Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.     

Effectiveness of School-Based Mental Health Services for Children: A 10-Year Research Review

A review of the literature from 1985 to 1995 on school-based mental health services for children was conducted using a computerized data-base search. Of the 5,046 references initially identified, 228 were program evaluations. Three inclusion criteria were applied to those studies: use of random assignment to the intervention; inclusion of a control group; and use of standardized outcome measures. Only 16 studies met these criteria. Three types of interventions were found to have empirical support for their effectiveness, although some of the evidence was mixed: cognitive-behavioral therapy, social skills training, and teacher consultation. The studies are discussed with reference to the sample, targeted problem, implementation, and types of outcomes assessed, using a comprehensive model of outcome domains, called the SFCES model. Future studies of school-based mental health services should (a) investigate the effectiveness of these interventions with a wider range of children's psychiatric disorders; (b) broaden the range of outcomes to include variables related to service placements and family perspectives; (c) examine the combined effectiveness of these empirically-validated interventions; and (d) evaluate the impact of these services when linked to home-based interventions.     

Positive and negative self-related goals and subjective well-being: A prospective study

To examine whether having self-related personal goals, or rather whether positive or negative appraisal of them, is associated with subjective well-being, 311 students were asked to complete the Personal Project Analysis (PPA) and revised Beck Depression Inventory, first at the beginning of their studies, and then 2 years later. After 3 years they were asked about the use of mental health services. Two groups of students were identified: (1) those with positive self-projects and (2) those with negative self-projects. The results showed that both positive and negative self-related projects showed stability across a 2-year period, but only negative ones were prospectively predicted by earlier depressive symptomatology. Although neither positive nor negative projects predicted depressive symptomatology, both predicted the use of mental health services.     

Termination of Mental Health Services for Children

In this paper, we examine the termination of children's mental health services. Analyses were based on the 901 families in the Fort Bragg Evaluation Project who participated at Wave 1 and Wave 2 six months later. The project compared a full continuum of care provided at a demonstration site with traditional care at two comparison sites. The results showed that in most cases families and providers were partners in decisions to terminate treatment. About half of the clients self-terminated or were terminated solely at the discretion of the provider. Providers tended to play a more dominant role in terminating restrictive services; families played a more central role in terminating outpatient care. Regardless of initial psychopathology, children in single-headed households, whose parents were dissatisfied with services, did not expect their child to cooperate with treatment and did not expect treatment to help their child, were more likely to terminate care than others. While the Demonstration site had significantly fewer terminations, the sites did not differ with regard to the reasons for termination, who participated in termination decisions, or the factors that affected the likelihood to terminate care. Of most interest, mental health outcomes among children who had terminated all care did not vary by reasons for termination or by who participated in the termination decision.     

The use of the occupational stress indicator (OSI) in factory workers in China

The purpose of the study was to investigate occupational stress among Chinese factory workers (N=342), from three cities of South East China, using the shortened version of the Occupational Stress Indicator (OSI)-2. The results showed that the reliabilities and predictive validity of the OSI-2 subscales and other subscales used for the study were reasonably high. Quite a high percentage of workers perceived high work pressure. The main sources of stress were intrinsic to the job; and the coping strategies that were most frequently used to tackle stress were “control” methods. In addition, “satisfaction on environmental condition” seemed to be a common predictor for job satisfaction, and mental and physical well-being. The logical relationships between job satisfaction, mental well-being and physical well-being in Chinese workers have provided support to the findings obtained in Western countries.     

Group Wrongs and Guilt Feelings

Can it ever be appropriate to feel guilt just because one's group has acted badly? Some say no, citing supposed features of guilt feelings as such. If one understands group action according to my plural subject account of groups, however, one can argue for the appropriateness of feeling guilt just because one's group has acted badly - a feeling that often occurs. In so arguing I sketch the plural subject account of groups, group intentions and group actions: for a group to intend (in the relevant sense) is for its members to be jointly committed to intend that such-and-such as a body. Individual group members need not be directly involved in the formation of the intention in order to participate in such a joint commitment. The core concept of joint commitment is in an important way holistic, not being reducible to a set of personal commitments over which each party holds sway. Parties to a group intention so understood can reasonably see the resulting action as "ours" as opposed to "theirs" and thus appropriately respond to the action's badness with a feeling of guilt, even when they themselves are morally innocent in the matter. I label the feeling in question a feeling of "membership guilt." A number of standard philosophical claims about the nature of guilt feelings are thrown into question by my argument.     

追踪作业中几种心理负荷评估指标敏感性的研究

本研究在模拟追踪作业情境下 ,对主任务绩效测定、主观评定和若干生理测量在心理负荷评估中的敏感性进行了实验。实验采用重复测量的被试者内设计 ,2 0名被试 (男女各半 )在六档负荷下分别从事五分钟追踪作业。所选用的指标有追踪作业平均误差距离、追踪警告次数、主观负荷评定、心率、心率变异和血压。结果发现 :1主任务绩效在评估追踪作业心理负荷中具有最高的敏感性 ,主观评定次之 ,心率变化率和心率变异变化率也随负荷变化 ,血压指标随负荷变化的趋势不明显 ;2除血压指标外 ,其余各指标之间均存在明显的相关 ,这提示它们在评估追踪作业心理负荷中具有较大的可靠性。     

A NOTE ON TRANSFER OF STIMULUS CONTROL IN THE DELAYED-CUE PROCEDURE: FACILITATION BY AN OVERT DIFFERENTIAL RESPONSE

This case study describes initially unsuccessful attempts to use the delayed-cue procedure to teach conditional discriminations to an individual with moderate mental retardation. The task was matching printed-word comparison stimuli to dictated-name sample stimuli. In three experiments, the subject typically waited for the delayed cue unless differential responses to the dictated samples (repeating the sample names) were required. Hence, the study provides an example of a way to make the delayed-cue method more effective. The stimulus control bases for the results are discussed.     

Mental health service utilization among Puerto Rican children ages 4 through 16

This paper examines those children receiving mental health services in Puerto Rico, their demographic and psychosocial characteristics, and describes service providers and nature of facilities. The survey was done on a probability sample of children ages 4 through 16 across the island of Puerto Rico (N=777). Need for services was clinically defined as presence of a DSM-III diagnosis and functional impairment. The overall rate of service utilization for Puerto Rican children was 6% (26.2% of definite cases and 5.1% of probable cases). In most cases services were provided by psychologists and/or social workers, and they were mainly provided in schools and general medical facilities. In over 60% of the children assessed as cases, who did not receive services, the reason, given by the parent was that they considered the problem not serious. Factors associated with service utilization were measures of psychopathology, teacher's perceived need, and parental rates of criticism and hostility. These findings suggest that there is a need for more research on the motivating factors for service use (impairment and parental criticism). Teachers could benefit from receiving special training to help them readily recognize behavioral problems in children, communicate them to parents and set up services alternatives.     

The detection and management of mental health disorders in pediatric primary care

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.