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Ganser syndrome | Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. The syndrome has also been called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, hysterical pseudodementia or prison psychosis.
The term prison psychosis is sometimes used because the syndrome occurs most frequently in prison inmates, where it may be seen as an attempt to gain leniency from prison or court officials. Psychological symptoms generally resemble the patient's sense of mental illness rather than any recognized category. The syndrome may occur in persons with other mental disorders such as schizophrenia, depressive disorders, toxic states, paresis, alcohol use disorders and factitious disorders. Ganser syndrome can sometimes be diagnosed as merely malingering, but it is more often defined as dissociative disorder.
The identification of Ganser syndrome is attributed to German psychiatrist Sigbert Ganser (1853–1931). In 1898, he described the disorder in prisoners awaiting trial in a penal institution in Halle, Germany. He named impaired consciousness and distorted communication, namely in the form of approximate answers (also referred to as Vorbeireden in the literature), as the defining symptoms of the syndrome. Vorbeireden involves the inability to answer questions precisely, although the content of the questions is understood.
Ganser syndrome is described as a dissociative disorder not otherwise specified (DDNOS) in the DSM-IV, and is not currently listed in the DSM-5. It is a rare and an often overlooked clinical phenomenon. In most cases, it is preceded by extreme stress and followed by amnesia for the period of psychosis. In addition to approximate answers, other symptoms include a clouding of consciousness, somatic conversion disorder symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia.
Cause
To date, no definitive cause or reason of the disorder has been established. The sources that classify the syndrome as a dissociative disorder or a factitious disorder conflict in their proposed aetiologies. As a result, there are differing theories as to why the syndrome develops.
Ganser syndrome was previously classified as a factitious disorder, explaining the symptoms as mimicking of what patients who do not experience psychosis believe is typical of the experience. However, the DSM-IV placed the syndrome under "Dissociative Disorders Not Otherwise Specified". There has been evidence of a strong correlation between approximate answers and amnesia, suggesting that these have an underlying dissociative mechanism.
Both Ganser's syndrome and the broader category of dissociative disorders have been linked to histories of hysteria, psychosis, conversion, multiple personality and possible feigning. Despite this, the condition's aetiology remains under question due to associations with established psychiatric disorders, as well as organic states.
According to Stern and Whiles (1942), Ganser syndrome is a fundamentally psychotic illness. As evidence, they describe the case of a woman with recurrent mania and a head injury before being submitted to treatment and the report of a man with schizophrenia who suffered from alcoholism and had recently been in prison.
Ganser syndrome is also sometimes referred to as "prison psychosis", emphasizing its prevalence among prisoners, generating discussion about whether the disorder only appears in this population. In a study of prisoners, Estes and New concluded that escaping an intolerable situation, such as being incarcerated, prompted the syndrome's key symptoms. The study touched on the malingering controversy surrounding the syndrome, as well as the stress component that often precedes the disorder.
According to consultant psychiatrist F. A. Whitlock, Ganser syndrome is a hysterical disorder, on par with Ganser's description of the disorder. Whitlock pointed to the number of cases in which Ganser syndrome was reported in settings of organic brain disease or functional psychosis as evidence of its hysterical foundations. Kraepelin and Bumke also believed the syndrome to be of a hysterical nature. Bumke thought the syndrome hysterical because amnesia for a traumatic emotional event tends to occur in hysteria more than in other disorders. The giving of approximate answers is thought to be produced in hysterical personalities.
According to Mayer-Gross and Bleuler, Ganser syndrome occurs mainly in epileptic or schizophrenic patients.
Still others claim that an organic condition that could lead to the manifestation of Ganser syndrome symptoms would have to be at an advanced stage in which a diagnosis could be easily given.
There have also been reports of trauma and stroke patients with the syndrome. A study investigating the neurological basis of Ganser syndrome described a patient with symptoms of the disorder who had a history of stroke and bifrontal infarcts. They discovered that hyperglutamatergic states, which are caused by both strokes and stress, share a relationship with dissociative symptoms, suggesting a possible organic pathology that can predispose individuals to the syndrome. Wirtz and colleagues (2008) described a patient with Ganser syndrome after a left-hemispheric middle cerebral artery infarct. A neuropsychological examination revealed atypical lateralisation of cognitive functions, leading to the conclusion that the giving of approximate answers might be related to frontal-executive cerebral dysfunction.
Diagnosis
Ganser syndrome was listed under Factitious Disorder with Psychological Symptoms in the DSM-III. The criteria of this category emphasized symptoms that cannot be explained by other mental disorders, psychological symptoms under the control of the individual, and the goal of assuming a patient role, not otherwise understandable given their circumstances.
The DSM-IV-TR classified Ganser syndrome as a dissociative disorder defined by the giving of approximate answers to questions (e.g. '2 plus 2 equals 5' when not associated with dissociative amnesia or dissociative fugue). The ICD-10 and DSM-IV do not specify any diagnostic criteria—apart from approximate answers—as a requirement for a Ganser syndrome diagnosis. Most case studies of the syndrome also depend on the presence of approximate answers and at least one of the other symptoms described by Ganser in his original paper. Usually when giving wrong answers, individuals are only slightly off, showing that the individual understood the question For instance, when asked how many legs a horse has, they might say, "five". Although subjects appear confused in their answers, in other respects they appear to understand their surroundings. Amnesia, loss of personal identity, and clouding of consciousness were among the most common symptoms apart from approximate answers.
Although there is currently no uniform way to diagnose the syndrome, a full neurological and mental state examination is recommended to determine its presence as well as tests that assess malingering. In addition to mental examination, other investigations should be done to exclude other underlying causes. These include computer tomography scans (CT) or magnetic resonance imaging (MRI) scans to exclude structural pathology, lumbar puncture to exclude meningitis or encephalitis, and electroencephalography (EEG), to exclude delirium or seizure disorder.
Diagnosing Ganser syndrome is challenging because of its rarity and symptom variability. The manifested symptoms may be dependent on the individual's conception of what mental illness entails, creating the possibility of a wide range of combinations of symptoms present in an individual with Ganser syndrome.
Treatment
In many cases, the symptoms seem to dwindle after a few days, and patients are often left with amnesia for the period of psychosis. Hospitalization may be necessary during the acute phase of symptoms, and psychiatric care if the patient is a danger to self or others. A neurological consult is advised to rule out any organic cause. Psychotherapy may also recommended for ensuring and maintaining safety.
Ganser patients typically recover quickly and completely. Since Ganser syndrome can be a response to psychic deterioration, its resolution may be followed by other psychiatric symptoms, such as schizophrenia and depression, hence the rationale behind the recommendation of psychotherapy. Medication is usually not required.
Epidemiology
Reviewing multiple collections of case studies, the incidence of the disorder is not precisely known. Individuals of multiple backgrounds have been reported as having the disorder. The syndrome was historically thought to be more common in men. However, Whitlock speculates that the higher reported rate of Ganser in men might be due to the greater proportion of men who are incarcerated. It has been most frequently seen in individuals ages 15 to 40 and has also been observed in children. This wide age range is derived from case studies, and therefore may not be an accurate estimate. Ganser syndrome has also been observed in groups other than prison populations.
Controversy
There is controversy regarding whether Ganser syndrome is a valid clinical entity. For example, Bromberg (1986) has argued that the syndrome is not due to or related to mental illness, but rather a sort of defense against legal punishment. Some see it as conscious lying, denial and repression, presenting Ganser syndrome symptoms as malingering instead of a dissociative or factitious disorder.
One case study of Ganser syndrome presented a middle-aged man who had been in a car crash and wanted disability insurance benefits. Since he had a big incentive, psychologists took careful measures and implemented testing with malingering instruments, which showed that the man performed below chance on simple memory tests and claimed to experience non-existent symptoms. Upon further inspection of the collateral information, they found that the patient took part in high-level sports and other activities that were inconsistent with the cognitive dysfunctions he reported, and they determined it to be a case of malingering.
Estes and New (1948) concluded that the motivation for the symptoms of the syndrome was escaping an "intolerable situation". Stern and Whiles proposed an alternative explanation, citing Ganser syndrome presented itself in individuals who, although not psychologically well, do not realize it, and want to appear so. Still others attribute the syndrome to inattention, purposeful evasion, suppression, alcoholic excess, head injury, and to unconscious attempts to deceive others as a means to free themselves from responsibility for their actions. This denial of behaviour can be seen as a way to overcome anxiety and helplessness brought on by the stressful event that often precedes the syndrome.
These aetiological debates focus on the main symptom of Ganser syndrome and its importance in its diagnosis. Approximate answers are prominent in the Ganser syndrome literature, causing concern in those who believe that this is a relatively simple symptom to feign.
Ganser syndrome was regarded as an Adjustment Reaction of Adult Life in the DSM-II and later was moved under the category of Factitious Disorder with Psychological Symptoms in the DSM-III. Ganser syndrome can also be found under the Dissociative Disorder Not Otherwise Specified (DDNOS) section of the DSM-IV-TR, however it is not listed in the DSM-5, which got rid of the DDNOS section and replaced it with Other Specified Dissociative Disorder (OSDD) and Unspecified Dissociative Disorder (USDD). Despite this, the International Classification of Diseases has Ganser syndrome listed under dissociative disorders.
In popular culture
In the novel Red Dragon by author Thomas Harris, there is a scene where Hannibal Lecter reports that Dr. Chilton, chief of staff at the mental hospital where he resides, has attributed Lector having Ganser syndrome as a reason to why he avoided prison. Chilton claims so in order to avoid embarrassment at Lecter easily outsmarting him whenever Chilton tried to give him various psychological tests.
See also
Paraphasia
References
Further reading
External links
Forensic psychology
Factitious disorders
Stress-related disorders
Dissociative disorders
Psychopathological syndromes | 0.766736 | 0.992893 | 0.761287 |
Compartmentalization (psychology) | Compartmentalization is a form of psychological defense mechanism in which thoughts and feelings that seem to conflict are kept separated or isolated from each other in the mind. Those with post traumatic stress disorder may use compartmentalization to separate positive and negative self aspects. It may be a form of mild dissociation; example scenarios that suggest compartmentalization include acting in an isolated moment in a way that logically defies one's own moral code, or dividing one's unpleasant work duties from one's desires to relax. Its purpose is to avoid cognitive dissonance, or the mental discomfort and anxiety caused by a person having conflicting values, cognitions, emotions, beliefs, etc. within themselves.
Compartmentalization allows these conflicting ideas to co-exist by inhibiting direct or explicit acknowledgement and interaction between separate compartmentalized self-states.
Psychoanalytic views
Psychoanalysis considers that whereas isolation separates thoughts from feeling, compartmentalization separates different (incompatible) cognitions from each other. As a secondary, intellectual defense, it may be linked to rationalization. It is also related to the phenomenon of neurotic typing, whereby everything must be classified into mutually exclusive and watertight categories.
It has been said that when thinking about death people end up compartmentalizing, and they are in a mode of denial and acceptance about it, but they both have the result of making the thinking individual very passive.
Otto Kernberg has used the term "bridging interventions" for the therapist's attempts to straddle and contain contradictory and compartmentalized components of the patient's mind.
Vulnerability
Compartmentalization can be positive, negative, and integrated depending on the context and person. Compartmentalization may lead to hidden vulnerabilities related to self-organization and self-esteem in those who use it as a major defense mechanism. When a negative self-aspect is activated, it may cause a drop in self-esteem and mood. This drop in self-esteem and mood is what the observed vulnerability is attributed to.
Social identity
Conflicting social identities may be dealt with by compartmentalizing them and dealing with each only in a context-dependent way.
Post Traumatic Stress Disorder (PTSD) and compartmentalization
Those who have PTSD often compartmentalize positive and negative self-aspects more than those without PTSD; this helps keep the negative self-aspects from overtaking the positive self-aspects. Positive self-concept can be kept safe through the use of compartmentalization, specifically for those who have experienced sexual trauma and have, subsequently, been diagnosed with PTSD.
Mindfulness and compartmentalization
Mindfulness meditation may help reduce compartmentalized self-knowledge. Also, those who have greater trait mindfulness may have less negative self-concepts about themselves.
Literary examples
In his novel, The Human Factor, Graham Greene has one of his corrupt officials use the rectangular boxes of Ben Nicholson's art as a guide to avoiding moral responsibility for bureaucratic decision-making—a way to compartmentalize oneself within one's own separately colored box.
Doris Lessing considered that the essential theme of The Golden Notebook was "that we must not divide things off, must not compartmentalise. 'Bound. Free. Good. Bad. Yes. No. Capitalism. Socialism. Sex. Love...'".
See also
Catharsis
Confirmation bias
Doublethink
Idealization and devaluation
Intellectualization
Psychodynamics
Rationalization (psychology)
Sublimation
Suspension of disbelief
References
Cognition
Defence mechanisms | 0.764463 | 0.995844 | 0.761286 |
Humanistic psychology | Humanistic psychology is a psychological perspective that arose in the mid-20th century in answer to two theories: Sigmund Freud's psychoanalytic theory and B. F. Skinner's behaviorism. Thus, Abraham Maslow established the need for a "third force" in psychology. The school of thought of humanistic psychology gained traction due to Maslow in the 1950s.
Some elements of humanistic psychology are
to understand people, ourselves and others holistically (as wholes greater than the sums of their parts)
to acknowledge the relevance and significance of the full life history of an individual
to acknowledge the importance of intentionality in human existence
to recognize the importance of an end goal of life for a healthy person
Humanistic psychology also acknowledges spiritual aspiration as an integral part of the psyche. It is linked to the emerging field of transpersonal psychology.
Primarily, humanistic therapy encourages a self-awareness and reflexivity that helps the client change their state of mind and behavior from one set of reactions to a healthier one with more productive and thoughtful actions. Essentially, this approach allows the merging of mindfulness and behavioral therapy, with positive social support.
In an article from the Association for Humanistic Psychology, the benefits of humanistic therapy are described as having a "crucial opportunity to lead our troubled culture back to its own healthy path. More than any other therapy, Humanistic-Existential therapy models democracy. It imposes ideologies of others upon the client less than other therapeutic practices. Freedom to choose is maximized. We validate our clients' human potential."
In the 20th century, humanistic psychology was referred to as the "third force" in psychology, distinct from earlier, less humanistic approaches of psychoanalysis and behaviorism.
Its principal professional organizations in the US are the Association for Humanistic Psychology and the Society for Humanistic Psychology (Division 32 of the American Psychological Association). In Britain, there is the UK Association for Humanistic Psychology Practitioners.
Differences with psychoanalytic theory and behaviorism
Through disagreement with the predominant theories at the time, developed by Freud and Skinner, Maslow was able to formulate the main points of humanistic theory.
Maslow had the following criticisms of the two main theories at the time:
Freud's theory was deterministic, meaning that it attributed the behavior of people to unconscious desires.
Freud and Skinner's theories focused on individuals with mental conflicts (pathological) rather than all individuals.
The other two theories focused too much on the negative traits of human beings, rather than focusing on the positive power Maslow believed individuals to have.
As a result, when Maslow developed his theory, he decided to focus on the conscious (rather than the unconscious) and decided to develop a new theory to explain how all individuals could reach their highest potential.
Origins
One of humanistic psychology's early sources was the work of Carl Rogers, who was strongly influenced by Otto Rank, who broke with Freud in the mid-1920s. Rogers' focus was to ensure that the developmental processes led to healthier, if not more creative, personality functioning. The term 'actualizing tendency' was also coined by Rogers, and was a concept that eventually led Abraham Maslow to study self-actualization as one of the needs of humans. Rogers and Maslow introduced this positive, humanistic psychology in response to what they viewed as the overly pessimistic view of psychoanalysis.
The other sources of inspiration include the philosophies of existentialism and phenomenology.
Conceptual origins
Whilst origins of humanistic psychology date back to the early 1960s, the origins of humanism date back to the classical civilizations of China, Greece, and Rome, whose values were renewed in the European Renaissance.
The modern humanistic approach has its roots in phenomenological and existentialist thought (see Kierkegaard, Nietzsche, Heidegger, Merleau-Ponty and Sartre). Eastern philosophy and psychology also play a central role in humanistic psychology, as well as Judeo-Christian philosophies of personalism, as each shares similar concerns about the nature of human existence and consciousness.
For further information on influential figures in personalism, see: Emmanuel Mounier, Gabriel Marcel, Denis de Rougemont, Jacques Maritain, Martin Buber, Emmanuel Levinas, Max Scheler and Karol Wojtyla.
As behaviorism grew out of Ivan Pavlov's work with the conditioned reflex, and laid the foundations for academic psychology in the United States associated with the names of John B. Watson and B. F. Skinner; Abraham Maslow gave behaviorism the name "the first force", a force which systematically excluded the subjective data of consciousness and much information bearing on the complexity of the human personality and its development. Behavioral theory continued to develop to both account for simple and complex human behavior through theorists such as Arthur Staats, Stephen Hayes, and other post-Skinnerian researchers. Clinical behavioral analysis continues to be widely employed in anxiety disorder treatments, mood disorders, and even personality disorders.
The "second force" arose out of Freudian psychoanalysis, which were composed by psychologists like Alfred Adler, Erik Erikson, Carl Jung, Erich Fromm, Karen Horney, Melanie Klein, Harry Stack Sullivan, and Sigmund Freud himself. Maslow then emphasized the necessity of a "third force" (even though he did not use the term), saying that "it is as if Freud supplied us the sick half of psychology and we must now fill it out with the healthy half", as a critical review towards the cold and distant approach of the psychoanalysis and its deterministic way of viewing the human being.
In the late 1930s, psychologists, interested in the uniquely human issues, such as the self, self-actualization, health, hope, love, creativity, nature, being, becoming, individuality, and meaning—that is, a concrete understanding of human existence—included Abraham Maslow, Carl Rogers, and Clark Moustakas, who were interested in founding a professional association dedicated to a psychology focused on these features of human capital demanded by post-industrial society.
The humanistic psychology perspective is summarized by five core principles or postulates of humanistic psychology first articulated in an article written by James Bugental in 1964 and adapted by Tom Greening, psychologist and long-time editor of the Journal of Humanistic Psychology. The five basic principles of humanistic psychology are:
Human beings, as human, supersede the sum of their parts. They cannot be reduced to components.
Human beings have their existence in a uniquely human context, as well as in a cosmic ecology.
Human beings are aware and are aware of being aware—i.e., they are conscious. Human consciousness always includes an awareness of oneself in the context of other people.
Human beings have the ability to make choices and therefore have responsibility.
Human beings are intentional, aim at goals, are aware that they cause future events, and seek meaning, value, and creativity.
While humanistic psychology is a specific division within the American Psychological Association (Division 32), humanistic psychology is not so much a discipline within psychology as a perspective on the human condition that informs psychological research and practice.
Practical origins
WWII created practical pressures on military psychologists, they had more patients to see and care for than time or resources permitted. The origins of group therapy are here. Eric Berne's progression of books shows this transition out of what we might call pragmatic psychology of WWII into his later innovation, Transactional Analysis, one of the most influential forms of humanistic Popular Psychology of the later 1960s-1970. Even though transactional analysis was considered a unique methodology, it was challenged after Berne's death.
Orientation to scientific research
Humanistic psychologists generally do not believe that we will understand human consciousness and behavior through mainstream scientific research. The objection that humanistic psychologists have to traditional research methods is that they are derived from and suited for the physical sciences and not especially appropriate to studying the complexities and nuances of human meaning-making.
However, humanistic psychology has involved scientific research of human behavior since its inception. For example:
Abraham Maslow proposed many of his theories of human growth in the form of testable hypotheses, and he encouraged scientists to put them to the test.
Shortly after the founding of the American Association of Humanistic Psychology, its president, psychologist Sidney Jourard, began his column by declaring that "research" is a priority. "Humanistic Psychology will be best served if it is undergirded with research that seeks to throw light on the qualities of man that are uniquely human" (emphasis added)
In May 1966, the AAHP release a newsletter editorial that confirmed the humanistic psychologist's "allegiance to meaningfulness in the selection of problems for study and of research procedures, and an opposition to a primary emphasis on objectivity at the expense of significance." This underscored the importance of research to humanistic psychologists as well as their interest in special forms of human science investigation.
Likewise, in 1980, the American Psychological Association's publication for humanistic psychology (Division 32 of APA) ran an article titled, What makes research humanistic? As Donald Polkinghorne notes, "Humanistic theory does not propose that human action is completely independent of the environment or the mechanical and organic orders of the body, but it does suggest that, within the limits of experienced meanings, persons as unities can choose to act in ways not determined by prior events...and this is the theory we seek to test through our research" (p. 3).
A human science view is not opposed to quantitative methods, but, following Edmund Husserl:
favors letting the methods be derived from the subject matter and not uncritically adopting the methods of natural science, and
advocates for methodological pluralism. Consequently, much of the subject matter of psychology lends itself to qualitative approaches (e.g. the lived experience of grief), and quantitative methods are mainly appropriate when something can be counted without leveling the phenomena (e.g. the length of time spent crying).
Research has remained part of the humanistic psychology agenda, though with more of a holistic than reductionistic focus. Specific humanistic research methods evolved in the decades following the formation of the humanistic psychology movement.
Development of the field
Saybrook Conference
In November 1964 key figures in the movement gathered at Old Saybrook (CT) for the first invitational conference on Humanistic psychology. The meeting was a co-operation between the Association for Humanistic Psychology (AHP), which sponsored the conference, the Hazen Foundation, which provided financing, and Wesleyan University, which hosted the meeting. In addition to the founding figures of Humanistic psychology; Abraham Maslow, Rollo May, James Bugental and Carl Rogers, the meeting attracted several academic profiles from the humanistic disciplines, including: Gordon Allport, George Kelly, Clark Moustakas, Gardner Murphy, Henry Murray, Robert W. White, Charlotte Bühler, Floyd Matson, Jacques Barzun, and René Dubos. Robert Knapp was chairman and Henry Murray gave the keynote address.
