Generalised Chronic Musculoskeletal Pain as a Rational Reaction to a Life Situation?

While the biomedical model is still theleading paradigm within modern medicine and healthcare, and people with generalised chronicmusculoskeletal pain are frequent users of health careservices, their diagnoses are rated as having thelowest prestige among health care personnel. Anepistemological framework for understanding relationsbetween body, emotions, mind and meaning is presented.An approach based on a phenomenological epistemologyis discussed as a supplement to actions based on thebiomedical model.Within the phenomenological frame of understanding,the body is viewed as a subject and carrier ofmeaning, and therefore chronic pain can be interpretedas a rational reaction to the totality of a person'slife situation. Search for possible hidden individualmeanings in painful muscles presupposes meeting healthpersonnel who view the person within a holistic frameof reference.     

Making Meaning: The Constructive-Developmental Approach to Persons and Practice

The constructive (in the sense of construing) and developmental (but throughout the lifespan) framework, whose conceptual roots lie in the work of Piaget, outlines the holistic personality process of systems of making meaning, systems that organize human thought, feeling, and action. In this article Kegan discusses and then applies the model—to a worker in a CETA program and to a psychiatric ward patient—elucidating the perspectives—on mental health and employability—it can open for practitioners.     

Random error reduction in analytic hierarchies: a comparison of holistic and decompositional decision strategies

The principle of ‘divide and conquer’ (DAC) suggests that complex decision problems should be decomposed into smaller, more manageable parts, and that these parts should be logically aggregated to derive an overall value for each alternative. Decompositional procedures have been contrasted with holistic evaluations that require decision makers to simultaneously consider all the relevant attributes of the alternatives under consideration (Fischer, 1977 ). One area where decompositional procedures have a clear advantage over holistic procedures is in the reduction of random error (Ravinder, 1992 ; Ravinder and Kleinmuntz, 1991 ; Kleinmuntz, 1990 ). Adopting the framework originally developed by Ravinder and colleagues, this paper details the results of a study of the random error variances associated with another popular multi‐criteria decision‐making technique, the Analytic Hierarchy Process (AHP); (Saaty, 1977 , 1980 ), as well as the random error variances of a holistic version of the Analytic Hierarchy Process (Jensen, 1983 ). In addition, data concerning various psychometric properties (e.g. the convergent validity and temporal stability) and values of AHP inconsistency are reported for both the decompositional and holistic evaluations. The results of the study show that the Ravinder and Kleinmuntz ( 1991 ) error‐propagation framework extends to the AHP and decompositional AHP judgments are more consistent than their holistic counterparts. Copyright © 2001 John Wiley & Sons, Ltd.     

腰椎间盘突出症患者MED术前心理状态调查与分析

为了研究腰椎间盘突出症患者行MED微创治疗前的心理状况,对442例行MED手术治疗的患者应用焦虑自评量表（SAS）、抑郁自评量表（SDS）进行术前心理评估。结果显示MED微创治疗前患者SAS、SDS测量分明显高于常模组。患者性别、年龄、婚姻状况、文化程度、病程长短等都与心理状况的改变相关。有34.9%的患者SAS得分和36.7%的患者SDS得分显示阳性。因此,临床骨科医师应重视心理因素的作用,在MED术前应对患者进行心理状况评估,并对心理状况较差的患者进行术前干预,才能取得更好的临床疗效。     

Reflective practice framework for TESOL teachers: one teacher’s reflective journey

Just as in the field of general education, scholars within the field of teaching English to speakers of other languages (TESOL) have also struggled to come to a consensus as to how reflective practice should be operationalized with many different approaches suggesting a retrospective approach to questioning about practice. As a result, many of these approaches have led to a type of routinization of reflection. Worried about such routinization of reflection, Farrell developed a more holistic approach to reflective practice that recognizes the spiritual, moral, and emotional aspects of reflection, as well as the usual retrospective questions about practice. This paper outlines a case study of the reflections of one experienced TESOL teacher teaching in South Korea using Farrell’s framework for reflecting on practice that included reflections on his philosophy, principles, theory, practice, and beyond practice. The results revealed three common themes of approachability, art-oriented conceptions, and curiosity that emerged in all aspects of his reflection as uniquely influential parts of a larger whole. Thus, Farrell’s holistic framework for teacher reflection employed in this study provided multiple filters through which these various parts could be viewed.     

