Tolerance as a Primary Virtue

The commonly perceived tension between authentic moral and ethical action and action involving tolerance is held to be the illusory product of an unduly individualistic frame of thought. Moral and ethical actions are produced not by independent individuals but by participants in cultural traditions. And even the wholly routine continuation of a single homogeneous tradition must always and invariably involve mutual tolerance: participants must interact not as independent individuals but as tolerant members. Tolerance deserves recognition, accordingly, as a primary virtue, not merely compatible with authentic moral and ethical action, but required by it. An explicit rhetoric enjoining tolerance needs to be understood as performative discourse employed to change, or else to sustain, the systems of tolerances in which all cultures, whether simple or differentiated, homogeneous or diverse, unified or fragmented, invariably consist. This revised version was published online in August 2006 with corrections to the Cover Date.     

Recognition and Treatment of Late-Life Addictions in Medical Settings

Addictive disorders among the elderly have emerged as a growing public health concern. As the proportion of the elderly population increases, more and more older adults will either develop addictions as a dysfunctional means of coping with the psychosocial consequences of aging, or will carry their long-standing addictive behaviors with them into later life. Among the most common of these addictions are smoking, excess consumption of alcohol, and gambling. This article briefly reviews these three addictive disorders and examines assessment and treatment options. The current cohort of older adults tends not to seek help for addiction problems in specialty mental health or substance abuse treatment. To improve rates of cessation and abstinence, assessment and intervention should be delivered in general medical settings such as primary care. With the addition of a behavioral health specialist, primary care has the potential to offer improved interventions in a cost-effective and time-efficient manner.     

Health Risk Behaviors and Their Relationships to Health Care Utilization Among Veterans Receiving Primary Medical Care

This paper reports the findings of a behavioral health risk screening form and examines the interrelationships among behavioral risk factors and health care utilization. Participants were 1,000 veterans who completed a brief self-report questionnaire assessing affective distress and behavioral health risk factors while they waited to see their primary care provider. Participants reported a mean level of affective distress in the mild range on a scale of 0 to 20 (M = 6.4, SD = 4.95), and 22.4% reported moderate or high levels of affective distress. Fifty percent of the sample denied alcohol use; 5% of the men and none of the women reported a pattern of use that met established criteria for at-risk drinking. Twenty-six percent of the sample reported current tobacco use, 45% acknowledged concerns about diet and/or weight, and 54% reported concern about pain. These factors were largely significantly intercorrelated and several were related to indices of health care utilization. It was concluded that veterans receiving health care in primary care settings report significant levels of affective distress and other health risk behaviors and that the presence of these factors is associated with increased use of the health care system. These data encourage increased efforts to identify these factors and to develop behavior change interventions.     

The Effect of Racial and Ethnic Diversity on the Delivery of Mental Health Services in Pediatric Primary Care

The effects of racial and ethnic diversity on the detection and management of behavioral and emotional problems in pediatric primary care are addressed. Service access and utilization as a function of race and culture are initially examined. Important barriers within pediatric training including minimal emphases on behavioral training and the limited supply of minority physicians are underscored. The impact of ethnicity on the development and maintenance of the clinical relationship that is critical to accurately and sensitively identifying and managing behavioral and developmental problems is briefly addressed. Recommendations for further integration of racial/ethnic issues into mental health service provision within the pediatric primary care arena are presented.     

Exercise Stage of Change and Self-Efficacy in Primary Care: Implications for Intervention

Multiple chronic diseases are caused or complicated by a sedentary lifestyle. Thus, an important and challenging application of psychology in clinical settings is changing the behavior of sedentary primary care patients. This study focused on exercise stage of change and self-efficacy in a sample of adult family practice patients recruited while waiting for their scheduled physician appointment. Regarding exercise stage of change, 15% of respondents were in the Precontemplation stage, 26% in the Contemplation stage, 50% in the Preparation stage, 7% in the Action stage, and 13% in the Maintenance stage. Mean self-efficacy scores for exercise were significantly higher among respondents in the Action and Maintenance stages of change. These cross-sectional data are consistent with the hypothesis that movement through the exercise stages of change could be encouraged by clinical interventions that increase exercise self-efficacy. The identification of multiple personal opportunities for increasing exercise self-efficacy may be clinically useful in this context. Recommendations for psychologists in primary care settings in their work with physicians are offered.     