Among the intentions of the participants was to formulate a new vision for psychology that, in their view, took into consideration a more complete image of the person than the image presented by the current trends of Behaviorism and Freudian psychology. According to Aanstoos, Serlin & Greening the participants took issue with the positivistic trend in mainstream psychology at the time. The conference has been described as a historic event that was important for the academic status of Humanistic psychology and its future aspirations.
Major theorists
Several key theorists have been considered to have prepared the ground for humanistic psychology. These theorists include Otto Rank, Abraham Maslow, Carl Rogers and Rollo May. This section provides a short-handed summary of each individual's contributions for the theory.
Abraham Maslow: In regards to humanistic theory, Maslow developed a hierarchy of needs. This is a pyramid which basically states that individuals first must have their physiological needs met, then safety, then love, then self-esteem and lastly self-actualization. People who have met their self-actualization needs are self-aware, caring, wise and their interests are problem centered. He theorized that self-actualizing people are continuously striving, thinking broadly and focusing on broader problems. He also believed however, that only 1% of people actually achieved self-actualization.
Carl Rogers: Rogers built upon Maslow's theory and argued that the process of self-actualization is nurtured in a growth promoting climate. Two conditions are required in order for a climate to be a self-actualizing growth promoting climate: the individual must be able to be their genuine self, and as the individual expresses their true self, they must be accepted by others.
Counseling and therapy
The aim of humanistic therapy is usually to help the client develop a stronger and healthier sense of self, also called self-actualization. Humanistic therapy attempts to teach clients that they have potential for self-fulfillment. This type of therapy is insight-based, meaning that the therapist attempts to provide the client with insights about their inner conflicts.
Approaches
Humanistic psychology includes several approaches to counseling and therapy. Among the earliest approaches we find the developmental theory of Abraham Maslow, emphasizing a hierarchy of needs and motivations; the existential psychology of Rollo May acknowledging human choice and the tragic aspects of human existence; and the person-centered or client-centered therapy of Carl Rogers, which is centered on the client's capacity for self-direction and understanding of his or her own development. Client-centered therapy is non-directive; the therapist listens to the client without judgement, allowing the client to come to insights by themselves. The therapist should ensure that all of the client's feelings are being considered and that the therapist has a firm grasp on the concerns of the client while ensuring that there is an air of acceptance and warmth. Client-centered therapist engages in active listening during therapy sessions.
A therapist cannot be completely non-directive; however, a nonjudgmental, accepting environment that provides unconditional positive regard will encourage feelings of acceptance and value.
Existential psychotherapies, an application of humanistic psychology, applies existential philosophy, which emphasizes the idea that humans have the freedom to make sense of their lives. They are free to define themselves and do whatever it is they want to do. This is a type of humanistic therapy that forces the client to explore the meaning of their life, as well as its purpose. There is a conflict between having freedoms and having limitations. Examples of limitations include genetics, culture, and many other factors. Existential therapy involves trying to resolve this conflict.
Another approach to humanistic counseling and therapy is Gestalt therapy, which puts a focus on the here and now, especially as an opportunity to look past any preconceived notions and focus on how the present is affected by the past. Role playing also plays a large role in Gestalt therapy and allows for a true expression of feelings that may not have been shared in other circumstances. In Gestalt therapy, non-verbal cues are an important indicator of how the client may actually be feeling, despite the feelings expressed.
Also part of the range of humanistic psychotherapy are concepts from depth therapy, holistic health, encounter groups, sensitivity training, marital and family therapies, body work, the existential psychotherapy of Medard Boss, and positive psychology.
Empathy and self-help
Empathy is one of the most important features of humanistic therapy. This idea focuses on the therapist's ability to see the world through the eyes of the client. Without this, therapists can be forced to apply an external frame of reference where the therapist is no longer understanding the actions and thoughts of the client as the client would, but strictly as a therapist which defeats the purpose of humanistic therapy. Included in empathizing, unconditional positive regard is one of the key elements of humanistic psychology. Unconditional positive regard refers to the care that the therapist needs to have for the client. This ensures that the therapist does not become the authority figure in the relationship allowing for a more open flow of information as well as a kinder relationship between the two. A therapist practicing humanistic therapy needs to show a willingness to listen and ensure the comfort of the patient where genuine feelings may be shared but are not forced upon someone. Marshall Rosenberg, one of Carl Rogers' students, emphasizes empathy in the relationship in his concept of Nonviolent Communication.
Self-help is also part of humanistic psychology: Sheila Ernst and Lucy Goodison have described using some of the main humanistic approaches in self-help groups. Humanistic Psychology is applicable to self-help because it is oriented towards changing the way a person thinks. One can only improve once they decide to change their ways of thinking about themselves, once they decide to help themselves. Co-counselling, which is an approach based purely on self-help, is regarded as coming from humanistic psychology as well. Humanistic theory has had a strong influence on other forms of popular therapy, including Harvey Jackins' Re-evaluation Counselling and the work of Carl Rogers, including his student Eugene Gendlin; (see Focusing) as well as on the development of the Humanistic Psychodrama by Hans-Werner Gessmann since the 80s.
Ideal and real selves
The ideal self and real self involve understanding the issues that arise from having an idea of what you wish you were as a person, and having that not match with who you actually are as a person (incongruence). The ideal self is what a person believes should be done, as well as what their core values are. The real self is what is actually played out in life. Through humanistic therapy, an understanding of the present allows clients to add positive experiences to their real self-concept. The goal is to have the two concepts of self become congruent. Rogers believed that only when a therapist was able to be congruent, a real relationship occurs in therapy. It is much easier to trust someone who is willing to share feelings openly, even if it may not be what the client always wants; this allows the therapist to foster a strong relationship.
Non-pathological
Humanistic psychology tends to look beyond the medical model of psychology in order to open up a non-pathologizing view of the person. This usually implies that the therapist downplays the pathological aspects of a person's life in favour of the healthy aspects. Humanistic psychology tries to be a science of human experience, focusing on the actual lived experience of persons. Therefore, a key ingredient is the actual meeting of therapist and client and the possibilities for dialogue to ensue between them. The role of the therapist is to create an environment where the client can freely express any thoughts or feelings; he does not suggest topics for conversation nor does he guide the conversation in any way. The therapist also does not analyze or interpret the client's behavior or any information the client shares. The role of the therapist is to provide empathy and to listen attentively to the client.
Societal applications
Social change
While personal transformation may be the primary focus of most humanistic psychologists, many also investigate pressing social, cultural, and gender issues. In an academic anthology from 2018, British psychologist Richard House and his co-editors wrote, "From its very outset, Humanistic Psychology has engaged fulsomely and fearlessly with the social, cultural and political, in a way that much of mainstream scientific, 'positivistic' psychology has sought to avoid".
Some of the earliest writers who were associated with and inspired by psychological humanism explored socio-political topics. For example:
Alfred Adler argued that achieving a sense of community feeling is essential to human development.
Medard Boss defined health as an openness to the world, and unhealth as anything in the psyche or society that blocked or constricted that openness.
Erich Fromm argued that the totalitarian impulse is rooted in people's fear of the uncertainties and responsibilities of freedom – and that the way to overcome that fear is to dare to live life fully and compassionately.
R. D. Laing analyzed the political nature of "normal", everyday experience.
Rollo May said that people have lost their values in the modern world, and that their health and humanity depends on having the courage to forge new values appropriate to the challenges of the present.
Wilhelm Reich argued that psychological problems are often caused by sexual repression, and that the latter is influenced by social and political conditions – which can and should be changed.
Carl Rogers came to believe that political life did not have to consist of an endless series of winner-take-all battles, that it could and should consist of an ongoing dialogue among all parties. If such dialogue were characterized by respect among the parties and authentic speaking by each party, compassionate understanding and – ultimately – mutually acceptable solutions could be reached.
Virginia Satir was convinced that her approach to family therapy would enable individuals to expand their consciousness, become less fearful, and bring communities, cultures, and nations together.
Relevant work was not confined to these pioneer thinkers. In 1978, members of the Association for Humanistic Psychology (AHP) embarked on a three-year effort to explore how the principles of humanistic psychology could be used to further the process of positive social and political change. The effort included a "12-Hour Political Party", held in San Francisco in 1980, where nearly 1,400 attendees discussed presentations by such non-traditional social thinkers as Ecotopia author Ernest Callenbach, Aquarian Conspiracy author Marilyn Ferguson, Person/Planet author Theodore Roszak, and New Age Politics author Mark Satin. The emergent perspective was summarized in a manifesto by AHP President George Leonard. It proffered such ideas as moving to a slow-growth or no-growth economy, decentralizing and "deprofessionalizing" society, and teaching social and emotional competencies in order to provide a foundation for more humane public policies and a healthier culture.
There have been many other attempts to articulate humanistic-psychology-oriented approaches to social change. For example, in 1979 psychologist Kenneth Lux and economist Mark A. Lutz called for a new economics based on humanistic psychology rather than utilitarianism. Also in 1979, California state legislator John Vasconcellos published a book calling for the integration of liberal politics and humanistic-psychological insight. From 1979 to 1983 the New World Alliance, a U.S. political organization based in Washington, D.C., attempted to inject humanistic-psychology ideas into political thinking and processes; sponsors of its newsletter included Vasconcellos and Carl Rogers.
In 1989 Maureen O'Hara, who had worked with both Carl Rogers and Paulo Freire, pointed to a convergence between the two thinkers. According to O'Hara, both focus on developing critical consciousness of situations which oppress and dehumanize. Throughout the 1980s and 1990s, Institute of Noetic Sciences president Willis Harman argued that significant social change cannot occur without significant consciousness change. In the 21st century, influenced by humanistic psychology, people such as Edmund Bourne, Joanna Macy, and Marshall Rosenberg continued to apply psychological insights to social and political issues.
In addition to its uses in thinking about social change, humanistic psychology is considered to be the main theoretical and methodological source of humanistic social work.
Social work
After psychotherapy, social work is the most important beneficiary of the humanistic psychology's theory and methodology. These theories have produced a deep reform of the modern social work practice and theory, leading, among others, to the occurrence of a particular theory and methodology: Humanistic Social Work. Most values and principles of the humanistic social work practice, described by Malcolm Payne in his book Humanistic Social Work: Core Principles in Practice, directly originate from the humanistic psychological theory and humanistic psychotherapy practice, namely creativity in human life and practice, developing self and spirituality, developing security and resilience, accountability, flexibility and complexity in human life and practice.
Furthermore, the representation and approach of the client (as human being) and social issue (as human issue) in social work is made from the humanistic psychology position. According to Petru Stefaroi, the way humanistic representation and approach of the client and their personality is realized is, in fact, the theoretical-axiological and methodological foundation of humanistic social work.
In setting goals and the intervention activities, in order to solve social/human problems, there prevail critical terms and categories of the humanistic psychology and psychotherapy, such as: self-actualization, human potential, holistic approach, human being, free will, subjectivity, human experience, self-determination/development, spirituality, creativity, positive thinking, client-centered and context-centered approach/intervention, empathy, personal growth, empowerment. Humanistic psychology has been utilised as a framework for theorizing the African philosophy of Ubuntu in social work practice. In addition, humanistic social work calls for the pursuit of social justice, holistic service provision, technological innovation and stewardship, dialogue and cooperation as well as professional care and peer support during the COVID-19 pandemic.
Creativity in corporations
Humanistic psychology's emphasis on creativity and wholeness created a foundation for new approaches towards human capital in the workplace stressing creativity and the relevance of emotional interactions. Previously the connotations of "creativity" were reserved for and primarily restricted to, working artists. In the 1980s, with increasing numbers of people working in the cognitive-cultural economy, creativity came to be seen as a useful commodity and competitive edge for international brands. This led to corporate creativity training in-service trainings for employees, led pre-eminently by Ned Herrmann at G.E. in the late 1970s.
See also
References
Further reading
Arnold, Kyle. (2014). Behind the Mirror: Reflective Listening and its Tain in the Work of Carl Rogers. The Humanistic Psychologist, 42:4 354-369.
Bendeck Sotillos, S. (Ed.). (2013). Psychology and the Perennial Philosophy: Studies in Comparative Religion. Bloomington, IN: World Wisdom. .
Bugental, J. F. T. (Ed.). (1967). Challenges of humanistic psychology. New York, NY: McGraw-Hill.
Bugental, J.F.T (1964). "The Third Force in Psychology". Journal of Humanistic Psychology 4 (1): 19–25. .
Buhler, C., & Allen, M. (1972). Introduction to humanistic psychology. Monterey CA: Brooks/Cole Pub. Co.
Chiang, H. -M., & Maslow, A. H. (1977). The healthy personality (Second ed.). New York, NY: D. Van Nostrand Co.
DeCarvalho, R. J. (1991). The founders of humanistic psychology. New York, NY: Praeger Publishers.
Frick, W. B. (1989). Humanistic psychology: Conversations with Abraham Maslow, Gardner Murphy, Carl Rogers. Bristol, IN: Wyndham Hall Press. (Original work published 1971)
Fromm, E. (1955). The sane society. Oxford, England: Rinehart & Co.* Fromm, E. (1955). The sane society. Oxford, England: Rinehart & Co.
Gessmann, H.-W. (2012). Humanistic Psychology and Humanistic Psychodrama. - Гуманистическая психология и гуманистическая психодрама. Москва - jurpsy.ru/lib/books/id/25808.php
Gunn, Jacqueline Simon; Arnold, Kyle; Freeman, Erica. (2015). The Dynamic Self Searching for Growth and Authenticity: Karen Horney's Contribution to Humanistic Psychology. The Forum of the American Academy of Psychoanalysis and Dynamic Psychiatry, 59: 2 20-23.
Human Potentialities: The Challenge and the Promise. (1968). Human potentialities: The challenge and the promise. St. Louis, MO: WH Green.
Kress, Oliver (1993). "A new approach to cognitive development: ontogenesis and the process of initiation". Evolution and Cognition 2(4): 319-332.
Maddi, S. R., & Costa, P. T. (1972). Humanism in personology: Allport, Maslow, and Murray. Chicago, IL: Aldine·Atherton.
Misiak, H., & Sexton, V. S. J. A. (1973). Phenomenological, existential, and humanistic psychologies: A historical survey. New York, NY: Grune & Stratton.
Moss, D. (1999). Humanistic and transpersonal psychology: A historical and biographical sourcebook. Westport, CT: Greenwood Press.
Moustakas, C. E. (1956). The self: Explorations in personal growth. Harper & Row.
Murphy, G. (1958). Human potentialities. New York, NY: Basic Books.
Nevill, D. D. (1977). Humanistic psychology: New frontiers. New York, NY: Gardner Press .
Otto, H. A. (1968). Human potentialities: The challenge and the promise. St. Louis, MO: WH Green.
Rogers, CR, Lyon, HC Jr, Tausch, R: (2013) On Becoming an Effective Teacher - Person-centered teaching, psychology, philosophy, and dialogues with Carl R. Rogers and Harold Lyon. London: Routledge
Rowan, John (2001). Ordinary Ecstasy: The Dialectics of Humanistic Psychology (3rd ed.). Brunner-Routledge.
Schneider, K., Bugental, J. F. T., & Pierson, J. F. (2001). The handbook of humanistic psychology: Leading edges in theory, research, and practice. London: SAGE.
Schneider, K.J., ed (2008). Existential-integrative Psychotherapy: Guideposts to the Core of Practice. New York: Routledge.
Severin, F. T. (1973). Discovering man in psychology: A humanistic approach. New York, NY: McGraw-Hill.
Singh, J. (1979). The humanistic view of man. New Delhi, India: Indian Institute of Public Administration.
Sutich, A. J., & Vich, M. A. (Eds.). (1969). Readings in humanistic psychology. New York, NY: Free Press.
Welch, I., Tate, G., & Richards, F. (Eds.). (1978). Humanistic psychology: A source book. Buffalo, NY: Prometheus Books.
Zucker, R. A., Rabin, A. I., Aronoff, j., & Frank, S. (Eds.). (1992). Personality structure in the life course. New York, NY: Springer.
External links
What Is Humanistic Psychology?
Association for Humanistic Psychology
Society for Humanistic Psychology, Division 32 of the American Psychological Association
University of West Georgia's Humanistic Psychology Program
All about Humanistic Psychology
Existential therapy | 0.763802 | 0.996676 | 0.761263 |
Maladjustment | Maladjustment is a term used in psychology to refer the "inability to react successfully and satisfactorily to the demand of one's environment". The term maladjustment can be refer to a wide range of social, biological and psychological conditions.
Maladjustment can be both intrinsic or extrinsic. Intrinsic maladjustment is the disparities between the needs, motivations and evaluations of an individual, with the actual reward gain through experiences. Extrinsic maladjustment on the other hand, is referred to when an individual's behavior does not meet the cultural or social expectation of society.
The causes of maladjustment can be attributed to a wide variety of factors, including: family environment, personal factors, and school-related factors. Maladjustment affects an individual's development and the ability to maintain a positive interpersonal relationship with others. Often maladjustment emerges during early stages of childhood, when a child is in the process of learning methods to solve problem that occurs in interpersonal relationship in their social network. A lack of intervention for individuals who are maladjusted can cause negative effects later on in life.
Causes
Children who are brought up in certain conditions are more prone to maladjustment. There are three main causes associated to maladjustment:
Family causes
Socially, children that come from broken homes often are maladjusted. Feelings of frustration toward their situation stems from insecurities, and denial of basic needs such as food, clothing and shelter. Children whose parents are unemployed or possess a low socioeconomic status are more prone to maladjustment. Parents who are abusive and highly authoritative can cause harmful effect towards psychological need which are essential for a child to be socially well adjusted. The bond between a parent and child can affect psychological development in adolescents. Conflicts between parent and child relationship can cause adolescents to have poor adjustment. The level of conflict which occur between a parent and child can affect both the child's perception of the relationship with their parents and a child's self-perception. The perception of conflict between parent and child can be attributed to two mechanisms: reciprocal filial belief and perceived threats. Reciprocal filial belief refers to the love, care and affection that a child experience through their parent, it represents the amount of intimacy a child has with his or her parent. High levels of perceived conflict between parent and child reduces feelings of empathy, a child may feel isolated and therefore alienate themselves from their parent, this reduces the amount of reciprocal filial belief. Adolescents with lower levels of reciprocal filial belief are known to shown characteristic of a maladjusted individual. Perceived threats can be characterized as the anticipation of damage or harm to oneself during an emotional arousing event that induce a response towards stress. Worry, fear and the inability to cope with stress during conflicts are indicators of a rise in the level of perceived threat in a parent and child relationship. Higher levels of perceived threats in a parent and child relationship may exacerbate negative self-perception and weaken the ability to cope, this intensifies antisocial behavior which is a characteristic associated with maladjustment.
Personal causes
Children with physical, emotional or mental problems often have a hard time keeping up socially when compared to their peers. This can cause a child to experience feeling of isolation and limits interaction which brings about maladjustment. Emotion regulation plays a role in maladjustment. Typically, emotions are generally adaptive responses which allow an individual to have the flexibility to change their emotion based on the demand of their environment. Emotional inertia refers to "the degree in which emotional states are resistant to change"; there is a lack of emotional responsiveness due to the resistance of external environmental changes or internal psychological influences. High level of emotional inertia may be indicative of maladjustment, as an individual does not display a typical variability of emotions towards their social surroundings. A high level of emotional inertia may also represent impairment in emotional-regulation skill, which is known to be indicators of low self-esteem and neuroticism.
School related causes
Children who are victimized by their peers at school are more at risk of being maladjusted. Children who are victimized by their peer at school are prone to anxiety and feelings of insecurity. This affect their attitudes towards school, victimized children are more likely to show dislike towards schools and display high levels of school avoidance. Teachers who display unfair and biased attitudes towards children cause difficulties in their adjustment towards the classroom and school-life. Unhealthy and negative peer influence, such as delinquency, can cause children to be maladjusted in their social environment.
Associated characteristics
There are some characteristics that are associated with maladjustments.
Nervous behavior. Habits and tics in response to nervousness (e.g. biting fingernails, fidgeting, banging of head, playing with hair, inability to stay still).
Emotional overreaction and deviation. The tendency to respond to a situation with unnecessarily excessive or extravagant emotions and actions (e.g. avoidance of responsibility due to fear, withdrawal, easily distracted from slightest annoyance, unwarranted anxiety from small mistakes).
Emotional immaturity. The inability to fully control one's emotion (e.g. indecisiveness, over dependence on other, excessively self-conscious and suspicious, being incapable to work independently, hyperactivity, unreasonable fears and worries, high levels of anxiety).
Exhibitionist behavior. Behaviors conducted in attempts to gain attention or to portray a positive image (e.g. blame others for one's own failure, high level of overt agreeableness towards authority, physically hurting others).
Antisocial behavior. Behaviors and acts that showed hostility or aggression to others (e.g. cruelty to others, the use of obscene and abusive language, bullying others, destructive and irresponsible behaviors)
Psychosomatic disturbances. This can include: complications in bowel movement, nausea and vomiting, overeating, and other pains.
Negative effects
Poor academic performance
Maladjustments can have an effect on an individual's academic performance. Individual who have maladjusted behaviors tend to have a lower commitment to scholastic achievements, which cause poorer test results, higher rate of truancy and increase risk of dropping out of school.
Suicidal behavior
In cases where a child suffers from physical or sexual abuse, maladjustment is a risk for suicidal behavior. Individual with a history of childhood abuse tend to be maladjusted due to their dissatisfaction in social support and the prevalence of an anxious attachment style. Clinical implication suggests that by targeting maladjustment in individuals with history of childhood abuse, the risk of suicidal behavior may be attenuated.
See also
Adjustment (psychology)
References
Mental states | 0.771966 | 0.986131 | 0.761259 |
Rehabilitation (neuropsychology) | Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance.
Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.
Methods
Physical therapy, Speech therapy, occupational therapy, hot and cold therapy, and other methods that "exercise" specific brain functions are used. For example, eye–hand coordination exercises may rehabilitate certain motor deficits, or well structured planning and organizing exercises might help rehabilitate executive functions, following a traumatic blow to the head.
