Mental Health and Incarcerated Youth. I: Prevalence and Nature of Psychopathology

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the prevalence of psychopathology and level of behavioral symptomatology in incarcerated youth versus youth receiving community mental health services or hospitalization. We randomly recruited youth from middle South Carolina served by a local CMHC (n = 60), youth served by the state adolescent inpatient program (n = 50), and youth in the S.C. Dept. of Juvenile Justice facilities from the same region (n = 75). We used the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and the CBCL and YSR to evaluate behavioral symptomatology. On the DISC, incarcerated youth had significantly higher mean number of diagnoses and symptoms than CMHC youth, but lower numbers than hospitalized youth. Level of caseness (at least one diagnosis) was 86% in hospital youth, 72% in incarcerated youth, and 60% in CMHC youth. The groups differed in CBCL mean total T, internalizing T, and externalizing T scores as well as mean YSR internalizing T scores. Our results indicate the comparability in level of psychopathology in incarcerated and community-treated populations of youth, and the need to develop diversionary programs to prevent the entry of such youth into the juvenile justice system.     

Law and lamb: AKEDAH and the search for a deep religious symbol for an ecumenical bioethics.

This essay looks at the concept of AKEDAH, the essence of which is the travail of the human condition and the trust in vindication and victory, as a salient and deep metaphor for bioethics. The author first delineates the symbol, then shows its theological and ethical significance, and finally suggests its bioethical applications.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

Abstract Planning and Perceptual Chunks: Elements of Expertise in Geometry

We present a new model of skilled performance in geometry proof problem solving called the Diagram Configuration model (DC). While previous models plan proofs in a step-by-step fashion, we observed that experts plan at a more abstract level: They focus on the key steps and skip the less important ones. DC models this abstract planning behavior by parsing geometry problem diagrams into perceptual chunks, called diagram configurations, which cue relevant schematic knowledge. We provide verbal protocol evidence that DC's schemas correspond with the step-skipping inferences experts make in their initial planning. We compare DC with other models of geometry expertise and then, in the final section, we discuss more general implications of our research. DC's reasoning has important similarities with Larkin's (1988) display-based reasoning approach and Johnson-Laird's (1983) mental model approach. DC's perceptually based schemas are a step towards a unified explanation of (1) experts' superior problem-solving effectiveness, (2) experts' superior problem-state memory, and (3) experts' ability, in certain domains, to solve relatively simple problems by pure forward inferencing. We also argue that the particular and efficient knowledge organization of DC challenges current theories of skill acquisition as it presents an end-state of learning that is difficult to explain within such theories. Finally, we discuss the implications of DC for geometry instruction.