The use of genetic test information in insurance: The argument from indistinguishability reconsidered

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.     

An abbreviated PTSD checklist for use as a screening instrument in primary care

Although the importance of recognizing posttraumatic stress disorder (PTSD) in primary care has been well-established, routine screening for PTSD remains unfeasible for many primary care clinics because of the length of the available screening instruments. Thus, the purpose of this work was to develop and validate a brief screening tool for PTSD. In Study 1, four short forms of the PTSD Checklist-civilian version were identified that captured a majority of the variance in the measure. In Study 2, the performance of these short forms was evaluated in a separate sample of primary care patients. We found that both two-item and six-item versions have adequate psychometric properties for screening purposes and suggest that the selection of one version over the other depends on the specific needs of each primary care clinic.     

Adjusting To a New Racial Climate: Maintenance of Personal Integrity

This paper will focus on the writer’s experience as a native New Yorker relocating to Montgomery, Alabama. The writer will share how he adjusted and coped with overt discrimination and racism in the context of the high school in which he attended there-a majority white high school on the “other” side of town. The writer will share how he employed the following coping mechanisms as methods of adjusting to his new environment: translating emotional experiences into words (relaxation and talk therapy), involvement with other black positive peers, careful assessment before acting, withdrawal and avoidance, and consuming African-American literature.     

Racial Differences in Responses to the Caregiver Strain Questionnaire

The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders.     

Identity and moral responsibility of healthcare organizations

In this paper the moral responsibility of a Healthcare Organization (HCO) is conceived as an inextricable aspect of the identity of the HCO. We attempt to show that by exploring this relation a more profound insight in moral responsibility can be gained. Referring to Charles Taylor we explore the meaning of the concept of identity. It consists of three interdependent dimensions: a moral, a dialogical, and a narrative one. In section two we develop some additional arguments to apply his concept of personal identity to organizations. The final section works out the relationship of three dimensions of identity to some actual issues in contemporary HCOs: the tension between care and justice, the importance of dialogues about the diversity of goods, and the relevance of becoming familiar with the life-story of the HCO. Identity of an HCO is established and developed in commitments to and identification with certain goods that are central for a HCO. However, many of these goods are interwoven with everyday practices and policies. Therefore, moral responsibility asks for articulation of goods that often stay implicit and should not be reduced to a merely procedural approach. However difficult this articulation may be, if it is not tried at all HCOs run the risk of drifting away from their very identity as healthcare institutions: to offer care to patients and to do this in accordance with demands of social justice.     

The relationship of body image dissatisfaction to cigarette smoking in college students

This study examined the association of cigarette smoking status and body image dissatisfaction as measured by the Multidimensional Body-Self Relations Questionnaire (MBSRQ), in 1575 young adult college students, 18–24 years of age. Respondents were current cigarette smokers (N = 482) or never tobacco users (N = 1093). Smoking status was found to be significantly associated with 5 of the 10 MBSRQ subscales, with current smokers having lower scores on Fitness Orientation, Health Evaluation and Health Orientation (all p < 0.001) and higher scores on Appearance Orientation (p = 0.01) and Overweight Preoccupation (p = 0.03) compared with never tobacco users. Furthermore, among current smokers, a higher number of days smoked in the last 30 days were associated with lower scores on all MBSRQ subscales, except Self-Classified Weight. In terms of clinical implications, interventions for smoking cessation among college students might benefit from inclusion of components for addressing body image dissatisfaction and improving health beliefs.     

Identity, narcissism and the emotional core

This paper describes the course of an analysis which demonstrates how borderline and narcissistic functioning can be understood in terms of a struggle with issues of identity. It shows how such functioning can come to exert a profound hold on the individual and why it seems, at times, a matter of life and death to the patient to avoid states of separation from the analyst. The paper suggests that these complex phenomena can be understood, perhaps surprisingly, in the simple terms of the nature of affect itself. The concept of the emotional core is introduced to embody and highlight that which lies beneath both Jungian and Freudian models (offering a potential bridge between the two models)--namely the psyche's essentially affective nature. It is suggested that the emotional core can serve as an organ of perception giving the individual both their primary relation to reality and an emotional attachment to others. This emotional core is understood to function in a narcissistic manner to preference experiences of sameness and in aversion to experiences of difference--a view consonant with Stern's understanding of infant development where the infant is able to distinguish self from other from the beginning of life (as Fordham also held); taking up Stern's terminology, it gives the individual a 'core' sense of being. There is, however, no stable, on-going sense of 'I' associated with this form of functioning as the individual is immersed in the latest affect to enter consciousness (as in the borderline state of mind) and consequently the individual comes to rely intensely on the other to determine their sense of being (the other becomes a self-regulating other in Stern's terms). The development of ego-functioning gives a more stable and on-going sense of 'I' to the individual, giving contact with the broader personality, allowing the individual to be less reliant on the other and orientating them to reality in a way more fitting to their overall needs. The paper describes how consciousness, which is not seen as identical with the ego, moves between the mode of functioning of the ego and that of the emotional core, i.e., shifting in and out of states where projective identification predominates. It elaborates the range of self-experience encompassing spiritual experience and states of disintegration (which are understood to have a similar structure) on one side, to ego-based experience (which can itself be defensive and rigid at times) on the other. It explores the consequences of such a view for analytic technique and relates it to the Jungian view of the self and the Freudian unconscious.     

Norwegian versions of the Living with Asthma Questionnaire (LWAQ) and Asthma Bother Profile (ABP), validation and comparison of two asthma groups

The Living with Asthma Questionnaire (LWAQ) and the Asthma Bother Profile (ABP) were translated into Norwegian using conventional back translation procedures, and completed by 30 asthma outpatients and 30 asthma patients admitted to inpatient rehabilitation. Reliability (Cronbach's alpha and retest-reliability) was shown to be good for both scales. Validity was established by showing significantly poorer health in the rehabilitation sample, and correlations with state and trait anxiety. The Norwegian translations are reliable and valid versions of the original questionnaires.     

Jung's view on myth and post-modern psychology

Post-modern psychology embodies two core themes, the social mind and the narrative self. Whereas the social-mind thesis seems diametrically opposed to Jung's position regarding human nature, the narrative-self thesis is associated with research and theorizing about personal myth and mythmaking in ways that could make contact with Jung's concerns. Jung's view is examined here with particular attention to McAdams' theory of narrative identity. It is suggested that the ostensible differences between Jung and post-modern psychology might reflect divergent interests, rather than necessarily irreconcilable worldviews.     

Unemployment, Underemployment, and Mental Health: Conceptualizing Employment Status as a Continuum

The economy is one of the most important social environments that affect well-being, and community psychologists have long studied the social costs of one key economic stressor—job loss. But economically inadequate employment has received much less research attention than unemployment in regard to mental health effects. This paper contrasts these two literatures and considers factors that might account for their differential growth including actual rates of unemployment and underemployment. Recent panel studies offer no support for another possible basis for this differential growth—the assumption that inadequate employment is more like adequate employment than unemployment. Implications of a paradigm shift from a dichotomous perspective (employment vs. unemployment) to a continuum perspective with variations of both unemployment and employment are discussed for research and prevention. Another implication is the need to expand standard labor force statistics to reflect better the degree of underemployment.