Spiritual Practice,Health Promotion,and the Elusive Soul: Perspectives from Public Health

Spirituality and religion are topics of increasing interest in U.S. society and popular culture as well for many health professions, including medicine, psychology, and public health. This article comments on Mark Graves’ (2008) synthesis of science and spirituality/religion, Mind, Brain, and the Elusive Soul from the perspective of a public health professional. I briefly review the sources, extent, and conceptual approaches of emerging scientific and health interest in spirituality/religion. Spiritual practices are identified as phenomena of central interest. Major concepts of Graves’ synthesis are reviewed, and the soul’s relevance to spiritual growth, popular culture, and scientific application is discussed. Several questions are posed as a stimulus to further extension and refinement of Graves’ synthesis.     

Suicide Prevention from a Public Health Perspective

The public health approach to health problems provides a strong framework and rationale for developing and implementing suicide prevention programs. This approach consists of health-event surveillance to describe the problem, epidemiologic analysis to identify risk factors, the design and evaluation of interventions, and the implementation of prevention programs. The application of each of these components to suicide prevention is reviewed. Suggestions for improving surveillance include encouraging the use of appropriate coding, reviewing suicide statistics at the local level, collecting more etiologically useful information, and placing greater emphasis on analysis of morbidity data. For epidemiologic analysis, greater use could be made of observational studies, and uniform definitions and measures should be developed and adopted. Efforts to develop interventions must include evaluating both the process and the outcome. Finally, community suicide prevention programs should include more than one strategy and, where appropriate, should be strongly linked with the community's mental health resources. With adequate planning, coordination, and resources, and the public health approach can help reduce the emotional and economic costs imposed on society by suicide and suicidal behavior.     

Judging Public Health Research: Epistemology,Public Health and the Law

There are three broad ethical issues related to handling public health emergencies. They are the three R's—rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions.     

The Public Policy Pedagogy of Corporate and Alternative News Media

This paper argues for seeing in-depth news coverage of political, social, and economic issues as “public policy pedagogy.” To develop my argument, I draw on Nancy Fraser’s democratic theory, which attends to social differences and does not assume that unity is a starting point or an end goal of public dialogue. Alongside the formation of “subaltern counterpublics” (Fraser), alternative media outlets sometimes develop. There, members of alternative publics debate their interests and strategize about how to be heard in wider, mass-mediated public arenas. I address the normative implications of this non-unitary, multiple-publics model for news journalism, analyzing how current conventions in mainstream news journalism (e.g., “balance” defined as “airing two extremes”) can restrict public debate and impoverish the public policy pedagogy on offer. I illustrate my arguments with a case study of media coverage of the creation and implementation of a social justice curriculum in British Columbia, Canada.     

Euthanasia and Assisted Suicide from Confucian Moral Perspectives

This essay first discusses the three major arguments in favor of euthanasia and physician-assisted-suicide in contemporary Western society, viz., the arguments of mercy, preventing indignity, and individual autonomy. It then articulates both Confucian consonance and dissonance to them. The first two arguments make use of Confucian discussions on suicide whereas the last argument appeals to Confucian social-political thought. It concludes that from the Confucian moral perspectives, none of the three arguments is fully convincing.     

Bringing the Public Health Approach to the Problem of Suicide

Suicide and suicidal behavior are public health problems that should be addressed through a systematic public health approach. The need for such an approach can be found, for example, in Pierre, SD, where the suicide rate is 13 times the national rate; in the African American community, where the suicide rate among Black youths more than doubled between 1980 and 1995; and across the United States, where suicides outnumbered homicides in 1995. The U.S. Public Health Service is applying the public health approach to suicide by preparing the first-ever Surgeon General's Report on Mental Health, and by holding an October conference in Reno aimed at advancing a national strategy for suicide prevention.     

Changes in Reporting of Suicide News After the Promotion of the WHO Media Recommendations

Media recommendations on suicide reporting are available in many countries and in different languages. Hong Kong newspapers have been found to be noncompliant with WHO recommendations. A booklet containing WHO media guidelines Preventing Suicide: A Resource for Media Professionals, and an awareness campaign were launched in November 2004 in Hong Kong. Content analysis was then conducted to compare the reporting of suicide news before and after the launch. Results indicate that certain reporting styles were changed in accordance with the recommendations; namely, lessened use of pictorial presentations and headlines mentioning suicides. Most of the changes were attributed to the tabloid‐style newspapers. This study suggests that programs to promote media recommendations tailored for journalists appear to be efficacious in altering their way of reporting.     

Research in Adolescent Suicide: Implications for Training,Service Delivery,and Public Policy

Four domains of research in adolescent suicide are reviewed: (1) the role of psychopathology, (2) family history of psychopathology, (3) mental health treatments, and (4) firearms in the home. Based on the extant literature, recommendations are made for changes in training, service delivery, and public policy. Among the recommendations for training professionals are: an emphasis on diagnostic proficiency, skill and attentiveness in the assessment of the entire family unit, and assessment of the availability of firearms in the home. With respect to changes in service delivery, we recommend treatment of the entire family system, and treatment of psychiatric and substance abuse problems in the same setting, and we show the need for a continuum of intensity of care from inpatient to outpatient. With respect to policy changes, we recommended parity of mental and physical health insurance coverage, screening for psychiatrically at-risk youngsters in schools and physicians' offices, providing funding to support a continuum of care between inpatient and outpatient, and gun control laws to restrict access to handguns. We believe that these changes can result in a substantial reduction in the adolescent suicide rate.     

