The Financial Dimension of Integrated Behavioral/Primary Care

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.     

Molyneux’s question and the individuation of perceptual concepts

Molyneux's Question, that is, “Suppose a man born blind, and now adult, and taught by his touch to distinguish between a cube and a sphere... and the blind man made to see: Quaere, whether by his sight, before he touched them, he could now distinguish, and tell, which is the globe, which the cube”, was discussed by many theorists in the 17th and 18th centuries, and has recently been addressed by contemporary philosophers interested in the nature, and identity conditions, of perceptual concepts. My main concern in this paper is to argue – against Evans, Campbell, and a number of other contemporary philosophers – that a test of the sort Molyneux envisioned, at least if carefully designed and administered, can indeed be a crucial experiment for the claim that we deploy the same perceptual concepts when identifying shapes by sight and by touch. I will explore some implications of this argument for a theory of recognitional concepts. And I’ll try to trace out some unhappy consequences of various alternative views.     

Bodies at Menarche: Stories of Shame, Concealment, and Sexual Maturation

This study examines the embodied nature of menarche through a focus on themes of shame, concealment, and sexual maturation. Using a narrative analysis, it examines menarche stories of 155 undergraduates in the Pacific Northwest, USA, aged 21 years and younger, who started their periods between 1999 and 2003 and who grew up in a culture with changing attitudes and practices about women and the body. Unlike findings from past studies and those with older participants, women reported more positive experiences of menarche. While these data provide evidence for changing attitudes and practices associated with menarche, they may also reflect cultural changes that increasingly commodify the female body and encourage girls to identify the maturing female body as an asset.     

The developmental origins of cognitive vulnerability to depression: temperament, parenting, and negative life events in childhood as contributors to negative cognitive style

Cognitive models of depression have been well supported with adults, but the developmental origins of cognitive vulnerability are not well understood. The authors hypothesized that temperament, parenting, and negative life events in childhood would contribute to the development of cognitive style, with withdrawal negativity and negative parental feedback moderating the effects of negative life events to predict more depressogenic cognitive styles. These constructs were assessed in 289 children and their parents followed longitudinally from infancy to 5th grade; a subsample (n = 120) also participated in a behavioral task in which maternal feedback to child failure was observed. Results indicated that greater withdrawal negativity in interaction with negative life events was associated with more negative cognitive styles. Self-reported maternal anger expression and observed negative maternal feedback to child's failure significantly interacted with child's negative events to predict greater cognitive vulnerability. There was little evidence of paternal parenting predicting child negative cognitive style.     

Attention Deficit Disorder: A Neuropsychoanalytic Sketch

A neuropsychoanalytic sketch of attention deficit disorder (ADD) is presented. The syndrome is defined in terms of its core symptoms, and discussed from the perspective of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment. Also unique is the effort to describe the patient's inner experiences and begin to map these onto the external perspective of what is happening psychologically and neurologically, that is, inside the patient's brain (chemically, anatomically, and neurophysiologically). A number of speculations are thus created regarding the role of the executive control network (ECN), particularly, that of the basal ganglia, cerebellum, anterior cingulate, and those parts of the ECN that are responsible for such things as cognitive shifting between low-level routine information processing modes and those used for high-level processing applicable for sensitive or complex analysis. The effects of trauma on the tagging of memories are also considered. In this manner the research of Shevrin et al., Posner and Raichle, Gedo, Levin, and a number of others integrating mind and brain is brought to bear on an illness with known cognitive and personality disordering. This paper complements a companion paper on the subject of learning disability (Orenstein and Levin, in press).     

Gender differences in predicting loneliness from social network characteristics

In two studies we examined gender differences in predicting loneliness from measures of social network structure and a measure of perceived social support. The results showed that social network characteristics, especially density, were consistently better predictors of perceived loneliness for men than for women. Study 1 used the traditional measure of network density in which the number of relationships among network members was determined. Study 2 used a newly developed index of density that assessed the extent of closeness of relationships between pairs of network members. Uniformly, male subjects with more highly interconnected, cohesive sets of friends reported themselves to be less lonely, whereas density had little relation to loneliness in female subjects. These results are discussed as possibly indicating that men and women use different standards in evaluating whether they are lonely. It is suggested that men may use more group-oriented criteria in evaluating loneliness, whereas women focus more on the qualities of dyadic relationships.     

Graduate Pre-Selection: Some Findings and their Guidance Implications

The application forms of graduate applicants to six organisations were analysed in two investigations. In the first, those features of the forms which predicted whether they were rejected or passed on for interview were discovered. These differed across organisational type, and included aspects of the way in which the form was completed and personal background factors, as well as experience and achievement. In the second investigation, the think-aloud protocols of recruiters as they read the application forms were analysed. Inferences from information rather than the information itself predicted decisions. It is concluded that careers advisers should offer instruction on a variety of matters relating to completion of application forms; and that graduate recruiters should continue to undertake the task of pre selection rather than seeking to 'farm it out'.     

Temperament and sleep–wake behaviour from infancy to toddlerhood

Sleep–wake behaviours and temperament were examined longitudinally for trait stability and relationship to behavioural state regulation from infancy to early childhood. Subjects were 120 low‐risk, full‐term infants from a middle class sample. At 6 weeks, parents completed three consecutive days of the Baby's Day Diary which measures sleep, wake, fuss, feed and cry states and the Infant Characteristics Questionnaire. At 16 months, parents assessed sleep behaviours with the Sleep Habits Inventory and temperament with the Toddler Symptom Checklist. At 24 months, parents repeated 3 days of the Baby's Day Diary. Structural Equation Modelling was used to examine the cross‐age hypotheses for sleep–wake and temperament associations. From early infancy to toddlerhood, sleep–wake behaviours and irritable temperament were notably stable but independent in this cohort. Copyright © 2011 John Wiley & Sons, Ltd.