Brain functions that are impaired because of traumatic brain injuries are often the most challenging and difficult to rehabilitate. Much work is being done in nerve regeneration for the most severely damaged neural pathways.
Neurocognitive techniques, such as cognitive rehabilitation therapy, provide assessment and treatment of cognitive impairments from a variety of brain diseases and insults that cause persistent disability for many individuals. Such disabilities result in a loss of independence, a disruption in normal childhood activities and social relationships, loss in school attendance, and educational and employment opportunities. Injuries or insults that may benefit from neurocognitive rehabilitation include traumatic and acquired brain injuries (such as stroke, concussion, neurosurgery, etc.), cranial radiation, intrathecal chemotherapy and neurological disorders, such as ADHD. The rehabilitation targets cognitive functions such as attention, memory, and executive function (organization, planning, time management, etc.). Specific programs are tailored to develop and address an individual's challenges after a baseline assessment of abilities and challenges.
Concussion
Much research and focus has been given to concussion suffered frequently by athletes. While the severity of brain trauma has been standardized for immediate "sideline" assessment, much work needs to be done to understand how to rehabilitate or accelerate the rehabilitation of athletes' brain function following serious concussion—whether consciousness is lost or a dazed/confused feeling is experienced or not. Currently, rehabilitation of concussive brain injury is based on rest and gradual return to normal activities with as much involvement as can be tolerated.
Methods & Tools
Standardized neuropsychological tests
These tasks have been designed so the performance on the task can be linked to specific neurocognitive processes. These tests are typically standardized, meaning that they have been administered to a specific group (or groups) of individuals before being used in individual clinical cases. The data resulting from standardization are known as normative data. After these data have been collected and analyzed, they are used as the comparative standard against which individual performances can be compared. Examples of neuropsychological tests include: the Wechsler Memory Scale (WMS), the Wechsler Adult Intelligence Scale (WAIS), Boston Naming Test, the Wisconsin Card Sorting Test, the Benton Visual Retention Test, and the Controlled Oral Word Association.
Brain scans
The use of brain scans to investigate the structure or function of the brain is common, either as simply a way of better assessing brain injury with high resolution pictures, or by examining the relative activations of different brain areas. Such technologies may include fMRI (functional magnetic resonance imaging) and positron emission tomography (PET), which yields data related to functioning, as well as MRI (magnetic resonance imaging) and computed axial tomography (CAT or CT), which yields structural data.
Global Brain Project
Brain models based on mouse and monkey have been developed based on theoretical neuroscience involving working memory and attention, while mapping brain activity based on time constants validated by measurements of neuronal activity in various layers of the brain. These methods also map to decision states of behavior in simple tasks that involve binary outcomes.
Electrophysiology
The use of electrophysiological measures designed to measure the activation of the brain by measuring the electrical or magnetic field produced by the nervous system. This may include electroencephalography (EEG) or magneto-encephalography (MEG).
Experimental tasks
The use of designed experimental tasks, often controlled by computer and typically measuring reaction time and accuracy on a particular tasks thought to be related to a specific neurocognitive process. An example of this is the Cambridge Neuropsychological Test Automated Battery (CANTAB) or CNS Vital Signs (CNSVS).
See also
References
McKay Moore Sohlberg and Catherine A. Mateer (2001) Cognitive Rehabilitation: An Integrative Neuropsychological Approach. Andover: Taylor and Francis
Halligan, P.W., & Wade, D.T. (Eds.) (2005). Effectiveness of Rehabilitation for Cognitive Deficits. Oxford University Press, UK.
External links
Neurotrauma
Neuropsychology
Occupational therapy
Rehabilitation medicine | 0.783556 | 0.9715 | 0.761225 |
Einstellung effect | () is the development of a mechanized state of mind. Often called a problem solving set, refers to a person's predisposition to solve a given problem in a specific manner even though better or more appropriate methods of solving the problem exist.
The effect is the negative effect of previous experience when solving new problems. The Einstellung effect has been tested experimentally in many different contexts.
The example which led to the coining of the term by Abraham S. Luchins and Edith Hirsch Luchins is the Luchins water jar experiment, in which subjects were asked to solve a series of water jar problems. After solving many problems which had the same solution, subjects applied the same solution to later problems even though a simpler solution existed (Luchins, 1942). Other experiments on the Einstellung effect can be found in The Effect of on Compositional Processes and Rigidity of Behavior, A Variational Approach to the Effect of .
Background
literally means "setting" or "installation" as well as a person's "attitude" in German. Related to is what is referred to as an ("task" in German). The Aufgabe is the situation which could potentially invoke the effect. It is a task which creates a tendency to execute a previously applicable behavior. In the Luchins and Luchins experiment a water jar problem served as the , or task.
The effect occurs when a person is presented with a problem or situation that is similar to problems they have worked through in the past. If the solution (or appropriate behavior) to the problem/situation has been the same in each past experience, the person will likely provide that same response, without giving the problem too much thought, even though a more appropriate response might be available. Essentially, the effect is one of the human brain's ways of finding an appropriate solution/behavior as efficiently as possible. The detail is that though finding the solution is efficient, the solution itself is not or might not be. (This is consistent with the famous remark of Blaise Pascal: "I would have written a shorter letter, but I didn't have the time.")
Another phenomenon similar to is functional fixedness (Duncker 1945). Functional fixedness is an impaired ability to discover a new use for an object, owing to the subject's previous use of the object in a functionally dissimilar context. It can also be deemed a cognitive bias that limits a person to using an object only in the way it is traditionally used. Duncker also pointed out that the phenomenon occurs not only with physical objects, but also with mental objects or concepts (a point which lends itself nicely to the phenomenon of effect).
Luchins and Luchins water jar experiment
The water jar test, first described in Abraham S. Luchins' 1942 classic experiment, is a commonly cited example of an situation. The experiment's participants were given the following problem: there are 3 water jars, each with the capacity to hold a different, fixed amount of water; the subject must figure out how to measure a certain amount of water using these jars. It was found that subjects used methods that they had used previously to find the solution even though there were quicker and more efficient methods available. The experiment shines light on how mental sets can hinder the solving of novel problems.
In the Luchins' experiment, subjects were divided into two groups. The experimental group was given five practice problems, followed by four critical test problems. The control group did not have the five practice problems. All of the practice problems and some of the critical problems had only one solution, which was "B minus A minus 2⋅C." For example, one is given jar A capable of holding 21 units of water, B capable of holding 127, and C capable of holding 3. If an amount of 100 units must be measured out, the solution is to fill up jar B and pour out enough water to fill A once and C twice.
One of the critical problems was called the extinction problem. The extinction problem was a problem that could not be solved using the previous solution B − A − 2C. In order to answer the extinction problem correctly, one had to solve the problem directly and generate a novel solution. An incorrect solution to the extinction problem indicated the presence of the effect. The problems after the extinction problem again had two possible solutions. These post-extinction problems helped determine the recovery of the subjects from the effect.
The critical problems could be solved using this solution (B − A − 2C) or a shorter solution (A − C or A + C). For example, subjects were instructed to get 18 units of water from jars with capacities 15, 39, and 3. Despite the presence of a simpler solution (A + C), subjects in the experimental group tended to give the lengthier solution in lieu of the shorter one. Instead of simply filling up Jars A and C, most subjects from the experimental group preferred the previous method of B − A − 2C, whereas virtually all of the control group used the simpler solution. When Luchins and Luchins gave experimental group subjects the warning, "Don't be blind", over half of them used the simplest solution to the remaining problems.
Explanations and interpretations
The effect can be supported by theories of inductive reasoning. In a nutshell, inductive reasoning is the act of inferring a rule based on a finite number of instances. Most experiments on human inductive reasoning involve showing subjects a card with an object (or multiple objects, or letters, etc.) on it. The objects can vary in number, shape, size, color, etc., and the subject's job is to answer (initially by guessing) "yes" or "no" whether (or not) the card is a positive instance of the rule (which must be inferred by the subject). Over time, the subjects do tend to learn the rule, but the question is how? Kendler and Kendler (1962) proposed that older children and adults tend to exhibit noncontinuity theory; that is, the subjects tend to pick a reasonable rule and assume it to be true until it proves false. Regarding the effect, one can view noncontinuity theory as a way of explaining the tendency to maintain a specific behavior until it fails to work. In the water-jar problem, subjects generated a specific rule because it seemed to work in all situations; when they were given problems for which the same solution worked, but a better solution was possible, they still gave their 'tried and true' response. Where theories of inductive reasoning tend to diverge from the idea of the effect is when analyzing the fact that, even after an instance where the rule failed to work, many subjects reverted to the old solution when later presented with a problem for which it did work (again, this problem also had a better solution). One way to explain this observation is that in actuality subjects know (consciously) that the same solution might not always work, yet since they were presented with so many instances where it did work, they still tend to test that solution before any other (and so if it works, it will be the first solution found).
Neurologically, the idea of synaptic plasticity, which is an important neurochemical explanation of memory, can help to understand the effect. Specifically, Hebbian theory (which in many regards is the neuroscience equivalent of original associationist theories) is one explanation of synaptic plasticity (Hebb, 1949). It states that when two associated neurons frequently fire together – while infrequently firing apart from one another – the strength of their association tends to become stronger (making future stimulation of one neuron even more likely to stimulate the other). Since the frontal lobe is most often attributed with the roles of planning and problem solving, if there is a neurological pathway which is fundamental to the understanding of the effect, the majority of it most likely falls within the frontal lobe. Essentially, a Hebbian explanation of could be as follows: stimuli are presented in such a way that the subject recognizes themself as being in a situation which they have been in before. That is, the subject sees, hears, smells, etc., an environment which is akin to an environment which they have been in before. The subject then must process the stimuli which are presented in such a way that they exhibit a behavior which is appropriate for the situation (be it run, throw, eat, etc.). Because neural growth is, at least in part, due to the associations between two events/ideas, it follows that the more a given stimulus is followed by a specific response, the more likely in the future that stimulus will invoke the same response. Regarding the Luchins' experiment, the stimulus presented was a water-jar problem (or to be more technical, the stimulus was a piece of paper which had words and numbers on it which, when interpreted correctly, portray a water-jar problem) and the invoked response was B − A − 2C. While it is a bit of a stretch to assume that there is a direct connection between a water-jar problem and B − A − 2C within the brain, it is not unreasonable to assume that the specific neural connections which are active during a water-jar problem-state and those that are active when one thinks "take the second term, subtract the first term, then subtract two of the third term" tend to increase in the amount of overlap as more and more instances where B − A − 2C works are presented.
Other research
Psychological stress
The following experiments were designed to gauge the effect of different stressful situations on the effect. Overall, these experiments show that stressful situations increase the prevalence of the Einstellung effect.
The speed test
Luchins gave an elementary-school class a set of water jar problems. In order to create a stressful situation, experimenters told the students that the test would be timed, that the speed and accuracy of the test would be reviewed by their principal and teachers, and that the test would affect their grades. To further agitate the students during the test, experimenters were instructed to comment on how much slower the children were compared to children in lower grades. The experimenters observed anxious, stressed, and sometimes tearful faces during the experiment. (Note that while such methods were common in the 1950s, today it violates ethical practices in research.)
The results of the experiment indicated that the stressful speed test situation increased rigidity. Luchins found that only three of the ninety-eight students tested were able to solve the extinction problem, and only two students used the direct method for the critical problems. The same experiment conducted under non-stress conditions showed 70% rigidity during the test problems and 58% failure of the extinction problem, while the anxiety-inducing situation showed 98% and 97% respectively.
The speed test was performed with college students as well, which yielded similar results. Even when college students were told ahead of time to use the direct method in order to avoid mistakes made by children, the college students continued to exhibit rigidity under time pressure. The results of these studies showed that the emphasis on speed increased the effect on the water jar problems.
Maze tracing
Luchins also instructed subjects to draw a solution through a maze without crossing any of the maze's lines. The maze was either traced normally or traced using the mirror reflection of the maze. If the subject drew over the lines of the figure, they had to start at the beginning, which was disadvantageous since the subject was told that their score depended on the time and smoothness of the solution. The mirror-tracing situation was the stressful situation, and the normal tracing was the non-stressful, control situation. Experimenters observed that the mirror-tracing task caused more drawing outside the boundaries, increased overt signs of stress and anxiety, and required more time to accurately complete. The mirror-tracing situation produced 89% solution on the first two criticals instead of the 71% observed for normal tracing. In addition, 55% of the subjects failed with the mirror while only 18% failed without the mirror.
Hidden word test for stutterers
In 1951, Solomon gave both stutterers and fluent speakers a hidden word test, an arithmetical test, and a mirror maze test. Experimenters called the hidden word test a "speech test" to increase stutterer anxiety. There were no marked differences between the stutterers and the fluent speakers for the arithmetical and mirror maze tests. However, the results reveal a significant difference between the performance of the stutterers and the fluent speakers on the "speech test". On the first two critical problems, 58 percent of the stutterers gave solutions whereas only 4 percent of the fluent speakers showed effects.
Age
The original Luchins and Luchins experiment tested nine-, ten-, eleven-, and twelve-year-olds for the effect. The older groups showed more effects than the younger groups in general. However, this initial study did not control for differences in educational level and intelligence.
To remedy this problem, Ross (1952) conducted a study on middle-aged (mean 37.3 years) and older adults (mean 60.8 years). The adults were grouped according to the I.Q., years of schooling, and occupation. Ross administered five tests including the arithmetical (water jar) test, the maze test, the hidden word test, and two other tests. For every test, the middle-aged group performed better than the older group. For example, 65% of the older adults failed the extinction task of the arithmetical test, whereas only 29% of the middle-aged adults failed the extinction problem.
Luchins devised another experiment to determine the difference between effects in children and in adults. In this study, 140 fifth-graders (mean 10.5 years) were compared to 79 college students (mean 21 years) and 21 adults (mean 43 years). effects prior to the extinction task increased with age: the observed effects for the extinction task were 56, 68, and 69 percent for young adults, children, and older adults respectively. This implies that there exists a curvilinear relationship between age and the recovery from the effect. A similar experiment conducted by Heglin in 1955, also found this relationship when the three age groups were equated for IQ.
Therefore, the initial manifestation of the effect on the arithmetic test increases with age. However, the recovery from the effect is greatest for young adults (average age 21 years) and decreases as the subject moves away from this age.
Gender
In Luchins and Luchins' original experiment with 483 children, they found that boys demonstrated less of an effect than girls. The experimental difference was only significant for the group that was instructed to write "Don't be blind" on their papers after the sixth problem (the DBB group). "Don't be blind" was meant as a reminder to pay attention and guard against rigidity for the sixth problem. However, this message was interpreted in many different ways including thinking of the message as just some more words to remember. The alternative interpretations occurred more frequently in girls and increased with IQ score within the female group. This difference in interpretation of "don't be blind" may account for the fact that the male DBB group showed more direct solutions than their female counterparts.
To determine sex differences in adults, Luchins gave college students the maze test. The female group showed slightly more (although not statistically significant) effects than the male group. Other studies have provided conflicting data about the sex differences in the effect.
Intelligence
Luchins and Luchins looked at the relationship between the intelligence quotient (IQ) and the effects for the children in their original experiment. They found that there was a statistically insignificant negative relationship between the effect and intelligence. In general, large effects were observed for all subject groups regardless of IQ score. When Luchins and Luchins looked at the IQ range for children who did and did not demonstrate effects, they spanned from 51 to 160 and from 75 to 155 respectively. These ranges show a slight negative correlation between intelligence and effects.
See also
Anchoring (cognitive bias)
Cognitive inertia
Rigidity (psychology)
Beginner's mind (antonym)
( effect as a) wrong working hypothesis
Functional fixedness and the candle problem
Law of the instrument
Missing square puzzle (a typical effect)
Thinking outside the box
XY problem
Notes
References
Unpublished doctoral dissertation, McGill University.
Abstract of an unpublished Master's thesis, University of Michigan.
Further reading
Problem solving
Cognitive science | 0.770318 | 0.988183 | 0.761215 |
Applied psychology | Applied psychology is the use of psychological methods and findings of scientific psychology to solve practical problems of human and animal behavior and experience. Educational and organizational psychology, business management, law, health, product design, ergonomics, behavioural psychology, psychology of motivation, psychoanalysis, neuropsychology, psychiatry and mental health are just a few of the areas that have been influenced by the application of psychological principles and scientific findings. Some of the areas of applied psychology include counseling psychology, industrial and organizational psychology, engineering psychology, occupational health psychology, legal psychology, school psychology, sports psychology, community psychology, neuropsychology, medical psychology and clinical psychology, evolutionary psychology, human factors, forensic psychology and traffic psychology. In addition, a number of specialized areas in the general area of psychology have applied branches (e.g., applied social psychology, applied cognitive psychology). However, the lines between sub-branch specializations and major applied psychology categories are often mixed or in some cases blurred. For example, a human factors psychologist might use a cognitive psychology theory. This could be described as human factor psychology or as applied cognitive psychology. When applied psychology is used in the treatment of behavioral disorders there are many experimental approaches to try and treat an individual. This type of psychology can be found in many of the subbranches in other fields of psychology.
History
The founder of applied psychology was Hugo Münsterberg. He came to America (Harvard) from Germany (Berlin, Laboratory of Stern), invited by William James, and, like many aspiring psychologists during the late 19th century, originally studied philosophy. Münsterberg had many interests in the field of psychology such as purposive psychology, social psychology and forensic psychology. Hugo Münsterberg is credited with being one of the first people who has researched the field of applied psychology. He went to the University of Leipzig in Germany and attained his doctorate in Medicine. He opened the second psychology clinic in Germany in 1891 where he has continued his research. In 1907 he wrote several magazine articles concerning legal aspects of testimony, confessions and courtroom procedures, which eventually developed into his book, On the Witness Stand. The following year the Division of Applied Psychology was adjoined to the Harvard Psychological Laboratory. Within 9 years he had contributed eight books in English, applying psychology to education, industrial efficiency, business and teaching. Eventually Hugo Münsterberg and his contributions would define him as the creator of applied psychology. In 1920, the International Association of Applied Psychology (IAAP) was founded, as the first international scholarly society within the field of psychology.
Most professional psychologists in the U.S. worked in an academic setting until World War II. But during the war, the armed forces and the Office of Strategic Services hired psychologists in droves to work on issues such as troop morale and propaganda design. After the war, psychologists found an expanding range of jobs outside of the academy. Since 1970, the number of college graduates with degrees in psychology has more than doubled, from 33,679 to 76,671 in 2002. The annual numbers of masters' and PhD degrees have also increased dramatically over the same period. All the while, degrees in the related fields of economics, sociology, and political science have remained constant.
Professional organizations have organized special events and meetings to promote the idea of applied psychology. In 1990, the American Psychological Society held a Behavioral Science Summit and formed the "Human Capital Initiative", spanning schools, workplace productivity, drugs, violence, and community health. The American Psychological Association declared 2000–2010 the Decade of Behavior, with a similarly broad scope. Psychological methods are considered applicable to all aspects of human life and society.
Uses
There are many uses of applied psychology and can be found as a subfield in other genres of psychology. Applied Psychology has been used in teaching psychology because it focuses on the scientific findings and how it can be used to transfer that behavior. Many people who use applied psychology work in the fields of teaching, industrial, clinical, and consulting work areas. The Encyclopedia of Applied Psychology delves deeper into the many subsections that are used in correlation with this field and further explains the procedures that should be used in each of the respective industries.
Advertising
Business advertisers have long consulted psychologists in assessing what types of messages will most effectively induce a person to buy a particular product. The three main types of psychologists that participate in creating advertisements are cognitive, media, and social psychologists. These psychologists often work together to create advertisements that create an emotional impact on the viewer in order to make the advertisement more memorable. Using the psychological research methods and the findings in human's cognition, motivation, attitudes and decision making, those can help to design more persuasive advertisement. Their research includes the study of unconscious influences and brand loyalty. However, the effect of unconscious influences was controversial. The use of these psychologists often create successful advertisements with the scientific methods that are used to portray violence, humor and sex.
Educational
Educational psychology is devoted to the study of how humans learn in educational settings, especially schools. Psychologists assess the effects of specific educational interventions: e.g., phonics versus whole language instruction in early reading attainment. They also study the question of why learning occurs differently in different situations.
Another domain of educational psychology is the psychology of teaching. In some colleges, educational psychology courses are called "the psychology of learning and teaching". Educational psychology derives a great deal from basic-science disciplines within psychology including cognitive science and behaviorially-oriented research on learning.
Counseling
Counseling psychology is an applied specialization within psychology, that involves both research and practice in a number of different areas or domains. According to Gelso and Fretz (2001), there are some central unifying themes among counseling psychologists. These include a focus on an individual's strengths, relationships, their educational and career development, as well as a focus on normal personalities. Counseling psychologists help people improve their well-being, reduce and manage stress, and improve overall functioning in their lives. The interventions used by Counseling Psychologists may be either brief or long-term in duration. Often they are problem focused and goal-directed. There is a guiding philosophy which places a value on individual differences and an emphasis on "prevention, development, and adjustment across the life-span." The use of applied psychology in counseling is one of the most useful when it comes to the treatment of individuals. The use of knowledge from scientific findings are beneficial because there are many different options that can be tested to find the right treatment.
Medical and clinical
Medical psychology
Medical psychology involves the application of a range of psychological principles, theories and findings applied to the effective management of physical and mental disorders to improve the psychological and physical health of the patient. The American Psychological Association defines medical psychology as the branch of psychology that integrates somatic and psychotherapeutic modalities, into the management of mental illness, health rehabilitation and emotional, cognitive, behavioural and substance use disorders. According to Muse and Moore (2012), the medical psychologist's contributions in the areas of psychopharmacology which sets it apart from other of psychotherapy and psychotherapists.
Clinical psychology
Clinical psychology includes the study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy, although clinical psychologists may also engage in research, teaching, consultation, forensic testimony, and program development and administration. Some clinical psychologists may focus on the clinical management of patients with brain injury—this area is known as clinical neuropsychology. In many countries clinical psychology is a regulated mental health profession.
