The logic of delusion

Piagetian concepts explaining normal mental development are applied to delusion, a major psychiatric disorder of thought which can result in bizarre conduct. Piaget constructed problems in which the errors of six to eight year old children fit the standard textbook definition of delusion surprisingly well. When we examined cases of delusional individuals, we concluded that their apparent irrational and bizarre conduct could be explained as problem-solving errors like those of Piaget's young children. In contradistinction to existing theories, we define delusion as a regression under stress to the logic of children of a particular age range, and that what appears bizarre and irrational is the result of an adult attempting to filter experience through a child's logic.Under a different title this paper was presented at the Biennial Congress of the World Federation for Mental Health in Mexico City in August, 1991.     

A developmental perspective on the use of metaphors in family therapy

Because families generally consist of individuals at various developmental levels, family therapists require interventions that are effective regardless of an individual's developmental status. Although metaphor has proven particularly beneficial in therapy, it may be ineffective in families with preschool children who have yet developed sufficient cognitive capacities and knowledge for understanding metaphors. Previewing, a prospective technique derived from interaction between parent and infant, may be used for communicating metaphors about future change to individuals regardless of developmental level. Previewing provides knowledge about development and stimulates the cognitive skills necessary for viewing the present as a metaphor for the future.     

The child's participation in family therapy: A review and a model

A major gap in family therapy, the treatment of children and adults together, is addressed. The literature on the children's participation is reviewed and a model which systematizes their involvement is presented. The full participation of the child necessitates the use of play. To create a context of play without alienating the rest of the family, action-promoting methods are used. These methods are implemented through family activities and role playing, which are followed by discussion. The advantages, the indications, and the contraindications to the use of action in family therapy are presented.     

Need-adapted treatment of schizophrenic processes: The essential role of family-centered therapy meetings

Need-adapted treatment is a psychotherapeutically oriented approach to psychoses that has been planned and is implemented individually in each case, combining different activities so that they meet the needs of each patient as well as the people making up her or his personal interactional network (usually the family). A systemic initial intervention, carried out as a conjoint session of the patient, the family members, and a team of 3–4 staff members is an essential part of this approach. The name therapy meeting was given to these sessions because of their notable therapeutic significance. Therapy meetings are often continued during the later phases of treatment to follow up the course of treatment and to reassess the therapeutic plans.     

Couple therapy and the developmental phase of couple relations with students

The aim of this research project has been, in terms of couple evaluation and therapy, to study structural couplings between individual development and the epigenesis of couple relationships. The epigenesis of couple relations was studied according to the model developed by Wynne in which the epigenetic stages are attachment/ caregiving, communicating, joint problem-solving, mutuality, and intimacy. Attachment/caregiving is crucial for the success of couple therapy. The research on 57 couples makes possible a new paradigm for theoretically understanding interconnections between individual development and development of the couple relation; valuable information for planning integrated and need-specific treatment of the couple relation; and evaluation of the course and prognosis of couple relationship with student.This study was carried out at the Health Care Center for Students, in Turku, Finland, and was financially supported by the Pro Sanitate Studiosorum Institute, Helsinki, Finland. We have been in cooperation with and received invaluable constructive criticism from Lyman C. Wynne, MD, PhD, whose theoretical model we applied in this study. Ms. Birgitta Nolvi's secretarial work was greatly appreciated.     

HOW PSYCHIATRIC TREATMENTS CAN ENHANCE PSYCHOLOGICAL DEFENSE MECHANISMS

Psychological defense mechanisms are a powerful and often unappreciated force safeguarding mental health. Although rarely directed in this way, the most common forms of psychiatric treatment—psychotherapy and antidepressants—can enhance psychological defense mechanisms. Psychotherapy, through both specific and nonspecific factors, induces positive perspective shifts favoring positive cognitive distortions, including adaptive classical defense mechanisms and healthy attribution biases. Antidepressants, by altering very basic emotional information processing, such as facial expression recognition and emotional memories, also foster positive cognitive distortions. By shifting perceptions and thoughts in a positive direction, psychotherapy and antidepressants improve the capacity to dissociate from negative emotional stimuli.Brad Bowins, M.D., FRCP(C), is a staff psychiatrist at the University of Toronto Health Service and he is in private practice.     

Authors and publication practices

Although authors are usually considered to be the main perpetrators of research and publication misconduct, any person involved in the process has the potential to offend. Editors may breach ethical standards particularly with respect to conflicts of interest. In the same way that authors are now required to declare competing interests, notably commercial affiliations, financial interests and personal connections, so must editors. Editors can influence the chances of acceptance or rejection of a paper by reviewer selection. Reviewers should also be ready to disclose conflicts of interest. They must ensure that their reviews are evidence based and free from destructive criticism driven by self interest. It seems likely that ultimately we will progressively move towards 'open' peer review in which both the authors and the reviewers are known to each other. There is an urgent need for increased transparency of the relationship between editors and owners. The events of the last few years indicate that unless this interface is fully understood by all parties, conflicts may arise. There is also a need for a radical overhaul in the relationship between journals, journal editors and the biomedical industry. It is now increasingly accepted that all clinical trials should be registered in a centrally held database and that protocols should include the primary and secondary outcome measures and the intended approach to data analysis thereby avoiding opportunistic post hoc analyses. However, the even more radical proposal that journals should cease to publish clinical trials sponsored by industry deserves wider debate.     

Community engagement,greening, and violent crime: A test of the greening hypothesis and Busy Streets

Researchers have documented that vacant lot greening can reduce community-level crime and violence. Busy Streets Theory (BST) suggests that residents who are involved in the greening process can help to improve physical environments and build social connections that deter crime and violence. Yet few researchers have explored how community engagement in the greening process may affect crime and violence outcomes. We applied BST to test the effects of community-engaged vacant lot greening compared to vacant lots that received either professional mowing or no treatment, on the density of violent crime around study lots. Using mixed effects regression models, we analyzed trends in violent crime density over the summer months from 2016 to 2018 at 2102 street segments in Youngstown, OH. These street segments fell within 150 meters of an intervention parcel that was classified as one of three conditions: community-engaged maintenance, professional mowing, or no treatment (control). We found that street segments in areas receiving community-engaged maintenance or professional mowing experienced greater declines in violent crime density than street segments in areas receiving no treatment, and more decline occurred in the community-engaged condition compared to the professional mow condition. Our findings support BST and suggest that community-engaged greening of vacant lots in postindustrial cities with a concentrated vacancy can reduce crime and violence.