Competing for Reality

In this article, we will apply aspects of Rychlak's philosophy of science to some of the most important issues in psychology today (issues of brain versus behavior, genetic destiny, the nature of scientific investigation, ecopsychology, and artificial intelligence). In our discussion of these issues, we attempt to show the ways that an appreciation of Rychlak's views can help conceptualize the bases of the disagreements in the field as well as explain why so many psychologists tend to “talk past” as opposed to “talk to” one another. We believe that a greater appreciation of Rychlak's major theses could allow psychologists to respect the work of others instead of trying to assert politically their favorite truth claims.     

Attitudes to doctors and medicine: The preliminary development of a new scale

Abstract

The preliminary development of a new scale to measure attitudes towards medicine and doctors is described. The scale comprises four factors: “positive attitude towards doctors,” “positive attitude towards medicine,” “negative attitude towards doctors,” and “negative attitude towards medicine.” Alpha coefficients for the four scales were satisfactory, ranging from 0.69 to 0.76. Test re-test reliabilities ranged from 0.69 to 0.81. Evidence of criterion-related validity was obtained from comparison of the attitudes of five groups involved in health care: nurses, medical students, patients, and sociologists and psychologists who are teachers in medical schools. Patients and medical students held significantly more positive attitudes towards doctors and medicine that did nurses and behavioural scientists. While nurses were as negative towards doctors as sociologists and psychologists, they were significantly less negative about medicine.     

The Influence of Silent Learning Disorders on the Lives of Women

Abstract

Longstanding neurocognitive deficits such as learning disorders greatly influence development of a woman's personality, relationships, and educational and vocational attainment. In our clinical practice, we increasingly see women with previously undiagnosed “silent learning disorders.” Educational and career milestones, problems in the workplace, parenting a child with a learning disorder, and normal aging along with common medical conditions can exacerbate these “silent learning disorders.” As a result, neurocognitive deficits might appear more pronounced as former ways of compensating for learning problems no longer are adequate. When such learning disorders are not detected, women and their therapists might not avail themselves of interventions that can help to treat the reading, visual-spatial, organizational, or other neurocognitive deficits, and indirectly help with patterns of anxiety, depression, and low self-esteem. In the present paper, we characterize women with silent learning disorders, discuss implications if disorders remain undetected, and present case examples. A model and strategies for detecting silent learning disorders also are presented.     

Étude de validation de la version française de l’Échelle d’Estime Corporelle (Body Esteem Scale) chez les adolescentes et les jeunes adultes

IntroductionThe literature of body image suggests that many women and young women suffer from body dissatisfaction and this dissatisfaction is an important risk factor for the development of eating disorders.ObjectiveThe aim of the study was to validate the French female version of the Body Esteem Scale (BES; Mendelson et al., 2001).MethodThis self-administered questionnaire assesses body esteem and includes three subscales: “Weight”, “Appearance” and “Attribution”. The questionnaire was given to a sample of 835 adolescent girls and young adults (mean age = 16.62 ± 1.50).ResultsExploratory factorial analysis yielded three factors “Weight”, “Appearance” and “Desire to modify and negative affect associated with the general appearance”, somewhat similar to those of the original validation study. The goodness-of-fit of the three factors model was satisfactory. Correlations were found between the three subscales of the BES, BMI and general self-esteem.ConclusionThe French version of the BES shows satisfactory psychometric properties and provides a useful tool for better understanding the psychological aspects of attitudes towards one's body. In France, very few questionnaires are available to measure body attitudes, despite the fact that the body dissatisfaction affects many adolescent girls and represents a risk factor for the development of eating disorders.     

