Integrating Behavioral and Social Sciences in the Medical School Curriculum: Opportunities and Challenges for Psychology

The Institute of Medicine has reviewed and made recommendations concerning current teaching approaches, content, and barriers to the incorporation of behavioral/social sciences in medical school curricula (Cuff & Vanselow, 2004). This paper discusses those recommendations, the history of medical education reform, the barriers to and evolution of behavioral/social sciences’ inclusion, and the implications for psychology’s future role in academic medicine. Psychological concepts and technology permeate medical practice, but little progress has been made in integrating psychological and biological sciences. Looking to its basic science domains (e.g. cognition, learning, development, neuroscience), psychology can take scientific leadership in illuminating the mechanisms by which behavioral/social processes interact with biological functions in health, thereby providing the empirical basis for a truly integrated bio-behavioral curriculum. This article is based upon a symposium, “IOM Report on Enhancing Behavioral & Social Science in Medical Education: Impact and Opportunities for Psychology,” presented at the Annual meeting of the American Psychological Association, Washington, D.C., August 21, 2005. Suzanne Bennett Johnson, Chair; Elena Reyes, John E. Carr, and Anthony Errichetti, participants; Eugene K. Emory, Discussant.     

A Heideggerian Defense of Therapeutic Cloning

Debates about the legitimacy of embryonic stem-cell research have largely focused on the type of ethical value that should be accorded to the human embryo in␣vitro. In this paper, I try to show that, to broaden the scope of these debates, one needs to articulate an ontology that does not limit itself to biological accounts, but that instead focuses on the embryo’s place in a totality of relevance surrounding and guiding a human practice. Instead of attempting to substantiate the ethical value of the embryo exclusively by pointing out that it has potentiality for personhood, one should examine the types of practices in which the embryo occurs and focus on the ends inherent to these practices. With this emphasis on context, it becomes apparent that the embryo’s ethical significance can only be understood by elucidating the attitudes that are established towards it in the course of specific activities. The distinction between fertilized embryos and cloned embryos proves to be important in this contextual analysis, since, from the point of view of practice, the two types of embryos appear to belong to different human practices: (assisted) procreation and medical research, respectively. In my arguments, I highlight the concepts of practice, technology, and nature, as they have been analyzed in the phenomenological tradition, particularly by Martin Heidegger. I come to the conclusion that therapeutic cloning should be allowed, provided that it turns out to be a project that benefits medical science in its aim to battle diseases. Important precautions have to be taken, however, in order to safeguard the practice of procreation from becoming perverted by the aims and attitudes of medical science when the two practices intersect. The threat in question needs to be taken seriously, since it concerns the structure and goal of practices which are central to our very self understanding as human beings.     

Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.     

论疾病之病痛与病损

文章认为,疾病可分为“病损”（疾病对机体的损害）和“病痛”（患者感受到的不适感）两个方面,此二者可一致亦可背离,故治疗必须分别对待。特别指出“病痛”于康复过程的重要意义,提出了合理祛除“病痛”的要点。分析也揭示了中西医之间的优缺点,于正确诊治疾病和认识中西医之关系,促进医学健康发展具有一定意义。     

辩证看待老年人的药物应用

老年人的用药具有特殊性和复杂性,每位医师在做出,临床决策时,应具有人文精神和辩证的思维方式,使哲学思维与科学思维密切结合,应用这种方式,重点探讨了老年人的个体化用药、注重整体、顺势而治、侧重治未病与自然疗法,从而为老年人提供人性化的最优化治疗,降低药源性损害。     

论移植医学新角色——移植协调员的工作职责

随着移植医学的蓬勃发展,许多国家纷纷制定了人体器官捐赠和移植法令,建立了移植协调机构等配套管理措施和制度。随之,一个新型的专业角色——移植协调员应运而生。在研究国外移植协调员的工作基础上,借鉴国外的经验和模式,根据我国实际状况,提出我国移植协调员的工作职责。     

The Complex Use of Religion in Decisions on Organ Transplantation

Because of its existential character, organ transplantation is strongly connected to a person’s view of life. This article describes how participants in a focus group use religious elements in decision-making on transplantation medicine in four European countries. Further these findings are related to two influential theologians: James Gustafson and Paul Ramsey, and their thinking on the role of religion in medical ethics. Both participants’ and theologians’ use of religious elements is complex, and show significant variety in regard to both content and form. Decisions in transplantation medicine would benefit from considering the complexity of religious views when striving for informed consent as participative involvement.     

The Huichol Offering: A Shamanic Healing Journey

An American transcultural psychiatrist, and a Mexican engineer deeply involved with the Huichol Indians, build a team that heals a decade-long epidemic caused by sorcery. Huichol children in boarding schools became possessed by demonic witchcraft that transformed them into aggressive animals. Many local shaman had been called in to treat the illness but had been unsuccessful. The team found a way to incorporate traditional belief and ritual, with modern psychological principles to weave a healing story. This article represents the ultimate integration of mind/body/spirit medicine to heal across cultures.

Chaplain–Physician Consultancy: When Chaplains and Doctors Meet in the Clinical Context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.     

第三只眼睛看医学--对当代医学的反思和价值重审

当代医学的主体语境充满了对疾病的憎恶和排斥,限制了医学的视野。医学对人类的过度呵护,使人体“恃宠生矫”,导致人体生命内在素质的下降。因此,有必要对当代医学进行价值重审。与当代医学相配套的新的临床治疗体系“呼之难出”,使医学难以均衡发展,目前的当务之急是应尽快构建新的临床治疗体会。