A Community of Psychotherapists

Services for chronic mental patients in this era of deinstitutionalization present a major challenge to clinicians and planners alike. The complexity of these patients' clinical and other programmatic needs requires that an array of viable comprehensive services be made available to them. Following certain established principles of service planning will help facilitate patients' longitudinal, psychological, financial, and geographical access to care.     

Double Effect and the End-Not-Means Principle: A Response to Bennett

Proponents of double-effect reasoning — relying in part on a distinction between intention and foresight — assert that it is worse intentionally to cause harm than to cause harm with foresight but without intention. They hold, for example, that terror bombing is worse than tactical bombing in so far as terror bombing is the intentional harming of non-combatants while tactical bombing is not. In articulating the ethical relevance of the intended/foreseen distinction, advocates of double effect employ the Kantian end-not-means principle.
Jonathan Bennett has recently argued that this principle cannot ground the ethical relevance of the intended/foreseen distinction. He holds that the principle demands that one benefit others while double effect deals with acts that do not benefit others. Thus, he maintains, the intended/foreseen distinction does not have ethical import and double effect is not tenable. I argue for a reading of the end-not-means principle that grounds the ethical relevance of both the intended/foreseen distinction and double effect.     

Non-parametric inference for ordered alternatives in a randomized block design

This paper treats the problem of testing an ordered hypothesis based on the ranks of the data. The statistical procedures for the randomized block design with more than one observation per cell are derived. Multiple comparisons and estimation procedures are also included.     

Smoking onset in adolescence: a person-centered analysis with time-varying predictors.

Predictions from smoking-specific versus contextual models of smoking onset were tested with data from a 4-wave sample with 1,364 adolescents. Predictor variables were derived from stress-coping theory, social influence theory, and problem-behavior theory. In addition to groups of abstainers and experimenters, cluster analysis of smoking data indicated 3 groups who showed onset either in 7th grade (early onset), 9th grade (intermediate onset), or 10th grade (late onset). Almost all study variables discriminated the smoking groups from the abstainers. The onset groups were discriminated by Group X Time interactions showing differential changes in predictors (increases in risk factors and declines in protective factors), which occurred just prior to onset. The results generally support a contextual model of the onset process.     

Reliability and sensitivity of suicide certification in higher-income countries.

World Health Organization age-, sex-, and cause-specific mortality data for the United States and 19 other democratic higher-income countries were utilized to assess the reliability and sensitivity of suicide certification for purposes of cross-national research. Data are found to be highly reliable across age and sex (rs > 0.92; P < 0.001). Relative discrepancies between official suicide rates (putative lower limits) and projected upper limits vary widely internationally. Austrian and Dutch suicide certification is the most sensitive. Least sensitive is certification for certain subpopulations in Finland, Greece, Ireland, Israel, and the United Kingdom. We recommend similar analyses be performed for routine, low-cost surveillance of suicide data quality, and to guide choice of population groups for multivariate comparative research.     

Believers and Their Disbelief

Several recent Roman Catholics who were known for their devotion have left accounts of their troubled faith. I consider three of these: St. Therese of Lisieux, Mother Teresa of Calcutta, and Pierre Teilhard de Chardin. Then I tell of the troubled atheism of Jean‐Paul Sartre. Finally, I use texts of Sartre and Teilhard to understand the unsettled nature of belief.