Futility in Chronic Anorexia Nervosa: A Concept Whose Time Has Not Yet Come

Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa (AN). A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of capacity in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile.     

“Queering” Spiritual Direction: Towards a Trans*-Literary Praxis

Abstract

The praxis of spiritual direction has a number of well-established orthodoxies, most notably Ignatian, Franciscan and Benedictine, each typically characterized as paths that invite us to become our “true” selves in God. This article interrogates practices of spiritual direction from a queer perspective, examining the exclusions and inclusions for trans* people implicit in traditional notions of “spiritual direction”. Concentrating on a theo-literary reading of Psalm 139 using trans* understandings of the terms “passing” and “stealth” and grounded in my experience as a trans* woman, a spiritual director and poet, this article presents critical strategies to enable trans* Christians to locate themselves in the Christian spiritual discourse.     

Religio‐Spiritual Participation in Two American Indian Populations

Following a previous investigation of religio‐spiritual beliefs in American Indians, this article examined prevalence and correlates of religio‐spiritual participation in two tribes in the Southwest and Northern Plains (N = 3,084). Analysis suggested a “religious profile” characterized by strong participation across three traditions: aboriginal, Christian, and Native American Church. However, sociodemographic variables that have reliably predicted participation in the general American population, notably gender and age, frequently failed to achieve significance in multivariate analyses for each tradition. Religio‐spiritual participation was strongly and significantly related to belief salience for all traditions. Findings suggest that correlates of religious participation may be unique among American Indians, consistent with their distinctive religious profile. Results promise to inform researchers’ efforts to understand and theorize about religio‐spiritual behavior. They also provide tribal communities with practical information that might assist them in harnessing social networks to confront collective challenges through community‐based participatory research collaborations.     

Consumer Perspectives of Participation in Vocational Programs by Individuals With Serious Mental Illness: Two Phenomenological Studies

Engagement in worker roles presents significant challenges for individuals with serious mental illnesses. Evolution of vocational rehabilitation programs has yielded evidence-based support for supported employment models. This research presents a phenomenological study of consumer viewpoints concerning participation in earlier vocational rehabilitation programs, followed by a study of supported employment participation perspectives. Initial study themes of Chaos: Living with Disruptions, Mixed Blessings: Vocational Rehabilitation Program, Feelings of Discrepancy, and Searching for Order were reinforced by follow-up study themes of Positive Feelings of Worker Satisfaction and Managing Self/Illness. Consumers identified success in employment outcomes, if able to balance illness and work demands.     

NATURALIZED SACREDNESS? A REALIST,PANENTHEIST, AND PERENNIALIST ALTERNATIVE TO KAUFFMAN'S CONSTRUCTIVISM

In his recent book Reinventing the Sacred, renowned biologist and systems theorist Stuart Kauffman offers an avenue for the revival of the sacred and for reconciling sacredness with a robust scientific outlook. According to Kauffman, God is a human cultural invention, and he urges us to reinvent the sacred as the ceaseless creativity in nature. I argue that Kauffman's proposal suffers from a major shortcoming, namely, being at odds with the nature, and content, of authentic experiences of the sacred, experiences which point invariably in the direction of a reality which transcends human imagination and capacity for cultural innovation. Correspondingly, I point in the direction of an alternative approach to the revival of the sacred rooted in what I call the path of direct spiritual awareness. I argue that, while being in better accord with the phenomenology of religious experience, this realist alternative to Kauffman's constructivism also avoids the unpleasant symptoms which often accompany traditional theism, namely, dogmatism, irrationalism, and incompatibility with a scientifically minded metaphysics.     

Which Symptoms of Depression and Anxiety Matter Most? An Investigation of Subjective Importance Ratings With College Students in India

One goal of clinical psychological science is to help people with problems that matter to them. However, little is known about which kinds of symptoms are viewed as most important, particularly among individuals in non-western settings. We examined the extent to which young adults in India rated individual symptoms of depression and anxiety as important, concerning, and undesirable. Participants were college students at Indian Universities (n = 283). They received a measure of depressive symptoms (Patient Health Questionnaire-9) and anxiety symptoms (Generalized Anxiety Disorder Screener-7). For each of the 16 symptoms, they provided three judgments relating to the extent to which they found the symptom important, harmful, and undesirable. These judgments were averaged to form a “subjective importance rating” (SIR) for each symptom. Anxiety symptoms were viewed as more important than depressive symptoms (d = 0.34), and nonsomatic symptoms were viewed as more important than somatic symptoms (d = 0.83). Females rated symptoms as more important than males (d = 0.32), and individuals with higher self-reported symptoms rated symptoms as more important. Sad mood, suicidal ideation, and controlling worries were rated as the most important symptoms, whereas concentration problems, appetite problems, and psychomotor problems were rated as the least important. Overall, some symptoms are viewed as more important and concerning than others. We discuss how this understanding can affect our conceptualization, assessment, and treatment of mental disorders around the world.     

宽恕与人格特征关系的研究综述

宽恕是积极心理学研究的最热点内容之一,大量研究都表明宽恕与个体的人格特征具有密切的关系。本文详细探讨了宽恕与大五人格、共情、自尊及宗教性和精神性等人格特征之间的关系,最后对宽恕与人格的研究进行了总结和研究展望。     

Factor Analysis of the Mystical Experience Questionnaire: A Study of Experiences Occasioned by the Hallucinogen Psilocybin

A large body of historical evidence describes the use of hallucinogenic compounds, such as psilocybin mushrooms, for religious purposes. But few scientific studies have attempted to measure or characterize hallucinogen‐occasioned spiritual experiences. The present study examined the factor structure of the Mystical Experience Questionnaire (MEQ), a self‐report measure that has been used to assess the effects of hallucinogens in laboratory studies. Participants (N = 1,602) completed the 43‐item MEQ in reference to a mystical or profound experience they had had after ingesting psilocybin. Exploratory factor analysis of the MEQ retained 30 items and revealed a four‐factor structure covering the dimensions of classic mystical experience: unity, noetic quality, sacredness (F1); positive mood (F2); transcendence of time/space (F3); and ineffability (F4). MEQ factor scores showed good internal reliability and correlated with the Hood Mysticism Scale, indicating convergent validity. Participants who endorsed having had a mystical experience on psilocybin, compared to those who did not, had significantly higher factor scores, indicating construct validity. The four‐factor structure was confirmed in a second sample (N = 440) and demonstrated superior fit compared to alternative models. The results provide initial evidence of the validity, reliability, and factor structure of a 30‐item scale for measuring single, hallucinogen‐occasioned mystical experiences, which may be a useful tool in the scientific study of mysticism.     

Using Systems of Care to Reduce Incarceration of Youth with Serious Mental Illness

Youth with serious mental illness come into contact with juvenile justice more than 3 times as often as other youth, obliging communities to expend substantial resources on adjudicating and incarcerating many who, with proper treatment, could remain in the community for a fraction of the cost. Incarceration is relatively ineffective at remediating behaviors associated with untreated serious mental illness and may worsen some youths' symptoms and long-term prognoses. Systems of care represent a useful model for creating systems change to reduce incarceration of these youth. This paper identifies the systemic factors that contribute to the inappropriate incarceration of youth with serious mental illness, including those who have committed non-violent offenses or were detained due to lack of available treatment. It describes the progress of on-going efforts to address this problem including wraparound and diversion programs and others utilizing elements of systems of care. The utility of systems of care principles for increasing access to community-based mental health care for youth with serious mental illness is illustrated and a number of recommendations for developing collaborations with juvenile justice to further reduce the inappropriate incarceration of these youth are offered.