The Media and Suicide: A Nonadditive Model, 1968–1980

Unlike previous work, the present investigation tests a nonadditive model of the suggestion/imitation. Suicide stories are predicted to have the greatest effect on suicide in times of high suicidogenic conditions. The latter are measured in terms of unemployment. Data on the American monthly suicide rate are analyzed using Cochrane Orcutt techniques. While support was found for the nonadditive model based on an interaction effect between media stories and the rate of unemployment, it did not prove more powerful than an additive model. Future work is needed, however, for a systematic testing of the nonadditive thesis.     

Ethics for Mental Health Influencers: MFTs as Public Social Media Personalities

The increase in social media usage contributes to a greater number of Marriage and Family Therapists (MFTs) using social media to grow their professional outreach and to increase awareness about mental health by engaging with online audiences. Although existing literature has discussed how MFTs can make ethical use of personal social media in and around their therapeutic role, no literature at this time has explored the potential ethical issues faced by MFTs seeking to build public presence on social media as a “mental health influencer.” The present paper intends to provide a definition of mental health influencers (MHIs) and reviews ethical concerns relevant to MFTs acting as MHIs. Particular consideration is given to ethical dilemmas and conflicts-of-interest which may emerge via parasocial relationships developed through social media influencing, as well as how the boundaries and the limitations of an MFT’s professional scope can be tested when presenting as a personable, public figure over digital platforms. A framework for conceptualizing ethical issues for MHI-MFTs is offered, with a selection of prescient issues being examined within the scope of existing ethical standards set forth by the American Association of Marriage and Family Therapy’s (AAMFT) Code of Ethics. Reflections are offered about what questions and guidelines should be observed by MFTs in order to avoid unethical use of social media as an MHI, followed by a brief discussion about future considerations which should be considered by MHIs.

     

Assisted Suicide,Euthanasia, and Suicide Prevention: The Implications of the Dutch Experience

What impact would legalization of assisted suicide and euthanasia have on our ability to treat suicidal patients and to prevent suicide? Information from a study of the Dutch experience illustrates how legal sanction promotes a culture that transforms suicide into assisted suicide and euthanasia and encourages patients and doctors to see choosing death as a preferred way of dealing with serious or terminal illness. The extension of the right to euthanasia to those who are not physically ill further complicates the problem. So too does the tendency of doctors in such a culture to begin to feel that they can make decisions about ending the life of competent terminally ill patients without consulting the patient. “Normalizing” suicide as a medical option lays the groundwork for a society that turns euthanasia into a “cure” for suicidal depression.     

The Effect of the Media on Suicide: Evidence From Japan, 1955–1985

Research on media impacts on suicide has been largely restricted to the United States, a Christian nation marked by moral aversion to suicide. The present study extends the analysis to an Eastern nation, Japan, where people are less critical of those who suicide. Such a cultural definition of suicide might multiply imitative effects. Yule-Walker times series estimates indicate that the imitative effect is restricted to stories concerning Japanese victims. Further, the increase is similar in magnitude to that reported in the American cultural context. The Japanese audience may not be as predisposed to media effects, given a lower divorce rate, low couple centeredness, and a high level of extended family social support. These factors may offset a potentially very high “Werther effect.” The model explains 88% of the variance in monthly Japanese suicide rates.     

Differentiating Suicide Attempters from Suicide Ideators: A Critical Frontier for Suicidology Research

Most individuals who consider suicide do not make suicide attempts. It is therefore critical to identify which suicide ideators are at greatest risk of acting on their thoughts. However, few seminal theories of suicide address which ideators go on to make attempts. In addition, perhaps surprisingly, most oft‐cited risk factors for suicide—such as psychiatric disorders, depression, hopelessness, and even impulsivity—distinguish poorly between those who attempt suicide and those who only consider suicide. This special section of Suicide and Life‐Threatening Behavior serves to highlight this knowledge gap and provide new data on differences (and similarities) between suicide attempters and suicide ideators.     

Suicide: Media Impacts in War and Peace, 1910–1920

The literature of the impact of publicized suicide stories on suicide has neglected the influence of social contexts. In the present study, the context of a popular war was inspected. A Durkheimian perspective was tested, wherein the context of war would lower suicide through promoting social integration. Suicide stories in such times should have less of an impact than in times of peace. Data were collected on widely publicized suicide stories during the World War I decade. A Cochrane—Orcutt iterative time series analysis found that publicized suicide stories during war had no impact on suicide. In contrast, peacetime suicide stories were associated with an increase of 48 suicides. This is significant, since the electronic media were nonexistent and hence could not reinforce the publicity in the printed media, as they do today. Further analysis of the relationship found similar results for New York City.