Psychosocial Correlates of Medical Mistrust Among African American Men

The current study proposed and tested a conceptual model of medical mistrust in a sample of African American men (N = 216) recruited primarily from barbershops in the Midwest and Southeast regions of the United States. Potential psychosocial correlates were grouped into background factors, masculine role identity/socialization factors, recent healthcare experiences, recent socioenvironmental experiences (e.g., discrimination), and healthcare system outcome expectations (e.g., perceived racism in healthcare). Direct and mediated relationships were assessed. Results from the hierarchical regression analyses suggest that perceived racism in healthcare was the most powerful correlate of medical mistrust even after controlling for other factors. Direct effects were found for age, masculine role identity, recent patient–physician interaction quality, and discrimination experiences. Also, perceived racism in healthcare mediated the relationship between discrimination experiences and medical mistrust. These findings suggest that African American men’s mistrust of healthcare organizations is related to personal characteristics, previous negative social/healthcare experiences, and expectations of disparate treatment on the basis of race. These findings also imply that aspects of masculine role identity shape the tone of patient–physician interactions in ways that impede trust building processes.     

A Priestly Approach to Environmental Theology: Learning to Receive and Give Again the Gifts of Creation

Abstract : A priestly sensibility is here presented as a way to characterize humanity's place in creation. Sacrifice, asceticism, and gratitude are described as three distinct and practical modalities of a priestly life that contribute to the care and celebration of creation. While a priestly understanding is often associated with Orthodox environmental theology, it has the potential to inform environmental theology broadly construed.     

The priest as counsellor: An investigation of critical incidents in the pastoral work of catholic priests

Given the number of priests engaged in the apostolate and considering the interpersonal nature of most of their tasks it is remarkable that despite the number of books and articles written on the priesthood, it appears there has been no attempt to empirically examine and typify the interpersonal context of priestly practice. This paper presents the results of an investigation which was undertaken to identify and analyze what actually happens at the priest-priest and priest-layperson interace apropos interpersonal communication in the pastoral work of catholic priests. The paper provides a picture of critical incidents in interpersonal interactions. It presents a report of the central communication problems in priestly work using an ethnographic approach to sketch and analyze the range of factors which impinge on the interpersonal process. The results indicate that counselling skills form a key part of the day-to-day work of the priest.     

Gandalf’s solution to the Newcomb problem

This article proposes a new theory of rational decision, distinct from both causal decision theory (CDT) and evidential decision theory (EDT). First, some intuitive counterexamples to CDT and EDT are presented. Then the motivation for the new theory is given: the correct theory of rational decision will resemble CDT in that it will not be sensitive to any comparisons of absolute levels of value across different states of nature, but only to comparisons of the differences in value between the available options within states of nature; however, the correct theory will also resemble EDT in that it will rely on conditional probabilities (not unconditional probabilities). The new theory gives a prominent role to the notion of a “benchmark” for each state of nature, by comparison with which the value of the available options in that state of nature are measured, and so it has been called the Benchmark Theory (BT). It is argued that BT gives the right verdict on the cases that seem to be counterexamples to CDT and EDT. Finally, some objections to BT are considered and answered.     

In Pursuit of the MD: The Impact of Role Models, Identity Compatibility, and Belonging Among Undergraduate Women

Women continue to face gender-related challenges in the medical field in places around the world where it has traditionally been male-dominated, including in the U.S. In an online experimental study with women attending a mid-sized public university in the Northeastern U.S. (N?=?55) who were interested in pursuing a pre-medical track (being pre-med) as undergraduates, we explored the mechanisms involved in undergraduate women’s pursuit of a career as a physician, focusing on three factors: exposure to successful female physician role models, perceived identity compatibility between being a woman and being pre-med, and sense of belonging in pre-med. Participants were randomly assigned to an experimental condition in which they were exposed to information about successful female physicians, or to a control condition in which no information about female physicians was provided. First, as hypothesized, participants exposed to successful female physicians reported higher perceived identity compatibility, sense of belonging, and interest in a medical career compared to those in the control condition. Second, also as hypothesized, perceived identity compatibility mediated the effect of role models on sense of belonging, and sense of belonging mediated the relationship between perceived identity compatibility and interest in a medical career. This study highlights three key factors in women’s pursuit of a career as a physician and the process through which these factors may operate. Findings support the use of role models to set a positive psychosocial process in motion that can support women’s persistence in medicine.     

