No Blame No Gain? From a No Blame Culture to a Responsibility Culture in Medicine

Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where healthcare professionals are held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of ‘responsibility without blame’, applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors.     

Practicing mind-body medicine before Freud: John G. Gehring,the “Wizard of the Androscoggin”

This article describes the psychotherapy practice of physician John G. Gehring and places it in historical context. Forgotten today, Gehring was a highly sought-after therapist from the 1890s to the 1920s by prominent figures in the arts, sciences, business, and law. He practiced a combination of work therapy, suggestion, and autosuggestion that has similarities to Cognitive Behavior Therapy and Behavioral Activation. Using biographies, memoirs, and archival records, the details of Gehring's work are reconstructed and the reasons for its success are analyzed. His invisibility in the history of psychiatry is attributed to the later dominance of Freudianism within the field.     

When two are a family: looking backward and looking forward in a group intervention with single‐by‐choice mothers

Objective: We describe a preventive short‐term group intervention with nine single‐by‐choice (SBC) mothers to provide maximal support for parental functioning and to minimize possible emotional and/or developmental difficulties in their children. Method: Dynamically oriented group work (fifteen one‐and‐a‐half‐hour sessions) focused on: elaboration of painful experiences in the peri‐natal period; reducing stress, tension and guilt; helping mothers with problematic aspects of parenting through work on parental self‐image and perceptions of the child and the dyadic interaction; and strengthening their acceptance of the chosen family model. Results: Therapeutic gains described by mothers and facilitators include: reduced tension, anxiety and guilt; improved integration of the mother's parental self‐image and perception of the child; reduced ambivalence in dyadic relationships; strengthening the mother's fantasized triadic relationships; better acceptance of chosen family pattern; mothers' willingness to tell children their birth story. Conclusion: Dynamically oriented preventive group intervention with SBC mothers can identify potential psychological risk factors and help mothers with sensitive aspects of parenting.     

Chronicles and social memory

This written version of the 2016 Mowinckel Lecture draws attention to and characterizes in broad strokes a particular approach that is strongly influenced by Social Memory studies and then, through a number of examples, demonstrates its potential use for addressing questions about Chronicles, as read among the literati of the late Persian or Early Hellenistic Yehud/Judah, and especially about the contribution that Chronicles made to the social memory of this group.