The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Factors Perceived as Helpful by the Members of Self-Help Groups: An Exploratory Study

The factors perceived as helpful by members of three different types of self-help groups are examined, using the 12 factors identified by Yalom as operative in group psychotherapy. Questionnaires were given to 45 members of self-help groups, asking for their views of the most and least helpful aspects of their experiences of their group, and for their judgement of its effectiveness. Results indicated that members of a group concerned with social and personal support in the face of a socially problematic situation (widowhood) found the experience of Universality to be the most helpful factor, while Self-Disclosure was least helpful. Members from a group for the physically sick (asthma sufferers) also reported the least helpful factor to be Self-Disclosure, but said that the most helpful factor was Guidance. By contrast, the group concerned with providing 'therapy' for depressives reported Cohesiveness to be most helpful, and Guidance to be least helpful. Comparison with other studies using similar methodologies with different group populations suggests that the factors likely to be effective in self-help groups for the socially unsupported and physically sick on the one hand, and for the psychologically disturbed on the other, may differ.     

The role of spatial-frequency channels in the perception of local and global structure

Adaptation and reaction-time techniques were used to examine the role of different spatial-frequency channels in the perception of local and global structure. Subjects were shown figures consisting of a large C composed of smaller Cs and asked to identify the orientation of either the global C or its local elements. Prior to performing the task subjects were adapted to different spatial frequencies and the effect on subsequent performance was assessed. Two main results were found. First, the adapting frequency that most affected the global task was often lower than that most affecting the local task, suggesting that high and low frequencies independently code the structure of an image. Second, reaction time to global figures was often faster than to local figures at all levels of detectability, again suggesting a role of low-frequency channels in global processing.     

The effects of nature or of nurture on sex differences in intellectual functioning: Israeli findings

Sex Roles - This paper contrasts the results of studies examining sex differences in intellectual functioning in the United States and in Israel. Israeli studies indicate earlier sex differences as...     

RELIGIOUS EXPERIENCE, ARCHETYPES, AND THE NEUROPHYSIOLOGY OF EMOTIONS

Abstract. Established religions integrate a society's everyday secular realities with humankind's numinous experience of the holy. Powerful emotions nourish the cultural expression of the archetypes propelling the "ritual dances" of art, sport, and technocracy. During sacred moments such as mother-infant or adult bonding, neuroendocrine triggers activate lifelong ties. The cultural canon of the left cortex contrasts with the intuitive right. Brainstem "switches" alternate the left's cool, extraverted, sympathetic drive for control with the right's "warm" attachment behavior and dreaming sleep. Psychic trauma damages flexibility with resultant alexithymic blindness to emotions and archetypes. Substance abuse and narcissistic overemphasis on control ensue.     

Reserve capacity of the elderly in aging-sensitive tests of fluid intelligence: replication and extension

Fluid intelligence belongs to that cluster of intellectual abilities evincing aging loss. To examine further the range of intellectual reserve available to aging individuals and the question of replicability in a new cultural and laboratory setting, 204 healthy older adults (mean age = 72 years; range = 60-86) participated in a short-term longitudinal training study. For experimental subjects, 10 sessions consisted of cognitive training involving two subability tests (Figural Relations, Induction) of fluid intelligence. The pattern of outcomes replicates and expands on earlier studies. Older adults have the reserve to evince substantial increases in levels of performance in fluid intelligence tests. Transfer of training, however, is narrow in scope. Training also increases accuracy of performance and the ability to solve more difficult test items. Difficulty level was estimated in a separate study, with a comparable sample of N = 112 elderly adults. Future research is suggested to examine whether intellectual reserve extends to near-maximum levels of performance.     

Cross-sectional studies of personality in a national sample: 1. Development and validation of survey measures

Short scales were developed to measure three broad dimensions of personality in the National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Followup Study. Items to measure neuroticism were selected rationally from the General Well-Being Schedule, and items to measure extraversion and openness to experience were selected by multiple regression from the NEO Personality Inventory. In a sample of 654 men and women from the Augmented Baltimore Longitudinal Study of Aging, all three short scales showed clear evidence of convergent and discriminant validity against full scales in self-reports, and against peer and spouse ratings. Because they were developed and validated on a sample with a comparable age range, the NHANES scales should be useful in examining age trends in these three personality dimensions in a national sample.