医学专业精神及医疗保密:美国历史及现状中的冲突

讨论卫生部门宣传和加强强制汇报的法律的努力、强制性汇报的规定与医学专业精神及个人自主性之间的冲突、私人医生避免遵守这些规则的策略、病人和倡议者设法避免强制性登记和检测的策略,以及医生/病人和公共卫生官员达成的妥协.最后对公共卫生政策提出建议,认识到强制性汇报存在的问题和卫生政策透明度的重要性.     

The self beyond words: comment on ‘Is there a place for individual subjectivity within a social constructionist epistemology’

Roy‐Chowdhury (2010) is on a quest to reclaim the subject in constructionist practice, specifically therapeutic practice. His argument rests on the claim that there is no subject, no self, no individual outside language in social construction. To be sure, the notion of a self‐contained, privately cognizing individual is dismissed within social construction, noting instead that knowledge of self and world is a byproduct of relational interchange. As Lock and Strong (2010 , p.7) put it, ‘meaning and understanding have their beginnings in social interaction, in shared agreements as to what these symbolic forms are to be taken to be’. The relational self – social construction's version of the self – is very much alive and well. The relational self is very much a person.     

Treatment of obsessions: A randomized controlled trial

This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre-post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment.     

Character,Attitude and Disposition

Recent debate over the empirical psychological presuppositions of virtue ethics has focused on reactive behavioural dispositions. But there are many character traits that cannot be understood properly in this way. Such traits are well described by attitude psychology. Moreover, the findings of attitude psychology support virtue ethics in three ways. First, they confirm the role of habituation in the development of character. Further, they show virtue ethics to be compatible with the situation manipulation experiments at the heart of the recent debate. Finally, they show how the cognitive‐affective theory of personality and the two‐system theory of behavioural cognition are compatible, thereby undermining the current empirical challenge to virtue ethics. Empirical research into the nature and development of attitudes should therefore be central to philosophical discussions of virtue and character.     

Radical presence: Alternatives to the therapeutic state

This article introduces the idea of radical presence as an alternative to the current therapeutic state (or psy-complex) within which we live today. Radical presence challenges us to confront the dominance of psychological discourses which define, control, and limit the ways in which we live. It shifts our attention from diagnosis and treatment of individuals to an exploration of broader relational and institutional contexts, and the ways in which professionals and ordinary people alike can be responsive, present, and open to a multiplicity of life forms.     

More than a Media Moment: The Influence of Televised Storylines on Viewers’ Attitudes toward Transgender People and Policies

Numerous studies have demonstrated the power of entertainment narratives to influence attitudes and behaviors; fewer have examined the effects of TV portrayals on attitudes toward marginalized groups. The present study is among the first to explore how entertainment narratives depicting transgender individuals influence viewers’ attitudes toward transgender people and related policies. The study examines the impact of exposure to a TV storyline on Royal Pains (USA Network) and cumulative effects of viewing other TV series featuring transgender individuals. An online survey of 488 U.S. viewers of Royal Pains was conducted (391 had seen the relevant episode). ANCOVAs revealed exposure to both the Royal Pains’ storyline and other storylines portraying transgender individuals were associated with more supportive attitudes toward transgender people and policies. Mediation models revealed that for viewers of the Royal Pains’ storyline, the relationships between political ideology and attitudes toward transgender people and policies were mediated by identification with the main characters and the emotion of hope. Disgust mediated viewers’ attitudes toward transgender people, but not policies. Post hoc analyses revealed that exposure to transgender narratives reduced the influence of viewers’ political ideology on their attitudes. The attitudes of more conservative viewers became increasingly positive as they saw more media portrayals of transgender individuals. These findings highlight the potential for entertainment narratives to influence attitudes toward marginalized groups, and they demonstrate the importance of emotion in the context of divisive topics. Social, political, and public health implications are discussed.     

Drag Gender: Experiences of Gender for Gay and Queer Men who Perform Drag

The present study explored the experience and understanding of gender for gay and queer men who perform drag. It is part of a 20-year program of research focused on how LGBTQ gender identities arise, why they coalesce, and how they are enacted within their social contexts. Interviewers on this topic involving 18 participants were subjected to a grounded theory analysis. Drag genders were tied to common experiences of overcoming social messages that maligned femininity within men, an appreciation of performance arts, and a desire to use social power to confront issues of sexism, genderism, and/or heterosexism. At the same time, participants reported differences in experiencing gender as binary or fluid and in whether they experienced their gender as shifting when engaged in performance. The study contributes to the program of research on LGBTQ genders by examining how drag gender is both essential and constructed, and how it resist sets of oppressive values and is eroticized. It examines how gendered communication functions when performed for audiences and how the social position of these men is both elevated and stigmatized within LGBTQ community. Drag gender’s multiple meanings are credited to its position between gay and transgender politics within this socially transformative moment in time.     

Influence of Multiple Traumatic Event Types on Mental Health Outcomes: Does Count Matter?

The experience of potentially traumatizing events (PTEs) may be associated with conflicting outcomes: individuals may experience greater psychological distress (dose-response theory), or individuals may become more resilient against repeated PTEs (stress-inoculation theory). With limited empirical data comparing these theories, we examined the relationships between the count of lifetime PTE types and psychological outcomes [posttraumatic stress disorder (PTSD), depression, impaired distress tolerance] using linear and quadratic regressions. A linear relationship would support the dose-response theory, and a quadratic relationship would support the stress-inoculation theory. We also explored whether there was a threshold number of PTE types fostering resiliency before an increase of distressing outcomes. The sample included 123 (68.30% female) treatment-seeking patients at a community mental health center participating in a larger study (Contractor et al. in Psychiatry Research, 252, 252215–252222, 2017). Linear regression results indicated number of PTE types significantly predicted increasing PTSD and depression severity and distress tolerance difficulties. Quadratic regression model results were not significant. ROC analyses indicated exposure to at least 3.5 PTE types predicted PTSD with moderate accuracy. In conclusion, the dose-response theory was supported, with results indicating there may be a threshold count of lifetime PTE types (> 3) influencing traumatic stress outcomes.