THE CONCEPT OF ‘PSYCHOLOGICAL SAFETY’ – A PSYCHOANALYTICALLY‐INFORMED CONTRIBUTION TOWARDS ‘SAFE,SOUND & SUPPORTIVE’ MENTAL HEALTH SERVICES

It is not controversial to say that we live in an era of unprecedented preoccupation with the notion of ‘risk’ in our public mental health services, not to mention other areas of public life. Notions of ‘risk’ and ‘safety’ have long been at the heart of current government policy on mental health as epitomized by the guidance document entitled Modernising Mental Health Services: Safe, Sound & Supportive (Department of Health [DoH] 1998 Department of Health. 1998. Modernising Mental Health Services: Safe, Sound and Supportive, London: Department of Health.  [Google Scholar]). This is partly a consequence of the continuing switch of emphasis by both major political parties over the last 20 years or more away from hospital or in‐patient care and towards community‐based services. This is not the place, however, to focus on the political context. However, in clinical terms what really is the difference between a ‘safe’ or ‘secure’ mental health service and an ‘unsafe’ or ‘insecure’ one? The more I have been invited to think about this question, the more complex and unfamiliar the territory has revealed itself to be.     

What's so special about medicine?

Health care has increasingly come to be understood as a commodity. The ethical implications of such an understanding are significant. The author argues that health care is not a commodity because health care (1) is non-proprietary, (2) serves the needs of persons who, as patients, are uniquely vulnerable, (3) essentially involves a special human relationship which ought not be bought or sold, (4) helps to define what is meant by ‘necessity’ and cannot be considered a commodity when subjected to rigorous conceptual analysis. The Oslerian conception that medicine is a calling and not a business ought to be reaffirmed by both the profession and the public. Such a conception would have significant ramifications for patient care and health care policy.     

Masculine and feminine voices: Making ethical decisions in the care of the dying

Drawing on the example of one specific Ethics Committee, the author delineates feminine and masculine styles of ethical decision making and work with the dying as two sides of what it means to be humanistic in patient care. The author draws particularly on the work of Carol Gilligan to differentiate feminine from masculine approaches.     

Is Thomas Reid a Direct Realist about Perception?

The controversy over the interpretative issue—is Thomas Reid a perceptual direct realist?—has recently had channelled into it a host of imaginative ideas about what direct perception truly means. Paradoxically enough, it is the apparent contradiction at the heart of his view of perception which keeps teasing us to review our concepts: time and again, Reid stresses that the very idea of any mental intermediaries implies scepticism, yet, nevertheless insists that sensations are signs of objects. But if sensory signs are not mental intermediaries, what are they? Hasn't Reid merely swapped the common ‘sensation’ for the notorious ‘idea’, ending up with indirect realism? ^{1 1}This view is attributed to Reid by Hamilton (1865) and Mill (1877) , as well as Duggan 1960, Immerwahr 1978 , Chappell 1989 , Putnam 1994 , and Wolterstorff 2001 . Madden 1986 refuses to assign sensations any cognitive role. Others think that sensations are compatible with direct realism: See Cummins 1974, Daniels 1974, DeRose 1989, Pappas 1989, Haldane 1989, Copenhaver 2000 , and Van Cleve 2004 .
Current imaginative strategies answer negatively: Reid's sensory sign does not contradict direct perception, and those who think otherwise merely fail to understand what it means.     

Just health care (II): Is equality too much?

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1]. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a ‘non-ideal’ mode, a framework in which philosophers have done little.     

Hegel,the Trinity,and the ‘I’

The main goal of this paper is to argue the relevance of Hegel’s notion of the Trinity with respect to two aspects of Hegel’s idealism: the overcoming of subjectivism and his conception of the ‘I’. I contend that these two aspects are interconnected and that the Trinity is important to Hegel’s strategy for addressing these questions. I first address the problem of subjectivism by considering Hegel’s thought against the background of modern philosophy. I argue that the recognitive structure of Hegel’s idealism led him to give the Trinity a decisive role in his philosophical account. Next, I discuss the Trinity by analysing the three divine persons. This analysis paves the way for the conclusion, where I argue that the Trinity represents a model for re-thinking the ‘I’ in a way that overcomes a ‘naïve realist’ and a ‘subjective’ account of the self. I suggest that Hegel’s absolute idealism can be conceived as an approach to the ‘I’ that considers the role of acts of mutual recognition for the genesis of self-conscious thought, and that the Trinity is the Darstellung of the relational and recognitive structure of the ‘I’.     