The work performed by clinical psychologists tends to be done inside various therapy models, all of which involve a formal relationship between professional and client—usually an individual, couple, family, or small group—that employs a set of procedures intended to form a therapeutic alliance, explore the nature of psychological problems, and encourage new ways of thinking, feeling, or behaving. The four major perspectives are psychodynamic, cognitive behavioral, existential-humanistic, and systems or family therapy. There has been a growing movement to integrate these various therapeutic approaches, especially with an increased understanding of issues regarding ethnicity, gender, spirituality, and sexual-orientation. With the advent of more robust research findings regarding psychotherapy, there is growing evidence that most of the major therapies are about of equal effectiveness, with the key common element being a strong therapeutic alliance. Because of this, more training programs and psychologists are now adopting an eclectic therapeutic orientation.
Clinical psychologists do not usually prescribe medication, although there is a growing number of psychologists who do have prescribing privileges, in the field of medical psychology. In general, however, when medication is warranted many psychologists will work in cooperation with psychiatrists so that clients get therapeutic needs met. Clinical psychologists may also work as part of a team with other professionals, such as social workers and nutritionists.
Environmental
Environmental psychology is the psychological study of humans and their interactions with their environments. The types of environments studied are limitless, ranging from homes, offices, classrooms, factories, nature, and so on. However, across these different environments, there are several common themes of study that emerge within each one. Noise level and ambient temperature are clearly present in all environments and often subjects of discussion for environmental psychologists. Crowding and stressors are a few other aspects of environments studied by this sub-discipline of psychology. When examining a particular environment, environmental psychology looks at the goals and purposes of the people in the using the environment, and tries to determine how well the environment is suiting the needs of the people using it. For example, a quiet environment is necessary for a classroom of students taking a test, but would not be needed or expected on a farm full of animals. The concepts and trends learned through environmental psychology can be used when setting up or rearranging spaces so that the space will best perform its intended function. The top common, more well known areas of psychology that drive this applied field include: cognitive, perception, learning, and social psychology.
Forensic, legal and criminal
Forensic psychology and legal psychology are the areas concerned with the application of psychological methods and principles to legal questions and issues. Most typically, forensic psychology involves a clinical analysis of a particular individual and an assessment of some specific psycho-legal question. The psycho-legal question does not have to be criminal in nature. Forensic psychologists rarely get involved in the actual criminal investigations, which falls under a broader category of applied psychology called criminal psychology. Custody cases are an example of non-criminal evaluations by forensic psychologists. The validity and upholding of eyewitness testimony is an area of forensic psychology that does veer closer to criminal investigations, though does not directly involve the psychologist in the investigation process. Psychologists are often called to testify as expert witnesses on issues such as the accuracy of memory, the reliability of police interrogation, and the appropriate course of action in child custody cases.
Legal psychology refers to any application of psychological principles, methods or understanding to legal questions or issues. In addition to the applied practices, legal psychology also includes academic or empirical research on topics involving the relationship of law to human mental processes and behavior. However, inherent differences that arise when placing psychology in the legal context. Psychology rarely makes absolute statements. Instead, psychologists traffic in the terms like level of confidence, percentages, and significance. Legal matters, on the other hand, look for absolutes: guilty or not guilty. This makes for a sticky union between psychology and the legal system. Some universities operate dual JD/PhD programs focusing on the intersection of these two areas.
The Committee on Legal Issues of the American Psychological Association is known to file amicus curae briefs, as applications of psychological knowledge to high-profile court cases.
A related field, police psychology, involves consultation with police departments and participation in police training.
Health and medicine
Health psychology concerns itself with understanding how biology, behavior, and social context influence health and illness. Health psychologists generally work alongside other medical professionals in clinical settings, although many also teach and conduct research. Although its early beginnings can be traced to the kindred field of clinical psychology, four different approaches to health psychology have been defined: clinical, public health, community and critical health psychology.
Health psychologists aim to change health behaviors for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens. The focus of health psychologists tend to center on the health crisis facing the western world particularly in the US. Cognitive behavioral therapy and behavior modification are techniques often employed by health psychologists. Psychologists also study patients' compliance with their doctors' orders.
Health psychologists view a person's mental condition as heavily related to their physical condition. An important concept in this field is stress, a mental phenomenon with well-known consequences for physical health.
Occupational health psychology
Occupational health psychology (OHP) is a relatively new discipline that emerged from the confluence of health psychology, industrial and organizational psychology, and occupational health. OHP has its own journals and professional organizations. The field is concerned with identifying psychosocial characteristics of workplaces that give rise to health-related problems in people who work. These problems can involve physical health (e.g., cardiovascular disease) or mental health (e.g., depression). Examples of psychosocial characteristics of workplaces that OHP has investigated include amount of decision latitude a worker can exercise and the supportiveness of supervisors. OHP is also concerned with the development and implementation of interventions that can prevent or ameliorate work-related health problems. In addition, OHP research has important implications for the economic success of organizations. Other research areas of concern to OHP include workplace incivility and violence, work-home carryover, unemployment and downsizing, and workplace safety and accident prevention. Two important OHP journals are the Journal of Occupational Health Psychology and Work & Stress. Three important organizations closely associated with OHP are the International Commission on Occupational Health's Scientific Committee on Work Organisation and Psychosocial Factors (ICOH-WOPS), the Society for Occupational Health Psychology, and the European Academy of Occupational Health Psychology.
Human factors and ergonomics
Human factors and ergonomics is the study of how cognitive and psychological processes affect our interaction with tools, machines, and objects in the environment. Many branches of psychology attempt to create models of and understand human behavior. These models are usually based on data collected from experiments. Human Factor psychologists however, take the same data and use it to design or adapt processes and objects that will complement the human component of the equation. Rather than humans learning how to use and manipulate a piece of technology, human factors strives to design technology to be inline with the human behavior models designed by general psychology. This could be accounting for physical limitations of humans, as in ergonomics, or designing systems, especially computer systems, that work intuitively with humans, as does engineering psychology.
Ergonomics is applied primarily through office work and the transportation industry. Psychologists here take into account the physical limitations of the human body and attempt to reduce fatigue and stress by designing products and systems that work within the natural limitations of the human body. From simple things like the size of buttons and design of office chairs to layout of airplane cockpits, human factor psychologists, specializing in ergonomics, attempt to de-stress our everyday lives and sometimes even save them.
Human factor psychologists specializing in engineering psychology tend to take on slightly different projects than their ergonomic centered counterparts. These psychologists look at how a human and a process interact. Often engineering psychology may be centered on computers. However at the base level, a process is simply a series of inputs and outputs between a human and a machine. The human must have a clear method to input data and be able to easily access the information in output. The inability of rapid and accurate corrections can sometimes lead to drastic consequences, as summed up by many stories in Set Phasers on Stun. The engineering psychologists wants to make the process of inputs and outputs as intuitive as possible for the user.
The goal of research in human factors is to understand the limitations and biases of human mental processes and behavior, and design items and systems that will interact accordingly with the limitations. Some may see human factors as intuitive or a list of dos and don'ts, but in reality, human factor research strives to make sense of large piles of data to bring precise applications to product designs and systems to help people work more naturally, intuitively with the items of their surroundings.
Industrial and organizational
Industrial and organizational psychology, or I-O psychology, focuses on the psychology of work. Relevant topics within I-O psychology include the psychology of recruitment, selecting employees from an applicant pool, training, performance appraisal, job satisfaction, work motivation. work behavior, occupational stress, accident prevention, occupational safety and health, management, retirement planning and unemployment among many other issues related to the workplace and people's work lives. In short, I-O psychology is the application of psychology to the workplace. One aspect of this field is job analysis, the detailed study of which behaviors a given job entails.
Though the name of the title "Industrial Organizational Psychology" implies 2 split disciplines being chained together, it is near impossible to have one half without the other. If asked to generally define the differences, Industrial psychology focuses more on the Human Resources aspects of the field, and Organizational psychology focuses more on the personal interactions of the employees. When applying these principles however, they are not easily broken apart. For example, when developing requirements for a new job position, the recruiters are looking for an applicant with strong communication skills in multiple areas. The developing of the position requirements falls under the industrial psychology, human resource type work, and the requirement of communication skills is related to how the employee with interacts with co-workers. As seen here, it is hard to separate task of developing a qualifications list from the types of qualifications on the list. This is parallel to how the I and O are nearly inseparable in practice. Therefore, I-O psychologists are generally rounded in both industrial and organizational psychology though they will have some specialization. Other topics of interest for I-O psychologists include leadership, performance evaluation, training, and much more.
Military psychology includes research into the classification, training, and performance of soldiers.
School
School psychology is a field that applies principles of clinical psychology and educational psychology to the diagnosis and treatment of students' behavioral and learning problems. School psychologists are educated in child and adolescent development, learning theories, psychological and psycho-educational assessment, personality theories, therapeutic interventions, special education, psychology, consultation, child and adolescent psychopathology, and the ethical, legal and administrative codes of their profession.
According to Division 16 (Division of School Psychology) of the American Psychological Association (APA), school psychologists operate according to a scientific framework. They work to promote effectiveness and efficiency in the field. School psychologists conduct psychological assessments, provide brief interventions, and develop or help develop prevention programs. Additionally, they evaluate services with special focus on developmental processes of children within the school system, and other systems, such as families. School psychologists consult with teachers, parents, and school personnel about learning, behavioral, social, and emotional problems. They may teach lessons on parenting skills (like school counselors), learning strategies, and other skills related to school mental health. In addition, they explain test results to parents and students. They provide individual, group, and in some cases family counseling (State Board of Education 2003; National Clearinghouse for Professions in Special Education, n.d.). School psychologists are actively involved in district and school crisis intervention teams. They also supervise graduate students in school psychology. School psychologists in many districts provide professional development to teachers and other school personnel on topics such as positive behavior intervention plans and achievement tests.
One salient application for school psychology in today's world is responding to the unique challenges of increasingly multicultural classrooms. For example, psychologists can contribute insight about the differences between individualistic and collectivistic cultures.
School psychologists are influential within the school system and are frequently consulted to solve problems. Practitioners should be able to provide consultation and collaborate with other members of the educational community and confidently make decisions based on empirical research.
Social change
Psychologists have been employed to promote "green" behavior, i.e. sustainable development. In this case, their goal is behavior modification, through strategies such as social marketing. Tactics include education, disseminating information, organizing social movements, passing laws, and altering taxes to influence decisions.
Psychology has been applied on a world scale with the aim of population control. For example, one strategy towards television programming combines social models in a soap opera with informational messages during advertising time. This strategy successfully increased women's enrollment at family planning clinics in Mexico. The programming—which has been deployed around the world by Population Communications International and the Population Media Center—combines family planning messages with representations of female education and literacy.
Sport psychology
Sport psychology is a specialization within psychology that seeks to understand psychological/mental factors that affect performance in sports, physical activity and exercise and apply these to enhance individual and team performance. The sport psychology approach differs from the coaches and players perspective. Coaches tend to narrow their focus and energy towards the end-goal. They are concerned with the actions that lead to the win, as opposed to the sport psychologist who tries to focus the players thoughts on just achieving the win. Sport psychology trains players mentally to prepare them, whereas coaches tend to focus mostly on physical training. Sport psychology deals with increasing performance by managing emotions and minimizing the psychological effects of injury and poor performance. Some of the most important skills taught are goal setting, relaxation, visualization, self-talk awareness and control, concentration, using rituals, attribution training, and periodization. The principles and theories may be applied to any human movement or performance tasks (e.g., playing a musical instrument, acting in a play, public speaking, motor skills). Usually, experts recommend that students be trained in both kinesiology (i.e., sport and exercise sciences, physical education) and counseling.
Traffic psychology
Traffic psychology is an applied discipline within psychology that looks at the relationship between psychological processes and cognitions and the actual behavior of road users. In general, traffic psychologists attempt to apply these principles and research findings, in order to provide solutions to problems such as traffic mobility and congestion, road accidents, speeding. Research psychologists also are involved with the education and the motivation of road users.
Additional areas
Community psychology
Ecological psychology
Media psychology
Operational psychology
Peace psychology
Fashion psychology
See also
Linguistics
Neuroscience
Social work
Outline of psychology
References
Sources
Anastasi, Anne. Fields of Applied Psychology. Second edition. New York: McGraw-Hill, 1979.
Cina, Carol. "Social Science for Whom? A Structural History of Social Psychology." Doctoral dissertation, accepted by the State University of New York at Stony Brook, 1981.
Donaldson, Stewart I., Dale E. Berger, & Kathy Pezdek (eds.). Applied Psychology: New Frontiers and Rewarding Careers. Mahwah, NJ: Lawrence Erlbaum Associates, 2006.
Bibliography
Applied Psychology in Lecturing, John M. Prentice, 1946
External links
Human Capital Initiative documents from the American Psychological Society (now the Association for Psychological Science) | 0.767757 | 0.991475 | 0.761212 |
Eight disciplines problem solving | Eight Disciplines Methodology (8D) is a method or model developed at Ford Motor Company used to approach and to resolve problems, typically employed by quality engineers or other professionals. Focused on product and process improvement, its purpose is to identify, correct, and eliminate recurring problems. It establishes a permanent corrective action based on statistical analysis of the problem and on the origin of the problem by determining the root causes. Although it originally comprised eight stages, or 'disciplines', it was later augmented by an initial planning stage. 8D follows the logic of the PDCA cycle. The disciplines are:
D0: Preparation and Emergency Response Actions: Plan for solving the problem and determine the prerequisites. Provide emergency response actions.
D1: Use a Team: Establish a team of people with product/process knowledge. Teammates provide new perspectives and different ideas when it comes to problem solving.
D2: Describe the Problem: Specify the problem by identifying in quantifiable terms the who, what, where, when, why, how, and how many (5W2H) for the problem.
D3: Develop Interim Containment Plan: Define and implement containment actions to isolate the problem from any customer.
D4: Determine and Verify Root Causes and Escape Points: Identify all applicable causes that could explain why the problem has occurred. Also identify why the problem was not noticed at the time it occurred. All causes shall be verified or proved. One can use five whys or Ishikawa diagrams to map causes against the effect or problem identified.
D5: Verify Permanent Corrections (PCs) for Problem that will resolve the problem for the customer: Using pre-production programs, quantitatively confirm that the selected correction will resolve the problem. (Verify that the correction will actually solve the problem).
D6: Define and Implement Corrective Actions: Define and implement the best corrective actions. Also, validate corrective actions with empirical evidence of improvement.
D7: Prevent Recurrence / System Problems: Modify the management systems, operation systems, practices, and procedures to prevent recurrence of this and similar problems.
D8: Congratulate the Main Contributors to your Team: Recognize the collective efforts of the team. The team needs to be formally thanked by the organization.
8Ds has become a standard in the automotive, assembly, and other industries that require a thorough structured problem-solving process using a team approach.
Ford Motor Company's team-oriented problem solving
The executives of the Powertrain Organization (transmissions, chassis, engines) wanted a methodology where teams (design engineering, manufacturing engineering, and production) could work on recurring chronic problems. In 1986, the assignment was given to develop a manual and a subsequent course that would achieve a new approach to solving identified engineering design and manufacturing problems. The manual for this methodology was documented and defined in Team Oriented Problem Solving (TOPS), first published in 1987. The manual and subsequent course material were piloted at Ford World Headquarters in Dearborn, Michigan. Ford refers to their current variant as G8D (Global 8D). The Ford 8Ds manual is extensive and covers chapter by chapter how to go about addressing, quantifying, and resolving engineering issues. It begins with a cross-functional team and concludes with a successful demonstrated resolution of the problem. Containment actions may or may not be needed based on where the problem occurred in the life cycle of the product.
Usage
Many disciplines are typically involved in the "8Ds" methodology. The tools used can be found in textbooks and reference materials used by quality assurance professionals. For example, an "Is/Is Not" worksheet is a common tool employed at D2, and Ishikawa, or "fishbone," diagrams and "5-why analysis" are common tools employed at step D4.
In the late 1990s, Ford developed a revised version of the 8D process that they call "Global 8D" (G8D), which is the current global standard for Ford and many other companies in the automotive supply chain. The major revisions to the process are as follows:
Addition of a D0 (D-Zero) step as a gateway to the process. At D0, the team documents the symptoms that initiated the effort along with any emergency response actions (ERAs) that were taken before formal initiation of the G8D. D0 also incorporates standard assessing questions meant to determine whether a full G8D is required. The assessing questions are meant to ensure that in a world of limited problem-solving resources, the efforts required for a full team-based problem-solving effort are limited to those problems that warrant these resources.
Addition of the notion of escape points to D4 through D6. An 'escape point' is the earliest control point in the control system following the root cause of a problem that should have detected that problem but failed to do so. The idea here is to consider not only the root cause, but also what went wrong with the control system in allowing this problem to escape. Global 8D requires the team to identify and verify an escape point at D4. Then, through D5 and D6, the process requires the team to choose, verify, implement, and validate permanent corrective actions to address the escape point.
Recently, the 8D process has been employed significantly outside the auto industry. As part of lean initiatives and continuous-improvement processes it is employed extensively in the food manufacturing, health care, and high-tech manufacturing industries.
Benefits
The benefits of the 8D methodology include effective approaches to finding a root cause, developing proper actions to eliminate root causes, and implementing the permanent corrective action. The 8D methodology also helps to explore the control systems that allowed the problem to escape. The Escape Point is studied for the purpose of improving the ability of the Control System to detect the failure or cause when and if it should occur again.
Finally the Prevention Loop explores the systems that permitted the condition that allowed the Failure and Cause Mechanism to exist in the first place.
Prerequisites
Requires training in the 8D problem-solving process as well as appropriate data collection and analysis tools such as Pareto charts, fishbone diagrams, and process maps.
Problem solving tools
The following tools can be used within 8D:
Ishikawa diagrams also known as cause-and-effect or fishbone diagrams
Pareto charts or Pareto diagrams
5 Whys
5W and 2H (who, what, where, when, why, how, how many or how much)
Statistical process control
Scatter plots
Design of experiments
Check sheet
Histograms
FMEA
Flowcharts or process maps
Background of common corrective actions to dispose of nonconforming items
The 8D methodology was first described in a Ford manual in 1987. The manual describes the eight-step methodology to address chronic product and process problems. The 8Ds included several concepts of effective problem solving, including taking corrective actions and containing nonconforming items. These two steps have been very common in most manufacturing facilities, including government and military installations. In 1974, the U.S. Department of Defense (DOD) released “MIL-STD 1520 Corrective Action and Disposition System for Nonconforming Material”. This 13 page standard defines establishing some corrective actions and then taking containment actions on nonconforming material or items. It is focused on inspection for defects and disposing of them. The basic idea of corrective actions and containment of defectives was officially abolished in 1995, but these concepts were also common to Ford Motor Company, a major supplier to the government in World War II. Corrective actions and containment of poor quality parts were part of the manual and course for the automotive industry and are well known to many companies. Ford's 60 page manual covers details associated with each step in their 8D problem solving manual and the actions to take to deal with identified problems.
Military usage
The exact history of the 8D method remains disputed as many publications and websites state that it originates from the US military. Indeed, MIL-STD-1520C outlines a set of requirements for their contractors on how they should organize themselves with respect to non-conforming materials. Developed in 1974 and cancelled in February 1995 as part of the Perry memo, you can compare it best to the ISO 9001 standard that currently exists as it expresses the same philosophy. The aforementioned military standard does outline some aspects that are in the 8D method, however, it does not provide the same structure that the 8D methodology offers. Taking into account the fact that the Ford Motor Company played an instrumental role in producing army vehicles during the Second World War and in the decades after, it could very well be the case that the MIL-STD-1520C stood as a model for today's 8D method.
Relationship between 8D and FMEA
FMEA (failure mode and effect analysis) is a tool generally used in the planning of product or process design. The relationships between 8D and FMEA are outlined below:
The problem statements and descriptions are sometimes linked between both documents. An 8D can utilize pre-brainstormed information from a FMEA to assist in looking for potential problems.
Possible causes in a FMEA can immediately be used to jump start 8D Fishbone or Ishikawa diagrams. Brainstorming information that is already known is not a good use of time or resources.
Data and brainstorming collected during an 8D can be placed into a FMEA for future planning of new product or process quality. This allows a FMEA to consider actual failures, occurring as failure modes and causes, becoming more effective and complete.
The design or process controls in a FMEA can be used in verifying the root cause and Permanent Corrective Action in an 8D.
The FMEA and 8D should reconcile each failure and cause by cross documenting failure modes, problem statements and possible causes. Each FMEA can be used as a database of possible causes of failure as an 8D is developed.
See also
Complaint system
Corrective and preventive action
Failure mode and effects analysis
Fault tree analysis
Quality management system (QMS)
Eight dimensions of quality
Problem solving
References
External links
8-D Problem Solving Overview from the Ford Motor Company
Laurie Rambaud (2011), 8D Structured Problem Solving: A Guide to Creating High Quality 8D Reports, PHRED Solutions, Second Edition 978-0979055317
Society of Manufacturing Engineers: SME,
Chris S.P. Visser (2017), 8D Problem solving explained – Turning operational failures into knowledge to drive your strategic and competitive advantages,
Quality
Problem solving methods | 0.766057 | 0.993578 | 0.761137 |
Health Level 7 | Health Level Seven, abbreviated to HL7, is a range of global standards for the transfer of clinical and administrative health data between applications with the aim to improve patient outcomes and health system performance. The HL7 standards focus on the application layer, which is "layer 7" in the Open Systems Interconnection model. The standards are produced by Health Level Seven International, an international standards organization, and are adopted by other standards issuing bodies such as American National Standards Institute and International Organization for Standardization. There are a range of primary standards that are commonly used across the industry, as well as secondary standards which are less frequently adopted.
Purpose
Health organizations typically have many different computer systems used to process different patient administration or clinical tasks, such as billing, medication management, patient tracking, and documentation. All of these systems should communicate, or "interface", with each other when they receive new information or when they wish to retrieve information. HL7 International specifies a number of flexible standards, guidelines, and methodologies by which these healthcare systems can communicate with each other. The standards allow for easier 'interoperability' of healthcare data as it is shared and processed uniformly and consistently by the different systems. This allows clinical and non-clinical data to be shared more easily, theoretically improving patient care and health system performance.
