Double agency and the ethics of rationing health care: a response to Marcia Angell

The arguments against doctors as "double agents" that are presented by Marcia Angell in the preceding article do not defeat the core justification for rationing some relatively high-expense, low-benefit care, and they do not enable us to conclude that clinicians should be barred from any active, substantive role in decisions to limit that care. They do, however, reveal several important conditions that need to govern cost-conscious medial practice in order to preserve an ethic of fidelity to patients: insurers' profits and providers' incomes must be fair, providers must inform patients of any economic reasons that lead to the foregoing of care, and "direct incentive" arrangements must not be used to contain costs.     

Child and adolescent services research at the national institute of mental health: Research opportunities in an emerging field

This article describes an important new area of research on services for children and adolescents with mental disorders at the National Institute of Mental Health, the parameters of mental health services research for youth, and the opportunities that are available for grant-funded investigations in this area.     

Nonsuicidal physically self-damaging acts in adolescents

To determine the frequency and correlates of nonsuicidal physically self-damaging acts in 12–14 year olds, a two stage epidemiologic survey with a self-administered questionnaire (N=3283) followed by a psychiatric interview of a subsample of the adolescents and their parents (N=444) was used. Prevalence estimates of interview validated nonsuicidal physically self-damaging acts were 2.46% in males and 2.79% in females. Significant relationships were found between nonsuicidal physically self-damaging acts and suicidal ideation, major depression and undesirable life events. Data suggest that physically self-damaging acts occur at substantial rates during early adolescence. The strong correlation between nonsuicidal self-destructive acts and both suicidal ideation and major depression clarifies prior conflicting reports in the literature and suggests that a history of self-damaging acts should be taken into consideration when evaluating for possible depression and suicide risk.     

The effects of exposure to different sources of sexual information on sexual behavior: Comparing a “sex-expert system” to other educational material

Sexpert, an expert computer program designed to counsel couples on their sexual relationships, was evaluated. Eighty-one heterosexual couples were assigned to one of three experimental manipulations (Sexpert, video, and self-help book) or a control condition. Daily sexual behavior monitoring forms and structured retrospective reports served as measures of baseline and post-manipulation behavior. Daily monitoring of sexual behavior failed to show significant changes occurring after the manipulations. However, retrospective data concerning the postmanipulation period show that compared with the control, the Sexpert, video, and book manipulations had a significant positive impact on couples’ sexual behavior, communication, and learning about sexuality. Sexpert, video, and book were similarly evaluated, except that Sexpert was evaluated as more engaging. In addition, subjects retrospectively reported positive changes in communication, relationship satisfaction, and sexual behavior during the baseline period. This suggests that daily behavioral monitoring is intrusive and may confound the variables measured by it.     

Disordered Communication and Grieving in Deaf Member Families

When a deaf child is born to hearing parents, a grieving process is initiated in the parents. Unresolved grieving over their child's deafness often makes it difficult for hearing parents to accept the importance of signing, thus increasing the child's problems — further source of grief for these parents. Clinical illustrations are provided of (1) the reciprocal relationship between disruption of the mourning process and disturbance of communication between family members, and (2) the transmission of the dysfunctional relationship between hearing parents and deaf children to the subsequent relationship between the deaf children, when they reach adulthood, and their hearing children.     

A logic of intentions and beliefs

Intentions are an important concept in Artificial Intelligence and Cognitive Science. We present a formal theory of intentions and beliefs based on Discourse Representation Theory that captures many of their important logical properties. Unlike possible worlds approaches, this theory does not assume that agents are perfect reasoners, and gives a realistic view of their internal architecture; unlike most representational approaches, it has anobjective semantics, and does not rely on anad hoc labeling of the internal states of agents. We describe a minimal logic for intentions and beliefs that is sound and complete relative to our semantics. We discuss several additional axioms, and the constraints on the models that validate them.     

The imp of the reverse: A phenomenology of the unconscious

The debate regarding the unitary versus multiple nature of the human person is examined with special attention to the division between conscious and unconscious. The roots of the unconscious are traced to the experience of alienation or feeling divided within. An existential analysis is provided in order to shed light on the nature of the unconscious. The experience of feeling divided within is explained as a metaphor that is taken literally. An existential-phenomenological explanation of the unconscious is provided which preserves the essential unity of the human person.