The effects of patient's frequency of attendance and etiology of symptoms,on the General Practitioners wellbeing

IntroductionThe presence of Medically Unexplained Symptoms and a high Frequency of Attendance negatively affects the General Practitioners’ (GP) wellbeing. Although, overlapping between both phenomena is partial, with a number of frequent attenders reporting medically unexplained symptoms during consultation, there is no evidence on how GP's well-being it is affected by the specific main effects of these factors and their interaction. Evidence is also scant on the psychological processes explaining the negative impact of attendance and the etiology of symptoms on GP's wellbeing.ObjectiveDrawing on the Job Demand-Control and the Conservation of Resource stress models, this paper tests the moderating effects of the GP’ perception of patient's attendance and etiology of symptoms on the relationship between patient's demands and feedback on the GP's wellbeing.MethodA total of 105 volunteer GPs self-reported on the study variables through an experience sampling methodology after 898 patients’ consultation. Patients attendance and etiology of symptoms were categorized according to the physician self-perception and an external criterion (organizational records).ResultsPerception of Patients Frequent Attendance and Medically Unexplained Symptoms were positively related to physician's Emotional Exhaustion. Contrary to expected the test of the moderation effects of patients characteristics on the relation between patient's demands and feedback and the GP's emotional exhaustion were stronger for normal attenders compared with frequent attenders. An ad hoc study shows this unexplained result is related to the GP's expectations on Frequent vs. normal attenders’ behaviors. No significant results were found when the external criterion of classification was used.ConclusionCombined analysis of Frequency of Attendance and Etiology of Symptoms lead to a better understanding of the GP's decreased wellbeing. Also, the perception of the strain level (demands/positive feedback levels) associated to the consultation with different types of patients contribute to explain the consequences for the GP's wellbeing, especially when GP's expectations on patient's behaviors are violated.     

The agony of integration and the blessings of finitude – facing ‘extinction points’ and moments of madness

This paper explores the inevitable pain that integration requires in our individuation process. The unspeakable agony we defended against in order to survive we now experience consciously, including moments of going out of existence at the core of our madness. Clinical examples are given of these ‘extinction points’ and the abject helplessness analysand and analyst suffer in the face of this destructiveness. The first and second witness to this process (usually the analyst and the psyche itself) and the primordial creative life force are recognized in the process of recovery, a recovery that recoups the blessings of our finite human living.     

Bad gifts,community standards,and the disciplining of Theravāda monks

ABSTRACT

The act of giving is among the most fundamental acts within the Buddhist world, particularly in the Theravāda communities of Southeast Asia. In many of these communities, lay followers give food and other dāna (merit-making gifts), providing monastics with the ‘requisites’ that they need to survive. Yet there is relatively little discussion within Buddhist or scholarly communities about what should be given, with formulaic lists representing the majority of discussions about these gifts. However, sometimes, the gifts given to monastics are not always appropriate, even bad. What to do in those cases is not always clear. In this article, I explore the ways in which monks in Thailand and Southwest China think about gifts that are not good. What becomes clear is that, despite the prevailing view that discipline is a universal process based on the vinaya (disciplinary code of Buddhism), monks have different views about what constitutes a ‘bad gift’ and what to do about it. I argue that paying attention to bad gifts allows us to see that lay communities have significant voice—although this is often implicit rather than explicit—about what constitutes ‘proper’ monastic behavior.     

Gift narration: dynamic themes of reciprocity,debt, and social relations in Theravāda Buddhist Myanmar

ABSTRACT

Scholarly studies of Buddhist gift-giving have explored the many ways in which gifts are or are not reciprocal. This topic is revisited in this article by the author drawing greater attention to the practice of narration. Instead of understanding Buddhist words about dāna as representing religious doctrines or the experience of its social practice, the author considers how Buddhists narrate dāna as a means of maintaining relationships with self and others. Examining narratives of one monastic gift-recipient, meanings of dāna and moral principles of gift-giving are shown to vary alongside shifting relations between givers and receivers. This case suggests that themes of reciprocity are most salient when narrators grapple with interpersonal threats. Offering possible interpretations of this correlation, the author argues how reciprocal forces could be external social conditions to which narratives respond as well as created ex nihilo through the practice of narration as a strategy of ordering interpersonal conflicts potentially unrelated to reciprocity.     