Primary standards
HL7 International considers the following standards to be its primary standards – those standards that are most commonly used and implemented:
Version 2.x Messaging Standard – an interoperability specification for health and medical transactions
Version 3 Messaging Standard – an interoperability specification for health and medical transactions
Clinical Document Architecture (CDA) – an exchange model for clinical documents, based on HL7 Version 3
Continuity of Care Document (CCD) – a US specification for the exchange of medical summaries, based on CDA.
Structured Product Labeling (SPL) – the published information that accompanies a medicine, based on HL7 Version 3
Clinical Context Object Workgroup (CCOW) – an interoperability specification for the visual integration of user applications
Other HL7 standards/methodologies include:
Fast Healthcare Interoperability Resources (FHIR) – a standard for the exchange of resources
Arden Syntax – a grammar for representing medical conditions and recommendations as a Medical Logic Module (MLM)
Claims Attachments – a Standard Healthcare Attachment to augment another healthcare transaction
Functional Specification of Electronic Health Record (EHR) and Personal Health Record (PHR) systems – a standardized description of health and medical functions sought for or available in such software applications
GELLO – a standard expression language used for clinical decision support
HL7 Version 2
The HL7 version 2 standard (also known as Pipehat) has the aim to support hospital workflows. It was originally created in 1989.
HL7 version 2 defines a series of electronic messages to support administrative, logistical, financial as well as clinical processes. Since 1987 the standard has been updated regularly, resulting in more than ten iterations. The v2.x standards are backward compatible, meaning a message based on version 2.3 will be understood by an application that supports version 2.6.
HL7 v2.x messages use a non-XML encoding syntax based on segments (lines) and one-character delimiters. Segments have composites (fields) separated by the composite delimiter. A composite can have sub-composites (components) separated by the sub-composite delimiter, and sub-composites can have sub-sub-composites (subcomponents) separated by the sub-sub-composite delimiter. The default delimiters are carriage return for the segment separator, vertical bar or pipe (|) for the field separator, caret (^) for the component separator, ampersand (&) for the subcomponent separator, and number sign (#) for the default truncation separator. The tilde (~) is the default repetition separator. Each segment starts with a 3-character string that identifies the segment type. Each segment of the message contains one specific category of information. Every message has MSH as its first segment, which includes a field that identifies the message type. The message type determines the expected segment types in the message. The segment types used in a particular message type are specified by the segment grammar notation used in the HL7 standards.
The following is an example of an admission message. MSH is the header segment, PID the Patient Identity, PV1 is the Patient Visit information, etc. The 5th field in the PID segment is the patient's name, in the order, family name, given name, second name (or their initials), suffix, etc. Depending on the HL7 V2.x standard version, more fields are available in the segment for additional patient information.
HL7 v2.x has allowed for the interoperability between the plethora of digital health systems, from Patient Administration Systems, to Electronic Health Records, and specialised Laboratory and Radiology Information Systems. Currently, the HL7 v2.x messaging standard is supported by every major health informatics vendor in the United States.
HL7 Version 3
The HL7 version 3 standard has the aim to support all healthcare workflows. Development of version 3 started around 1995, resulting in an initial standard publication in 2005. The v3 standard, as opposed to version 2, is based on a formal methodology (the HDF) and object-oriented principles.
RIM - ISO/HL7 21731
The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process and an essential part of the HL7 V3 development methodology. RIM expresses the data content needed in a specific clinical or administrative context and provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.
HL7 Development Framework - ISO/HL7 27931
The HL7 Version 3 Development Framework (HDF) is a continuously evolving process that seeks to develop specifications that facilitate interoperability between healthcare systems. The HL7 RIM, vocabulary specifications, and model-driven process of analysis and design combine to make HL7 Version 3 one methodology for the development of consensus-based standards for healthcare information systems interoperability. The HDF is the most current edition of the HL7 V3 development methodology.
The HDF not only documents messaging, but also the processes, tools, actors, rules, and artifacts relevant to the development of all HL7 standard specifications. Eventually, the HDF will encompass all of the HL7 standard specifications, including any new standards resulting from the analysis of electronic health record architectures and requirements.
HL7 specifications draw upon codes and vocabularies from a variety of sources. The V3 vocabulary work ensures that the systems implementing HL7 specifications have an unambiguous understanding of the code sources and code value domains they are using.
V3 Messaging
The HL7 version 3 messaging standard defines a series of Secure Text messages (called interactions) to support all healthcare workflows.
HL7 v3 messages are based on an XML encoding syntax, as shown in this example:
<POLB_IN224200 ITSVersion="XML_1.0" xmlns="urn:hl7-org:v3"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<id root="2.16.840.1.113883.19.1122.7" extension="CNTRL-3456"/>
<creationTime value="200202150930-0400"/>
<!-- The version of the datatypes/RIM/vocabulary used is that of May 2006 -->
<versionCode code="2006-05"/>
<!-- interaction id= Observation Event Complete, w/o Receiver Responsibilities -->
<interactionId root="2.16.840.1.113883.1.6" extension="POLB_IN224200"/>
<processingCode code="P"/>
<processingModeCode nullFlavor="OTH"/>
<acceptAckCode code="ER"/>
<receiver typeCode="RCV">
<device classCode="DEV" determinerCode="INSTANCE">
<id extension="GHH LAB" root="2.16.840.1.113883.19.1122.1"/>
<asLocatedEntity classCode="LOCE">
<location classCode="PLC" determinerCode="INSTANCE">
<id root="2.16.840.1.113883.19.1122.2" extension="ELAB-3"/>
</location>
</asLocatedEntity>
</device>
</receiver>
<sender typeCode="SND">
<device classCode="DEV" determinerCode="INSTANCE">
<id root="2.16.840.1.113883.19.1122.1" extension="GHH OE"/>
<asLocatedEntity classCode="LOCE">
<location classCode="PLC" determinerCode="INSTANCE">
<id root="2.16.840.1.113883.19.1122.2" extension="BLDG24"/>
</location>
</asLocatedEntity>
</device>
</sender>
<!-- Trigger Event Control Act & Domain Content -->
</POLB_IN224200>
Clinical Document Architecture
The HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange. The standard was jointly published with ISO as ISO/HL7 27932.
Continuity of Care Document
The Continuity of Care Document framework is a US-specific standard for the exchange of medical summaries, based on the Clinical Document Architecture standard.
Structured Product Labeling
Structured Product Labeling describes the published information that accompanies a medicine, based on HL7 Version 3.
Clinical Context Object Workgroup
CCOW, or "Clinical Context Object Workgroup," is a standard protocol designed to enable disparate applications to share user context and patient context in real-time, and at the user-interface level. CCOW implementations typically require a CCOW vault system to manage user security between applications.
Other standards and methods
Fast Healthcare Interoperability Resources (FHIR)
Fast Healthcare Interoperability Resources is a modern interoperability specification from HL7 International designed to be easier to implement, more open, and more extensible than HL7 versions 2.x or 3.x. It leverages a modern web-based suite of API technology, including a HTTP-based RESTful protocol, HTML and Cascading Style Sheets for user interface integration, a choice of JSON or XML for data representation, OAuth for authorization and ATOM for query results. The main purpose of the FHIR standard is to ensure interoperability between different computer systems. It defines the data format and protocol for exchanging medical information, regardless of how it is stored in these systems.
Services Aware Interoperability Framework
The HL7 Services-Aware Enterprise Architecture Framework (SAIF) provides consistency between all HL7 artifacts, and enables a standardized approach to Enterprise Architecture (EA) development and implementation, and a way to measure the consistency.
SAIF is a way of thinking about producing specifications that explicitly describe the governance, conformance, compliance, and behavioral semantics that are needed to achieve computable semantic working interoperability. The intended information transmission technology might use a messaging, document exchange, or service approach.
SAIF is the framework that is required to rationalize interoperability of other standards. SAIF is an architecture for achieving interoperability, but it is not a whole-solution design for enterprise architecture management.
Arden syntax
The Arden syntax is a language for encoding medical knowledge. HL7 International adopted and oversees the standard beginning with Arden syntax 2.0. These Medical Logic Modules (MLMs) are used in the clinical setting as they can contain sufficient knowledge to make single medical decisions. They can produce alerts, diagnoses, and interpretations along with quality assurance function and administrative support. An MLM must run on a computer that meets the minimum system requirements and has the correct program installed. Then, the MLM can give advice for when and where it is needed.
Clinical Quality Language
Clinical Quality Language (CQL) is a ANSI certified clinically focused high-level expression language standard curated by Health Level 7. It is designated for clinical knowledge sharing in the domains of electronic clinical quality measurement and clinical decision support.
Clinical quality language is being used for a variety of clinical applications including WHO SMART guidelines where it is used for encoding decision logic and performance indicators. The Centers for Medicare & Medicaid Services adopted CQL for clinical quality measure specifications since 2019.
CQL allows modular and flexible expression of logic and is both human-readable and machine processable.
An implementation of CQL was open sourced and published by the National Committee for Quality Assurance in 2023 with the aim of encouraging adoption of the language.
MLLP
A large portion of HL7 messaging is transported by Minimal Lower Layer Protocol (MLLP), also known as Lower Layer Protocol (LLP) or Minimum Layer Protocol (MLP). For transmitting via TCP/IP, header and trailer characters are added to the message to identify the beginning and ending of the message because TCP/IP is a continuous stream of bytes. Hybrid Lower Layer Protocol (HLLP) is a variation of MLLP that includes a checksum to help verify message integrity. Amongst other software vendors, MLLP is supported by Microsoft, Oracle, Cleo.
MLLP contains no inherent security or encryption but relies on lower layer protocols such as Transport Layer Security (TLS) or IPsec for safeguarding Protected health information outside of a secure network.
Functional EHR and PHR specifications
Functional specifications for an electronic health record.
Message details
The OBR segment
An OBR Segment carries information about an exam, diagnostic study/observation. It is a required segment in an ORM (order message) or an ORU (Observation Result) message.
See also
CDISC
DICOM
DVTk
Electronic medical record
eHealth
EHRcom
European Institute for Health Records (European Union)
Fast Healthcare Interoperability Resources
Health Informatics
Health Informatics Service Architecture (HISA)
Integrating the Healthcare Enterprise(IHE)
ISO TC 215
LOINC
NextGen Connect
Public Health Information Network
SNOMED and SNOMED CT
References
External links
HL7.org site
What does HL7 education mean?
HL7 International is a member of the Joint Initiative on SDO Global Health Informatics Standardization
HL7 Tools Page
Australian Healthcare Messaging Laboratory (AHML) - Online HL7 Message Testing and Certification
Comprehensive Implementation of HL7 v3 Specifications in Java
NIST HL7 Conformance Testing Framework
ICH-HL7 Regulated Product Submissions
HL7 Tutorial Directory
HL7 Programming Tutorials, Short Tutorials on many HL7 concepts for Programmers.
Critical reviews
HL7 RIM: An Incoherent Standard
HL7 RIM Under Scrutiny (attempted rebuttal)(publication date?)
HL7 WATCH
Update 2013: Human Action in the Healthcare Domain: A Critical Analysis of HL7’s Reference Information Model
International standards
Agent-based software
American National Standards Institute standards
Standards for electronic health records
Data coding framework
Health informatics | 0.765073 | 0.994839 | 0.761124 |
Mad pride | Mad Pride is a mass movement of current and former users of mental health services, as well as those who have never used mental health services but are aligned with the Mad Pride framework. The movement advocates that individuals with mental illness should be proud of their 'mad' identity. In recent years, Mad Pride has increasingly aligned with the neurodiversity movement, recognizing the interconnected nature of mental health advocacy and neurodivergent experiences.
Core principles
Mad Pride activists seek to reclaim terms such as "mad", "nutter", and "psycho" from misuse, such as in tabloid newspapers, and to transform them from negative to positive descriptors. Through mass media campaigns, Mad Pride activists seek to re-educate the general public on the causes of mental disabilities and the experiences of those using the mental health system.
Mad Pride was formed in 1993 in response to local community prejudices towards people with a psychiatric history living in boarding homes in the Parkdale area of Toronto, Ontario, Canada; since then, an event has been held in Toronto every year (except for 1996). A similar movement began around the same time in the United Kingdom, and by the late 1990s, Mad Pride events were organized around the globe, including in Australia, Brazil, France, Ireland, Portugal, Madagascar, South Africa, South Korea, and the United States. Events draw thousands of participants, according to MindFreedom International, a United States mental health advocacy organization that promotes and tracks events spawned by the movement.
History
Mad Studies grew out of mad pride and the psychiatric survivor framework, and focuses on developing scholarly thinking around "mental health" by academics who self-identify as mad. As noted in Mad matters: a critical reader in Canadian mad studies, "Mad Studies can be defined in general terms as a project of inquiry, knowledge production, and political action devoted to the critique and transcendence of psy-centred ways of thinking, behaving, relating, and being".
The first known event, held on 18 September 1993, was called "Psychiatric Survivor Pride Day, and was organized by and for people who identified as survivors, consumers, or ex-patients of psychiatric practices.
Founders
Mad Pride's founding activists in the UK include Simon Barnett, Pete Shaughnessy, and Robert Dellar.
Books and articles
Mad Pride: A celebration of mad culture records the early Mad Pride movement. On Our Own: Patient-Controlled Alternatives to the Mental Health System, published in 1978 by Judi Chamberlin, is a foundational text in the Mad Pride movement, although it was published before the movement was launched.
Mad Pride was launched shortly before a book of the same name, Mad Pride: A celebration of mad culture, published in 2000. On May 11, 2008, Gabrielle Glaser documented Mad Pride in The New York Times. Glaser stated, "Just as gay-rights activists reclaimed the word queer as a badge of honor rather than a slur, these advocates proudly call themselves mad; they say their conditions do not preclude them from productive lives."
Culture and events
Mad Pride and disability pride are both celebrated in July in many countries, including Canada, Ireland, and the United Kingdom. There is a connection to Bastille Day, a French national holiday which occurs annually on July 14 to commemorate the Storming of the Bastille on July 14, 1789. This event was adopted a symbol of Mad Pride, representing liberation and freedom.
The Mad Pride movement has spawned recurring cultural events in Toronto, London, Dublin, and other cities around the world. These events often include live music, poetry readings, film screenings, and street theatre. "Bed push" protests are one form of street threatre unique to Mad Pride events; their aim is to raise awareness about the barriers that prevent people from accessing quality treatment – which disproportionately affect people who are oppressed for other aspects such as race or class – as well as the widespread use of force in psychiatric hospitals. Past events have included British journalist Jonathan Freedland and novelist Clare Allan. Mad Pride cultural events take a variety of forms, such as the South London collective Creative Routes, the Chipmunka Publishing enterprise, and the many works of Dolly Sen.
Bed push
A Bed Push is a method of activism employed by multiple mental health agencies and advocates as a method of raising awareness about psychiatric care. Activists wheel a gurney through public spaces to provoke discussion about mental health care. MindFreedom has a recipe for a successful Bed Push on their website, urging participants to remain peaceful but also ensure they are seen, using attention-grabbing tactics such as blowing horns, mild traffic disruptions, and loud music. Often patients in psychiatric care feel silenced and powerless, so the act of intentionally securing visibility and showing off resilience is one method of regaining dignity.
Mad Pride Week in Toronto is recognized by the city itself. The festivities surrounding this week are highlighted by the Mad Pride Bed Push, which typically takes place on the 14th of July. The event is staged at Toronto's Queen Street West "to raise public awareness about the use of force and lack of choice for people ensnared in the Ontario mental health system". This week is officially run by Toronto Mad Pride which partners a number of mental health agencies in the city. In recent years, some advocates have pushed for Parkdale, Toronto to be renamed MAD! Village, to reclaim pride in its surrounding communities' long history of struggle with mental health and addictions.
A series of bed push events take place around London each year.
Psychiatric Patient-Built Wall Tours
The Psychiatric Patient-Built Wall Tours take place in Toronto, at the CAMH facility on Queen St West. The tours show the patient-built walls from the 19th century that are located at present day CAMH. The purpose of the tours is to give a history on the lives of the patients who built the walls, and bring attention to the harsh realities of psychiatry.
Geoffrey Reaume and Heinz Klein first came up with the idea of walking tours as part of a Mad Pride event in 2000. The first wall tour occurred on what is now known as Mad Pride Day, on July 14, 2000, with an attendance of about fifty people. Reaume solely leads the tours, and they have grown from annual events for Mad Pride, to occurring several times throughout the year in all non-winter months.
See also
Anti-psychiatry
Autistic Pride Day
Brazilian anti-asylum movement
Clifford Whittingham Beers
David Reville
Disability rights movement
Disability flag
Elizabeth Packard
Functional diversity
Icarus Project
Involuntary commitment
Judi Chamberlin
Kate Millett
Leonard Roy Frank
Linda Andre
Lyn Duff
Mentalism (discrimination)
National Empowerment Center
Neurodiversity
Outline of the psychiatric survivors movement
Psychiatric survivors movement
Ted Chabasinski
World Network of Users and Survivors of Psychiatry
References
External links
Mad Pride Toronto
MAD Pride Australia
Mad Pride & Disability Pride Month Are Both in July
Mad in America
Mad Pride Resources
Anti-psychiatry
Health movements
History of mental health
Identity politics
Mental health organizations
Psychiatric survivor activists
1993 introductions
Disability pride
July events
1993 establishments in Ontario
Activism | 0.771637 | 0.986326 | 0.761086 |
Neuro-linguistic programming | Neuro-linguistic programming (NLP) is a pseudoscientific approach to communication, personal development and psychotherapy, that first appeared in Richard Bandler and John Grinder's 1975 book The Structure of Magic I. NLP asserts that there is a connection between neurological processes, language and acquired behavioral patterns, and that these can be changed to achieve specific goals in life. According to Bandler and Grinder, NLP can treat problems such as phobias, depression, tic disorders, psychosomatic illnesses, near-sightedness, allergy, the common cold, and learning disorders, often in a single session. They also say that NLP can model the skills of exceptional people, allowing anyone to acquire them.
NLP has been adopted by some hypnotherapists as well as by companies that run seminars marketed as leadership training to businesses and government agencies.
There is no scientific evidence supporting the claims made by NLP advocates, and it has been called a pseudoscience. Scientific reviews have shown that NLP is based on outdated metaphors of the brain's inner workings that are inconsistent with current neurological theory, and that NLP contains numerous factual errors. Reviews also found that research that favored NLP contained significant methodological flaws, and that there were three times as many studies of a much higher quality that failed to reproduce the claims made by Bandler, Grinder, and other NLP practitioners.
Early development
According to Bandler and Grinder, NLP consists of a methodology termed modeling, plus a set of techniques that they derived from its initial applications. They derived many of the fundamental techniques from the work of Virginia Satir, Milton Erickson and Fritz Perls. Bandler and Grinder also drew upon the theories of Gregory Bateson, Alfred Korzybski and Noam Chomsky (particularly transformational grammar).
Bandler and Grinder say that their methodology can codify the structure inherent to the therapeutic "magic" as performed in therapy by Perls, Satir and Erickson, and indeed inherent to any complex human activity. From that codification, they say, the structure and its activity can be learned by others. Their 1975 book, The Structure of Magic I: A Book about Language and Therapy, is intended to be a codification of the therapeutic techniques of Perls and Satir.
Bandler and Grinder say that they used their own process of modeling to model Virginia Satir so they could produce what they termed the Meta-Model, a model for gathering information and challenging a client's language and underlying thinking. They say that by challenging linguistic distortions, specifying generalizations, and recovering deleted information in the client's statements, the transformational grammar concept of surface structure yields a more complete representation of the underlying deep structure and therefore has therapeutic benefit. Also derived from Satir were anchoring, future pacing and representational systems.
In contrast, the Milton-Model—a model of the purportedly hypnotic language of Milton Erickson—was described by Bandler and Grinder as "artfully vague" and metaphoric. The Milton-Model is used in combination with the Meta-Model as a softener, to induce "trance" and to deliver indirect therapeutic suggestion.
Psychologist Jean Mercer writes that Chomsky's theories "appear to be irrelevant" to NLP. Linguist Karen Stollznow describes Bandler's and Grinder's reference to such experts as namedropping. Other than Satir, the people they cite as influences did not collaborate with Bandler or Grinder. Chomsky himself has no association with NLP, with his work being theoretical in nature and having no therapeutic element. Stollznow writes, "[o]ther than borrowing terminology, NLP does not bear authentic resemblance to any of Chomsky's theories or philosophies—linguistic, cognitive or political."
According to André Muller Weitzenhoffer, a researcher in the field of hypnosis, "the major weakness of Bandler and Grinder's linguistic analysis is that so much of it is built upon untested hypotheses and is supported by totally inadequate data." Weitzenhoffer adds that Bandler and Grinder misuse formal logic and mathematics, redefine or misunderstand terms from the linguistics lexicon (e.g., nominalization), create a scientific façade by needlessly complicating Ericksonian concepts with unfounded claims, make factual errors, and disregard or confuse concepts central to the Ericksonian approach.
More recently, Bandler has stated, "NLP is based on finding out what works and formalizing it. In order to formalize patterns I utilized everything from linguistics to holography ... The models that constitute NLP are all formal models based on mathematical, logical principles such as predicate calculus and the mathematical equations underlying holography." There is no mention of the mathematics of holography nor of holography in general in Spitzer's, or Grinder's account of the development of NLP.
