Philosophy of medicine in the Netherlands

This report explores the relationship between philosophy and medicine in the Netherlands. In Section 1 we outline the ups and downs of medico-philosophical research in our country: pre-war flourishing, post-war decline, and modern renaissance. In Section 2 we review recent Dutch literature in the philosophy of medicine. The topics dealt with include methodology of medical science, alternative medicine, the basic concepts of medicine, anthropological medicine, medicalization, medicine and culture, and health care ethics.     

An information processing system for the psychiatric emergency room

An information processing system for a psychiatric emergency room is described. Several studies are presented that show the utility of the system. In the first study, variables involved in diagnosis are explicated. The second study attempts to determine the characteristics that distinguish recidivists from nonrecidivists at an emergency room. The third study attempts to find patient variables related to success in short-term treatment programs. The final study is aimed at discovering whether there are psychopathological effects related to the use of inhalants. Together, these studies show the potential of a mental health information system for learning more about the nature of mental disorders and their treatment.     

Feedback interventions and driving speed: A parametric and comparative analysis

Five experiments were conducted to assess the effects of several variables on the efficacy of feedback in reducing driving speed. Experiment 1 systematically varied the criterion used to define speeding, and results showed that the use of a lenient criterion (20 km/hr over the speed limit), which allowed for the posting of high percentages of drivers not speeding, was more effective in reducing speeding than the use of a stringent criterion (10 km/hr over the speed limit). In Experiment 2 an analysis revealed that posting feedback reduced speeding on a limited access highway and the effects persisted to some degree up to 6 km. Experiments 3 and 4 compared the effectiveness of an unmanned parked police vehicle (Experiment 3) and a police air patrol speeding program (Experiment 4) with the feedback sign and determined whether the presence of either of these enforcement variables could potentiate the efficacy of the sign. The results of both experiments demonstrated that although the two enforcement programs initially produced larger effects than the feedback sign, the magnitude of their effect attenuated over time. Experiment 5 compared the effectiveness of a traditional enforcement program with a warning program which included handing out a flier providing feedback on the number and types of accidents occuring on the road during the past year. This experiment demonstrated that the warning program produced a marked reduction in speeding and the traditional enforcement program did not. Furthermore, the warning program and a feedback sign together produced an even greater reduction in speeding than either alone.     

Component analysis of the type A coronary-prone behavior pattern in male and female college students

Two studies investigated the psychological dimensions encompassed by the Rosenman Structured Interview (SI) method of assessing the Type A behavior pattern. In Study 1, female students completed the SI and Jenkins Activity Survey (JAS). Factor analysis of the verbal stylistic and answer content components of the SI yielded a 5-factor solution, with one factor--Clinical Rating--accounting for most nonerror variance in Type A ratings. The remaining factors were derived from answer content and correlated more substantially with JAS Type A ratings than with SI Type A ratings. In Study 2, male and female college students completed the SI and JAS and a battery of questionnaires that tap trait dimensions implied by the conceptual definition of Type A. For both males and females, SI ratings of Type A could almost be completely predicted by scores on the Clinical Rating factor. For both sexes, content dimensions of the SI related to other measures of Type A and to Type A-consistent traits, whereas the Clinical Rating factor was only modestly associated with such traits. Moreover, sex differences were observed in the trait constellations composing SI and JAS definitions of Type A. These results suggest that a discrepancy exists between conceptual and operational definitions of the Type A pattern.     

A case report of pathological rule-governed syllable intrusion

A detailed analysis of a unique speech disturbance, marked by the frequent appearance in the speech stream of a meaningless intrusive syllable, is presented. Following a lengthy thoracic surgery, an American English speaking patient began to speak with non-English prosodic patterns, which evolved to a conspicuous intrusion in his speech of the syllable /sis/. This syllable and its variants were attached to words in a manner which conformed to the regular phonological rules in English (for formation of plural, possessive, and third person singular morphemes). The distribution and frequency of the intrusive syllable are described, and possible explanations for the abnormal occurrence of this particular syllable are discussed.     

Programmed stuttering therapy for children: Comparison of four establishment programs

Four different establishment programs (programmed traditional, delayed auditory feedback, pause, and gradual increase in length and complexity of utterance) for improving the fluency of school-age children who stutter were compared. The programs were carried out by eight public school clinicians with 16 children (eight elementary and eight junior-senior high school) in their respective schools. All four programs produced important improvement in the speech fluency of the 16 children. All the children demonstrated transfer of fluency to extratraining settings. The delayed auditory feedback program required the least therapy hours, but it was difficult for the clinicians to operate correctly. The gradual increase in length and complexity of utterance programs produced the best overall results. The transfer and maintenance programs provided for additional generalization and permanency of fluency. Follow-up revealed that the children continued their increased level of fluency.     

Managing countertransference: what the experts think

The present study attempted to assess the importance of five factors theorized to play a central role in managing countertransference: Self-integration, Anxiety Management, Conceptualizing Skills, Empathy, and Self-insight. 33 experts provided ratings of 50 characteristics of therapists as to the importance of each in managing countertransference. Analysis indicated that each factor is at least somewhat important to management of countertransference, with two of the factors, Self-integration and Self-insight, rated as playing a particularly important role. Clinical implications are discussed.