Fonctionnements et dysfonctionnements des psychothérapies : synthèse de la littérature et présentation de deux méthodologies associées aux meilleurs résultats

IntroductionPsychological difficulties are part of higher stakes health issues. What are the real effects and the difficulties to generate results of psychotherapies?Literature resultsPsychotherapy is efficient for multiple psychological disorders, as well in controlled as in naturalistic studies, and participate in reduction of health expenditure. However, all patients do not get real benefits from care, patients can deteriorate or drop-out treatment, and persistent side effects can occur; clinicians overestimate their efficiency and their performances decline during their career. Two promising methodologies seems to be associated with better outcomes: Routine Outcome Monitoring (ROM) and a specific form of training clinician expertise named “Deliberate Practice”.DiscussionUsing client feedback allows to implement ROM and “Deliberate Practice” in routine care.ConclusionImplementation of Routine Outcome Monitoring should be encouraged in French Speaking countries to produce evidence-informed practice for the delivering, the improvement and the payment for psychotherapy expenditure.     

Social control doctrines of mental illness and the medical profession in nineteenth-century America

Social control doctrines of mental disorders have influenced a generation of psychologists and have shaped attitudes and discussions about how to treat the mentally ill. In light of the failure of deinstitutionalization as a public policy and the contemporary concern with the medical or biological bases of psychiatric disorders, this paper re-examines social control doctrines. Reviewing mid-nineteenth century statistical accounts, the author challenges claims of social control theorists and shows that in recent years some former social control advocates and revisionists have “recanted” and criticized their earlier use of the concept of social control, particularly the characterization of the asylum as a “total institution”.     

The Personality and Emotions of Men

Summary

The present study investigated the effect of required effort (moderate vs. low), level of expertise (“Dr.” vs. “Mr.”), and sex of the psychologist on compliance with the recommendations of school psychologists. One hundred forty-four elementary school teachers served as subjects. The psychologists evaluated a child from each teacher's class and recommended that she send for materials which would help the child's perceptual and reading development. Results indicate that compliance varied directly with required effort, but was unrelated to level of expertise and sex. It is argued that psychologists in schools may influence teachers as a function of legitimate power, whereas expert power is operative when dealing with the public.     

Accidental Communities: Race,Emergency Medicine,and the Problem of PolyHeme®

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a “community” within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between “autonomy” and “community.” The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part II examines a clinical trial for the blood substitute PolyHeme^® (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of “community.” The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment.     

Nurturing our future through effective mentoring: Developing roots as well as wings aaasp 1993 presidential address

Abstract

According to Scanlan, sport psychology is not for the faint hearted. She advises prospective sport psychologists to seriously assess the strength of their “pioneering spirit.” Sport psychologists, Scanlan continues, often have to travel uncharted routes, and they should make sure that they can handle the challenges, risks, and ambiguities. (Straub & Hinman, 1992, p. 307)     

Damage Compounded: Disparities,Distrust, and Disparate Impact in End-of-Life Conflict Resolution Policies

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed “medically inappropriate” will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience.     

Treatment of Assaultiveness

Summary

Assaultiveness and abusiveness have a psychology that must be addressed in therapy; they are not merely the product of “bad attitudes” or social roles, nor can they be narrowly defined as the robotic imitation of action. Perceptions and feelings about the world of intimate relationships both sustain and are sustained by abusive actions. These provide points of intervention for cognitive behavioral therapy (CBT). Given the tendency to shame easily, abusive men must not be confronted too quickly or too strongly. On the other hand, given their well-established denial system and tendency to minimize the consequences of their abusiveness, some confrontation must occur. Hence a “Zen” line of least resistance must be found between the opposites of acceptance and confrontation. Treatment outcome studies indicate moderate success for cognitive behavioral treatment (CBT) for batterers. Treatment is less successful with men who have personality disorders, especially psychopathy.     

