The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.     

Teaching religious education as a second choice. The case of three male student teachers in Finland

This article explores the professional reflection of three male religious education (RE) student teachers during their one-year pedagogical training. The participants (n = 3) interviewed in this article were chosen on the basis of their self-report in the questionnaire in which they claimed no previous teaching experience. The participants were interviewed three times: at the beginning, in the middle and at the end of their one-year teacher education. The interviews were analysed with qualitative content analysis. The study showed some patterns in the student teachers reflections concerning developmental aims, professionalism, and convictions during the year. The article concludes that in RE teacher education developing pedagogical thinking should be accompanied with becoming aware of the role of personal life history and contextual situation play in the process of becoming a sound professional in RE.     

Giving and receiving autonomy support in a high-stakes sport context: A field-based experiment during the 2012 London Paralympic Games

ObjectiveRecognizing that high-stakes competitions tend to pressure coaches toward a maladaptive controlling motivating style, we sought to evaluate the capacity of an intervention to help coaches adopt a more autonomy-supportive style as they and their athletes prepared for the 2012 London Paralympic Games.DesignWe adopted a coach-focused experimental research design that longitudinally assessed coaches' and athletes' self-report, rater-scored, and objective dependent measures.MethodWe randomly assigned 33 coaches and their 64 athletes from 10 sports into either an experimental or control group and assessed their motivation and functioning longitudinally.ResultsIn the control group, athletes and coaches both showed a significant longitudinal deterioration in all measures of motivation, engagement, and functioning. In the experimental group, none of the measures of motivation, engagement, and functioning deteriorated but, instead, were generally maintained. In terms of performance, athletes of coaches in the experimental group won significantly more Olympic medals than did athletes in the control group.ConclusionEnacting an autonomy-supportive coaching style within the context of a high-stakes sports competition functioned as an antidote to coaches' otherwise situationally-induced controlling style.     

Exercise can improve physical self perceptions in adolescents with low motor competence

Adolescents with low motor competence have diminished perceptions of their physical self and tend to avoid physical activities. This study examined the outcomes of an exercise intervention that focused on improving aerobic fitness, strength, and self-perceptions in the physical domain in adolescents with poor motor coordination. The sample included 35 adolescents with low motor competence, comprising boys (n = 25) and girls (n = 10) ranging in age from 13 to 17 years, who attended two sessions per week in the 13 week exercise intervention study (AMP it up). Physical self-perceptions were measured before and after the intervention using the Physical Self Perception Profile and Perceived Importance Profile. Significant improvements in perceived Physical Condition, Attractive Body and Physical Strength sub domain scores were identified between pre and post-test. Adjusting for age, gender, BMI and attendance, regression analyses revealed that Attractive Body was the strongest predictor of Physical Self Worth at pre-test, joined by Physical Condition at post-test. This exercise intervention had a positive impact on adolescent physical self-perceptions, in particular males, with improvements in those sub domains specifically related to the exercise program. Changes in specific aspects of Physical Self Worth can be facilitated by exercise interventions, after a relatively short period of time, in adolescents with poor motor coordination.     

移动医疗视域下HIV/AIDS患者自我管理体验及需求的质性研究

采用目的抽样选取成都市、绵阳市及西昌市19名HIV/AIDS患者作为研究对象,采用描述性质性研究对研究对象进行半结构式访谈,对访谈结果进行主题分析,共提炼出一级主题5个：（1）患者有基于移动医疗的自我管理需求;（2）基于移动医疗自我管理平台期望载体及形式;（3）基于移动医疗的医疗或行为管理需求;（4）基于移动医疗的角色管理需求;（5）基于移动医疗的情绪管理需求。患者对基于移动医疗的自我管理平台有较高接受度。可设计开发易用性与隐私性强的移动医疗平台,通过提供疾病知识、线上诊疗、疾病监测与心理社会支持等功能,提升患者自我管理能力。

     

基于扎根理论的志愿者遗体（器官）捐献的动力探索

在濒临死亡情境下,对26名遗体（器官）捐献志愿者进行深度访谈并收集资料,运用扎根理论的开放编码、关联编码及选择编码对原始资料进行分解、检测、比较、概念化及类属化,并围绕志愿者遗体（器官）捐献的动力进行理论编码。结果显示,构建了扎根于原始资料的志愿者遗体（器官）捐献的新利他主义动机心理模型,形成了正确生死观构筑志愿者遗体（器官）捐献的认识基础、追寻意义存在构建志愿者遗体（器官）捐献的心理特征及利他主义新理念成为志愿者遗体（器官）捐献的动力三条新理论,对诠释志愿者遗体（器官）捐献行为具有一定参与价值。

     

“助手”还是“杀手”：用ChatGPT求医问药的风险分析

ChatGPT正在影响人们求医问药的传统方式,将医疗保健应用场景从院内转移到院外,提高了医学知识和诊疗信息的可及性。但ChatGPT在回答医学问题时也存在不足,如回答内容的不准确性和随意性,也难以将每个患者视为独立个体并给出体现医者智慧、思想和精神关怀的答案。用ChatGPT求医问药还存在生命健康、道德伦理、安全隐私和医疗公平风险。未来,在人工智能赋能医疗发展并促进人类健康的同时,仍应警惕ChatGPT对生命健康权、知情同意权、隐私保护权的冲击。

     

艾滋病防控中获取患者信息的伦理问题刍议

当前艾滋病获取患者信息中,存在公私观念上的摩擦、相关规定与环节存在疏漏、对信息弱势群体关照不足的伦理难题。问题背后包含着患者为了公共健康的伦理目的却又失去伦理关系的风险,“失德”名声带来的耻感与歧视,遵守政策规范却缺少应有的尊重与保护等矛盾。问题的解决需要在文化背景和利益关系下思量个人身心秩序与社会整体秩序间如何权衡,结合历史、理论与现实维度提出路径。“信”的建立是关键所在,包括公共卫生部门公信力的树立和相应制度措施建设,同时在信息活动中需要给“私”以合理地位,并注重艾滋病治疗相关医学信息的宣传。     

困境与希望：新冠肺炎疫情下的医学叙事

数月以来,新冠肺炎疫情之下的中国医务人员及患者在这场抗疫之战中形成了许多独具特色的医学叙事,其中的文本意义既具有深刻的社会属性,亦具有极强的个人属性。采用参与式观察法,收集、记录自然条件下不同的患者在疫情期间前来医院就诊的疾病故事,共计29个案例,并根据患者就诊中的不同心态将这些案例分为恐慌、无奈和乐观三类,最后尝试以医者的视角,通过三个医务人员的平行病历对疫情之下这三类不同的患者心态进行解读,借此重新审视特殊时代背景之下医者的责任和医学的意义,旨在为后疫情时期的医患关系研究提供一些理论基础和思考空间。     

疫病态势下国家健康权力行使的伦理规制

国家健康权力是由国家行使的专为对社会民众或其他主体的健康权利进行权衡、协调和确认之力。它包括健康定义权、健康立法权、健康资源配置调节权等权能。国家通过权力认可健康概念、制定健康法律法规、协调健康人力和物力资源。在疫病态势下,国家健康权力在疫病防控、人员物资调配、疾病检测、疾病治疗等方面起着关键作用。在健康权力行使过程中,既受医学伦理原则的制约,又赋予"生命神圣"、自主、行善、不伤害、公正原则以新的涵义。