On the matter of the development of NLP, Grinder recollects:
The philosopher Robert Todd Carroll responded that Grinder has not understood Kuhn's text on the history and philosophy of science, The Structure of Scientific Revolutions. Carroll replies: (a) individual scientists never have nor are they ever able to create paradigm shifts volitionally and Kuhn does not suggest otherwise; (b) Kuhn's text does not contain the idea that being unqualified in a field of science is a prerequisite to producing a result that necessitates a paradigm shift in that field and (c) The Structure of Scientific Revolutions is foremost a work of history and not an instructive text on creating paradigm shifts and such a text is not possible—extraordinary discovery is not a formulaic procedure. Carroll explains that a paradigm shift is not a planned activity, rather it is an outcome of scientific effort within the dominant paradigm that produces data that cannot be adequately accounted for within the current paradigm—hence a paradigm shift, i.e. the adoption of a new paradigm. In developing NLP, Bandler and Grinder were not responding to a paradigmatic crisis in psychology nor did they produce any data that caused a paradigmatic crisis in psychology. There is no sense in which Bandler and Grinder caused or participated in a paradigm shift. "What did Grinder and Bandler do that makes it impossible to continue doing psychology ... without accepting their ideas? Nothing," argues Carroll.
Commercialization and evaluation
By the late 1970s, the human potential movement had developed into an industry and provided a market for some NLP ideas. At the center of this growth was the Esalen Institute at Big Sur, California. Perls had led numerous Gestalt therapy seminars at Esalen. Satir was an early leader and Bateson was a guest teacher. Bandler and Grinder have said that in addition to being a therapeutic method, NLP was also a study of communication and began marketing it as a business tool, writing that, "if any human being can do anything, so can you." After 150 students paid $1,000 each for a ten-day workshop in Santa Cruz, California, Bandler and Grinder gave up academic writing and started producing popular books from seminar transcripts, such as Frogs into Princes, which sold more than 270,000 copies. According to court documents relating to an intellectual property dispute between Bandler and Grinder, Bandler made more than $800,000 in 1980 from workshop and book sales.
A community of psychotherapists and students began to form around Bandler and Grinder's initial works, leading to the growth and spread of NLP as a theory and practice. For example, Tony Robbins trained with Grinder and utilized a few ideas from NLP as part of his own self-help and motivational speaking programmes. Bandler led several unsuccessful efforts to exclude other parties from using NLP. Meanwhile, the rising number of practitioners and theorists led NLP to become even less uniform than it was at its foundation. Prior to the decline of NLP, scientific researchers began testing its theoretical underpinnings empirically, with research indicating a lack of empirical support for NLP's essential theories. The 1990s were characterized by fewer scientific studies evaluating the methods of NLP than the previous decade. Tomasz Witkowski attributes this to a declining interest in the debate as the result of a lack of empirical support for NLP from its proponents.
Main components and core concepts
NLP can be understood in terms of three broad components: subjectivity, consciousness, and learning.
According to Bandler and Grinder, people experience the world subjectively, creating internal representations of their experiences. These representations involve the five senses and language. In other words, our conscious experiences take the form of sights, sounds, feelings, smells, and tastes. When we imagine something, recall an event, or think about the future, we utilize these same sensory systems within our minds Furthermore it is stated that these subjective representations of experience have a discernible structure, a pattern.
Bandler and Grinder assert that behavior (both our own and others') can be understood through these sensory-based internal representations. Behavior here includes verbal and non-verbal communication, as well as effective or adaptive behaviors and less helpful or "pathological" ones. They also assert that behavior in both the self and other people can be modified by manipulating these sense-based subjective representations.
NLP posits that consciousness can be divided into conscious and unconscious components. The part of our internal representations operating outside our direct awareness is referred to as the "unconscious mind".
Finally, NLP uses a method of learning called "modeling", designed to replicate expertise in any field. According to Bandler and Grinder, by analyzing the sequence of sensory and linguistic representations used by an expert while performing a skill, it's possible to create a mental model that can be learned by others.
Techniques or set of practices
According to one study by Steinbach, a classic interaction in NLP can be understood in terms of several major stages including establishing rapport, gleaning information about a problem mental state and desired goals, using specific tools and techniques to make interventions, and integrating proposed changes into the client's life. The entire process is guided by the non-verbal responses of the client. The first is the act of establishing and maintaining rapport between the practitioner and the client which is achieved through pacing and leading the verbal (e.g., sensory predicates and keywords) and non-verbal behavior (e.g., matching and mirroring non-verbal behavior, or responding to eye movements) of the client.
Once rapport is established, the practitioner may gather information about the client's present state as well as help the client define a desired state or goal for the interaction. The practitioner pays attention to the verbal and non-verbal responses as the client defines the present state and desired state and any resources that may be required to bridge the gap. The client is typically encouraged to consider the consequences of the desired outcome, and how they may affect his or her personal or professional life and relationships, taking into account any positive intentions of any problems that may arise. The practitioner thereafter assists the client in achieving the desired outcomes by using certain tools and techniques to change internal representations and responses to stimuli in the world. Finally, the practitioner helps the client to mentally rehearse and integrate the changes into his or her life. For example, the client may be asked to envision what it is like having already achieved the outcome.
According to Stollznow, "NLP also involves fringe discourse analysis and 'practical' guidelines for 'improved' communication. For example, one text asserts 'when you adopt the "but" word, people will remember what you said afterwards. With the "and" word, people remember what you said before and after.'"
Applications
Alternative medicine
NLP has been promoted as being able to treat a variety of diseases including Parkinson's disease, HIV/AIDS and cancer. Such claims have no supporting medical evidence. People who use NLP as a form of treatment risk serious adverse health consequences as it can delay the provision of effective medical care.
Psychotherapeutic
Early books about NLP had a psychotherapeutic focus given that the early models were psychotherapists. As an approach to psychotherapy, NLP shares similar core assumptions and foundations in common with some contemporary brief and systemic practices, such as solution focused brief therapy. NLP has also been acknowledged as having influenced these practices with its reframing techniques which seeks to achieve behavior change by shifting its context or meaning, for example, by finding the positive connotation of a thought or behavior.
The two main therapeutic uses of NLP are, firstly, as an adjunct by therapists practicing in other therapeutic disciplines and, secondly, as a specific therapy called Neurolinguistic Psychotherapy.
According to Stollznow, "Bandler and Grinder's infamous Frogs into Princes and their other books boast that NLP is a cure-all that treats a broad range of physical and mental conditions and learning difficulties, including epilepsy, myopia and dyslexia. With its promises to cure schizophrenia, depression and Post Traumatic Stress Disorder, and its dismissal of psychiatric illnesses as psychosomatic, NLP shares similarities with Scientology and the Citizens Commission on Human Rights (CCHR)." A systematic review of experimental studies by Sturt et al. (2012) concluded that "there is little evidence that NLP interventions improve health-related outcomes." In his review of NLP, Stephen Briers writes, "NLP is not really a cohesive therapy but a ragbag of different techniques without a particularly clear theoretical basis ... [and its] evidence base is virtually non-existent." Eisner writes, "NLP appears to be a superficial and gimmicky approach to dealing with mental health problems. Unfortunately, NLP appears to be the first in a long line of mass marketing seminars that purport to virtually cure any mental disorder ... it appears that NLP has no empirical or scientific support as to the underlying tenets of its theory or clinical effectiveness. What remains is a mass-marketed serving of psychopablum."
André Muller Weitzenhoffer—a friend and peer of Milton Erickson—wrote, "Has NLP really abstracted and explicated the essence of successful therapy and provided everyone with the means to be another Whittaker, Virginia Satir, or Erickson? ... [NLP's] failure to do this is evident because today there is no multitude of their equals, not even another Whittaker, Virginia Satir, or Erickson. Ten years should have been sufficient time for this to happen. In this light, I cannot take NLP seriously ... [NLP's] contributions to our understanding and use of Ericksonian techniques are equally dubious. Patterns I and II are poorly written works that were an overambitious, pretentious effort to reduce hypnotism to a magic of words."
Clinical psychologist Stephen Briers questions the value of the NLP maxim—a presupposition in NLP jargon—"there is no failure, only feedback". Briers argues that the denial of the existence of failure diminishes its instructive value. He offers Walt Disney, Isaac Newton and J.K. Rowling as three examples of unambiguous acknowledged personal failure that served as an impetus to great success. According to Briers, it was "the crash-and-burn type of failure, not the sanitised NLP Failure Lite, i.e. the failure-that-isn't really-failure sort of failure" that propelled these individuals to success. Briers contends that adherence to the maxim leads to self-deprecation. According to Briers, personal endeavour is a product of invested values and aspirations and the dismissal of personally significant failure as mere feedback effectively denigrates what one values. Briers writes, "Sometimes we need to accept and mourn the death of our dreams, not just casually dismiss them as inconsequential." Briers also contends that the NLP maxim is narcissistic, self-centered and divorced from notions of moral responsibility.
Other uses
Although the original core techniques of NLP were therapeutic in orientation their generic nature enabled them to be applied to other fields. These applications include persuasion, sales, negotiation, management training, sports, teaching, coaching, team building, public speaking, and in the process of hiring employees.
Scientific criticism
In the early 1980s, NLP was advertised as an important advance in psychotherapy and counseling, and attracted some interest in counseling research and clinical psychology. However, as controlled trials failed to show any benefit from NLP and its advocates made increasingly dubious claims, scientific interest in NLP faded.
Numerous literature reviews and meta-analyses have failed to show evidence for NLP's assumptions or effectiveness as a therapeutic method. While some NLP practitioners have argued that the lack of empirical support is due to insufficient research which tests NLP, the consensus scientific opinion is that NLP is pseudoscience and that attempts to dismiss the research findings based on these arguments "[constitute]s an admission that NLP does not have an evidence base and that NLP practitioners are seeking a post-hoc credibility."
Surveys in the academic community have shown NLP to be widely discredited among scientists. Among the reasons for considering NLP a pseudoscience are that evidence in favor of it is limited to anecdotes and personal testimony that it is not informed by scientific understanding of neuroscience and linguistics, and that the name "neuro-linguistic programming" uses jargon words to impress readers and obfuscate ideas, whereas NLP itself does not relate any phenomena to neural structures and has nothing in common with linguistics or programming. In education, NLP has been used as a key example of pseudoscience.
As a quasi-religion
Sociologists and anthropologists have categorized NLP as a quasi-religion belonging to the New Age and/or Human Potential Movements.
Medical anthropologist Jean M. Langford categorizes NLP as a form of folk magic; that is to say, a practice with symbolic efficacy—as opposed to physical efficacy—that is able to effect change through nonspecific effects (e.g., placebo). To Langford, NLP is akin to a syncretic folk religion "that attempts to wed the magic of folk practice to the science of professional medicine".
Bandler and Grinder were influenced by the shamanism described in the books of Carlos Castaneda. Concepts like "double induction" and "stopping the world", central to NLP modeling, were incorporated from these influences.
Some theorists characterize NLP as a type of "psycho-shamanism", and its focus on modeling has been compared to ritual practices in certain syncretic religions. The emphasis on lineage from an NLP guru has also been likened to similar concepts in some Eastern religions. Aupers, Houtman, and Bovbjerg identify NLP as a New Age "psycho-religion". Bovbjerg argues that New Age movements center on a transcendent "other". While monotheistic religions seek communion with a divine being, this focus shifts inward in these movements, with the "other" becoming the unconscious self. Bovbjerg posits that this emphasis on the unconscious and its hidden potential underlies NLP techniques promoting self-perfection through ongoing transformation.
Bovbjerg's secular critique echoes the conservative Christian perspective, as exemplified by David Jeremiah. He argues that NLP's emphasis on self-transformation and internal power conflicts with the Christian belief in salvation through divine grace.
Legal disputes
Founding, initial disputes, and settlement (1979–1981)
In 1979, Richard Bandler and John Grinder established the Society of Neuro-Linguistic Programming (NLP) to manage commercial applications of NLP, including training, materials, and certification. The founding agreement conferred exclusive rights to profit from NLP training and certification upon Bandler's corporate entity, Not Ltd. Around November 1980, Bandler and Grinder had ceased collaboration for undisclosed reasons.
On September 25, 1981, Bandler filed suit against Grinder's corporate entity, Unlimited Ltd., in the Superior Court of California, County of Santa Cruz seeking injunctive relief and damages arising from Grinder's NLP-related commercial activities; the Court issued a judgment in Bandler's favor on October 29, 1981. The subsequent settlement agreement granted Grinder a 10-year license to conduct NLP seminars, offer NLP certification, and utilize the NLP name, subject to royalty payments to Bandler.
Further litigation and consequences (1996–2000)
Bandler commenced further civil actions against Unlimited Ltd., various figures within the NLP community, and 200 initially unnamed defendants in July 1996 and January 1997. Bandler alleged violations of the initial settlement terms by Grinder and sought damages of no less than US$10,000,000.00 from each defendant.
In February 2000, the Court ruled against Bandler. The judgment asserted that Bandler had misrepresented his exclusive ownership of NLP intellectual property and sole authority over Society of NLP membership and certification.
Trademark revocation (1997)
In December 1997, a separate civil proceeding initiated by Tony Clarkson resulted in the revocation of Bandler's UK trademark of NLP. The Court ruled in Clarkson's favor.
Resolution and legacy (2000)
Bandler and Grinder reached a settlement in late 2000, acknowledging their status as co-creators and co-founders of NLP and committing to refrain from disparaging one another's NLP-related endeavors.
Due to these disputes and settlements, the terms 'NLP' and 'Neuro-Linguistic Programming' remain in the public domain. No single party holds exclusive rights, and there are no restrictions on offering NLP certifications.
The designations "NLP" and "Neuro-linguistic Programming" are not owned, trademarked, or subject to centralized regulation. Consequently, there are no restrictions on individuals self-identifying as "NLP Master Practitioners" or "NLP Master Trainers." This decentralization has led to numerous certifying associations.
Decentralization and criticism
This lack of centralized control means there's no single standard for NLP practice or training. Practitioners can market their own methodologies, leading to inconsistencies within the field. This has been a source of criticism, highlighted by an incident in 2009 where a British television presenter registered his cat with the British Board of Neuro Linguistic Programming (BBNLP), demonstrating the organization's lax credentialing. Critics like Karen Stollznow find irony in the initial legal battles between Bandler and Grinder, considering their failure to apply their own NLP principles to resolve their conflict. Others, such as Grant Devilly, characterize NLP associations as "granfalloons"—a term implying a lack of unifying principles or a shared sense of purpose.
See also
Avatar Course
Family systems therapy
Frank Farrelly
List of New Age topics
List of unproven and disproven cancer treatments
Solution-focused brief therapy
Notable practitioners
Steve Andreas
Paul McKenna
Notes
References
Citations
Works cited
Primary sources
Secondary sources
Further reading
External links
Hypnotherapy
Pseudoscience | 0.761602 | 0.999296 | 0.761066 |
Social work | Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work practice draws from liberal arts and STEM areas such as psychology, sociology, health, political science, community development, law, and economics to engage with systems and policies, conduct assessments, develop interventions, and enhance social functioning and responsibility. The ultimate goals of social work include the improvement of people's lives, alleviation of biopsychosocial concerns, empowerment of individuals and communities, and the achievement of social justice.
Social work practice is often divided into three levels. Micro-work involves working directly with individuals and families, such as providing individual counseling/therapy or assisting a family in accessing services. Mezzo-work involves working with groups and communities, such as conducting group therapy or providing services for community agencies. Macro-work involves fostering change on a larger scale through advocacy, social policy, research development, non-profit and public service administration, or working with government agencies. Starting in the 1960s, a few universities began social work management programmes, to prepare students for the management of social and human service organizations, in addition to classical social work education.
The social work profession developed in the 19th century, with some of its roots in voluntary philanthropy and in grassroots organizing. However, responses to social needs had existed long before then, primarily from public almshouses, private charities and religious organizations. The effects of the Industrial Revolution and of the Great Depression of the 1930s placed pressure on social work to become a more defined discipline as social workers responded to the child welfare concerns related to widespread poverty and reliance on child labor in industrial settings.
Definition
Social work is a broad profession that intersects with several disciplines. Social work organizations offer the following definitions:
Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities, and indigenous knowledge, social work engages people and structures to address life challenges and enhance well-being.
—International Federation of Social Workers
Social work is a profession concerned with helping individuals, families, groups and communities to enhance their individual and collective well-being. It aims to help people develop their skills and their ability to use their resources and those of the community to resolve problems. Social work is concerned with individual and personal problems but also with broader social issues such as poverty, unemployment, and domestic violence.
— Canadian Association of Social Workers
Social work practice consists of the professional application of social principles, and techniques to one or more of the following ends: helping people obtain tangible services; counseling and psychotherapy with individuals, families, and groups; helping communities or groups provide or improve social and health services, and participating in legislative processes. The practice of social work requires knowledge of human development and behavior; of social and economic, and cultural institutions; and the interaction of all these factors.
—[US] National Association of Social Workers
Social workers work with individuals and families to help improve outcomes in their lives. This may be helping to protect vulnerable people from harm or abuse or supporting people to live independently. Social workers support people, act as advocates and direct people to the services they may require. Social workers often work in multi-disciplinary teams alongside health and education professionals.
—British Association of Social Workers
History
The practice and profession of social work has a relatively modern and scientific origin, and is generally considered to have developed out of three strands. The first was individual casework, a strategy pioneered by the Charity Organization Society in the mid-19th century, which was founded by Helen Bosanquet and Octavia Hill in London, England. Most historians identify COS as the pioneering organization of the social theory that led to the emergence of social work as a professional occupation. COS had its main focus on individual casework. The second was social administration, which included various forms of poverty relief – 'relief of paupers'. Statewide poverty relief could be said to have its roots in the English Poor Laws of the 17th century but was first systematized through the efforts of the Charity Organization Society. The third consisted of social action – rather than engaging in the resolution of immediate individual requirements, the emphasis was placed on political action working through the community and the group to improve their social conditions and thereby alleviate poverty. This approach was developed originally by the Settlement House Movement.
This was accompanied by a less easily defined movement; the development of institutions to deal with the entire range of social problems. All had their most rapid growth during the nineteenth century, and laid the foundation basis for modern social work, both in theory and in practice.
Professional social work originated in 19th century England, and had its roots in the social and economic upheaval wrought by the Industrial Revolution, in particular, the societal struggle to deal with the resultant mass urban-based poverty and its related problems. Because poverty was the main focus of early social work, it was intricately linked with the idea of charity work.
Other important historical figures that shaped the growth of the social work profession are Jane Addams, who founded the Hull House in Chicago and won the Nobel Peace Prize in 1931; Mary Ellen Richmond, who wrote Social Diagnosis, one of the first social workbooks to incorporate law, medicine, psychiatry, psychology, and history; and William Beveridge, who created the social welfare state, framing the debate on social work within the context of social welfare provision.
United States
During the 1840s, Dorothea Lynde Dix, a retired Boston teacher who is considered the founder of the Mental Health Movement, began a crusade that would change the way people with mental disorders were viewed and treated. Dix was not a social worker; the profession was not established until after she died in 1887. However, her life and work were embraced by early psychiatric social workers (mental health social worker/clinical social worker), and she is considered one of the pioneers of psychiatric social work along with Elizabeth Horton, who in 1907 was the first social worker to work in a psychiatric setting as an aftercare agent in the New York hospital systems to provide post-discharge supportive services.
The early twentieth century marked a period of progressive change in attitudes towards mental illness. The increased demand for psychiatric services following the First World War led to significant developments. In 1918, Smith College School for Social Work was established, and under the guidance of Mary C. Jarrett at Boston Psychopathic Hospital, students from Smith College were trained in psychiatric social work. She first gave social workers the "Psychiatric Social Worker" designation. A book titled "The Kingdom of Evils," released in 1922, authored by a hospital administrator and the head of the social service department at Boston Psychopathic Hospital, described the roles of psychiatric social workers in the hospital. These roles encompassed casework, managerial duties, social research, and public education. After World War II, a series of mental hygiene clinics were established. The Community Mental Health Centers Act was passed in 1963. This policy encouraged the deinstitutionalisation of people with mental illness. Later, the mental health consumer movement came by 1980s. A consumer was defined as a person who has received or is currently receiving services for a psychiatric condition. People with mental disorders and their families became advocates for better care. Building public understanding and awareness through consumer advocacy helped bring mental illness and its treatment into mainstream medicine and social services. The 2000s saw the managed care movement, which aimed at a health care delivery system to eliminate unnecessary and inappropriate care to reduce costs, and the recovery movement, which by principle acknowledges that many people with serious mental illness spontaneously recover and others recover and improve with proper treatment.
Social workers made an impact with 2003 invasion of Iraq and War in Afghanistan (2001–2021); social workers worked out of NATO hospitals in Afghanistan and Iraqi bases. They made visits to provide counseling services at forward operating bases. Twenty-two percent of the clients were diagnosed with posttraumatic stress disorder, 17 percent with depression, and 7 percent with alcohol use disorder. In 2009, there was a high level of suicides among active-duty soldiers: 160 confirmed or suspected Army suicides. In 2008, the Marine Corps had a record 52 suicides. The stress of long and repeated deployments to war zones, the dangerous and confusing nature of both wars, wavering public support for the wars, and reduced troop morale all contributed to escalating mental health issues. Military and civilian social workers served a critical role in the veterans' health care system.
Mental health services is a loose network of services ranging from highly structured inpatient psychiatric units to informal support groups, where psychiatric social workers indulges in the diverse approaches in multiple settings along with other paraprofessional workers.
Canada
A role for psychiatric social workers was established early in Canada's history of service delivery in the field of population health. Native North Americans understood mental trouble as an indication of an individual who had lost their equilibrium with the sense of place and belonging in general, and with the rest of the group in particular. In native healing beliefs, health and mental health were inseparable, so similar combinations of natural and spiritual remedies were often employed to relieve both mental and physical illness. These communities and families greatly valued holistic approaches for preventive health care. Indigenous peoples in Canada have faced cultural oppression and social marginalization through the actions of European colonizers and their institutions since the earliest periods of contact. Culture contact brought with it many forms of depredation. Economic, political, and religious institutions of the European settlers all contributed to the displacement and oppression of indigenous people.