The 2003 Survey of Academic Medical Center Psychologists: Implications and Outlook

This paper offers commentaries on Pate and Kohout’s (2005) report of data from the 1997 and 2003 surveys of psychologists in medical school settings. The commentaries reflect upon the significance of the survey findings and implications for psychology’s role in medical school and academic health science settings. Though the response rate to the survey was disappointing, the data indicate that psychologists are moving up in academic rank, and have made substantial gains in salary. The data also indicate that among psychologists who are medical staff members, who constitute half the 2003 sample, an increasing proportion are functioning autonomously as reflected in gains in the percentage having admitting privileges, staff voting privileges, and authority to write orders. Research continues to be a major focus for psychologists in academic medical centers. Overall, the findings indicate that psychologists can have productive, satisfying careers in medical school/academic health center settings—though there is one troubling sign, a sizeable drop in the number of positions being created for younger, more recently trained psychologists. Methodological enhancements are described that could improve the quality, scope, and usefulness of data from future studies, both for understanding long-term trends and for conducting salary negotiations. High quality data provide a solid foundation for advocating for psychologists’ full participation in the life of medical schools and academic health centers.     

L’intelligence artificielle peut-elle aider à estimer le risque de récidive dans les comportements violents ?

In forensic psychiatry, magistrates raise the question of the existence of a risk of recidivism and dangerousness to psychiatric experts. Follow-up studies in forensic psychiatry showed that the psychiatric elements predictive of recidivism were mainly related to serious mental illnesses, toxic consumption, addictions, high levels of impulsivity, low insight, associated personality disorders, in particular antisocial personality disorders. There are also protective factors, in particular the observance of treatments. Given the complexity of psychiatric and criminological risk factors and protection, can artificial intelligence (AI) help psychiatrists and magistrates to improve the predictivity of recidivism?MethodsSystematic review of the literature on AI applications in the prediction of recidivism in forensic psychiatry, conducted according to PRISMA criteria, using the: “Artificial Intelligence”, “Recidivism”, “Personality Disorder”, “Impulsive” Behavior”, “Alcohol abuse”, “Drug Abuse”, “Schizophrenia”, “Bipolar disorder” on the PubMed, Science Direct, Clinical Trial and Google Scholar databases.ResultsThe vast majority of studies come from legal or computer reviews and very few from medical databases. The studies evaluating the AI in Forensic Psychiatry most often used Machine Learning based on sociodemographic, sociological and criminological data, notably the age of the first offense and the number of previous convictions. To date, there are very few studies evaluating psychiatric parameters, focusing on psychopathic personality disorders.Discussion/conclusionThe applications of the AI in Forensic Psychiatry are still very premature. However, some psychiatric criteria should be more prominent in this field, especially those from Webster's HCR-20 and Hare PCL-R scales. The challenge will also be to find relevant behavioral, psychological and psychiatric keywords to include in AI.     

Under what conditions do lay people and health professionals accept a breach of doctor-patient confidentiality regarding a patient with signs of terrorist radicalization?

IntroductionConfidentiality is crucial to the establishment of a strong patient-physician relationship. However, certain situations create a dilemma for the physician who is faced with the choice of either respecting medical confidentiality or protecting others from a serious risk of violence.ObjectiveThis study aimed to observe how lay people and health professionals assessed the acceptability of breaching confidentiality when a physician is confronted to a patient showing signs of terrorist radicalization.MethodA total of 228 participants (174 from the general population and 54 health professionals) judged the acceptability of 54 scenarios which were constructed through the orthogonal combination of 4 factors frequently mentioned in the literature: presence of a “Psychiatric disorder”; “Signs of radicalization”; “Projects of violence”; “Collegiality”. Variance and cluster analyses were performed on all the raw data.ResultsResults showed that all factors influenced the judgment of participants but that “Psychiatric disorders” had a weaker impact. Five clusters were identified: “Favorable if collegiality” (n = 23); “Favorable to breach confidentiality” (n = 77); “Unfavorable to breach confidentiality” (n = 26); “Sensitive to all factors” (n = 71); “Favorable if violence” (n = 31), respectively with mean ratings of 5.87, 8.42, 3.64, 6.30 and 7.16, on an acceptability scale of 0–10.ConclusionThe importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context.