A Psychometric Analysis of the “Divide and Conquer” Principle in Multicriteria Decision Making

The principle of “Divide and Conquer” (DAC) suggests that: (1) complex decision problems should be decomposed into smaller, more manageable parts and (2) these smaller parts should be logically aggregated to derive an overall value for each alternative. Typically, decompositional procedures have been compared to holistic evaluations that require decision makers to simultaneously consider all of the relevant attributes in the evaluation of the objects under consideration. These comparisons between decompositional and holistic judgments have primarily used a variant of Multiattribute Utility Theory (MAUT).We presented a general experimental framework that allows for a more extensive assessment of the DAC principle, as well as the effects of decision complexity on both holistic and decompositional procedures. We illustrate this approach with a study that uses the Simple Multiattribute Rating Technique with Swing Weights (SMARTS; Edwards & Barron, 1994) and the Analytic Hierarchy Process (AHP; Saaty, 1980). We report data comparing the convergent validity (e.g the agreement between decompositional and holistic strategies) and the temporal stability for decompositional and holistic judgments on a variety of dependent measures. Decision complexity did not significantly affect the correspondence between decompositional and holistic judgments for both SMARTS and AHP judgments. Results from an ordinal measure of temporal stability indicated the DAC principle was violated for the AHP judgments. For a linear measure of temporal stability, trends in the data indicated that the predicted effects of decision complexity on the DAC principle was violated for the SMARTS judgments.     

Dyadic Influence of Adverse Childhood Experiences: Counseling Implications for Mental and Relational Health

Adverse childhood experiences (ACEs) predict physical and mental health. We examined dyadic differences in intimate partner relationship health by ACE score among couples with low to moderate income enrolled in a relationship education program. Overall, we found a high prevalence of ACEs, disproportionate representation in the highest risk ACE group, and a significant effect between ACEs and indicators of mental and relational health. Implications for counselors include support for an ACE‐informed approach to couples counseling services, as well as a holistic and systemic view of mental and relational health.     

Community reintegrating former child soldiers in Northern Uganda: A qualitative study on the road to recovery

This study aimed to profile the qualities of a holistic community reintegration program for former child soldiers (FCS) in the Lira region of Northern Uganda. Informants were a convenience sample of 37 FCS (age range 17 to 34, mean age 23.86, SD = 4.715 years; females = 29.73%). FCS completed semi-structured interviews on their current living situations and existing resources. This was aimed at assessing how they were transitioning back into the community and identifying gaps in resources. About 24% of FCS reported feeling unwelcome in their communities, suggesting a need for additional support and resources through the community integration models. Thematic analysis of the data suggests that the FCS would benefit from a holistic community reintegration program with the following qualities: psychosocial support, workforce development training, and job placement. FCS emphasised the need for skills training and employment opportunities over health and wellness; suggesting that mental health support and health care are not sufficient alone for them to successfully reintegrate into the community. FCS community integration policies and practices should prioritise holistic approaches.     

Learning strategies in two Danish children's language development

A longitudinal investigation of two Danish children's linguistic and cognitive development during their second year is described. A summary of their Mean Length of Utterances (MLU), Vocabulary Scores and performance on the Uzgiris-Hunt infancy assessment scales is presented. The results reveal a pattern of individual differences that can be accommodated within a framework that identifies the use of analytic and holistic strategies as complementary approaches to the process of language learning. The consequences of this theoretical framework for the interpretation of MLU and Vocabulary Scores are discussed.     

The importance of a holistic concept of health for health care. Examples from the clinic

One of my main points in this study is that the knowledge of orthodox medical theory is an incomplete guide for practical action when relating to our patients' specifically human problems. By following a holistic perspective on patients' health and on our medical enterprise we will be more efficient as doctors. This standpoint is illuminated by means of two case reports. Instead of focusing on symptoms as such and letting them refer to orthodox medical theory, I explicitly relate to the patients as if they are conveying a personal meaning by means of experienced symptoms. The experience of illness could be a successful strategy on the existential level although destructive on the technical biological level. A holistic theory of health can give doctors a good conceptual base when relating to people whose presented illnesses are to be regarded explicitly as their way of making themselves understood. The doctor's understanding of the patient's illness, of the theory of health, and of how health is regained, is dependent on the doctor's having the courage to reduce the distance to the patient, the courage to participate and be changed.     

Evaluation of a holistic cardiac rehabilitation in the reduction of biopsychosocial risk factors among patients with coronary heart disease

The purpose of this pilot study is to evaluate the effectiveness of the Lifestyle Change Program (LSCP). LSCP was a holistic cardiac rehabilitation (CR) intervention focusing on several psychosocial and biological predictors of coronary heart disease including depression, hostility, low social support, high perceived stress, low spirituality, low life satisfaction, overall health status and cholesterol levels. Utilising a quasi-experimental design, overall health scores of LSCP patients were compared with those of a control group. To assess differences within-and between- groups, two (programme type) × 2 (age) × 2 (gender) × 2 (time) mixed design ANOVAs were used. Within-group relationships for psychosocial assessments and cholesterol levels were analysed using paired-samples t-tests. Results suggest that there were no significant differences between the LSCP group and the control group with regard to overall health status. However, the LSCP participants reported significantly lower levels of depression and perceived stress, as well as significantly higher levels of life satisfaction and spirituality upon programme completion. In addition, lipid panels changed significantly: A significant decrease in total cholesterol, low-density lipoproteins and triglycerides, as well as a significant increase in high-density lipoproteins. These trends suggest that holistic CR may be effective at reducing biopsychosocial risk factors for future cardiac events. Future studies, utilising an experimental design, are necessary to determine whether holistic programmes are more effective than traditional programmes in the reduction of cardiac risk factors.     

