The rhetorician's craft, distinctions in science, and political morality

In his response to Szasz' Secular Humanism and Scientific Psychiatry, the author considers the use of rhetorical devices in Szasz' work, Szasz' avoidance of acknowledging psychiatry's scientific distinctions, and Szaszian libertarianism versus liberalism.     

The "process" of running away: a redefinition

Unlike much of the research on runaway behavior in the last half decade, the present effort does not use legal definitions or individual motives to define a runaway. Rather, it views the designation as a "social process." The concept of "career" is central to this effort in that it allows for an identification of where in the overall process young persons see themselves. In general, becoming a runaway is conceived as a process of action and reaction, which unfolds over time. Becoming a runaway is the end product of a person's actions, reason, and symbols.     

"Automatism" and the emergence of dynamic psychiatry

This article is about the clash of two explanatory paradigms, each attempting to account for the same data of human experience. In the first half of the nineteenth century, physiologists investigated reflex actions and applied a recently coined word, "automatism," to describe actions which, although seeming to arise from higher centers, actually result from automatic reaction to sensory stimuli. Experiments with spinal reflexes led to the investigation of the reflex action of the brain or "cerebral automatisms." Reflex actions of this kind were used to explain everything from acting compulsively to composing symphonies. Physiological explanations of phenomena of this kind seemed insufficient to some and, in the 1880s, Frederic Myers and Pierre Janet developed psychological frameworks for understanding these phenomena, positing hidden centers of intelligence at work in the individual, outside ordinary awareness, which produce what came to be called "psychological automatisms." Their attempts to unify this psychological framework with the existing physiological one failed. Nevertheless, their work played a crucial role in paving the way for what Ellenberger called dynamic psychiatry, which accepts the reality of an unconscious dynamic of the psyche.     

Investigating true and false confessions within a novel experimental paradigm

The primary goal of the current study was to develop a novel experimental paradigm with which to study the influence of psychologically based interrogation techniques on the likelihood of true and false confessions. The paradigm involves guilty and innocent participants being accused of intentionally breaking an experimental rule, or "cheating." In the first demonstration of this paradigm, we explored the influence of two common police interrogation tactics: minimization and an explicit offer of leniency, or a "deal." Results indicated that guilty persons were more likely to confess than innocent persons, and that the use of minimization and the offer of a deal increased the rate of both true and false confessions. Police investigators are encouraged to avoid interrogation techniques that imply or directly promise leniency, as they appear to reduce the diagnostic value of any confession that is elicited.     

The standard of care in suicide risk assessment: An elusive concept

Suicide risk assessment is now a core competency requirement in the residency training of psychiatrists. The purpose of suicide risk assessment is to identify modifiable or treatable acute, high-risk suicide factors, and available protective factors that inform patient treatment and safety management. The standard of care varies according to state statutory definitions. Heretofore, most states adopted an average physician or "ordinarily employed standard." Currently, more states are adopting a "reasonable, prudent physician" standard. No single source or authority defines the standard of care for suicide risk assessment. Evidence-based psychiatry can inform clinicians' suicide risk assessments. Carefully documented risk assessments will assist the courts in evaluating clinicians' decision-making process.     

AGENCY AND MORAL RELATIONSHIP IN DEMENTIA

Abstract: This essay examines the goals of care and the exercise of guardianship authority in the long-term care of persons with Alzheimer's disease and other forms of chronic, progressive dementia. It counters philosophical views that deny both agency and personhood to individuals with Alzheimer's on definitional or analytic conceptual grounds. It develops a specific conception of the quality of life and offers a critique of hedonic conceptions of quality of life and models of guardianship that are based on a hedonic legal standard of "best interests." As an alternative, it proposes a conception of quality of life based on the notions of "semantic agency" and "memorial personhood."     