The first officially recorded treatment practices were in 1714, when Quebec opened wards for the mentally ill. In the 1830s social services were active through charity organizations and church parishes (Social Gospel Movement). Asylums for the insane were opened in 1835 in Saint John and New Brunswick. In 1841 in Toronto care for the mentally ill became institutionally based. Canada became a self-governing dominion in 1867, retaining its ties to the British crown. During this period, age of industrial capitalism began and it led to social and economic dislocation in many forms. By 1887 asylums were converted to hospitals, and nurses and attendants were employed for the care of the mentally ill. Social work training began at the University of Toronto in 1914. Before that, social workers acquired their training through trial and error methods on the job and by participating in apprenticeship plans offered by charity organization societies. These plans included related study, practical experience, and supervision. In 1918 Dr. Clarence Hincks and Clifford Beers founded the Canadian National Committee for Mental Hygiene, which later became the Canadian Mental Health Association. In the 1930s Hincks promoted prevention and of treating sufferers of mental illness before they were incapacitated (early intervention).
World War II profoundly affected attitudes towards mental health. The medical examinations of recruits revealed that thousands of apparently healthy adults suffered mental difficulties. This knowledge changed public attitudes towards mental health, and stimulated research into preventive measures and methods of treatment. In 1951 Mental Health Week was introduced across Canada. For the first half of the twentieth century, with a period of deinstitutionalisation beginning in the late 1960s psychiatric social work succeeded to the current emphasis on community-based care, psychiatric social work focused beyond the medical model's aspects on individual diagnosis to identify and address social inequities and structural issues. In the 1980s Mental Health Act was amended to give consumers the right to choose treatment alternatives. Later the focus shifted to workforce mental health issues and environmental root causes.
In Ontario, the regulator, the Ontario College of Social Workers and Social Service Workers (OCSWSSW) regulates two professions: registered social workers (RSW) and registered social service workers (RSSW). Each provinces has similar regulatory bodies. The Canadian Association of Social Workers (CASW) is the national professional body for social workers. Prior to provincial-level politicization, registrants of this professional body were able to engage in inter-provincial practice as registered social workers.
India
The earliest citing of mental disorders in India are from Vedic Era (2000 BC – AD 600). Charaka Samhita, an ayurvedic textbook believed to be from 400 to 200 BC describes various factors of mental stability. It also has instructions regarding how to set up a care delivery system. In the same era, Siddha was a medical system in south India. The great sage Agastya was one of the 18 siddhas contributing to a system of medicine. This system has included the Agastiyar Kirigai Nool, a compendium of psychiatric disorders and their recommended treatments. In Atharva Veda too there are descriptions and resolutions about mental health afflictions. In the Mughal period Unani system of medicine was introduced by an Indian physician Unhammad in 1222. The existing form of psychotherapy was known then as ilaj-i-nafsani in Unani medicine.
The 18th century was a very unstable period in Indian history, which contributed to psychological and social chaos in the Indian subcontinent. In 1745, lunatic asylums were developed in Bombay (Mumbai) followed by Calcutta (Kolkata) in 1784, and Madras (Chennai) in 1794. The need to establish hospitals became more acute, first to treat and manage Englishmen and Indian 'sepoys' (military men) employed by the British East India Company. The First Lunacy Act (also called Act No. 36) that came into effect in 1858 was later modified by a committee appointed in Bengal in 1888. Later, the Indian Lunacy Act, 1912 was brought under this legislation. A rehabilitation programme was initiated between 1870s and 1890s for persons with mental illness at the Mysore Lunatic Asylum, and then an occupational therapy department was established during this period in almost each of the lunatic asylums. The programme in the asylum was called 'work therapy'. In this programme, persons with mental illness were involved in the field of agriculture for all activities. This programme is considered as the seed of origin of psychosocial rehabilitation in India.
Berkeley-Hill, superintendent of the European Hospital (now known as the Central Institute of Psychiatry (CIP), established in 1918), was deeply concerned about the improvement of mental hospitals in those days. The sustained efforts of Berkeley-Hill helped to raise the standard of treatment and care and he also persuaded the government to change the term 'asylum' to 'hospital' in 1920. Techniques similar to the current token-economy were first started in 1920 and called by the name 'habit formation chart' at the CIP, Ranchi. In 1937, the first post of psychiatric social worker was created in the child guidance clinic run by the Dhorabji Tata School of Social Work (established in 1936). It is considered as the first documented evidence of social work practice in Indian mental health field.
After Independence in 1947, general hospital psychiatry units (GHPUs) were established to improve conditions in existing hospitals, while at the same time encouraging outpatient care through these units. In Amritsar Dr. Vidyasagar instituted active involvement of families in the care of persons with mental illness. This was advanced practice ahead of its times regarding treatment and care. This methodology had a greater impact on social work practice in the mental health field especially in reducing the stigmatisation. In 1948 Gauri Rani Banerjee, trained in the United States, started a master's course in medical and psychiatric social work at the Dhorabji Tata School of Social Work (now TISS). Later the first trained psychiatric social worker was appointed in 1949 at the adult psychiatry unit of Yerwada Mental Hospital, Pune.
In various parts of the country, in mental health service settings, social workers were employed—in 1956 at a mental hospital in Amritsar, in 1958 at a child guidance clinic of the college of nursing, and in Delhi in 1960 at the All India Institute of Medical Sciences and in 1962 at the Ram Manohar Lohia Hospital. In 1960, the Madras Mental Hospital (now Institute of Mental Health) employed social workers to bridge the gap between doctors and patients. In 1961 the social work post was created at the NIMHANS. In these settings they took care of the psychosocial aspect of treatment. This system enabled social service practices to have a stronger long-term impact on mental health care.
In 1966 by the recommendation Mental Health Advisory Committee, Ministry of Health, Government of India, NIMHANS commenced Department of Psychiatric Social Work started and a two-year Postgraduate Diploma in Psychiatric Social Work was introduced in 1968. In 1978, the nomenclature of the course was changed to MPhil in Psychiatric Social Work. Subsequently, a PhD Programme was introduced. By the recommendations Mudaliar committee in 1962, Diploma in Psychiatric Social Work was started in 1970 at the European Mental Hospital at Ranchi (now CIP). The program was upgraded and other higher training courses were added subsequently.
A new initiative to integrate mental health with general health services started in 1975 in India. The Ministry of Health, Government of India formulated the National Mental Health Programme (NMHP) and launched it in 1982. The same was reviewed in 1995 and based on that, the District Mental Health Program (DMHP) was launched in 1996 which sought to integrate mental health care with public health care. This model has been implemented in all the states and currently there are 125 DMHP sites in India.
National Human Rights Commission (NHRC) in 1998 and 2008 carried out systematic, intensive and critical examinations of mental hospitals in India. This resulted in recognition of the human rights of the persons with mental illness by the NHRC. From the NHRC's report as part of the NMHP, funds were provided for upgrading the facilities of mental hospitals. As a result of the study, it was revealed that there were more positive changes in the decade until the joint report of NHRC and NIMHANS in 2008 compared to the last 50 years until 1998. In 2016 Mental Health Care Bill was passed which ensures and legally entitles access to treatments with coverage from insurance, safeguarding dignity of the afflicted person, improving legal and healthcare access and allows for free medications. In December 2016, Disabilities Act 1995 was repealed with Rights of Persons with Disabilities Act (RPWD), 2016 from the 2014 Bill which ensures benefits for a wider population with disabilities. The Bill before becoming an Act was pushed for amendments by stakeholders mainly against alarming clauses in the "Equality and Non discrimination" section that diminishes the power of the act and allows establishments to overlook or discriminate against persons with disabilities and against the general lack of directives that requires to ensure the proper implementation of the Act.
Mental health in India is in its developing stages. There are not enough professionals to support the demand. According to the Indian Psychiatric Society, there are around 9000 psychiatrists only in the country as of January 2019. Going by this figure, India has 0.75 psychiatrists per 100,000 population, while the desirable number is at least 3 psychiatrists per 100,000. While the number of psychiatrists has increased since 2010, it is still far from a healthy ratio.
Lack of any universally accepted single licensing authority compared to foreign countries puts social workers at general in risk. But general bodies/councils accepts automatically a university-qualified social worker as a professional licensed to practice or as a qualified clinician. Lack of a centralized council in tie-up with Schools of Social Work also makes a decline in promotion for the scope of social workers as mental health professionals. Though in this midst the service of social workers has given a facelift to the mental health sector in the country with other allied professionals.
Iran
State welfare organization was previously part of health and social security ministry.
Theoretical models and practices
Social work is an interdisciplinary profession, meaning it draws from a number of areas, such as (but not limited to) psychology, sociology, politics, criminology, economics, ecology, education, health, law, philosophy, anthropology, and counseling, including psychotherapy. Field work is a distinctive attribution to social work pedagogy. This equips the trainee in understanding the theories and models within the field of work. Professional practitioners from multicultural aspects have their roots in this social work immersion engagements from the early 19th century in the western countries. As an example, here are some of the models and theories used within social work practice:
Empathy
Social case work
Social group work
Community organization
Behavioral
School social worker
Leadership and management
Crisis intervention
Suicide prevention
Mental health
Addiction
Cognitive-behavioral
Critical
Social insurance
Ecological
Equity theory
Financial social work
Macro social work
Motivational interviewing
Medical social work
Medical terminology
Person-centered therapy
Psychoanalytic
Psychodynamic
Existential
Humanistic
Social work management
Sociotherapy
Brief psychotherapy or solution-focused approach
Recovery approach
Reflexivity
Social exchange
Welfare economics
Anti-oppressive practice
Psychosocial rehabilitation
Cognitive behavioral therapy
Dialectical behavior therapy
Systems theory
Policy Analysis
Strength-based practice
Task-centered
Family therapy
Advocacy
Prevention science
Project management
Program evaluation and performance measurement
Systems thinking
Community development and intervention
Positive psychology
Social actions
Animal-assisted therapy
Profession
American educator Abraham Flexner in a 1915 lecture, "Is Social Work a Profession?", delivered at the National Conference on Charities and Corrections, examined the characteristics of a profession concerning social work. It is not a 'single model', such as that of health, followed by medical professions such as nurses and doctors, but an integrated profession, and the likeness with medical profession is that social work requires a continued study for professional development to retain knowledge and skills that are evidence-based by practice standards. A social work professional's services lead toward the aim of providing beneficial services to individuals, dyads, families, groups, organizations, and communities to achieve optimum psychosocial functioning.
Its eight core functions present in its methods of practice are described by Popple and Leighninger as:
Engagement — social worker must first engage the client in early meetings to promote a collaborative relationship
Assessment — data gathered must be specifically aimed at guiding and directing a plan of action to help the client
Planning — negotiate and formulate an action plan
Implementation — promote resource acquisition and enhance role performance
Monitoring/Evaluation — ongoing documentation for assessing the extent to which the client is following through on short-term goal attainment
Supportive Counseling — affirming, challenging, encouraging, informing, and exploring options
Graduated Disengagement — seeking to replace the social worker with a naturally occurring resource
Administration — planning and managing social work programs, providing operations management support, and administrating case management services
There are six broad ethical principles in National Association of Social Workers' (NASW) Code of Ethics that inform social work practice, they are both prescriptive and proscriptive, and are based on six core values:
Service — help people in need and provide pro bono services
Social Justice — engage in social change activities for and with people to promote social justice and challenge social injustice
Dignity and worth of the person — treat people with care and respect, be sensitive to cultural and ethnic diversity, and promote individuals socially responsible self determination
Importance of human relationships — maintain positive client relationships because they play a vital role in driving change, and engage with people as partners who empower them through the helping process
Integrity — engage clients with honesty and responsibility to build trust, and you are not only responsible for your own professional ethics and integrity but also of the service organization
Competence — practice and build expertise as a social worker, and continually seek to enhance and contribute professional knowledge and skills
The International Federation of Social Workers also outlines essential principles for guiding social workers towards high professional standards. These include recognizing the inherent dignity of all people, upholding human rights, striving for social justice, supporting self-determination, encouraging participation, respecting privacy and confidentiality, treating individuals holistically, using technology and social media responsibly, and maintaining professional integrity.
A historic and defining feature of social work is the profession's focus on individual well-being in a social context and the well-being of society. Social workers promote social justice and social change with and on behalf of clients. A "client" can be an individual, family, group, organization, or community. In the broadening scope of the modern social worker's role, some practitioners have in recent years traveled to war-torn countries to provide psychosocial assistance to families and survivors.
Newer areas of social work practice involve management science. The growth of "social work administration" (sometimes also referred to as "social work management") for transforming social policies into services and directing activities of an organization toward achievement of goals is a related field. Helping clients with accessing benefits such as unemployment insurance and disability benefits, to assist individuals and families in building savings and acquiring assets to improve their financial security over the long-term, to manage large operations, etc. requires social workers to know financial management skills to help clients and organization's to be financially self-sufficient. Financial social work also helps clients with low-income or low to middle-income, people who are either unbanked (do not have a banking account) or underbanked (individuals who have a bank account but tend to rely on high cost non-bank providers for their financial transactions), with better mediation with financial institutions and induction of money management skills. A prominent area in which social workers operate is Behavioral Social Work. They apply principles of learning and social learning to conduct behavioral analysis and behavior management. Empiricism and effectiveness serve as means to ensure the dignity of clients, and focusing on the present is what distinguishes behavioral social work from other types of social work practices. In a multicultural case, the behavior of multiple members from different cultures matters. In such cases, an ecobehavioral perspective is taken due to the external influences. The interpersonal skills that a social worker brings to the job make them stand out from behavioral therapists. Another area that social workers are focusing is risk management, risk in social work is taken as Knight in 1921 defined "If you don't even know for sure what will happen, but you know the odds, that is risk and If you don't even know the odds, that is uncertainty." Risk management in social work means minimizing the risks while increasing potential benefits for clients by analyzing the risks and benefits in the duty of care or decisions. Occupational social work is a field where the trained professionals assist a management with worker's welfare, in their psychosocial wellness, and helps management's policies and protocols to be humanistic and anti-oppressive.
In the United States, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services, professional social workers are the largest group of mental health services providers. There are more clinically trained social workers—over 200,000—than psychiatrists, psychologists, and psychiatric nurses combined. Federal law and the National Institutes of Health recognize social work as one of five core mental health professions.
Examples of fields a social worker may be employed in are poverty relief, life skills education, community organizing, community organization, community development, rural development, forensics and corrections, legislation, industrial relations, project management, child protection, elder protection, women's rights, human rights, systems optimization, finance, addictions rehabilitation, child development, cross-cultural mediation, occupational safety and health, disaster management, mental health, psychosocial therapy, disabilities, etc.
Roles and functions
Social workers play many roles in mental health settings, including those of case manager, advocate, administrator, and therapist. The major functions of a psychiatric social worker are promotion and prevention, treatment, and rehabilitation. Social workers may also practice:
Counseling and psychotherapy
Case management and support services
Crisis intervention
Psychoeducation
Psychiatric rehabilitation and recovery
Care coordination and monitoring
Program management/administration
Program, policy and resource development
Research and evaluation
Psychiatric social workers conduct psychosocial assessments of the patients and work to enhance patient and family communications with the medical team members and ensure the inter-professional cordiality in the team to secure patients with the best possible care and to be active partners in their care planning. Depending upon the requirement, social workers are often involved in illness education, counseling and psychotherapy. In all areas, they are pivotal to the aftercare process to facilitate a careful transition back to family and community.
Mental health of social workers
Several studies have reported that social workers have an increased risk of common mental disorders, long-term sickness absence due to mental illnesses and antidepressant use. A study in Sweden has found that social workers have an increased risk of receiving a diagnosis of depression or anxiety and stress-related disorders in comparison with other workers. The risk for social workers is high even when comparing to other similar human-service professions, and social workers in psychiatric care or in assistance analysis are the most vulnerable.
There are multiple explanations for this increased risk. Individual components include secondary traumatic stress, compassion fatigue and selection of vulnerable employees into the profession. On an organizational level, high job strain, organizational culture and work overload are important factors.
There is a difference in gender. When comparing to their same-gender counterparts in other professions, men in social work have a higher risk than women. Male social workers, when compared to men in other professions, have a 70% increased risk of being diagnosed with depression or anxiety disorders. Female social workers have an increased risk of 20% when comparing to women in other professions. This might be due the baseline prevalence of common mental disorders, which is high among women and lower among men in the general population. Another potential explanation is that men in gender-balanced workplaces tend to seek help from healthcare providers more often than men in male-dominated industries.
Qualifications and license
The education of social workers begins with a bachelor's degree (BA, BSc, BSSW, BSW, etc.) or diploma in social work or a Bachelor of Social Services. Some countries offer postgraduate degrees in social work, such as a master's degree (MSW, MSSW, MSS, MSSA, MA, MSc, MRes, MPhil.) or doctoral studies (Ph.D. and DSW (Doctor of Social Work)).
Several countries and jurisdictions require registration or license for working as social workers, and there are mandated qualifications. In other places, the professional association sets academic requirements as the qualification for practicing the profession. However, certain types of workers are exempted from needing a registration license. The success of these professionals is based on the recognition of and by the employers that provide social work services. These employers don't require the title of a registered social worker as a necessity for providing social work and related services.
North America
In the United States, social work undergraduate and master's programs are accredited by the Council on Social Work Education. A CSWE-accredited degree is required for one to become a state-licensed social worker. The CSWE even accredits online master's in social work programs in traditional and advanced standing options. In 1898, the New York Charity Organization Society, which was the Columbia University School of Social Work's earliest entity, began offering formal "social philanthropy" courses, marking both the beginning date for social work education in the United States, as well as the launching of professional social work. However, a CSWE-accredited program doesn't necessarily have to meet ASWB licensing knowledge requirements, and many of them do not meet them.
The Association of Social Work Boards (ASWB) is a regulatory organization that provides licensing examination services to social work regulatory boards in the United States and Canada. Due to the limited scope of the organization's objectives, it is not a social work organization that is accountable to the broader social work community or to the ones certified by ASWB exams. ASWB generates an annual profit of $6,000,000 from license examination administration and $800,000 from publishing study materials. As such, it is an organization that is focused on revenue maximization, and by principle, it is only responsible and answerable to its board members. The objective of a social work license is to ensure the public's safety and quality of service. It is intended to ensure that social workers understand and can follow NASW's Code of Ethics in their occupational practices, ascertain social workers' knowledge in service provision, and protect the use of the Social Work title from misuse and unethical practices. However, a study found out that having a social work license is not related to improved service quality for consumers. They substituted paraprofessionals with qualified licensed social workers and found out that there was no improvement in overall facility quality, quality of life, or the provision of social services. The paraprofessionals with training were able to perform similarly to licensed social workers, just like any trained human resource in a workforce would perform a job for which they are trained. Social work graduates gain this knowledge and training through academic and financial investment in earning an accredited social work degree, degree equalization process, and from receiving professional supervision during and post-graduation.
For decades, the social work community has called on ASWB for transparency regarding the data on the validity and racial sensitivity of the exams. However, ASWB suppressed this information, leading many critics to assess that if the exams were free from flaws and bias, such data would have been released a long time ago. In 2022, ASWB released the pass rate data, and a Change.org petition called "#StopASWB" highlighted with academic citations that the Association of Social Work Boards' exams are biased with feedback from white social workers. The petition also pointed out that the exams unfairly penalize social workers who practice in other languages, require privileged resources for success, and utilize oppressive standards in formatting the exams, which are inconsistent with social work values. The National Association of Social Workers (NASW) expressed opposition to the social work licensing exams conducted by the Association of Social Work Boards (ASWB). This came after analyzing ASWB data, which revealed considerable discrepancies in pass rates for aspiring social workers of diverse racial backgrounds, older individuals, and those who speak English as a second language (ESL). Pass rates of exams indicate that white test takers are more than twice as likely to pass on their first attempt compared to BIPOC test takers indicating high construct irrelevant variance among other issues. This finding raises questions about the reliability and credibility of social work licensure process through ASWB exams.
NASW's firm stance on the matter serves as a significant reckoning moment regarding the systemic racism in the social work profession, particularly within its regulatory system. It also highlights ASWB's silence about the licensure apparatus that perpetuates racial disparities, leading its association members to institutional betrayal. After the release of ASWB data showing race and age-related discrepancies in pass rates, the national accreditation body, the Council on Social Work Education (CSWE), removed the ASWB licensure exam pass rates as an option for social work education programs to meet accreditation requirements. Members from various communities in social work have expressed that discussions about addressing this systemic oppression should be guided by a formal acknowledgment of wrongdoing and a spirit of reconciliation and healing. The state of Illinois passed a landmark bill, HB2365 SA1, marking a significant step in reducing its regulatory body's dependency on ASWB. With this bill, Illinois has addressed the uneven power that ASWB held and its unfettered pursuit of profit, which affected the qualification of educated social workers for practice entry. Now, educated social workers can obtain licensing by completing 3000 hours of professional supervision, eliminating the previous requirement of ASWB exam results for licensure, which often led to issues of unemployment and related emotional, behavioral, and physical health consequences.
Since the early 1990s, researchers have critiqued ASWB exams for their lack of content and criterion validity that undermines the test validity all together. In a study conducted in 2023, it was discovered that there are questions in ASWB exams that have rationales based on theories that are not evidence-based, and that have significant item validity issues. The researchers used generative AI application, ChatGPT to test ASWB rationales and found that the rationales provided by ChatGPT were of higher quality. They revealed that ChatGPT exhibited an excellent ability to recognize social work-related text patterns for scenario-based decision-making and offered high-quality rationales while taking into account the safety and ethics in social work practice, even without specific training for such a task. They suggested that it may be necessary and timely to move away from oppressive assessment formats used to evaluate social workers' competence and reconsider licensing exams with serious validity issues that disproportionately exclude individuals based on their race, age, and language. A proposed assessment format is one based on mastery learning, which would lead to competency-based licensing.
Due to the accumulated evidence of significant validity flaws in ASWB's tests, its conflict of interest, and other issues, many researchers have urged state legislators and regulators to discontinue the use of ASWB exams for licensure or temporarily suspend them until a novel, anti-oppressive, and validated alternative is established. In the interim, they suggest relying on traditional supervision methods to ensure the safe and ethical practice of social work. They elucidate that supervision not only guides licensure seekers but also allows well-equipped supervisors to assess individuals' capabilities to practice safely and ethically more accurately in contexts, which is a more valid approach to assessing such competence.
