Health and behavior: The coming together of science and practice in psychology and medicine after a century of benign neglect

For thousands of years, physicians had available only a few drugs with which to minister to patients and the practice of psychology was an integral and therapeutically powerful component in the practice of medicine. Thus, good bedside medicine consisting of empathy, compassion, and a nurturant attitude toward the ill individual was a major component of the physician's armamentarium until relatively recently. However, the explosion in scientific knowledge in biology, physiology, chemistry, and microbiology which began a century ago and has continued through the twentieth century helped produce several generations of physician specialists and subspecialists with little knowledge of the powerful role psychological factors play in health and illness. As a result, practitioners of medicine and practitioners of psychology have had little or no contact during most of this century. However, as advances in microbiology, public health, and nutrition have eradicated many of the infectious diseases, infirmities associated with one's lifestyle have replaced the latter as the major causes of death today. One offshoot of this shift is that after a century of benign neglect, physicians and psychologists have rediscovered a common ground in the arena labeled health and behavior. Some factors responsible for these recent developments are highlighted.This article was an invited address delivered to a group of Japanese health psychologists as part of a Health Sciences Seminar in Tokyo on July 24, 1993. Concurrent with its publication here in English, it is being published in the Japanese language in the March 1994 issue of the journal,Japanese Health Psychology.     

Reflexive research and the grounding of analysis: Social psychology and the psy-complex

This paper is concerned with reflexivity in research, and the way research is grounded in the operations of the psy-complex in social psychology. A central argument is that qualitative research in general, and a focus on reflexivity in particular, requires theoretical grounding. Distinctions are drawn between ‘uncomplicated subjectivity’, ‘blank subjectivity’ and ‘complex subjectivity’; and the analytic device of the ‘discursive complex’ is described. It is argued that such theoretical grounding can usefully draw on developments in discourse analytic, deconstructionist, and psychoanalytic social research. The opposition between objectivity and subjectivity is deconstructed, and psychoanalytic conceptual reference points for an understanding of the discursive construction of complex subjectivity in the context of institutions are explored with particular reference to the location of the researcher in the psy-complex. The paper discusses the reflexive engagement of the researcher with data, and the construction of the identity of the researcher with reference to professional bodies. An analysis of a document produced by the British Psychological Society is presented to illustrate conceptual issues addressed in the first sections. This illustrative analysis is designed to show how the material is structured by a series of six discursive complexes, and that the institutional structure facilitates, and inhibits, certain forms of action and reflection.     

USING REINFORCEMENT-BASED METHODS TO ENHANCE MEMBERSHIP RECRUITMENT IN A VOLUNTEER ORGANIZATION

The present study employed reinforcement-based methods to induce existing members to recruit new members to join a chamber of commerce. Three interventions took place during June and July of 3 successive years. The investigators trained chamber leaders to use reinforcement methods (e.g., contingent tokens) to reinforce recruitment and dues collections. All three interventions produced substantial increases in their targets.     

欧洲大陆法律心理学述评

对欧洲大陆国家的法律心理学发展状况作了述评。全文包括３部分：对相关概念（犯罪心理学、审判心理学、法律心理学、司法心理学）的辨析;欧洲大陆国家法律心理学的现状;简要评价。     

Parallel lives: Community psychology in Latin America and the United States

Comparing the history of community psychology as it developed in the U.S. during the 1960s with the community psychology that developed 10 years later in Latin America, one is reminded of the title of Plutarch’s masterpice,Parallel Lives. Although there was very little contact or communication between the first community psychologists in these regions, very similar principles and orientations evolved. These similarities are particularly striking given the many ways in which the U.S. and Latin American contexts and histories differ. Since most readers are expected to be familiar with the history of community psychology as it developed in the U.S., this paper focuses primarily on the development of community psychology in Latin America in order to highlight areas of convergence as well as divergence from the U.S. experience. This paper is based on an address presented at the Fourth Biennial Conference, Society for Community Research and Action, Division 27 of the American Psychological Association, William and Mary College, Williamsburg, Virginia, 1993. The author acknowledges the valuable help received from J. R. Newbrough and from the referees in the revision of this paper.     