Getting over "the problem of other minds": communication in context

Theories of communication often assume that communication has a single, essential form or telos, the culmination of a one-track developmental process where precursors eventually give rise to the real thing. At one time, this essence of communication was identified with linguistic competence, whereas now it is largely defined in terms of "Theory of Mind." But the fundamental problem with "Theory of Mind" is the very problem it pretends to solve: "the problem of other minds."That problem, as formulated, is insoluble, even with the aid of theory or innate modules. In this article, we reject the superficial depth psychology of "Theory of Mind" in favour of a breadth psychology based on context.     

Critics and dissenters: reflections on "anti-psychiatry" in the United States

During the 1970s various professionals and social activists adopted an explicitly anti-psychiatry position which was perceived by many as a new phenomenon. Hostility to psychiatry actually predates the establishment of psychiatry as a profession in 1844, and organized opposition to psychiatric practices appeared in the late nineteenth century. The deinstitutionalization of the 1970s, which was aided by development within psychiatry, had a strong anti-psychiatry component, but the novel aspect was the organization of ex-mental patients themselves. By the 1980s the decline of psychiatric power, dissension among ex-patients, and new social trends vitiated the anti-psychiatry movement.     

Evidence-based treatment of stuttering: IV. Empowerment through evidence-based treatment practices

Assertion-based treatments for stuttering have historically been more popular than evidence-based treatments. In this paper it is argued that the use of evidence-based treatments for stuttering is professionally empowering for clinicians, but that the use of assertion-based treatments is a circular process that inhibits professional development. The arguments in favor of evidence-based treatment are elaborated under headings of "professional investment," "professional development and diversity," and "optimizing treatment efficacy." EDUCATIONAL OBJECTIVES: The reader will understand and be able (1) to describe the distinction between assertion-based and evidence-based treatment practices (2) to present a series of arguments that evidence-based treatment practices are professionally empowering.     

ABSTRACTS OF LITERATURE

A paper evaluating some basic concepts of child psychiatry, which finds these concepts incomplete without amending them "so that child and family may be treated as a single entity, rather than piecing them apart." Some basic family dynamics are discussed in support of that idea.     

W. H. R. Rivers and the war neuroses.

W. H. R. Rivers was the most famous member of the Cambridge Expedition to the Torres Strait. At the time, he was a physician and had an international reputation as a researcher in physiological psychology. The expedition signaled the beginning of his career in social anthropology, but also a long hiatus in his activities in medicine. His clinical interests revived during World War I. As an officer in the Royal Army Medical Corps (RAMC), Rivers became a leading proponent of "psychological medicine." Today, his war-time psychiatry is remembered mainly in association with his patient, Siegfried Sassoon. This article focuses on his wartime activities, his clinical practices, and his theories concerning the war neuroses and the unconscious. The currently popular view of Rivers as a quasi-Freudian humanist is challenged.     

Medical ethicists, human curiosities, and the new media midway

Medical ethicists have assumed a role in justifying public voyeurism of human "curiosities." This role has precedent in how scientists and natural philosophers once legitimized the marketing of museums of "human curiosities." At the beginning of the twentieth century, physicians dissociated themselves from entrepreneurial displays of persons with anomalies, and such commercial exhibits went into decline. Today, news media, principally on television, promote news features about persons that closely resemble the nineteenth century exhibits of human curiosities. Reporters solicit medical ethicists for soundbites to affirm the newsworthiness and propriety of public voyeurism of these medical stories. Ethicists' soundbites are usually ambiguous or self-evident and rarely enable viewers to morally engage the issues. The precedent of early twentieth century physicians disengaging from such exploitive public shows is a useful example for medical ethics.     

Looking a Hundred Years Back: Remarks on the Concept of "Wishing" in Psychoanalysis

While the concepts of "wish" and "wish fulfillment" have indeed remained central since the start of classical psychoanalysis, they are only weakly anchored both in theory and practice. It has become common today for psychoanalysts to use the term "to wish" in the sense of "to want" or "to intend." As a first step, it will be emphasized that "wish" should not be constructed along the lines of "intention." An examination of the relationship of "wish" to "wish fulfillment" is then followed by an evaluation of its practical significance for psychoanalysis and for our understanding of mental life in a general sense. Turning to an example dream sequence, we will arrive at the psychoanalytic core of the issue: the assumption of hidden, non-obvious, non-recognizable wish fulfillment scenarios. At this point in the discussion, a method of access will be sketched out - the dramaturgical approach - that, although it makes use of the idea of free association, does so in a manner that diverges from Freud's original recommendation.     

