医疗人工智能对知情同意的挑战与应对

目前在辅助诊断、辅助治疗方面,人工智能技术取得了较大进展,但是医疗人工智能对知情同意带来了诸多新问题：弱人工智能的黑箱属性不突出,患者对医疗人工智能决策过程的知情可以用对临床试验结果等的知情以及其他严格管理措施去间接地实现;强人工智能需要提高可解释性或以其他方式应对黑箱问题。因额外风险的存在,在使用医疗人工智能时,医方应增加患者知情同意的内容,并利用人工智能应对知情同意的形式主义问题。医方还应在必要时特别说明诊疗主体与责任主体。医疗人工智能处理患者个人信息时亦需严守知情同意原则。

     

Demon or disorder: A survey of attitudes toward mental illness in the Christian church

The present study assessed the attitudes and beliefs that mentally ill Christians encountered when they seek counsel from the church. Participants (n?=?293) completed an anonymous online survey in relation to their interactions with the church. Analysis of the results found that while a majority of the mentally ill participants were accepted by the church, approximately 30% reported a negative interaction. Negative interactions included abandonment by the church, equating mental illness with the work of demons, and suggesting that the mental disorder was the result of personal sin. Analysis of the data by gender found that women were significantly more likely than men to have their mental illness dismissed by the church and/or be told not to take psychiatric medication. Given that a religious support system can play a vital role in recovery from serious mental disorders, these results suggest that continued education is needed to bring the Christian and mental health communities together.     

Dimensions of Job Satisfaction Identified Among South African Black Middle-level Managers: A Qualitative Investigation

The aim of the present study was to identify the factors contributing to job satisfaction for black middle-level managers and to contextualise these factors in terms of Afrocentric values and South Africa's socio-political and historical background. The sample comprised eight participants (4 males and 4 females), primarily from the educational sector, selected by means of purposive sampling. Semi-structured telephonic interviews were conducted to collect data, and the Interpretative Phenomenological Analysis (IPA) was used for in-depth analysis of the participants' experiences. Social needs consistent with Ubuntu were identified as important. These included a need for effective communication, transparency, trust and tolerance in the face of cultural and work-related differences. The frustrations associated with cultural differences and language barriers were elaborated on. For the participants, professional development and recognition were related to affirmative action policies and practices as well as the socio-political background. These findings contribute to the limited research available for the particular population—an essential contribution, given the cultural diversity of the South African workforce.     

Black client,white therapist: Working with race in psychoanalytic psychotherapy in South Africa

In post‐apartheid South Africa we speak about race extensively. It permeates our workplace, weaves a thread through the fabric of our professional and personal lives, as well as our private conversations and public interactions with others. From within psychoanalytic theory, the thread weaves through the unknown content of our racialized unconscious. When there is a focus on race in the South African psychoanalytic context it largely takes the form of the struggle to articulate the complexities of working with difference, as Swartz notes, or the struggle to map out issues of race. Such struggles are not localized in South Africa, but strongly reflect a much broader struggle within the global psychoanalytic community, as mirrored in the expanding focus on race. Although the consulting rooms seem far removed from the ongoing political tensions that have recently emerged in South Africa, psychoanalytic psychotherapy remains a space of meaningful engagement with the other, and where the therapeutic dyad is one of racial difference it permits an encounter with our racialized unconscious. This article seeks to document the experience of my black client and my white response to her racial pain and struggle; in doing so, I describe the racial ‘contact’ between us and within us that triggers a racialized transference and countertransference dynamic, which contains the space for racial healing for both of us.     

Letters, Notes, & Comments

Comment by Aaron L. Mackler on 'Through Her I Too Shall Bear a Child': Birth Surrogates in Jewish Law by Elie Spitz
Reply by Elie Kaplan Spitz
Research Note by G. Scott Davis     

White Picket Fences,White Innocence

Focusing on the cultural implications of the relationship between white segregationist Senator Strom Thurmond and his biracial daughter Essie Mae Washington‐Williams, this essay explores national narratives of whiteness, femininity, morality, and the institutionalization of sexual violence against black women.     

From psychic holes to psychic representations

Abstract

In this essay, I will explore the term “psychic hole,” and compare it to similar terms from the world of astrophysics and terms used in the psychoanalytic literature. I will then present my own conception of the “psychic hole” in cases of Holocaust survivors' offspring. I will explain how this “hole” is created, and describe a particular aspect of the “psychic hole” that is unique to Holocaust survivors' offspring, namely the enactments (termed “concretization” by Bergman) generated by the negated traumatic themes that reside in it. I will illustrate these enactments using clinical material taken from case studies of Holocaust survivors' offspring that I have previously published. The clinical vignettes reveal the transgenerational impact of the memory hole resulting from negation of survivor parents on the lives of their offspring, up to the third generation. They also show the painful journey from enactments to psychic representations, a journey which exposes the traumatic events that have been denied or repressed, and facilitates the work of mourning and the eventual achievement of a better integrated self. Finally, I will offer technical suggestions for analysts to help patients transform psychic holes into psychic representations.     

Eschewing Community: Black Metal

There is a great deal of literature that examines community orientations, in particular consumption‐based subcultures rooted in the appreciation of music scenes such as heavy metal and its subgenres. Much of this literature focuses on aspects of community maintenance, reaffirmation of shared identities and building of social bonds. In the present article, we report a study in which consumption of, and fandom in a specific scene in extreme metal, namely black metal, may lead to very unique consumer cultural orientations. Our analyses reveal that black metal fans' identities reside in a realm outside of a desired collective identification and tightly knit community, but rather one that uses signification, or representational means to convey meaning and belonging, as a way to signal repugnance with society and a reverence of individuality. The study engages a mixed qualitative approach utilizing interviews, observational research and content analysis to demonstrate how self‐identity related to the black metal music scene can thrive through an ideological and semiotic rejection of traditional community orientations seen in the majority of other extreme metal music scenes. This paper challenges traditional conceptualizations of group identity in music scenes by closely examining aspects of signification and fandom in black metal that represent a unique system of shared identities devoid of community building. Copyright © 2014 John Wiley & Sons, Ltd.     

Black Women's Body Image: An Analysis of Culture-Specific Influences

A review of the literature on racial differences in body image in Black and White women indicates body image dissatisfaction is more common in White females than Black females. However, Black women are not protected from body image issues. Research on body image concerns specifically related to Black women is limited. The present study involves focus group and individual interviews conducted with 16 Black women. Data were analyzed using qualitative methodology. Results indicate 6 major themes, with shapely and curvaceous ideal body image standards within the Black community as the most prevalent theme across data sources. Therapeutic implications emphasize recognition of culture-specific ideal standards of beauty, as well as the influence of external factors such as men, family, peers, and media on Black women's self-evaluations.     

Black churches and HIV/AIDS: factors influencing congregations’ responsiveness to social issues

The ambivalent response of many black churches to current social issues has caused some scholars to question the centrality of black churches within African-American communities. Using a nationally representative sample of black congregations, this study engages the debate about the institutional centrality of black churches by focusing on their response to HIV/AIDS. Although many congregational studies treat black churches as a monolithic whole, this analysis identifies heterogeneity among black churches that shapes their responsiveness to social issues. Contrary to prior claims, a congregation's liberal-conservative ideological orientation does not significantly affect its likelihood of having an HIV/AIDS program. Beyond assessing churches’ internal characteristics, this study uses institutional theory to analyze churches as open systems that can be influenced by their surrounding environment. It demonstrates that externally engaged congregations are significantly more likely to have a program. These results indicate that black churches maintain institutional centrality by engaging their external environment.