The Reinvention of Behavioral Health Services in the VA System

The Veterans Health Administration under the direction of Kenneth Kizer, M.D., has faced the challenge of providing high-quality health care while controlling costs. Under Dr. Kizer's direction, VA hospitals are moving toward managed patient centered primary care. Hospital organization, funding, and clinical practices have been changed. Reorganization has meant a variety of possibilities for psychologists employed in the VA system.     

A transitory homosexual passion in the course of an analytic treatment1

Do homosexualities express a sexual confl ict originating in bisexuality or must we look for their deep determinism in the narcissistic confl ict and its vicissitudes? Two clinical sequences from the treatment of a borderline patient, which occurred during years seven and eight of treatment, a period characterised by intense drive turbulence and the unexpected occurrence of a transitory homosexual passion, will enable the reader to follow the psychical movements and evolution of the work of representation. The fi rst sequence throws light on the links between her sudden involvement in this homosexual passion and the traumatic dangers of a breakdown of her ego's capacity for representation, linked to a reactivation in the transference of early and later traumatic traces whose reverberation in the transfero/countertransference dynamic was the source of a painful transference that was responsible for this lateral transference movement. The second sequence shows the links between the strengthening of her capacity for representation, thanks to the working through of the oedipal confl ict in its two aspects, and her renunciation of this passion. The roots of this transitory homosexual passion in the deep fl aws of her psychical functioning raise metapsychological questions concerning, in particular, the dynamic of the ‘double’(‘twin’) and narcissism.     

Value Perceptions of Integrative Health Care: A Study of Primary Care Physicians and Professional Clinical Counselors

A study was conducted to identify value perceptions of primary care physicians and Professional Clinical Counselors on integrative health care. Surveys were collected from 54 primary care physicians and 33 Professional Clinical Counselors in Central Ohio. Quantitative and qualitative results indicate favorable perceptions and opportunities for professional collaboration.     

Weighting information from outside sources: a biased process

How do people utilize information from outside sources in their decisions? Participants observed a signal‐plus‐noise or noise‐alone event and then made a yes–no decision about whether a signal had occurred. Participants were provided with two information sources to aid decision making. Each source consisted of four components that provided estimates of signal likelihood. In Experiment 1, the two sources had equal overall accuracy but differed in the expertise and internal correlation of their components. A regression analysis indicated that participants overweighed the high‐expertise‐high‐correlation source. This bias occurred on trials when the aggregate opinions of the sources disagreed. In Experiment 2, both the overall accuracy of the source and its components were manipulated. Participants overweighed information from the higher accuracy source. These biases reflect people's sensitivity to across‐trial and within‐trial differences in the accuracy and internal consistency of information sources. Experiment 3 provided additional evidence supporting these conclusions. Copyright © 2004 John Wiley & Sons, Ltd.     

洛克思想的宽容与创新--纪念洛克逝世三百周年

本文从三个方面论述了洛克思想中的宽容与创新。首先,哲学与常识的融合。洛克的任务是使哲学成为常识,以代替天赋观念这一陈腐的常识。他认为,理性之所以伟大,就在于从常识中寻找根据,始终与常识一致,所以理性本质上就是一种常识的态度。其次,理性与虔敬的调和。洛克认为天赋观念说还未能把人的理性充分发挥出来,理性的充分发挥与肯定上帝的存在是相一致的。再次,机械论与经院哲学方法的混用。洛克在关于第一性和第二性的质的观念的形成以及观念与性质相似或不相似的论述中,既有机械论的方法,又有经院哲学因果观的成分。