La reprise d’études universitaires : entre continuité et rupture

The presented study pursued the objective to analyze the dialectic break/continuity susceptible to cross the transition of resumption of studies to the university, of the decision-making in the real-life experience of the first one-month of training. For that purpose, two models were summoned, that of motivations Push/Pull, Antipush/Antipull of Mullet, Lunch, Lemaire, Raiff and Barthorpe (2000) and that of the transitional processes proposed by Perret-Clermont and Zittoun (2002), as well as the concept of perceived social support completed of the notion of perceived social brake. The analysis of semi-directive conversations led with 10 adults in resumption of studies in a university of Île-de-France first brought to the foreground four motivational, certain dynamics more marked with the seal of the break (early or consummate), others more registered in a professional continuity (to develop or to install). Then, the analysis identified the most notable upheavals of the experience of the first months of training (identity plan and management of the various spheres of activity). Finally, it appeared that the social supports perceived, although important throughout the transition, vary in nature and function in each of the two periods of transition studied (decision, beginning of training). The results are particularly discussed in terms of Amartya Sen's capability approach.     

Verbal and practical intelligence in general anxiety,obsessive compulsive and major depression disorders

IntroductionPrevious researches have shown that anxiety symptoms are negatively associated with measures of intelligence. However, recent findings indicate possible positive relationships between Generalized Anxiety Disorders (GAD) and intelligence. Also, Obsessive Compulsive Disorder (OCD) is associated with a moderate degree of underperformance on cognitive tests, including deficient processing. There are inconsistent results to present the relationship between Major Depression Disorder (MDD) and IQ. The present study has three main aims. The first aim of this study is to investigate the difference between IQ in individuals with GAD, OCD and major depressive disorder, and normal group. The second purpose is to perform a comparative study between the GAD, OCD and MDD groups on verbal and non-verbal intelligence. The third aim of this study is to examine the relationships between GAD, OCD and MDD as well as their underlying cognitive processes, including worry, rumination, and post-event processing, with verbal and non-verbal intelligence.ObjectiveThe present study is performed on four groups of participants including those with GAD, OCD, MDD and Healthy Volunteer (HV) group consisting of individuals without psychiatric disorders.MethodThe number of 50 healthy volunteers as the control group, 45 patients with GAD, 20 patients with OCD and 25 patients with MDD (n = 140) were selected as the case-referent groups. The present study was a cross-sectional type and the research was performed based on the causal-comparative method. Verbal and non-verbal intelligence was measured with the Wechsler Adult Intelligence Scale-3rd edition (WAIS-III). Rumination and post-event processing were measured by PSWQ, RRS-BR, and PEPQ, respectively.ResultsThe results indicate that Verbal Intelligence and Verbal Comprehension Index in GAD patients have significant differences in comparison to the OCD, MDD and control groups. While, the value of the Working Memory Index (WMI) in the normal group is higher than the value of the same index in the GAD, OCD and MDD groups. Also, the values of the Processing Speed Index (PSI) in normal and GAD groups are higher than the OCD and MDD groups. The worry, rumination, and post-event processing in patients with GAD are positively correlated with general and verbal intelligence. But, verbal and non-verbal intelligence had a negative correlation with worry, rumination and post-event processing in healthy volunteers.ConclusionInvestigation of the possible connections between intelligence and the cognitive processes underlying emotional disorders can provide therapeutic strategies for smart individuals who are at risk for GAD.     

Tradition,Authority, and Immanent Critique in Comparative Ethics

Drawing on resources from pragmatist thought allows religious ethicists to take account of the central role traditions play in the formation and development of moral concepts without thereby espousing moral relativism or becoming traditionalists. After giving an account of this understanding of the concept of tradition, I examine the ways in which understandings of tradition play out in two contemporary examples of tradition‐based ethics: works in comparative ethics of war by James Turner Johnson and John Kelsay. I argue that a pragmatist approach to tradition‐based ethics allows for a nuanced and flexible understanding of moral traditions, and one that holds great promise for international consensus‐building around shared ethical norms for the use of armed force.