“A boy cannot marry another boy”: adolescent boys' talk about ‘gay’ boys at school

This study explored how black South African adolescent boys talk about ‘gay’¹1 The term ‘gay’ is put in inverted commas to acknowledge that as an identity category it is a social construct. The author in this article is aware that the term ‘gay’ implies a more liberated or liberatory form of identity, but the boys in the study were using it pejoratively. in schools. Thirty two boys (age ranged from 13–18 years old) attending two high schools in a historically black South African township took part. Data on their understanding of being gay were gathered using individual interviews and focus group discussions. The data were analysed using Edley and Wetherell's (2001 Edley, N., & Wetherell, M. (2001). Jekyll and Hyde: Men's constructions of feminism and feminists. Feminism & Psychology, 11(4), 439–457. http://dx.doi.org/10.1177/0959353501011004002 doi: 10.1177/0959353501011004002[Crossref], [Web of Science ®] , [Google Scholar]) discursive interpretive framework. Findings suggest negative bias in the boys' attitudes towards ‘gay’ boys. The boys considered being ‘gay’ as ‘deviant’, ‘abnormal’, ‘un-Christian’ and ‘un-African’. Furthermore, ‘straight’²2 The term ‘straight’ is also put in inverted commas initially to acknowledge that this is also a social construct the participants used in the study to categorise and label each other. boys reported isolating themselves from ‘gay’ boys and avoiding practices stereotypically associated with being ‘gay’, such as wearing colorful pink clothes. Social constructions of hegemonic masculinity and homophobia appear present within an ordinary South African school setting.     

The Attractiveness of Panentheism—a Reply to Benedikt Paul Göcke

In his recent article in Sophia, Benedikt Paul Göcke concluded that ‘as long as we do not have a sound argument entailing the necessity of the world, panentheism is not an attractive alternative to classical theism’ (Benedikt Paul Göcke, ‘Panentheism and Classical Theism’, Sophia 52, no. 1 (2013): 75). As the article progresses, Göcke clarifies his view of what panentheism is, essentially identical to Göcke’s view of classical theism in every way, except in the world’s modal relation to God. This concept is vastly different to many of the panentheistic notions that are more commonly held. While it is not initially made transparent—especially with the label Göcke chooses to use—it becomes increasingly clear that Göcke critiques a God concept of his own making. More common variations of panentheism are contrasted with Göcke’s version, in order to provide a broader and more accurate view of the ancient concept, and to demonstrate that Göcke’s view of panentheism is idiosyncratic. It is finally explained that even if Göcke’s view of panentheism were definitive, he has not successfully argued for the relative unattractiveness of the concept, relative to his view of classical theism.     

Culture and collective argumentation

What are the mechanisms underlying the reproduction and change of collective beliefs? The paper suggests that a productive and promising approach for dealing with this question can be found in ontogenetic and cross-cultural studies on ‘collective argumentations and belief systems’; this is illustrated with regard to moral beliefs: After a short discussion of the rationality/relativity issue in cultural anthropology some basic elements of a conceptual framework for the empirical study of collective argumentations are outlined. A few empirical case studies are summarized; the results deliver some empirical evidence to the assumption that as the ‘logic of collective argumentations’ develops in children and adolescent there will be different and increasingly more complex constraints on the kinds of basic moral beliefs that can be collectively accepted. Most importantly, as children approach adolescence they may have acquired a ‘logic of argumentation’ which makes possible a collectively valid distinction between the ‘is’ and the ‘ought’ of some disputed particular moral issue. A comparison with a land litigation among Trobriands (Papua New Guinea) shows that the ‘logic of argumentation’ and the corresponding basic moral beliefs of Trobriands very much resemble the ‘logic of argumentation’ and moral rationality standards of (German) adolescents.     

