O presente artigo articula a teoria winnicottiana da constituição do self com experiências clínicas de uma paciente que vivenciou situações de violência intrafamiliar de forma precoce. Observou-se na análise deste caso clínico que a paciente no início do seu processo de amadurecimento desenvolveu um falso self patológico para proteger seu verdadeiro self. Diante de seu ambiente familiar invasivo e ameaçador a paciente acabou por desenvolver uma personalidade borderline do tipo como se. A partir destes pressupostos teóricos propõe-se uma aplicação deste modelo à compreensão das dimensões sintomáticas e etiológicas das perturbações do tipo estado-limite bastante freqüente nos casos de violência intrafamiliar.

Family violence is an ancient and complex problem, which occurs throughout the life cycle, in all regions of the world, without distinction of social class, racial, economic, educational, or religion. It constitutes a violation of fundamental human rights and is an affront to human dignity, limiting the recognition and exercise of such rights. The present paper articulates Winnicott’s theory of self organization in one patient subject to violent family relations early on. One could observe in the analysis of this clinical case that the patient at the beginning of his maturation process developed a pathological false self to protect his true self. In face if his family’s invasive and threatening environment, the patient eventually developed a borderline personality type as if. Considering the Winnicott’s theoretical assumptions an application of this model is proposed to the understanding of the symptomatic and etiological dimensions of borderline disorders, very common in the cases of domestic violence.