The Ecclesiology of Saint Maximos the Confessor

Abstract

Maximos wrote no work expressly on the Church, the nearest being his work, the Mystagogia, on the Divine Liturgy. This article explores the notion of the Church presented in the Mystagogia, which focuses on the action of the Divine Liturgy, and the way in which what happens in the Church is reflected at every level of reality, from the transcendent reality of God, through the manifold unity of the cosmos, to the depths of the human soul. This vision of the Church — at once cosmic, eschatological, eucharistic and ascetic — is then related to Maximos' views on the institutional Church, as revealed in a few works preserved and related to his struggle for Orthodoxy during the monothelite controversy. These views concerned the place of the priestly hierarchy, especially the papacy, and also the claims of the Byzantine emperor to involve himself in doctrinal matters.     

A Contextualized Approach to Patient Autonomy Within the Therapeutic Relationship

Some authors have advanced a contractual model to protect patient autonomy within the therapeutic relationship. Such a conception of the physician–patient relationship is intended to serve both parties by respecting patients' choices and preserving physician integrity. I critique this contractual view and offer an alternative, feminist contextualized approach to autonomy within the therapeutic relationship. This approach places the physician-patient relationship within a larger social context, and indicates the many social inequalities that render insupportable the notion of physicians and patients as contracting equals.     

Family therapy and communion

There has been a shift of healing authority in our culture from priestly practitioners to scientific and medical practitioners. As part of this change the care and healing of stressed or broken families is now seen as the responsibility of the family therapist. A consequence of this has been some role confusion on the part of the clergy and therapists. A comparison of the symbolic complex of belief and value systems used in MacGregor's team-family method of family therapy and Joseph Haroutunian's theology of the church shows four striking similarities. The implications of these similarities for the continued confusion or clarity of the roles of priest and therapist are noted.Rev. Fitchett is Chaplain-Supervisor and Assistant Professor, Department of Religion and Health, Rush-Presbyterian-St. Luke's Medical Center, 1753 West Congress Parkway, Chicago, Illinois 60612.     

The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: an analogue study.

Evaluated the effect of varied physician affect on subject recall, anxiety, and perceptions in a simulated tense and ambiguous medical situation. Forty women at risk for breast cancer viewed videotapes of an oncologist presenting--with either worried or nonworried affect--mammogram results. Although the mammogram results and the oncologist were the same in both presentation, analyses indicated that, compared to the women receiving the results from a nonworried physician, the women receiving the results from a worried physician recalled significantly less information, perceived the clinical situation as significantly more severe, reported significantly higher levels of state anxiety, and had significantly higher pulse rates. These results suggest that physician affect plays a critical role in patient reaction to medical information. Implications for compliance research, patient satisfaction, and physician training are discussed.     

从医师的视角浅析医疗差错的辩证观

医疗差错是影响医疗安全的最重要因素。有效预防和正确处理医疗差错,需要以科学辩证的认识为前提。当前,我国医院管理实践在一定程度上缺乏对医疗差错的辩证认识,导致在处理上存在些许不足。本文从医师的视角,对如何辩证地认识医疗差错进行浅述。指出,医疗差错在相当程度上源于人的出错之天性和医学的复杂性,广泛存在于医疗实践中,发生具有必然性;虽然从表象上看,医疗差错的原因是局部的,但其本质的原因是系统性的;医疗差错是医疗安全系统运行状况的"指示灯",有助于及时地了解安全系统的薄弱环节,为完善和提升系统安全、提高医疗服务水平提供契机。     

Informed consent and the disclosure of risks of treatment: The Supreme Court of Canada Decides

The requirement for disclosure of risks of treatment as part of informed consent came before the Supreme Court of Canada in two 1980 cases. The Court found the duty of disclosure of risks to be based in negligence and not battery. The scope of the duty is not to be determined by medical evidence alone and requires the physician to disclose the nature of the proposed treatment, its gravity, any material risks and any special or unusual risks as well as answering in a reasonable way all specific questions asked by the patient. Whether the patient would have decided differently if all the information were known is an objective test, based on what the reasonable person in the patient's particular circumstance would do.     

