Containment and ‘rational health’: Moran and psychoanalysis

The paper focuses on Richard Moran's account (in Authority and Estrangement) of the distinction between attitudes that meet, and alternatively fail to meet, his transparency criterion for what he calls rational health, and compare this with the psychoanalytic distinction between contained and uncontained states of mind. On the face of it, Moran's distinction appears to be a useful theoretical deepening of the psychoanalytic distinction. On closer examination, however, it appears that (a) rational health is a more demanding standard than containment, so the rationally unhealthy contains much that is mentally (quite) healthy; and (b) more seriously, some states that meet the “transparency” condition are manifestly mentally unhealthy. So transparency needs to be supplemented by an independently understood notion of containment to approach a realistic norm of mental health/ill health.     

Counseling the ‘disadvantaged’

In this article, Henrietta Tolson looks at the obstacles to a sharing relationship with clients which counselors set up by stereotyping people and seeking to enhance their own status. With the vision of someone who has worked for many years with people in Seattle's central area, she discusses the subtleties of racial and economic prejudice among well meaning, middle class counselors and case workers.     

A client‐generated psychometric instrument: The development of ‘PSYCHLOPS’

PSYCHLOPS (Psychological Outcome Profiles) is a recently developed, client‐generated, psychometric instrument that can be used as an outcome measure. Based on a similar instrument developed primarily for use in physical illnesses (MYMOP — ‘Measure Your Medical Outcome Profile’), it seeks the client's perspective on their psychological distress. It asks them to describe and then score the problem that troubles them the most at the start of counselling. We describe the development of PSYCHLOPS, including the involvement of the Plain English Campaign and two national mental health organisations: the mental health charity and support group, Depression Alliance (DA) and Primary Care Mental Health Education (PRIMHE). We review the literature and suggest that PSYCHLOPS, by focusing on the problems of greatest priority to the client, might prove a sensitive measure of improvement after counselling.     

THE ILLIBERALITY OF ‘LIBERAL EUGENICS’

This essay evaluates the moral logic of ‘liberal eugenics’: the ideal of genetic control which leaves decisions about what sort of people to produce in the hands of individual parents, absent government intervention. I argue that liberal eugenics cannot be justified on the basis of the underlying liberal theory which inspires it. I introduce an alternative to Rawls's social primary goods that might be called natural primary goods: hereditable mental and physical capacities and dispositions that are valued across a range of projects and pursuits. I suggest that reproductive genetic biotechnologies like embryo selection, cellular surgery, and genetic engineering, which aim to enhance ‘general purpose’ traits in offspring are less like childrearing practices a liberal government leaves to the discretion of parents than like practices the state makes compulsory. I argue that if the liberal commitment to autonomy is important enough for the state to mandate childrearing practices such as health care and basic education, that very same interest is important enough for the state to mandate safe, effective, and functionally integrated genetic practices that act on analogous all‐purpose traits such as resistance to disease and general cognitive functioning. I conclude that the liberal case for compulsory eugenics is a reductio against liberal theory.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

Metaphysics of Pain; Semantics of ‘Pain’

Functionalism is often used to identify mental states with physical states. A particularly powerful case is Lewis's analytical functionalism. Kripke's view seriously challenges any such identification. The dispute between Kripke and Lewis's views boils down to whether the term ‘pain’ is rigid or nonrigid. It is a strong intuition of ours that if it feels like pain it is pain, and vice versa, so that ‘pain’ should designate, with respect to every possible world, all and only states felt as pain. Hence, in order to settle the dispute, we need to check which of the two – Kripke's use of ‘pain’ as rigid, or Lewis's use of ‘pain’ as nonrigid – better meets this intuition. I show that, despite crucial differences in both their semantic and metaphysical assumptions, surprisingly, both views meet this intuition equally well. Thus it appears that this question of rigidity cannot, in principle, be solved, and so, at least with respect to this particular dispute, the jury is still out on whether mental states are identical to physical states. 1     

The ‘healthy’ family*

The importance of concepts and hypotheses about ‘healthy’ families for family therapists is stressed. A number of different approaches to defining ‘health’ is described. Concepts and hypotheses of family therapists from different schools are integrated into a more encompassing theory, thereby focusing on statements with respect to personality, cognition, behaviour, communication, relationship, role, family system and network. It is noted that family therapy literature lacks information about ‘healthy’ families. Moreover, nearly all statements are non-scientific and normative as they are not founded on empirical research.     

Creating space for interdisciplinary and interagency learning: the Newham ‘responsiveness’ days

Family therapists in Newham's specialist child and adolescent mental health services describe an interdisciplinary and interagency training day for Newham's children's workforce; the workshop aims to develop co‐learning about communication and collaboration in the context of a rapidly changing service environment, driven by current national and local policy initiatives. The training team attempts to generate a rich learning context using three themes: networking, responsiveness and complexity. The workshop demonstrates that it is perhaps possible to embed complex communication discourses in brief, pragmatic training, enhancing collaboration between professionals in local networks.     

Neither ‘Good’ in Terms of ‘Better’ nor ‘Better’ in Terms of ‘Good’

In this paper, I argue against defining either of ‘good’ and ‘better’ in terms of the other. According to definitions of ‘good’ in terms of ‘better’, something is good if and only if it is better than some indifference point. Against this approach, I argue that the indifference point cannot be defined in terms of ‘better’ without ruling out some reasonable axiologies. Against defining ‘better’ in terms of ‘good’, I argue that this approach either cannot allow for the incorruptibility of intrinsic goodness or it breaks down in cases where both of the relata of ‘better’ are bad.     

