Towards the Postmodernization of Aging: The Body and Social Theory

This article reviews the significance of postmodernism as applied to understanding social gerontology. We begin by looking at the disciplinary dominance of biomedical models to understanding bodily change through later life. We then move our analysis to the lack of theoretical models within social gerontology which have not attempted to analyze or develop social explanations of the body. The article introduces the concept of postmodernism and reviews the work of major theorists who have impacted postmodern gerontology. We conclude by arguing for an interface between social theory and social gerontology by drawing on recent examples of the mask of aging thesis, biotechnologies, and new technologies that impact aging identity and understanding the self.     

The Loss of Aging Identity: Social Theory, Old Age, and the Power of Special Hospitals

Medical and health languages have emerged as master narratives used to police the identities that older offenders adopt in contemporary special hospitals such as Broadmoor, Rampton, and Ashworth, in the United Kingdom. Both contain continually changing technologies that function to mediate relations between older offenders and special hospitals. Medical and institutional discourses have been presented as reducing limitations associated with psychiatric disorders. This represents an increase in professional control that can be exerted on inmates' lifestyles in special hospitals which extends to the surveillance and governance of older persons in such secure settings. It is evident that the use of the indeterminate sentence, compulsory treatment prevents older offenders from rehabilitation. The process of treatment is to transform, discipline and normalize their behavior. In order to achieve normalization, coercive forms of treatment are invoked from informal social rules to the use and overuse of psychothropic drugs. Mentally disordered older offenders are placed under the gaze of perpetual surveillance but find ways of negotiating, resisting, and subverting that gaze. Furthermore, this article illuminates how the aging body and the use of time become other sources of punishment, which are pivotal to the structural organization of secure settings in the United Kingdom.     

Differential Conditioning Based on a Difference in the Predictability of Reinforcement

A Pavlovian procedure containing a set of several alternative reliable trial stimuli and a set of several alternative unreliable trial stimuli was used to determine if reliability of outcome, per se, would differentially condition additional trial stimuli that either preceded or followed those original trial stimuli in a serial conditioning paradigm. The reinforcing effectiveness of the antecedent stimuli themselves was later tested in a higher-order conditioning design. It was found that different rates could be established to the different antecedent stimuli in the absence of a difference in the probability of reinforcement. Further, stimuli paired with those antecedent stimuli in the higher-order conditioning test also exhibited a difference in rate. It was concluded that a combination of a stimulus that is always followed by food and another that is never followed by food are, in net, a more effective reinforcer than a common stimulus that has the same overall probability of reinforcement but which is followed by both outcomes.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

The relationship of interparental conflict and global marital adjustment to aggression,anxiety, and immaturity in aggressive and nonclinic children

Although there is agreement that marital problems are associated either directly or indirectly with particular child behavior problems, there is disagreement about the types of marital conflict associated with these problems and the differential effects on boys and girls in clinic and nonclinic samples. We examined the relationships among mothers' ratings of marital adjustment, parenting disagreements, and three child problem factors (aggression, anxiety, and immaturity) after the child's age and family socioeconomic status were controlled. These relationships were compared with samples of boys and girls (3 to 8 years of age) from clinic and nonclinic populations, revealing that parenting disagreement predicted aggression in all groups and that both marital adjustment and parenting disagreement predicted anxiety in boys. Neither marital variable predicted immaturity. Possible reasons for the results (including methodological limitations of the present data) are discussed.Thanks to Merryl Reville and Kath Faulkner, Monica Smith and Dr. Bill Bor of Queensland Division of Child Guidance, and Pat Roberts of the Lady Gowrie Child Centre for their help with subject recruitment. Part of this study was supported by a Social Science Research Grant from the University of Queensland.