The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Criminal profiling from crime scene analysis

Since the 1970s, investigative profilers at the FBI's Behavioral Science Unit (now part of the National Center for the Analysis of Violent Crime) have been assisting local, state, and federal agencies in narrowing investigations by providing criminal personality profiles. An attempt is now being made to describe this criminal-profile-generating process. A series of five overlapping stages lead to the sixth stage, or the goal of apprehension of the offender: (1) profiling inputs, (2) decision-process models, (3) crime assessment, (4) the criminal profile, (5) investigation, and (6) apprehension. Two key feedback filters in the process are: (a) achieving congruence with the evidence, with decision models, and with investigation recommendations, and (b) the addition of new evidence.     

Naturalistic psychophysics: thresholds of ducklings (Anas platyrynchos) and chicks (Gallus gallus) to tones that resemble mallard calls

Neonatal ducklings and chickens were tested for responsiveness to a pulsing pure tone that was as similar as possible to the mallard maternal alarm call. It is known that ducklings momentarily cease vocalizing when they hear the alarm call and that chicks do the same when they hear pure tones. The duration of peep suppression can thus be used as a measure of whether subjects of either species heard the stimulus. Chicks might not be as sensitive as ducklings to a mallard alarm call because the signal is less significant to them. An adaptive or staircase procedure was used to estimate absolute thresholds, and group psychometric functions were reconstructed for each species from the trial-by-trial data. Ducklings had lower thresholds than chickens as well as steeper psychometric functions to this stimulus. The results suggest that more sensitive and consistent behavioral responses can be elicited by naturalistic sounds than by more arbitrary acoustic stimuli.     

The process of scapegoating in a neonatal nurses' group

This paper reviews the literature on scapegoating, elaborating on the underlying mechanisms before describing the process of scapegoating as it occurred in a neonatal nurse support group. Illustrative vignettes are used to discuss how scapegoating was used by group members to avoid painful feelings arising from their care of extremely ill infants. Group process is related to the stages of the group's development as feelings were addressed more directly and the need to use scapegoating as a defense decreased.     

Leaders' behavior and group members' interpersonal gains

Early and late in 18 2-day solo-led psychodynamic groups for mental health professionals, 185 participants rated their own behavior and each other's on composite measures of Acceptance versus Rejection of Self (ARS) and of Others (ARO). Only on ARO were leaders consistently rated more favorably than members. Considered by group units, members' mean ratings of peers made modest but significant early-to-late advances on both measures. About two-thirds of all intergroup differences in members' net shifts were separately predictable from ratings of leaders by self and also by pooled group members each time. Groups' ARO shifts were best predicted by members' ratings of leaders toward Warm versus Cold. Leader self-ratings toward Accepts others versus Rejects others best predicted groups' ARS shifts. Featuring interpersonal behavior's two principal dimensions and bridging the common split between studies of group outcome versus group processes, these findings generally support Roger's (1959) theory of personality change.     

Microfeedback: Biofeedback Monitoring Using Home Computers - a Pilot Study

The increasing focus on information technology has led to widespread growth in the use of microcomputer systems in counselling settings. While many applications depend on expensive and sophisticated equipment, the humble home computer has many facilities to offer. High resolution graphics and versatile control interfacing, designed for games use, enable easy adaptation to tasks such as visual presentation of biofeedback with the facility for data retention and analysis. A pilot system based on the Commodore 64 is described.     

Gender and sex role differences in the perception of social support

This study examined the relationships among support types (i.e., emotional, instrumental, and nonintimate social participation), gender, sex role orientation, and stress level among college undergraduates (N=253). Dependent variables included need, perceived availability, and satisfaction with support. Sex differences were found only in emotional support, with men reporting less need, perceived availability, and marginally less satisfaction than women. The only gender by sex role interaction was on need for emotional support. Traditional sex-typed men reported less need than traditional women, whereas there was no difference between androgynous men and women. While sex differences do exist for emotional support, the effects of sex role orientation on perceptions of social support appears to be somewhat circumscribed.     

Relationship of parental education,race, and gender to sex role stereotyping in five-year-old kindergartners

This study examined the relationship of parental education, race, and gender to sex-role stereotyping in five-year-old kindergartners. A significant effect for race and parental education level was noted. White children gave more stereotyped responses than did black children, and children whose parents were in the middle- and high-educational levels gave more stereotyped responses than did children whose parents were in the low-educational level. A significant interaction was also found between educational level of parents and race. White children tended to give more stereotyped responses as the educational level of their parents increased; this trend was not evident for black children. No significant differences in stereotyping were noted between the sexes.To whom requests for reprints or information concerning the Bardwell-Sietsema Sex Stereotype Scale should be addressed at Department of Elementary Education, East Texas State University, Commerce, Texas 75428.     

San Diego suicide study: comparison of gay to straight males

Previous large studies of completed suicides have not considered sexual orientation in their data analyses. In this study, data from the known homosexual subpopulation (13 males, aged 21-42) in a series of 283 suicides were examined. They were compared with all other aged male suicides 21-42 (n = 106). Both groups showed considerable substance abuse plus a variety of other psychiatric diagnoses. Both also had a high frequency of relationship difficulties near the time of death. Gays who committed suicide did not have a history of more police trouble and were no more likely to be living alone than the comparison group. They did not have more prior suicide attempts or previous psychiatric treatment. We conclude that, among the factors examined here, there appears to be little difference between gay and heterosexual male suicides.     

Reserve capacity of the elderly in aging-sensitive tests of fluid intelligence: replication and extension

Fluid intelligence belongs to that cluster of intellectual abilities evincing aging loss. To examine further the range of intellectual reserve available to aging individuals and the question of replicability in a new cultural and laboratory setting, 204 healthy older adults (mean age = 72 years; range = 60-86) participated in a short-term longitudinal training study. For experimental subjects, 10 sessions consisted of cognitive training involving two subability tests (Figural Relations, Induction) of fluid intelligence. The pattern of outcomes replicates and expands on earlier studies. Older adults have the reserve to evince substantial increases in levels of performance in fluid intelligence tests. Transfer of training, however, is narrow in scope. Training also increases accuracy of performance and the ability to solve more difficult test items. Difficulty level was estimated in a separate study, with a comparable sample of N = 112 elderly adults. Future research is suggested to examine whether intellectual reserve extends to near-maximum levels of performance.