Men's experience of considering counselling: ‘Entering the unknown’

Agency statistics in the UK and North America reveal that fewer men than women attend counselling, at a ratio of about 1:2. This study investigated men's experience of considering counselling, with the aim of gaining further understanding of factors that might contribute to the existing gender discrepancy in utilisation of counselling. Following responses by 47 men to written questionnaires, 10 men who had considered and ultimately attended counselling were interviewed, and a grounded theory method of analysis was used to generate and analyse the participants' experiences. Three interconnected categories emerged: societal perceptions of counselling and gender roles; change of experience over time; and knowledge — ‘knowing’ and ‘not knowing’ the protocols of counselling. The implications of these findings are discussed. It is recommended that prospective male clients should be provided with information about the counselling process, and that there needs to be increased awareness by counsellors and referring agents of male gender issues.     

Development and the epigenome: the ‘synapse’ of gene–environment interplay

This paper argues that there is a revolution afoot in the developmental science of gene–environment interplay. We summarize, for an audience of developmental researchers and clinicians, how epigenetic processes – chromatin structural modifications that regulate gene expression without changing DNA sequences – may offer a strong, parsimonious account for the convergence of genetic and contextual variation in the genesis of adaptive and maladaptive development. Epigenetic processes may play a plausible explanatory role in understanding: divergent trajectories and sexual dimorphisms in brain development; statistical interactions between genes and environments; the biological embedding of early psychosocial adversities; the linkages of such adversities to disorders of mental health; the striking individual variation in the strength of those linkages; the molecular origins of critical and sensitive periods; and the transgenerational inheritance of risk and protection. Taken together, these arguments converge in a claim that epigenetic processes constitute a promising and illuminating point of connection – a ‘synapse’ – between genes and environments.     

Coercion and ‘voluntary’ admission: An examination of psychiatric patient views

This article examines coercion in voluntary psychiatric patients. Three main themes are highlighted using qualitative and quantitative data from a sample of 412 psychiatric patients surveyed in 1990 who had experienced at least one period of hospitalisation. The themes are: the extent to which the label of ‘voluntary’ was an indicator of the patients' experience of being in hospital of their own volition; aspects of admission which patients considered to be coercive; and the impact that coercion might have on patients' views about their problem, professionals and treatment. The findings suggest that a substantial number of nominally voluntary patients reported coercive aspects of their hospitalisation. The impact of feeling coerced was found to produce a more rejecting attitude towards psychiatric services. The findings are discussed in relation to British mental health legislation and care. I particularly want to thank David Pilgrim for his collaboration with the research which made this article possible and for his useful and supportive comments. I am also indebted to John Monahan for his helpful comments on an earlier draft of this paper.     

Inviting passage to new discourse: ‘Alive moments’ and their spiritual significance

Some social constructionists assert that therapeutic change occurs when clients' meanings for problems and solutions shift from those found in resource‐impoverished discourses to those affording resourceful and preferred possibilities. Referred to as ‘positioning theory’, our research examined this assertion by inviting clients and therapists to speak of a significant, but ambiguous, experience in unfamiliar discourse: spiritual discourse. Clients were asked to review videotapes of their sessions, selecting moments that felt most ‘alive’ to them for discussions with the researcher, including inquiries as to whether ‘alive’ moments held any spiritual significance. The outcomes are portrayed as a ‘poetic collaboration’ between the researcher, clients and therapists — while clients' and therapists' reported experiences for changes in discourse and meaning are highlighted. Implications regarding sensitivities required when co‐constructing meanings for ambiguous but significant experiences in therapy are discussed. Possibilities for more research examining poetic practices and processes in therapy are also considered in terms of positioning theory.     

Philosophical dialogues as paths to a more ‘positive psychology’

Although family support programmes have been in place for several decades in Greece very little attention has been paid to evaluating the effectiveness of such endeavours, the techniques that influence their outcomes and the receptiveness to their messages. The purpose of this paper is to give an overview of research findings collected during the first qualitative research phase of a community mental health promotion project. The research was conducted in order to delineate programme outcomes and the characteristics that had an impact on the participants' lives. The 3‐month family support programme intended to introduce ‘philosophical dialogues’ as means to developing personal and communal understandings of what makes life worth living. The programme was developed and implemented on Crete under the auspices of a non‐profit community organization appropriately named ‘The Lyceum for Women’. The features of the programme that contributed and enhanced the participants' tendencies to become not passive targets but active partners and stakeholders in the process will be clarified, as will the conceptualization and approach. Of the 45 evaluation protocols that were analysed the following themes were most important for the participants: ‘Group as‐a‐whole process’—the sense of sharing and development understandings in a ‘parea’ (in‐group); ‘relational outcomes’—feeling of belonging, ‘reciprocated kindness’, and giving of self to others; personal and emotional outcomes‐self‐efficacy and empowerment; knowledge outcomes‐learning about positive emotions and enjoying the simple things in life; and group facilitator outcomes‐sharing stories, ‘gives of self to the community’. Copyright © 2007 John Wiley & Sons, Ltd.     

Peter Winch on ‘Aristotelian’ and ‘Socratic’ Reasoning

Peter Winch often returned to questions about the nature of logic. In the context of his work on Wittgenstein and political philosophy in the 1990s, Winch described a contrast between ‘Aristotelian’ and ‘Socratic’ reasoning. Aristotelian conceptions of reasoning, attributed to Frege and Russell, would see logic as a formal science and rationality as consistency with pre‐existent rules of inference. The Socratic conception, attributed to Wittgenstein, understands rational argument as a form of socially embedded dialogue that involves moral relationships and a dimension of depth. Rational persuasion may also involve use of persuasive images and examples.