COUNSELING AND PSYCHOTHERAPY AS MORAL AND SPIRITUAL PRACTICE: FACING A MAJOR PARADIGM SHIFT

Blakeney and Blakeney offer a metatheoretical perspective for counseling and therapy that gives primacy to developmental issues and to understanding the worldview of the client. Their thinking adds to the growing paradigm shift currently occurring in the counseling field. This article further demonstrates the holistic and integrative nature and potential of the Blakeney framework, using Developmental Counseling and Therapy (DCT) as a method of translation. The authors offer a framework that challenges the notion of “higher” forms of knowledge, emphasizing instead multiperspctive thought and life-span cognitive-developmental processes.     

Reconceptualizing Quantitative and Qualitative Methods: A Case Study Dealing with Place as an Exemplar

A useful framework for understanding methods is to think of them as being on a continuum of holistic and pattern focused to particularistic and specific. This paper argues for this conceptualization rather than thinking of quantitative and qualitative methods as oppositional and potentially contradictory. A case study provides an example of using both quantitative and qualitative methods in a holistic and pattern-focused study, while also attending to the values and goals of community psychology. The substantive research goal is to understand a child's experience of places related to school. Methods include ethnographic long-term participation and observation, interviews, multidimensional scaling, and social network analysis. Most quantitative method variables are generated from study participants; no outside structure is imposed. The quantitative methods extend and inform the qualitative methods, just as the qualitative methods extend and inform the quantitative methods. The quantitative and qualitative methods work reciprocally to extend and inform each other.     

Participation in Church or Religious Groups and its Association with Health: A National Study of Young Canadians

The purpose of this study was to determine how participation of young Canadians in a church or religious group correlated with holistic health indicators. Health was viewed in terms of risk and protective behaviors, outward looking prosocial behaviors, and measures of internal feelings, with the composite picture of health connecting to the Hebrew concept of shalom. A separate analysis of sports-involved children was used as a comparator. Children involved in religious groups reported lower participation in risk behaviors, higher prosocial behaviors, but poorer levels of the more holistic measures of health. Sports-connected youth reported more positive holistic measures of health and some increases in overt risk-taking. Our findings raise theological and practical issues regarding how the church understands itself and lives out its mission. They suggest an emphasis on teaching about behaviors and morality rather than an understanding of shalom that is grounded in the Incarnation and in the deeply integrative nature of the Christian life.     

Metaphysics and the vision of health

Whitehead's philosophy of organism provides the most comprehensive and adequate basis for the transformation of contemporary health care. In contrast to the reductionist and fragmentary medical models supported by Cartesian dualism, materialism, and idealism, Whitehead's metaphysics serves as the foundation for a holistic health care system, inclusive of the dimensions of spirituality, emotions, physical existence, and environment as they relate to health and illness. Whitehead's understanding of the relationship of mind and body and the role of the divine in the creative process encourages the inclusion of pastoral care, imaging, and meditation in responding to illness.     

Size and Structure of the Holistic Milieu: A Comparison of Local Mapping Studies in Austria and Sweden

This article presents the results of two local mapping studies in Sweden and Austria that follow the methodological procedure of the British Kendal project. All practitioners offering courses, therapies or counseling in the areas of holistic spirituality and complementary health methods (such as yoga, Reiki, kinesiology, astrology, and shamanism) were mapped. A sub-sample of the mapped practitioners were contacted in person and asked about their professional situation and the number of their clients. On the basis of these data, the proportion of persons participating in the holistic milieu was estimated. The article discusses the similarities and differences between the two regions in regard to the supply of specific types of holistic activities, the professional situation of the practitioners, and the proportion of the population involved in holistic activities. The level of engagement in holistic activities in the Swedish, Austrian, and British mapping areas is also compared with the level of church attendance in the three countries.     

Spirituality, Gender, and Expressive Selfhood

This article discusses contemporary spiritualities, focusing in particular on the recent growth of practices attending to "mind, body, and sprit" and centered on the goal of "holistic well-being." We argue that the growing popularity of such "holistic spirituality" since the 1980s can be greatly illuminated by reference to Charles Taylor's account of the expressive mode of modern selfhood. Taylor's account is limited, however, by its inability to explain why women are disproportionately active within the sphere of holistic spirituality. By paying closer attention to gender, we seek to refine Taylor's approach and to advance our understanding of contemporary spirituality. Drawing on findings from two qualitative studies of holistic spirituality and health carried out in the United Kingdom, this article offers an analysis of what the "subjective turn" may mean for women. We argue that holistic spiritualities align with traditional spheres and representations of femininity, while simultaneously supporting and encouraging a move away from selfless to expressive selfhood. By endorsing and sanctioning "living life for others" and "living life for oneself," holistic spiritualities offer a way of negotiating dilemmas of selfhood that face many women — and some men—in late modern contexts .