Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.     

不只是“谈话疗法”：精神分析治疗中的非言语维度

精神分析治疗在很长一段时间里被视为“谈话疗法”,其治愈机制是将潜意识的内容意识化,语言解释在其中发挥关键作用。自20世纪末开始,越来越多分析师强调非言语交流在治疗中的作用。非言语交流不仅能够为咨访双方提供更丰富的交流形式,还能通过互动中的“相遇时刻”,实现对患者过去经验的重组,改变其有缺陷的内隐关系知晓。非言语交流和语言交流能够在治疗中发挥互补作用,未来的精神分析心理学要继续加强对非言语领域的研究。     

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children’s externalizing behaviors and parenting problems, was associated with improvements in parents’ emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children’s improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents’ self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents’ self-report of children’s symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children’s symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents’ perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children’s externalizing behaviors.     

Measuring generalised expectancies for negative mood regulation in China: The Chinese language Negative Mood Regulation scale

Negative mood regulation expectancies (NMRE) represent people's confidence that they can alleviate their negative affect or induce a positive emotional state through thought or action. NMRE predict coping behaviour and mood outcomes for individuals under stress. Since 1990, much research documents the reliability and validity of the English language Negative Mood Regulation (NMR) scale as a measure of NMRE. The current research reports two studies developing a Chinese language translation of the NMR (NMR‐C) scale that goes beyond literal translation to be a culturally sensitive measure of NMRE in China. In Study 1, 713 college students from both a major city and a rural setting in China were surveyed. Data support the resulting 32‐item NMR‐C's reliability (alpha = .88) and validity. The NMR‐C showed both direct and indirect links to depression and anxiety; coping mediated the indirect effect. In Study 2, 331 prison police officers in three Chinese provinces participated. NMRE buffered the effect of high role pressure, moderating the relationship between prison police role stress and job engagement. Results of the two studies support the reliability and validity of the Chinese language NMR scale and parallel results found with measures of NMRE in the West and in other Asian countries.     

Development and validation of Indian Affective Picture Database

Since culturally salient stimuli for emotion recognition are scarce in India, we developed and validated a set of 140 coloured pictures of six basic emotions along with a neutral expression. The expressions were posed by four expressers, two males and two females, with mean age of 25.25 (SD 3.77) years. The expressions were captured from five different angles keeping the background uniform. These pictures were shown to 350 undergraduates who labelled the emotion and rated their intensity. The mean biased hit rate was 93.02 (SD 7.33) and mean unbiased hit rate was .519 (SD .015). Within subjects ANOVA revealed significant main effect of emotion (F(1, 6) = 7.598, p < .001). The t‐test value (23.116, p < .001) shows that the given emotion was identified correctly by participants beyond chance factors. The mean intensity rating was 5.94 (SD .77). Overall, the results reveal that the pictures are a valid set of affective stimuli.     

Perceived emotion suppression and culture: Effects on psychological well‐being

Whether the negative effects of emotion suppression on psychological well‐being are applicable cross‐culturally is a long‐debated topic. The present study attempted to shed light on this debate, focusing on the effects of perceived emotion suppression and examining the psychological processes leading from perceived emotion suppression to lower psychological well‐being. We used a scale manipulation to lead 196 American and 213 Chinese participants to perceive themselves as having suppressed their emotions to a greater or lesser extent and then measured their life satisfaction. As expected, both the American and Chinese participants reported lower life satisfaction in the high‐suppression condition than in the low‐suppression condition; this negative effect was mediated by positive affect and moderated by self‐esteem. Specifically, perceived high emotion suppression decreased positive affect, which in turn led to lower well‐being. This effect was observed only for those with low self‐esteem, but the patterns and mechanisms were consistent cross‐culturally.     

Do community and autonomy moral violations elicit different emotions?