"Psychotherapy" versus "treatment"

Presents a comment on "Psychological treatments" by D. H. Barlow. Barlow proposed that we distinguish between the terms "treatment" and "psychotherapy." The author believes that not only is the distinction unnecessary, but that its implications could have negative consequences for the field of clinical psychology. It is the proposed distinguishing feature that treatments are "specifically tailored to the pathological process that is causing the impairment and distress" that is most problematic. Clinical psychology does not need a distinction that further exacerbates the split between researchers and practitioners.     

Moral Responsibility,Reactive Attitudes and Freedom of Will

In his influential paper, “Freedom and Resentment,” P. F. Strawson argued that our ordinary practices of holding persons morally responsible and related reactive attitudes (such as blame, resentment, indignation, and moral approval) were wholly “internal” to the practices themselves and could be insulated from traditional philosophical and metaphysical concerns, including concerns about free will and determinism. This “insulation thesis” is a controversial feature of Strawson’s influential paper; and it has had numerous critics. The first purpose of this paper is to explain my own reasons for thinking that our practices of holding responsible cannot be entirely insulated from incompatibilist concerns about freedom and determinism. The second purpose is to argue that these incompatibilist concerns are in fact legitimate concerns: There are sound reasons to believe that our ordinary practices of holding persons morally responsible do require at least sometimes in our lives that we must be capable of acting freely in a manner that is not determined. I defend this thesis by spelling out why I believe various compatibilist strategies attempting to show that moral responsibility is compatible with determinism fail to show this. In the course of this critique, a general theme will emerge: In order to do full justice to our ordinary practices of holding persons responsible and the freedoms thus involved, one must distinguish between different types of freedom, and in particular, between freedom of action and freedom of will.     

Unstable Embodiments: A Phenomenological Interpretation of Patient Satisfaction with Treatment Outcome

Many patients experience aspects of treatment and care as dehumanizing because the body is considered separate from the self and its life context. An attempt to transcend viewing persons in dualistic terms is posed by phenomenologists who focus not on "the body" as such but on what it means to be "embodied." In this paper, we review the relevance of the phenomenology of the body for health care and report the results of comparing Sally Gadow's phenomenological insights about body-self unity with a qualitative analysis of patients' accounts of satisfaction with the outcome of hand surgery. We illustrate the ways in which our findings were and were not congruent with Gadow's conceptualization of embodiment and highlight aspects that are ambiguous. We conclude that the body-self dialectical relationship should be recast as a body-self-society trialectic and discuss the implications of this new conceptualization for clinical practices.     

Psychiatry: The Importance of Understanding Persons While Treating Diagnoses

Modern psychiatry emphasizes chemical, genetic, psychosocial, and similar theoretical biological sciences. While these sciences can explain mental disorders they fail to generate a full understanding of the patient as a person. I argue that psychiatry, to not stereotype persons, must integrate both the important advances in molecular and social sciences needed to diagnose and treat mental illnesses and provide an encounter with the person who is the patient. Standardized forms of diagnostic interviewing now dominate in the psychiatrist–patient relationship. Individualizing forms of inquiry, by contrast, elicit a personal understanding of the patient and her problems and the information necessary to diagnose and treat the patient's mental disorders.

This understanding attitude towards individuals is essential so that psychiatrists avoid falling into over-simplified stereotyping explanations of the persons who are their patients. If psychiatry allows its diagnoses of disordered processes that occur within persons to function as labels for persons, then psychiatry appears scientifically to condone the uses of stereotypes. With an understanding attitude towards patients, psychiatry can better treat mental disorders, while also respecting human diversity.