Characterizing hallucination epistemically

According to the epistemic theory of hallucination, the fundamental psychological nature of a hallucinatory experience is constituted by its being ‘introspectively indiscriminable’, in some sense, from a veridical experience of a corresponding type. How is the notion of introspective indiscriminability to which the epistemic theory appeals best construed? Following M. G. F. Martin, the standard assumption is that the notion should be construed in terms of negative epistemics: in particular, it is assumed that the notion should be explained in terms of the impossibility that a hallucinator might possess a certain type of knowledge on a certain basis. I argue that the standard assumption is mistaken. I argue that the relevant notion of introspective indiscriminability is better construed in terms of positive epistemics: in particular, I argue that the notion is better explained by reference to the fact that it would be rational for a hallucinator positively to make a certain type of judgement, were that judgement made on a certain basis.     

Der Begriff „ličnost’“ in den theoretischen Schriften Andrej Belyjs und Aleksandr Bloks

In the work of the Russian symbolist Andrej Belyj (1880–1934) the question concerning the essence of personality [li?nost’] plays an important role throughout his life and is developed in both his literary and philosophical-theoretical writings. Although Belyj wrote no text specifically devoted to this notion, it is nonetheless possible to reconstruct genetically a more or less cohesive theory of personality. In the case of Aleksandr Blok (1880–1921), who left behind relatively few works of a theoretical nature, the situation is different. In these works, moreover, the problems involved in the notion of personality are hardly touched upon and are not philosophically deepened. Nevertheless, a few disparate elements of a notion of personality can be pointed out for Blok.     

Training for Priesthood in the Modern World: A Zarathushtrian Perspective

Abstract. This essay traces the development of the Zarathushtrian (Zoroastrian) priesthood from the time of the prophet Zarathushtra, through the Median priestly tribe as Magi, and the Macedonian and Arab invasions. This sets the stage for the separation of the Zarathushti priesthood between Iran and India and the generation of independent training methods. Centuries later dialogue between the two groups revealed some remarkable differences due to diverse cultural influences. From the eighteenth to the twentieth century there is a loss of respect for the priestly class and organization by the community of learning institutions to revamp the priestly training. The last portion of the paper discusses factors that affect the training of priests in North America. Some recommendations are put forward to adapt the training of the priesthood in the changing world society, and how these ideas can be brought to reality.     

Body of knowledge and the ontology of the body

The notion of competence in A Philosophical Basis of Medcial Practice presents a problem concerning the ontology of the body. This paper will maintain that an ontology of the body can only be based upon Cartesian grounds whereby the scientific knowable order is supposed to be identical to the natural order of things. Moral questions are not a part of this order and depend upon free will. Foucault has demonstrated that such a dualism between nature and morality cannot be warranted for contemporary medical practice. Medical science does not derive its foundation from a natural order but from the order of knowing which is present in the body of knowledge (episteme). This body of knowledge is the significative cultural force in the way of looking at problems of disease, life and death. Thus in contemporary medical practice, concepts of morality and competence which are based on notions of free will, shall be discarded as non-sensical, even for the patient.     

The physician in the technological age

Translator's summary and notes: Karl Jaspers (1883–1969) argues that modern advances in the natural sciences and in technology have exerted transforming influence on the art of clinical medicine and on its ancient Hippocratic ideal, even though Plato's classical argument about slave physicians and free physicians retains essential relevance for the physician of today. Medicine should be rooted not only in science and technology, but in the humanity of the physician as well. Jaspers thus shows how, within the mind of every medical person, the researcher contests with the physician and the technician with the humanist. Jaspers therefore opposes all modern tendencies that regard men as abstractions. As a creative existentialist influenced by Kierkegaard, Nietzsche, and Husserl, he reasons that clinical medicine should always treat patients as irreducable individuals, and his thinking on psychotherapy argues for a realm of interiority, freedom, intelligibility, and existential communication that transcends the reach of the causal thinking of natural science. This essay, written in 1959, reflects Jaspers' lifelong preoccupation with the philosophical meaning of medicine (he received his MD degree in 1909) and the totality of the human person. It should significantly enhance our own comprehension of medical power, dangers, reasoning, and accomplishments. Key words have been added by the translator.     