According to one important set of theories, different domains of immorality are linked to different discrete emotions—panculturally. Violations against the community elicit contempt, whereas violations against an individual elicit anger. To test this theory, American, Indian and Japanese participants (N = 480) indicated contempt and anger reactions (with verbal rating and face selection) to both the types of immorality. To remedy method problems in previous research, community and autonomy violations were created for the same story‐frame, by varying the target to be either the community or an individual. Community and autonomy violations did not differ significantly in the emotion elicited: overall, both types of violations elicited more anger than contempt (and more negative emotion of any kind than positive emotion). By verbal rating, Americans and Indians reported more anger than contempt for both types of violation, whereas Japanese reported more contempt than anger for both types. By face selection, the three cultural groups selected anger more than contempt for both types of violation. The results speak against defining distinct domains of morality by their association with distinct emotions.     

Strategy Induction Enhances Creativity in Figural Divergent Thinking

Instructional effects in creative‐thinking tasks are important to understand in order to promote creative performance of individuals. In divergent‐thinking tasks, for example, instructional and strategic enhancement effects have been extensively studied for verbal tasks. However, while studies on instructional enhancement effects on creative drawing tasks exist, it is surprising that strategy enhancement in figural divergent thinking is still underresearched. In this study, we used a strategy manipulation approach to reassess the role of executive strategy implementation and the moderating role of an indicator of fluid intelligence, figural analogical reasoning, in two types of figural divergent‐thinking tasks (abstract vs. concrete). The sample comprised N = 75 high‐school students. Importantly, we found strategic enhancement effects by combining strategy instructions with a prompt to “be creative.” This combined instruction was contrasted with a standard instruction, and main effects were found for overall, concrete, and abstract creativity. Moreover, we found in a regression analysis a main effect for figural analogical reasoning on overall creativity and creativity for only the concrete object tasks. An expected interaction effect of instruction and figural analogical reasoning was not found. As another addition, the role of current motivation in figural divergent thinking was explored.     

Stratégies et réactions des victimes et de leur entourage face au harcèlement scolaire : une étude rétrospective

The negative consequences faced by students who are victims of school bullying are clearly documented. Nevertheless, few studies have examined victim's reactions and strategies to cope with bullying. Yet a better understanding of these reactions would allow a better support from health professionals and to improved prevention actions. This study aims to explore the victim's coping strategies through the content-analysis of 32 interviews conducted with former victims. Given their decisive influence on the bullying's situation, spontaneous or requested reactions of peers, teachers and parents are examined as well. To include these two aspects in a common theoretical framework, this research proposes to combine two distinct approaches: the coping strategies and the Participant Role Approach (Salmivalli, 2010; Salmivalli et al., 1996). The efficiency of each highlighted strategy is analysed and discussed regarding current scientific knowledge. Results suggest that victims generally experiment a large panel of reactions and strategies to cope with bullying. Nevertheless, few of these strategies seem to have an effect on bullying itself, but some can improve the emotional well-being of the victims. Victims who attempted to be liked by their bullies by changing their own behaviour reported no improvement of their relations with the bullies, neither did the ones who used humour in order to get closer to bullies. Bullies didn’t get tired when victims passively endured the bullying, hoping that it would stop by itself. Stand up (verbally or physically) to the bully led to increased bullying (one situation excepted). Physical avoidance of bullies (e.g. staying in classroom during playtimes) allowed some victims to temporarily reduce their emotional distress. Several victims experimented positive interactions with peers in extra-curricular activities (e.g. sport, art, scouting) that helped them recovering confidence in their social skills. Most of victims sought social support at one point of the bullying time. The efficiency of this strategy entirely belongs to the warned person's reaction and is thus highly variable. Based on participants’ report, only increased connectedness with a peer could have an impact on the bullying behaviour through a better integration in the peer-group. On the contrary, parents and teachers’ reactions are often perceived by the victims as not appropriate and as leading to a worse situation. In terms of practical implications, these results highlight the importance of raising teachers and parents’ awareness of the bullying, as well as the significance of the peers group dynamic. Following-up any bullying situation observed or reported in the school would probably help ensuring relevant interventions.