What do infants understand of others’ action? A theoretical account of early social cognition

Intention reading and action understanding have been reported in ever-younger infants. However, the notions of intention attribution and action understanding, as well as their relation to each other, are surrounded by much confusion, making it difficult to assess the meaning and value of such findings. In this paper we set out to clarify the notions of ‘action understanding’ and ‘intention attribution’. We will show that what is commonly referred to as ‘action understanding’ in fact encompasses various heterogeneous association and prediction mechanisms. In general, these forms of action understanding will not result in the attribution of an intention to an observed actor. By detaching intention attribution from action understanding, and by exposing the latter as an umbrella notion, we provide a theoretical framework on early social cognition that allows for better comparison of findings from different experimental paradigms, and better assessment of infant action understanding abilities. Taking into account the plurality of forms that action understanding can adopt will help cognitive neuroscience to gain a full understanding of the early roots of social cognition.     

Visual and semantic effects in a serial word classification task

Subjects were asked to decide as quickly as possible whether each of a series of items was one of the four target words, ‘dog’, ‘rat’, ‘boar’ and ‘mole’. The relationship of distractors to the targets was varied. Distractors which were of high visual similarity to the targets took longer to reject than those which were of lower visual similarity, and distractors which were semantically related to the targets took longer to reject than those which were unrelated. These effects were independent. There was no effect of familiarity, with non-animal distractors and pronounceable non-words rejected equally quickly. These results are qualitatively the same as those earlier found with faces (Bruce, 1979).     

Comments on Richard Jeffrey

In this commentary, after first summarizing the three major theses of Jeffrey's paper ‘Probability and Falsification: Critique of the Popper Program’, and sketching out what I take to be his central argument, I criticize Jeffrey on two grounds. The first is that he has failed to explain why his version of Bayesianism provides us with better theories upon which to make decisions; the second is that he has offered a theory about decision-making that by-passes the important question: How can we make more rational decisions?     

Perception,illusion, and hallucination

Patrick Suppes' set-theoretical approach to the analysis of theories, and Joseph D. Sneed's metatheory are briefly outlined. The notions of observation, illusion and hallucination are reconstructed according to these approaches. It is argued that the terms ‘perception’ and ‘truth’ are theoretical with respect to observation but nontheoretical with respect to illusion and hallucination. Hallucination is construed as a special kind of illusion.     

Examining the Internal Consistency Reliability and Construct Validity of the Authentic Happiness Inventory (AHI) among Iranian EFL Learners

Unlike other measures of happiness that have tended to capture current levels of happiness, the Authentic Happiness Inventory (AHI) (Peterson, 2005; Seligman et al. in The American Psychologist 60:410–421, 2005) assesses changes in happiness based on the creation of positive emotions (the pleasant life), engagement in activities that facilitate the utilization of one’s strengths (the engaged life), and serving a more worthwhile purpose than merely the self’s pleasures (the meaningful life). Nonetheless, there is little published data regarding the construct validation of the AHI. The present study, which is part of a larger research project in assessing the effectiveness of integrating happiness intervention programs in the foreign language teaching curriculum at private English institutes and universities in Iran, attempts an examination of the psychometric quality and the construct validation of the Persian version of AHI (hereafter AHI-PV) using data collected from 234 Iranian learners of English as a Foreign Language (EFL), mainly through employing the Exploratory Factor Analysis (EFA). The AHI was translated into Persian to ensure item comprehension by the Iranian participants. The results show that the AHI-PV enjoys a high internal consistency (alpha?=?.93). Further, having determined a ‘marvelous’ factorability of the present sample through the Kaiser-Meyer-Olkin (KMO) test of Sampling Adequacy (.94) and Bartlett’s Test of Sphericity (p?Principal Component Analysis (PCA) and the Scree test indicated that, in contrast to earlier findings, a four-factor solution provides a more parsimonious grouping of the items in the inventory. Having analyzed the items on the scale, we labeled the four factors as ‘Meaningful and Purposeful Life’, ‘Pleasures and Positive Emotions’, ‘Engagement in Life Activities’, and ‘Interpersonal Connectedness’, hence the alignment of these new factors to Seligman’s (2002) conceptualization of authentic happiness.     