A study of the relationship between individual differences in nonverbal expressiveness and factors of personality and social interaction

Some theoretical and applied implications of individual differences in nonverbal expressiveness were investigated in a medical setting. In Study I, the abilities of 21 physicians to express different emotions through voice tone were assessed and related to physician personality and to actual patient ratings of the physician. Study II replicated Study I using visual as well as vocal cues (i.e., videotapes) of a new sample of physicians, and added a study of physician greetings. It was found that: (1) Aspects of expressive ability were reliably correlated with a cluster of personality traits, thus supporting the notion that nonverbal affective style may be a window to inner dispositions; and (2) expressive ability was related to patient satisfaction with the interpersonal manner of their physicians and to the judged likeability of the physician's greeting, thus providing evidence for the importance of this ability for social interaction.     

The flesh of the forest: Wild being in Merleau-Ponty and Werner Herzog

The history of the sublime within aesthetics has tended to focus on the natural world. Within this history, the sublime has been a category reserved for awe-inspiring and overwhelming experiences, in which the finite subject is dwarfed by a more expansive force. Despite subjectivity being foremost in this topic, what has been overlooked, is the role the body plays in being the centre of aesthetic experience. In this paper, I will turn the tide on this omission and thematize the role of the body within the experience of the sublime. My plan for reconsidering this movement is to unite Werner Herzog’s Aguirre, Wrath of God (1972) with the late thought of Merleau-Ponty, especially his enigmatic notion of "flesh" (Merleau-Ponty, 1968). In both Herzog and Merleau-Ponty, a philosophy of nature exists which challenges the dichotomy between the autonomous self encountering the objective realm of wilderness. In each case, an ambiguity undercuts the idea of wilderness existing "there" while human subjectivity remains placed "here." I will "read" the film as an instant of the chiasmatic relation between nature and humanity. Doing so, I will suggest that the reversibility between the body and the environment can be seen as an amplification of Merleau-Ponty’s notion of "wild being" (l’etre sauvage).     

On the self-undermining functionality critique of morality

Nietzsche's injunction to examine “the value of values” can be heard in a pragmatic key, as inviting us to consider not whether certain values are true, but what they do for us. This oddly neglected pragmatic approach to Nietzsche now receives authoritative support from Bernard Reginster's new book, which offers a compelling and notably cohesive interpretation of Nietzsche's On the Genealogy of Morality. In this essay, I reconstruct Reginster's account of Nietzsche's critique of morality as a “self-undermining functionality critique” and raise three problems for it: (i) Is there room within an etiological conception of function for the notion of self-undermining functionality? (ii) If Nietzsche's critique is internal and based solely on the function it ascribes to morality, where does that critique derive its normative significance from? (iii) Does Reginster's account not make out ascetic morality to be more universally dysfunctional than it is, given that some priestly types have done remarkably well out of morality?     

Two Philosophical Problems in the Study of Happiness

In this paper two philosophical issues are discussed that hold special interest for empirical researchers studying happiness. The first issue concerns the question of how the psychological notion(s) of happiness invoked in empirical research relates to those traditionally employed by philosophers. The second concerns the question of how we ought to conceive of happiness, understood as a purely psychological phenomenon. With respect to the first, I argue that 'happiness', as used in the philosophical literature, has three importantly different senses that are often confused. Empirical research on happiness concerns only one of these senses, and serious misunderstandings about the significance of empirical results can arise from such confusion. I then argue that the second question is indeed philosophical and that, in order to understand the nature of (what I call) psychological happiness, we need first to determine what a theory of happiness is supposed to do: what are our theoretical and practical interests in the notion of happiness? I sketch an example of how such an inquiry might proceed, and argue that this approach can shed more light on the nature and significance of happiness (and related mental states) than traditional philosophical methods.