Effects of involuntary outpatient commitment on subjective quality of life in persons with severe mental illness

Recent evidence suggests that involuntary outpatient commitment (OPC), when appropriately applied, can improve adherence with psychiatric treatment, decrease hospital recidivism and arrests, and lower the risk of violent behavior in persons with severe mental illness. Presumably these are benefits that improve quality of life (QOL); however, insofar as OPC involves legal coercion, the undesirable aspects of OPC could also exert a negative effect on quality of life, thus offsetting clinical benefits. Involuntarily hospitalized subjects, awaiting discharge under outpatient commitment, were randomly assigned to be released or continue under outpatient commitment in the community after hospital discharge, and were followed for one year. Quality of life was measured at baseline and 12 months follow-up. Treatment characteristics and clinical outcomes were also measured.Subjects who underwent longer periods of outpatient commitment had significantly greater quality of life as measured at the end of the 1 year study. Multivariable analysis showed that the effect of OPC on QOL was mediated by greater treatment adherence and lower symptom scores. However, perceived coercion moderated the effect of OPC on QOL. Involuntary outpatient commitment, when sustained over time, indirectly exerts a positive effect on subjective quality of life for persons with SMI, at least in part by improving treatment adherence and lowering symptomatology.     

Building capacity or enforcing normalcy? Engaging with disability scholarship in Africa

In contemporary South African academia, “community engagement” is a valued commodity. My work as a nondisabled white man with disability activists and as editor of the African Journal of Disability is viewed as good for my career, and as an appropriate form of engagement and empowerment. In this article, I engage critically with the question of the extent to which capacity building is simply about increasing capacity. I ask whether capacity building inevitably involves elements of disavowal of the experience and competencies of less powerful people. I compare capacity building to the enforcement of normalcy, a process which disability scholars criticize with justification. I ask whether it is possible in unequal social contexts to engage with the politics of voice without imposing a hegemonic narrative on nondominant voices. I suggest links between the politics of engaged scholarship and processes of domestication of troubling bodies and minds.     

Imbalances in the knowledge about infancy: The divide between rich and poor countries

Over 90% of the world's infants are born in low‐income or “developing” countries, and these countries bear a disproportionate burden in terms of health and social problems. In this article we compare the contributions of richer and poorer countries to knowledge about infancy. We surveyed articles on infancy from 12 international journals dealing with psychological aspects of childhood and infancy and found that 94% of articles surveyed were written from Europe or North America. We suggest that the imbalance in knowledge about infancy is serious and that efforts must be made to increase collaborative research between poor and rich countries. ©2003 Michigan Association for Infant Mental Health.     

Resistance of voice onset time variability to intoxication.

Voice onset times of /d/ and /t/ were measured for 16 adult subjects (age range 21 to 26 years) under conditions of sobriety and intoxication. Subjects consumed beer to reach intoxication levels between 0.075 and 0.100% as measured using a portable breathalyzer test. Analysis indicated consistent variabilities over time for each subject and resistance of VOT variability to alcohol influence.     

Mechanisms of hypnotic and nonhypnotic forgetting

Subjects participated in two experimental sessions designed to study laboratory-induced amnesia, one using a standard hypnosis paradigm and one using a non-hypnotic directed-forgetting paradigm. Two independent sources of variation were derived from the hypnotic amnesia data: retrieval inhibition and inhibition release. In the nonhypnotic directed-forgetting procedure, some items were cued to be forgotten shortly after presentation and some were cued to be remembered. At test, the subjects were asked to recall both the to-be-remembered and the to-be-forgotten items. Over 39% of the variance in the recall of the to-be-forgotten items could be accounted for by the inhibition and release constructs obtained with hypnosis. These relations between the two procedures were not mediated by verbal ability or cognitive style (field independence). We concluded that the mechanisms of forgetting involved in laboratory demonstrations of hypnotic and nonhypnotic amnesia are related, and the implication is that some of them are the same, namely, retrieval inhibition and inhibition release. We also argued that the possible demand characteristics that accompany the hypnosis procedure are not apparent with the nonhypnotic procedure. Therefore, the relationships observed in the present results were taken as evidence that hypnotically induced amnesia is not entirely the result of subjects' reactions to demand characteristics.     

Giving In,Giving Up,and Being Blown to Smithereens: A Discussion of “‘When Reparation Is Felt to Be Impossible’: Persecutory Guilt and Breakdowns in Thinking and Dialogue about Race”

In describing the paralysis that encumbers those struggling with persecutory guilt about their white privilege, and suggesting we seek opportunities for meaningful repair within the realm of the ordinary, Caflisch (this issue) is directing us toward an ethic of personal accountability to everyday interaction. This paper explores possible routes toward the “ordinary” reparation Caflisch seeks, and describes several pitfalls that might be encountered along the way.     

Perspectives in psychology

The Psychological Record -