Prescriptions: Autonomy,Humanism and the Purpose of Health Technology

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems.     

Report of the Working Group on Research

Prepared by the Working Group on Research from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper focuses upon the challenges for psychologists who wish to maintain active research programs in academic medical settings. Six specific strategies are offered that, if followed, would increase opportunities and visibility of psychological research programs both within academic medical settings and within society at large.     

Assessment and treatment of problem behavior maintained by mand compliance

We modified functional analysis procedures to include a condition in which we reinforced problem behavior by complying with a child's mands. After identifying compliance with mands as a reinforcer, we evaluated the efficacy of a token system with a response‐cost contingency and incorporated discriminative stimuli to signal when mands would be reinforced. The token system with response cost effectively reduced problem behavior. Similar procedures may be beneficial when continuous adult compliance is not possible, when adults want to control when they will comply with the child's mands, or to build a child's tolerance for adult‐directed situations.     

Modern health worries – the dark side of spirituality?

Modern health worries (MHWs) are widespread in modern societies. MHWs were connected to both negative and positive psychological characteristics in previous studies. The study aimed to investigate the relationships among intuitive‐experiential information processing style, spirituality, MHWs, and psychological well‐being. Members of the Hungarian Skeptic Society (N = 128), individuals committed to astrology (N = 601), and people from a non‐representative community sample (N = 554) completed questionnaires assessing intuitive‐experiential information processing style, spirituality, modern health worries (MHWs), and psychological well‐being. Astrologers showed higher levels of spirituality, intuitive‐experiential thinking, and modern health worries than individuals from the community sample; and skeptics scored even lower than the latter group with respect to all three constructs. Within the community sample, medium level connections between measures of spirituality and the experiential thinking style, and weak to medium level correlations between spirituality and MHWs were found. The connection between MHWs and experiential thinking style was completely mediated by spirituality. Individuals with higher levels of spirituality are particularly vulnerable to overgeneralized messages on health related risks. Official communication of potential risks based on rational scientific reasoning is not appropriate to persuade them as it has no impact on the intuitive‐experiential system.     

Building therapeutic relationship in schizophrenic and alcohol-related disorder cases

Current literature on the dual diagnosis in cases of schizophrenia and alcohol dependence has reported how pharmacological treatment has positive effects on the reduction of both disorders. Nevertheless, patients have considerable difficulties in following the prescribed medication. This work aims to build an engagement stage and therapeutic relationship in seven patients with schizophrenic and alcohol-related disorder cases. This result was achieved through the use of the vignette technique and narrative psychodynamic approach during group counselling sessions. Positive and Negative Symptoms Scale (PANSS) and Munich Alcoholism Test (MALT) were applied before and after treatment. A follow-up session was organized. The PANSS and MALT scores indicated there was no reduction of the psychiatric symptoms after treatment. The follow-up session showed positive outcomes in terms of increasing the level of socialisation as well as awareness of their own condition; at the same, an adherence to pharmacological treatment and psychotherapy for all the subjects.     

Using Community Partnerships to Better Understand the Barriers to Using an Evidence‐Based,Parent‐Mediated Intervention for Autism Spectrum Disorder in a Medicaid System

Service use disparities have been noted to impede under‐resourced families' ability to access high‐quality services for their child with autism spectrum disorder (ASD). These disparities are particularly relevant for parent‐mediated interventions and may suggest a lack of fit between these interventions and the needs of under‐resourced community settings. This study used Roger's Diffusion of Innovations theory to guide community partnerships aimed at understanding the perceived compatibility, complexity, and relative advantage of using an evidence‐based, parent‐mediated intervention (Project ImPACT) within a Medicaid system. Three focus groups were conducted with 16 Medicaid‐eligible parents, and three focus groups were conducted with 16 ASD providers operating within a Medicaid system. Across all groups, parents and providers reported general interest in using Project ImPACT. However, primary themes emerged regarding the need to (a) reduce the complexity of written materials; (b) allow for a more flexible program delivery; (c) ensure a strong parent–therapist alliance; (d) involve the extended family; and (e) help families practice the intervention within their preexisting routines. Results are discussed as they relate to the design and fit of evidence‐based, parent‐mediated interventions for under‐resourced community settings.     

Intra- and inter-subject variation in lower limb coordination during countermovement jumps in children and adults

The purpose of the present study was to investigate the coordination pattern and coordination variability (intra-subject and inter-subject) in children and adults during vertical countermovement jumps. Ten children (mean age: 11.5 ± 1.8 years) and ten adults (mean age: 26.1 ± 4.9 years) participated in the experiment. Lower body 3D-kinematics and kinetics from both legs were obtained during 9 vertical jumps of each subject. Coordination pattern and coordination variability of intra-limb and inter-limb coupling were established by modified vector coding and continuous relative phase. The adult group jumped higher and with less performance variability compared to the children. Group differences were mainly observed in the right–left foot coupling. The intra-subject coordination variability was higher in coupling of proximal segments in children compared to adults. No group differences were observed in inter-subject variability. Based on these results, it was concluded that the same movement solutions were available to both age groups, but the children were less able to consistently utilize the individually chosen coordination pattern. Thus, this ability appears to be developed through normal ontogenesis.     

道不同不相为谋? 信息相关断裂带对团队学习的影响

传统观点认为,存在断裂带的团队中成员学习行为会受到不利影响,即"道不同不相为谋"。本研究通过聚焦信息相关断裂带,全面剖析内部学习和外部学习等不同团队学习方式,深入考察影响断裂带团队学习的关键情境因素,探讨并论证本文的基本观点——"道不同",可以"相为谋"。基于56个实际工作团队配对样本数据的统计分析结果表明,信息相关断裂带对团队内部学习和外部学习都没有直接作用。团队共同任期和交互记忆系统对信息相关断裂带团队内外部学习起调节作用:团队共同任期越长,信息相关断裂带越有利于团队内部学习及外部学习;交互记忆系统水平越高,信息相关断裂带越有利于团队内部学习及外部学习。     

A fertile matrix: the birth of the Forensic Psychotherapy Society

This paper traces some aspects of the fertile matrix within which, over many years, the application of a psychoanalytic perspective to clinical work with the most severely mentally ill, difficult and at times frightening patients in secure and community settings has evolved and now led to the recent inauguration of the Forensic Psychotherapy Society (FPS), a new Member Institution of the British Psychoanalytic Council. The Society provides both a framework for a national, multidisciplinary professional training in psychodynamic forensic psychotherapy and the potential launching pad for an active post-qualification organisation supporting CPD and all other forms of professional development. The particular contributions to the birth of the FPS of the Forensic Psychotherapy Department at West London Mental Health NHS Trust, partly because we know it best but also because it is part of the largest forensic psychiatric service in the United Kingdom, are described.