Beyond bruises and broken bones: the joint effects of stress and injuries on battered women's health

We investigated the joint mediating effects of injuries and stress on the relationship between abuse and women's health. A community sample of 397 women, half of whom had been assaulted by an intimate partner within the prior 6 months, was interviewed about their experience of intimate partner violence, injuries, stress, income, depression, and physical health problems. Structural equation modeling techniques confirmed the complex model of hypothesized indirect effects of abuse on women's physical health problems through injuries, stress, and depression. Stress accounted for 80% of the indirect effect of abuse on women's physical health. Its direct effect on physical health was somewhat larger than its indirect effect through depression, but both processes played a key role in determining the effect of abuse on women's physical health problems. Furthermore, abuse was a stronger predictor of women's stress than was poverty. Implication and future research are discussed.     

Causal Responsibility and Rationing in Medicine

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age.     

Pace of Life and Enjoyment of Life

The paper addresses the paradox that people in modern societies believe themselves to be very happy and satisfied with their lives while simultaneously are subjected to increasing time pressure and pace of life. It starts with presenting evidence for time pressure covering objective and subjective indicators. Evidence for Germany is given by comparing time-budgets in 1991/92 and in 1999. Time use among full time employed in Germany and other EU-societies in the 1990s is compared to the US and Japan by means of diary-data. As regards work life, overwork and the gap between actual and preferred working hours are examined. Survey-results on the relationship between work load, time pressure, stress and health are reported.Most of these data support the conclusion that time pressure has emerged as a major social problem. Hence citizens are beginning to consider time prosperity as a dimension of their well-being beyond their consumer wealth.However, this growing pace of life does not reduce life satisfaction and happiness. Here a paradox evolves as increasing time pressure goes hand in hand with increased subjective well-being (SWB) at country level in cross-cultural comparison as well as at individual level.In the third section some answers to this paradox are explored: A first answer is offered through the modernization theory: life satisfaction and QOL are proliferating along with economic growth and living standards. This process at the same time accelerates social life. Hence, the negative effects of time pressure are counterbalanced by various yields of the modernization process resulting in a pattern of "heavy-going" satisfaction.A second explanation is the psychological approach: time pressure fulfils positive functions for mobilizing individual resources. A variation of this argument is that the multiple-choice-society offers a wide variety of attractive options resulting in people engaging in too many activities. Here, the enjoyment of life is equated with taking advantage of every opportunity.However, this paper prefers a third approach based on Simmel's explanation of the ambivalent consequences of modernity. Even where the majority of citizens report high levels of happiness and life satisfaction – which can be explained through "arousal" or "eu-stress" – the need to ease the time-burden of disadvantaged groups and to down-speed work and social life in general is essential.     

Hotep's Story: Exploring the Wounds of Health Vulnerability in the US

A wide variety of forms of domination hasresulted in a highly heterogeneous health riskcategory, ``the vulnerable.' The study of healthinequities sheds light on forces thatgenerate, sustain, and alter vulnerabilities toillness, injury, suffering and death. Thispaper analyzes the case of a high-risk teenfrom a Boston ghetto that illuminatesintersections between ``race' and class in theconstruction of vulnerability in the US.Exploration of his ``wounds' helps specify howlarge-scale social and cultural forces becomeembodied as individual experience of disparatehealth risk. The case demonstrates that healthinequities would not occur if resources –employment, income, wealth, education, housing,profiling in the legal system, and health care– were more justly managed in keeping withstandards outlined in the Universal Declarationof Human Rights. Professional responses to the``wounds of vulnerability' may reveal importantaspects of who we are and what our work asscholars, practitioners, and advocates mustbecome.     

The Role of Referent and Expert Power in Mutual Help

This study explored the roles of referent power (i.e., influence based on sense of identification) and expert power (i.e., influence based on knowledge and expertise) in Schizophrenics Anonymous (SA), a mutual-help group for persons experiencing a schizophrenia-related illness. The study describes SA participants' experience of referent and expert power with SA members, SA leaders, and with mental health professionals. It also examines whether or not referent and expert power ascribed to fellow SA participants predicts the perceived helpfulness of the group. One hundred fifty-six SA participants were surveyed. Participants reported experiencing higher levels of referent power with fellow SA members and leaders than with mental health professionals. They reported higher levels of expert power for mental health professionals and SA leaders than for SA members. The respondents' ratings of their SA group's helpfulness was significantly correlated with ratings of referent and expert power. Although expert power was the best independent predictor of helpfulness, a significant interaction between referent and expert power indicated that when members reported high referent power, expert power was not related to helpfulness. These results are interpreted to suggest that there are multiple forms of social influence at work in mutual help.     

A Pathological View of Disease

This paper is a response to Christopher Boorse's recent defense of hisBiostatistical Theory (BST) of health and disease. Boorse maintains that hisconcept of theoretical health and disease reflects the ``consideredusage of pathologists.' I argue that pathologists do not use ``disease' inthe purely theoretical way that is required by the BST. Pathology does notdraw a sharp distinction between theoretical and practical aspects ofmedicine. Pathology does not even need a theoretical concept of disease. Itsfocus is not theoretical, but practical; pathology's goal is to contribute tothe healing of patients. Pathology, even experimental pathology, is notvalue-free. Not only ``disease' but also such terms as ``nerve' and ``organ'are laden with conceptual values.     

Auguste Comte on Positivism and Happiness

Auguste Comte (1798–1857) is the founder of a French school of thought that became famous for its encyclopaedic account of the sciences as well as for its exposition of what was designed as a way out of a state of intellectual and moral crisis. This essay demonstrates that there is a linkage between the diagnosis of crisis and the pursuit of happiness in Comte's foundation of positivism. It begins by distinguishing Comte's notion of positivism from that of a value-free science. In analysing Comte's peculiar usage of the term happiness, the essay shows that happiness is understood as the result of the convergence (consensus) of three components: a scientific conception of the world, the feelings of love and veneration, and a wisely ordered activity. The essay then demonstrates that the first of these components is of primary importance inasmuch as it is to frame a new horizon within which man is expected to return to a healthy state of mind, to reshape both his hopes and activities, and to discover his own participation in a supreme order acting through the laws of nature as well as through those of the civilization in which he lives. Conveying this new horizon to citizens of a lasting Republic is the sacred mission of sociology. The essay concludes by pointing out that Comte's conception of happiness can be assessed as unifying some main qualities of life as they are classified in Ruut Veenhoven's fourfold matrix.     

"中小学生心理健康"公众观的调查和分析

本研究调查分析了家长、教师对中小学生心理健康判断标准的认识.因素分析表明,家长主要强调四个因素"精神和神经病症"、"良好品行"、"健康人格"和"循环性";教师则强调五个因素"精神分裂症状"、"神经质"、"好学生标准"、"不良人格"和"不良品行".公众对于情、意、个性及社会适应等同心理健康的关系认识较为清楚,但对认知、品行及体征与之的关系认识则片面和模糊."好学生标准"对判断有重要影响.     

Health Focused Psychotherapy In Treating a Dual Diagnosed Patient

Health-focused psychotherapy offers a contemporary model used in assessment, treatment planning and evaluation in addressing patients with both medical and psychiatric diagnoses. Clinicians in the health and mental health disciplines must know and understand the importance of standards of care and models of intervention and evaluation in clinical practice for this type of patient. Examined is the use of a specific model providing a tailored orientation to patient education, along with the development and use of a clinical algorithm and care pathway for clinical practice. Provided is a case study for applying the development and use of a clinical algorithm and care pathway for a dual diagnosed patient receiving health-focused psychotherapy.