Holocaust survivors in a primary care setting: fifty years later

Past studies have not assessed the prevalence of emotional disturbances in Holocaust survivors seeking medical treatment in a family practice environment. The present study examined the prevalence of lifetime (the presence of symptomatology at any time) and current posttraumatic stress disorder (PTSD) symptoms, general anxiety, and depression in Holocaust survivors seeking medical treatment in a primary care setting. 20 of the 27 Holocaust survivors in our sample received a current diagnosis of PTSD and reported significant symptoms of depression and general anxiety. Although 74% of the survivors were currently diagnosed with PTSD, participants in this study had reported an overall decline in reexperiencing, hyperarousal, and overall PTSD symptoms but exhibited increased avoidance and numbing symptoms throughout the lifespan. These preliminary results suggest that removing avoidance as a defense mechanism during the course of psychotherapy may leave these survivors without an adequate way for coping with their trauma, subsequently increasing their vulnerability to psychopathology. Implications for psychological interventions are provided.     

HMOs and physician conflicts of interest

In a recent issue of this journal, Francis Beckwith's "The Ethics of Referral Kickbacks and Self-Referral and the HMO Physician as Gatekeeper: An Ethical Analysis" provided an admirably provocative defense of the claim that Health Maintenance Organization (HMO) physician gatekeepers are morally indistinguishable from physician referral kickbacks and self-referrals. Here I will argue that Beckwith's defense is weak. I will also make some tentative suggestions about approaching the issue of physician conflicts of interest.     

Propagation of depth information from local regions in 3-D scenes

The effects of regions with local linear perspective on judgments of the depth separation between two objects in a scene were investigated for scenes consisting of a ground plane, a quadrilateral region, and two poles separated in depth. The poles were either inside or outside the region. Two types of displays were used: motion-parallax dot displays, and a still photograph of a real scene on which computer-generated regions and objects were superimposed. Judged depth separations were greater for regions with greater linear perspective, both for objects inside and outside the region. In most cases, the effect of the region's shape was reduced for objects outside the region. Some systematic differences were found between the two types of displays. For example, adding a region with any shape increased judged depth in motion-parallax displays, but only high-perspective regions increased judged depth in real-scene displays. We conclude that depth information present in local regions affects perceived depth within the region, and that these effects propagate, to a lesser degree, outside the region.     

Organisation: what levels of processing are levels of

The psychology of thought and memory has historically been concerned with a struggle between associationism and its opponents. Organisation theory--in part an offspring of Gestalt concepts--has been the most successful and vocal of these contenders. The levels-of-processing framework has been a part of the effort to overcome associationist predilections. Aspects of principles of organisation and of the recent history of organisation theory are presented, followed by an analysis of the levels-of-processing approach in terms of organisational concepts.     

Pessimism

The problem of pessimism is the secular analogue to the evidential problem of evil facing traditional theism. The traditional theist must argue two things: that the evidence shows that this is on balance a good world and that it is the best possible world. Though the secular optimist who advocates any form of secular moral theory need not argue that the current and future world will likely be the best possible world, she nonetheless must argue that were there a clean solution to the problem of current and future suffering in which all sentient life could be instantly and painlessly eliminated, we would have reasons not to employ the clean solution because the future promises to bring on balance a good world in which the evil of human and animal suffering is outweighed by whatever is good in the world. Pessimism is the view that the evidence argues against secular optimism. It is argued here that it is anything but clear that secular optimism is warranted when viewed from an impersonal point of view. The problem is then evaluated from the personal point of view in which a form of personal optimism is defended even in the face of impersonal pessimism.     

Volume Contents

Volume Contents

Volume Contents     

Vagus nerve stimulation: a new form of therapeutic brain stimulation

Although the vagus nerve has traditionally been considered to perform efferent functions, in reality it performs significant afferent functions as well, carrying information from the body, head, and neck to the brain. Preliminary studies examining this afferent activity led to the theory that vagus nerve stimulation (VNS) could successfully control seizure activity in persons who are refractory to antiepileptic medications. Unlike other forms of brain stimulation, VNS is unable to directly stimulate multiple discrete areas of the brain; however, through several pathways, it is able to relay sensory information to higher brain regions. An implantable VNS device known as the VNSTM NeuroCybernetic Prosthesis (NCP) System has been used in approximately 9,000 epilepsy patients in Europe and the United States since 1994. The implant has reduced seizure frequency by an average of 25% to 30%, with minimal side effects. Studies underway are also showing some degree of success in the management of treatment-refractory depression. The future efficacy of the implantable system in other disorders may depend on whether the implant can be more precisely focused to affect different brain regions. Research in this area is underway.     

Reviews of current books

Conclusion Wise counseling can relieve the anxiety and inner conflict of parents torn between the dread of their retarded offspring becoming a parent and the fear of an operation they believe to be illegal, immoral, and castrating.By knowing where to refer patients, clergymen can make it possible for some of these deprived members of society to find support and love within marriage without being overburdened by children they are not capable of rearing properly.