Making sense of (in)determinate truth: the semantics of free variables

It is argued that truth value of a sentence containing free variables in a context of use (or the truth value of the proposition it expresses in a context of use), just as the reference of the free variables concerned, depends on the assumptions and posits given by the context. However, context may under-determine the reference of a free variable and the truth value of sentences in which it occurs. It is argued that in such cases a free variable has indeterminate reference and a sentence in which it occurs may have indeterminate truth value. On letting, say, x be such that \(x^2=4\), the sentence ‘Either \(x=2\) or \(x=-2\)’ is true but the sentence ‘\(x=2\)’ has an indeterminate truth value: it is determinate that the variable x refers to either 2 or \(-2\), but it is indeterminate which of the two it refers to, as a result ‘\(x=2\)’ has a truth value but its truth value is indeterminate. The semantic indeterminacy is analysed in a ‘radically’ supervaluational (or plurivaluational) semantic framework closely analogous to the treatment of vagueness in McGee and McLaughlin (South J Philos 33:203–251, 1994, Linguist Philos 27:123–136, 2004) and Smith (Vagueness and degrees of truth, Oxford University Press, Oxford, 2008), which saves bivalence, the T-schema and the truth-functional analysis of the boolean connectives. It is shown that on such an analysis the modality ‘determinately’ is quite clearly not an epistemic modality, avoiding a potential objection raised by Williamson (Vagueness, Routledge, London, 1994) against such ‘radically’ supervaluational treatments of vagueness, and that determinate truth (rather than truth simpliciter) is the semantic value preserved in classically valid arguments. The analysis is contrasted with the epistemicist proposal of Breckenridge and Magidor (Philos Stud 158:377–400, 2012) which implies that (in the given context) ‘\(x=2\)’ has a determinate but unknowable truth value.     

Establishing Treatment Fidelity in Evidence-Based Parent Training Programs for Externalizing Disorders in Children and Adolescents

The current review evaluates the use of treatment fidelity strategies in evidence-based parent training programs for treating externalizing disorders. We used a broad framework for evaluating treatment fidelity developed by the National Institutes of Health Treatment Fidelity Workgroup that includes the aspects of treatment design, treatment delivery, training providers, and assessment of participant receipt of treatment and enactment of treatment skills. Sixty-five articles reporting outcome trials of evidence-based parent training programs met inclusion criteria and were coded for treatment fidelity strategies. The mean adherence to fidelity strategies was .73, which was higher than two previous review studies employing this framework in the health literature. Strategies related to treatment design showed the highest mean adherence (.83), whereas training of providers and enactment of treatment skills had the lowest (.58). In light of an increasing emphasis on effectiveness and dissemination trials, the broader treatment fidelity framework as applied in this review focuses needed attention on areas often overlooked in fidelity practices, such as training providers and generalization of treatment skills. We discuss the strengths and limitations of fidelity practices in parent training studies, implications of these findings, and areas for future research.     

Understanding behavioural clusters: Identifying differences between clusters of health behaviours on key constructs

Objective: To uncover the rationale underlying the perceived distinction between clusters of health behaviours by identifying cognitive constructs that differentiate among them, and creating a ‘cognitive profile’ for each behavioural cluster. Thus, different determinants and characteristics of health behaviours (e.g. ‘perceived behavioural control’, ‘impact on health’, ‘effort’, ‘non-health rewards’, ‘habit’) were used to compare health behaviour meta-clusters (physical and psychosocial) and clusters (e.g. nutrition behaviours, substance abuse, medical practices).

Methods: A sample of lay people (N = 1956) judged items representing behavioural clusters delineated in the Health Behaviour Taxonomy on 14 constructs.

Results: Significant differences emerged between the physical and psychosocial meta-clusters, as well as among their sub-clusters. For example, physical behaviours were higher on ‘perceived behavioural control’ and ‘impact on health’ compared to psychosocial behaviours, and nutrition was perceived highest on ‘effort’ and ‘non-health rewards’ compared to the other clusters of the physical meta-cluster.

Conclusion: The findings increase our understanding of the logic underlying lay people’s cognitive schema of health behaviour clusters. ‘Cognitive profiles’ that explain differences between the clusters were identified, which can be used to design health messages and interventions targeting multiple health behaviours.