Social desirability,perceived stress,and PACT ratings in lung transplant candidates: A preliminary investigation

Some aspect of psychosocial criteria is commonly utilized by most transplant programs in assessing candidates' acceptability for transplantation. However, regardless of the assessment methodology, information obtained in pretransplant assessments may be limited given the evaluative nature of the assessment as well as the sensitive nature of the contents. Indeed, transplant candidates may present themselves in a favorable fashion, minimizing any negative traits or psychological dysfunction which they perceive might prevent transplantation. Unfortunately, there are limited data addressing the extent to which transplant candidates may present themselves in an overly positive light. This investigation surveys the prevalence of social desirability in lung transplant candidates as well as its association with self-reports of perceived stress. Further, the relationship between social desirability and interviewer ratings of transplant candidacy is examined. Subjects included 24 patients in end-stage organ failure being evaluated for lung transplant candidacy. Subjects completed the Perceived Stress Scale and a brief version of the Marlowe-Crowne Social Desirability Scale. Additionally, subjects were interviewer-rated on the Psychosocial Assessment of Candidates for Transplantation. Results indicate social desirability is a prevalent phenomenon in lung transplant candidates, with more than half of the sample scoring at or above the 84th percentile on the social desirability measure. Further, self-reports of perceived stress are moderately and inversely associated with social desirability (r=–.55,p .01). Social desirability was unrelated to interviewer-ratings of transplant candidates acceptability (r=.13,p .56). Future research might include larger samples of subjects, other organ transplant candidates, and more detailed assessments of symptom distress.     

Psychology and mind-body segregation: Are we part of the problem?

Despite advances in behavioral medicine and health psychology, the health care system and medical education continue to show resistance to a truly biopsychosocial model of medical practice. Psychologists in medical settings have generally been identified as challenging the concept of mind-body duality and the segregation of biologic and psychosocial sciences in medicine. However, examples are presented of how psychologists contribute to and perpetuate mind-body segregation via exclusive theoretical conceptualizations, arbitrary definitions of professional behavior, and dogmatic constraints on the limits of psychology's field of knowledge.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

Increasing senior citizen participation in a community-based nutritious meal program

Two experiments were conducted to compare the effects of several prompting and reinforcement procedures on the participation of elderly citizens in a nutritious meal program. Experiment I employed a variation of the multiple-baseline design across three groups of approximately 60 households each. Elderly persons not previously participating in the program were introduced to the following conditions: (1) public service radio announcements for four weeks to advertise the meal program and the availability of free transportation, (2) a home visit that served as a personal invitation and a second prompt for participation, (3) a followup telephone call, and (4) an incentive menu for participation, which was sent through the mail. Results indicated that the home visits and incentives were both effective as recruitment procedures and superior to other conditions; however, incentives proved to be the most cost-effective intervention. Experiment II used a variation of the multi-element design to compare the effects of scheduled activities and incentives in maintaining higher levels of participation by those persons who had attended the meal program at least once in the past, but whose current rate of participation was low. Results showed that activities improved attendance levels somewhat and that incentives substantially increased the number of meal program participants. Data from these experiments thus indicate that relatively inexpensive procedures may be used effectively to increase the extent to which elderly persons make use of potentially beneficial community-based services.     

Seat belt usage: A potential target for applied behavior analysis

Results of 1,579 observations of cars entering or exiting campus parking lots showed direct relationships between seat belt wearing and the intrusiveness of the engineering device designed to induce belt usage, and between device intrusiveness and system defeat. For example, all drivers with working interlocks or unlimited buzzer reminders were wearing a seat belt; but 62% of the systems with interlocks or unlimited buzzers had been defeated, and only 15.9% of the drivers in these cars were wearing a seat belt. The normative data indicated marked ineffectiveness of the negative reinforcement contingencies implied by current seat belt inducement systems; but suggested that unlimited buzzer systems would be the optimal system currently available if contingencies were developed to discourage the disconnection and circumvention of such systems. Positive reinforcement strategies are discussed that would be quite feasible for large-scale promotion of seat belt usage.