Professional associations
Social workers have several professional associations that provide ethical guidance and other forms of support for their members and social work in general. These associations may be international, continental, semi-continental, national, or regional. The main international associations are the International Federation of Social Workers (IFSW) and the International Association of Schools of Social Work (IASSW).
The largest professional social work association in the United States is the National Association of Social Workers, they have instituted a code for professional conduct and a set of principles rooted in six core values: service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. There also exist organizations that represent clinical social workers such as the American Association of Psychoanalysis in Clinical Social Work. AAPCSW is a national organization representing social workers who practice psychoanalytic social work and psychoanalysis. There are also several states with Clinical Social Work Societies which represent all social workers who conduct psychotherapy from a variety of theoretical frameworks with families, groups, and individuals. The Association for Community Organization and Social Administration (ACOSA) is a professional organization for social workers who practice within the community organizing, policy, and political spheres. The American Academy of Social Work and Social Welfare (AASWSW) is a national honorific society of scholars and practitioners who focus on social work and social welfare.
In the UK, the professional association is the British Association of Social Workers (BASW) with just over 18,000 members (as of August 2015), and the regulatory body for social workers is Social Work England. In Australia, the professional association is the Australian Association of Social Workers (AASW) that ensure social workers meet required standards for social work practice in Australia, founded in 1946 and have more than 10,000 members. Accredited social workers in Australia can also provide services under the Access to Allied Psychological Services (ATAPS) program. In New Zealand, the regulatory body for social workers is Kāhui Whakamana Tauwhiro (SWRB).
Trade unions representing social workers
In the United Kingdom, just over half of social workers are employed by local authorities, and many of these are represented by UNISON, the public sector employee union. Smaller numbers are members of the Unite the Union and the GMB. The British Union of Social Work Employees (BUSWE) has been a section of the trade union Community since 2008.
While at that stage, not a union, the British Association of Social Workers operated a professional advice and representation service from the early 1990s. Social Work qualified staff who are also experienced in employment law and industrial relations provide the kind of representation you would expect from a trade union in the event of a grievance, discipline or conduct matters specifically in respect of professional conduct or practice. However, this service depended on the goodwill of employers to allow the representatives to be present at these meetings, as only trade unions have the legal right and entitlement of representation in the workplace.
By 2011 several councils had realized that they did not have to permit BASW access, and those that were challenged by the skilled professional representation of their staff were withdrawing permission. For this reason BASW once again took up trade union status by forming its arms-length trade union section, Social Workers Union (SWU). This gives the legal right to represent its members whether the employer or Trades Union Congress (TUC) recognizes SWU or not. In 2015 the TUC was still resisting SWU application for admission to congress membership and while most employers are not making formal statements of recognition until the TUC may change its policy, they are all legally required to permit SWU (BASW) representation at internal discipline hearings, etc.
Use of information technology in social work
Information technology is vital in social work, it transforms the documentation part of the work into electronic media. This makes the process transparent, accessible and provides data for analytics. Observation is a tool used in social work for developing solutions. Anabel Quan-Haase in Technology and Society defines the term surveillance as "watching over" (Quan-Haase. 2016. P 213), she continues to explain that the observation of others socially and behaviorally is natural, but it becomes more like surveillance when the purpose of the observation is to keep guard over someone (Quan-Haase. 2016. P 213). Often, at the surface level, the use of surveillance and surveillance technologies within the social work profession is seemingly an unethical invasion of privacy. When engaging with the social work code of ethics a little more deeply, it becomes obvious that the line between ethical and unethical becomes blurred. Within the social work code of ethics, there are multiple mentions of the use of technology within social work practice. The one that seems the most applicable to surveillance or artificial intelligence is 5.02 article f, "When using electronic technology to facilitate evaluation or research" and it goes on to explain that clients should be informed when technology is being used within the practice (Workers. 2008. Article 5.02).
Social workers in literature
In 2011, a critic stated that "novels about social work are rare", and as recently as 2004, another critic claimed to have difficulty finding novels featuring a main character holding a Master of Social Work degree.
However, social workers have been the subject of many novels, including:
The basis of the movie Precious.
Smith, Ali (2011) There But For The, Hamish Hamilton, Pantheon.
Fictional social workers in media
See also
Addiction medicine
Approved mental health professional
Clinical social work
Child welfare
Community development
Critical social work
Development studies
Disaster social work
Education in social work
Forensic social work
Gerontology
Humanistic social work
Human resource management
Human services
Integrated social work
International Social Work
Jocelyn Hyslop
Mental health professional
Recreational therapy
Right to an adequate standard of living
Social development
Social planning
Social psychology
Social research
Social Scientist
Social work with groups
Urban development
Welfare
References
Further reading
External links
Social Work, WCIDWTM - The University of Tennessee
Social Work Evaluation and Research Resources
Mental health occupations
Welfare agencies
Welfare and service organizations
Academic disciplines
Behavioural sciences
Branches of psychology
Health care occupations
Social sciences
Caregiving
Civil services | 0.762678 | 0.997868 | 0.761052 |
Abnormal psychology | Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant (statistically, functionally, morally, or in some other sense), and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind–body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.
The science of abnormal psychology studies two types of behaviors: adaptive and maladaptive behaviors. Behaviors that are maladaptive suggest that some problem(s) exist, and can also imply that the individual is vulnerable and cannot cope with environmental stress, which is leading them to have problems functioning in daily life in their emotions, mental thinking, physical actions and talks. Behaviors that are adaptive are ones that are well-suited to the nature of people, their lifestyles and surroundings, and to the people that they communicate with, allowing them to understand each other.
Clinical psychology is the applied field of psychology that seeks to assess, understand, and treat psychological conditions in clinical practice. The theoretical field known as abnormal psychology may form a backdrop to such work, but clinical psychologists in the current field are unlikely to use the term abnormal in reference to their practice. Psychopathology is a similar term to abnormal psychology, but may have more of an implication of an underlying pathology (disease process), which assumes the medical model of mental disturbance and as such, is a term more commonly used in the medical specialty known as psychiatry.
History
Humors
Hippocrates (460–377 BCE) hypothesized that the body and mind become unwell when the so-called humors, vital fluids in the body, become unbalanced. The four temperaments theory posits four such humors: black bile, yellow bile, phlegm, and blood. Each humor was associated with a particular temperament: too much phlegm causes a person to be fatigued, too much black bile causes melancholia, yellow bile causes a quick temper, and too much blood causes optimism, cheerfulness, and confidence.
Asylums
The act of placing individuals with mental illness in a separate facility known as an asylum dates to 1547, when King Henry VIII of England established the St. Mary of Bethlehem asylum in London. This hospital, nicknamed Bedlam, was famous for its deplorable conditions. Asylums remained popular throughout the Middle Ages and the Renaissance era. These early asylums often had miserable conditions. Patients were seen as a "burden" to society, locked away and treated almost like beasts to be dealt with, rather than patients needing treatment. However, many of the patients received helpful medical treatment. There was scientific curiosity into abnormal behavior, although it was rarely investigated in the early asylums. Inmates in these early asylums were often put on display for profit, as they were viewed as less than human. The early asylums were basically modifications of the existing criminal institutions.
In the late 18th century, the idea of humanitarian treatment for the patients gained much favor, due to the work of Philippe Pinel in France. He pushed for the idea that the patients should be treated with kindness, and not the cruelty inflicted on them, as if they were animals or criminals. His experimental ideas, such as removing the chains from the patients, were met with reluctance. The experiments in kindness proved to be a great success, which helped to bring about a reform in the way mental institutions would be run.
Institutionalization would continue to improve throughout the 19th and 20th century, as a result of the work of many humanitarians such as Dorothea Dix, and the mental hygiene movement which promoted the physical well-being of the mental patients. "Dix, more than any other figure in the nineteenth century, made people in America and virtually all of Europe aware that the insane were being subjected to incredible abuses." Through this movement, millions of dollars were raised to build new institutions to house the mentally ill. Mental hospitals began to grow substantially in numbers during the 20th century, as care for the mentally ill increased in them.
By 1939, there were over 400,000 patients in state mental hospitals in the US. Hospital stays were normally quite long for the patients, with some individuals being treated for many years. These hospitals, while better than the asylums of the past, were still lacking in the means of effective treatment for the patients. Even though the reform movement had occurred, patients were often still met with cruel and inhumane treatment.
Things began to change in the year 1946, when Mary Jane Ward published the influential novel titled The Snake Pit, which was made into a popular movie of the same name. The book called attention to the conditions which mental patients faced, and helped to spark concern in the general public to create more humane mental health care in these overcrowded hospitals.
That same year, the National Institute of Mental Health was also created, which provided support for the training of hospital employees, and research into the conditions of the patients. During this period, the Hill-Burton Acts was also passed, which was a program that funded mental health hospitals. Along with the Community Health Services Act of 1963, the Hill-Burton Acts helped with the creation of outpatient psychiatric clinics, inpatient general hospitals, and rehabilitation and community consultation centers.
Deinstitutionalisation
In the late twentieth century, however, a large number of mental hospitals were closed in many countries. In England, for example, only 14 of the 130 psychiatric institutions that had been created in the early 20th century remained open at the start of the 21st century. In 1963, President John F. Kennedy launched the community health movement in the United States as a "bold new approach" to mental health care, aimed at coordinating mental health services for citizens in mental health centers. In the span of 40 years, the United States was able to see an about 90 percent drop in the number of patients in psychiatric hospitals.
Deinstitutionalisation ended the long-term confinement of patients in isolating mental hospitals, which could and did cause long-term negative adaptations. For instance, institutionalizing people with schizophrenia worsens negative symptoms. However, the practice is sometimes criticised for a perceived rise in homelessness amongst people who were previously institutionalized, or are presumed that they would have been in the institution era.
Explaining abnormal behaviour
People have tried to explain and control abnormal behavior for thousands of years. Historically, there have been three main approaches to abnormal behavior: the supernatural, biological, and psychological traditions. Abnormal psychology revolves around two major paradigms for explaining mental disorders, the psychological paradigm and the biological paradigm. The psychological paradigm focuses more on the humanistic, cognitive, and behavioral causes and effects of psychopathology. The biological paradigm includes theories that focus more on physical factors, such as genetics and neurochemistry.
Evolution of Psychological Understanding
As the field of psychology has evolved, so has the understanding of mental health. Modern psychology recognizes the complexity and diversity of mental health conditions, advocating for more accurate and respectful terminology. Critics argue that continuing to use the term "abnormal psychology" fails to reflect these advancements and the current understanding of mental health.
Lack of Precision
The term "abnormal" is criticized for its lack of precision and specificity. Mental health conditions encompass a wide range of experiences and severities, which are not adequately captured by the broad and vague label of "abnormal." This lack of precision can result in oversimplification and misunderstanding of the complexities inherent in mental health conditions.
Evolution of Psychological Understanding
As the field of psychology has evolved, so has the understanding of mental health. Modern psychology recognizes the complexity and diversity of mental health conditions, advocating for more accurate and respectful terminology. Critics argue that continuing to use the term "abnormal psychology" fails to reflect these advancements and the current understanding of mental health.
Supernatural explanations
In the first supernatural tradition, also called the demonological method, abnormal behaviors are attributed to agents outside human bodies. According to this model, abnormal behaviors are caused by demons, aliens, or spirits, or the influences of the Moon, planets, and stars. During the Stone Age, trepanning was performed on those who had mental illness, to literally cut the evil spirits out of the victim's head. Conversely, Ancient Chinese, Ancient Egyptians, and Hebrews believed that these were evil demons or spirits and advocated exorcism. By the time of the Greeks and Romans, mental illnesses were thought to be caused by an imbalance of the four humors which lead treatments like the draining of fluids from the brain. During the Medieval period, many Europeans believed that the power of witches, demons, and spirits caused abnormal behaviors. People with psychological disorders were thought to be possessed by evil spirits that had to be exorcised through religious rituals. If exorcism failed, some authorities advocated steps such as confinement, beating, and other types of torture to make the body uninhabitable to witches, demons, and spirits. The belief that witches, demons, and spirits are responsible for the abnormal behavior continued into the 15th century. Swiss alchemist, astrologer, and physician Paracelsus (1493–1541), on the other hand, rejected the idea that abnormal behaviors were caused by witches, demons, and spirits and suggested that people's mind and behaviors were influenced by the movements of the moon and stars. This tradition is still alive today. Some people, especially in the developing countries, as well as some followers of religious sects in the developed countries, continue to believe that supernatural powers influence human behaviors. In Western academia, the supernatural tradition has been largely replaced by the biological and psychological traditions.
Supernatural traditions
Throughout time, societies have proposed several explanations of abnormal behavior within human beings. Beginning in some hunter-gatherer societies, animists have believed that people demonstrating abnormal behavior are possessed by malevolent spirits. This idea has been associated with trepanation, the practice of cutting a hole into the individual's skull in order to release the malevolent spirits. Although it has been difficult to define abnormal psychology, one definition includes characteristics such as statistical infrequency.
A more formalized response to spiritual beliefs about abnormality is the practice of exorcism. Performed by religious authorities, exorcism is thought of as another way to release evil spirits who cause pathological behavior within the person. In some instances, individuals exhibiting unusual thoughts or behaviors have been exiled from society, or worse. Perceived witchcraft, for example, has been punished by death. Two Catholic Inquisitors wrote the Malleus Maleficarum (Latin for "The Hammer Against Witches"), which was used by many Inquisitors and witch-hunters. It contained an early taxonomy of perceived deviant behavior, and proposed guidelines for prosecuting deviant individuals.
Biological explanations
In the biological tradition, psychological disorders are attributed to biological causes. In the psychological tradition, disorders are attributed to faulty psychological development, and to social context. The medical or biological perspective holds the belief that most or all abnormal behavior can be attributed to a medical factor; assuming all psychological disorders are diseases.
The Greek physician Hippocrates, who is considered to be the father of Western medicine, played a major role in the biological tradition. Hippocrates and his associates wrote the Hippocratic Corpus between 450 and 350 BC, in which they suggested that abnormal behaviors can be treated like any other disease. Hippocrates viewed the brain as the seat of consciousness, emotion, intelligence, and wisdom and believed that disorders involving these functions would logically be located in the brain.
These ideas of Hippocrates and his associates were later adopted by Galen, the Roman physician. Galen extended these ideas and developed a strong and influential school of thought within the biological tradition that extended well into the 18th century.
Kendra Cherry, MSEd, states: "The medical approach to abnormal psychology focuses on the biological causes of mental illness. This perspective emphasizes understanding the underlying cause of disorders, which might include genetic inheritance, related physical disorders, infections, and chemical imbalances. Medical treatments are often pharmacological in nature, although medication is often used in conjunction with some other type of psychotherapy."
Psychological explanations
According to Sigmund Freud's structural model, the id, ego, and superego are three theoretical constructs that define the way an individual interacts with the external world, as well as responding to internal forces The Id represents the instinctual drives of an individual that remain unconscious. The super-ego represents a person's conscience and their internalization of societal norms and morality. Finally, the ego serves to realistically integrate the drives of the id with the prohibitions of the super-ego. Lack of development in the Superego, or an incoherently developed Superego within an individual, will result in thoughts and actions that are irrational and abnormal, contrary to the norms and beliefs of society.
Advocacy for Person-First Language
There is a growing movement towards using person-first language, which emphasizes the individual rather than defining them by their condition. Terms like "mental health conditions" or "psychological disorders" are preferred as they focus on the person first and the condition second. This approach promotes dignity, respect, and a more humane perspective, reducing the risk of dehumanization that can be associated with the term "abnormal."
Alignment with Contemporary Standards
Many modern psychological associations, diagnostic manuals, and academic texts have moved away from using the term "abnormal psychology." For instance, the American Psychological Association (APA) and other professional bodies advocate for the use of language that respects the dignity and humanity of individuals with mental health conditions. Critics argue that adhering to contemporary standards in terminology is crucial for promoting an inclusive and progressive approach to mental health.
Irrational beliefs
Irrational beliefs are driven by unconscious fears and can result in abnormal behavior. Rational emotive behavior therapy helps to drive irrational and maladaptive beliefs out of one's mind.
Sociocultural influences
The term sociocultural refers to the various circles of influence on the individual, ranging from close friends and family, to the institutions and policies of a country, or the world as a whole. Discriminations, whether based on social class, income, race and ethnicity, or gender, can influence the development of abnormal behaviour.
Multiple causality
The number of different theoretical perspectives in the field of psychological abnormality has made it difficult to properly explain psychopathology. The attempt to explain all mental disorders with the same theory leads to reductionism (explaining a disorder or other complex phenomena using only a single idea or perspective). Most mental disorders are composed of several factors, which is why one must take into account several theoretical perspectives, when attempting to diagnose or explain a particular behavioral abnormality or mental disorder. Explaining mental disorders with a combination of theoretical perspectives is known as multiple causality.
The diathesis–stress model emphasizes the importance of applying multiple causality to psychopathology, by stressing that disorders are caused by both precipitating causes, and predisposing causes. A precipitating cause is an immediate trigger that instigates a person's action or behavior. A predisposing cause is an underlying factor that interacts with the immediate factors to result in a disorder. Both causes play a key role in the development of a psychological disorder. For example, high neuroticism antedates most types of psychopathology.
Recent concepts of abnormality
Statistical abnormality – when a certain behavior/characteristic is relevant to a low percentage of the population. However, this does not necessarily mean that such individuals have mental illness (for example, statistical abnormalities such as extreme wealth/attractiveness)
Psychometric abnormality – Psychometric abnormality implicates abnormality as a deviation from a statistically determined norm, such as the population average IQ of 100. In this case, an IQ score less than about 70–75 may define someone as having a learning disability, and suggests they will have some difficulties coping with life. However, the problems associated with a low IQ differ widely across individuals depending on their life circumstances. So, even when an individual is defined as psycho-metrically 'abnormal', this tells us little about their actual condition or problems. Furthermore, if one takes the other end of the IQ spectrum, a deviation of 30 points above the mean is generally not considered to be abnormal, or to indicate the presence of mental health problems.
Deviant behavior – this is not always a sign of mental illness, as mental illness can occur without deviant behavior, and such behavior may occur in the absence of mental illness.
Combinations – including distress, dysfunction, distorted psychological processes, inappropriate responses in given situations, and causing/risking harm to oneself.
Examples
There is a wide range of mental disorders that are considered to be forms of Abnormal Psychology. These include, but are not limited to:
Schizophrenia
Schizophrenia can be described as a disorder that causes extreme loss of touch with reality. The Psychotic nature of schizophrenia manifests itself through delusions, as well as auditory and visual hallucinations. Schizophrenia is known to have a genetic etiology, as well as other biological components, such as brain disruptions in the prenatal development period.
Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD) is characterized by high amounts of inattention and hyperactive impulsiveness. Inattentive symptoms include not listening, careless errors, disorganization, losing personal belongings, becoming easily distracted, and forgetfulness. Symptoms of hyperactive impulsiveness include fidgeting, talking excessively, and interrupting others.
Antisocial personality disorder
Antisocial personality disorder can be described as a cluster of personality traits that lead to specific outcomes, and violate the rights of other people. These personality traits include callousness, deceitfulness, lack of remorse, apathy, manipulation of others, impulsiveness, and grandiosity. Additional traits may include superficial charm, sexual promiscuity, and pathological lying.
Dissociative identity disorder
Dissociative identity disorder (DID) involves one individual having multiple personalities. Those with DID are described as having multiple selves that each have their own consciousness and awareness.
DID has two main etiologies, which are the post-traumatic and socio-cognitive models. The post-traumatic model states that DID is caused by inescapable past trauma, such as child abuse. The child dissociates and forms alternate personalities as a coping mechanism, in response to the current trauma. Even when the trauma ends, the personalities continue to disrupt the person's life longterm. The socio-cognitive model states that people will implicitly act as if they have multiple personalities and that it is done to align with cultural norms.
Social anxiety disorder
Those with social anxiety disorder (SAD) have a very intense fear of social situations. This fear stems from the belief that the person will be evaluated negatively or embarrass themselves.
SAD is also considered to be one of the more disabling mental disorders. Symptoms of this disorder include fear in most, if not all, social situations. SAD can develop after a traumatic and/or embarrassing experience has occurred while the person was being observed by other people.
Generalized anxiety disorder
Generalized anxiety disorder is characterized by a constant, chronic state of worry and anxiety that is related to a large variety of situations, and is difficult to control. Additional symptoms may include irritability, fatigue, concentration difficulties, and restlessness.
Specific phobia
Individuals with specific phobias have an extreme fear and avoidance of various objects or situations. Specifically, fears become phobias when there is excessive and unreasonable fear that is disproportionate to the culture that the individual is in. Examples of specific phobias include, but are not limited to, phobias of school, blood, injury, needles, small animals, and heights.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is described as physical and mental distress related to past traumatic experiences. PTSD can manifest a large variety of symptoms, including, but not limited to, nightmares, flashbacks, avoidance and/or physiological reactions related to stimuli regarding the trauma, shame, guilt, anger, hypervigilance, and social withdrawal.
PTSD symptoms can arise due to various experiences that involve actual or threatened violence, injury, or death. Firsthand experience, witnessing, or learning about traumatic experiences can possibly lead to the development of PTSD.
Approaches
Somatogenic – abnormality is seen as a result of biological disorders in the brain. This approach has led to the development of radical biological treatments, e.g. lobotomy.
Psychogenic – abnormality is caused by psychological problems. Psychoanalytic (Freud), Cathartic, Hypnotic and Humanistic Psychology (Carl Rogers, Abraham Maslow) treatments were all derived from this paradigm. This approach has, as well, led to some esoteric treatments: Franz Mesmer used to place his patients in a darkened room with music playing, then enter it wearing a flamboyant outfit and poke the "infected" body areas with a stick.
Classification
DSM-5
The DSM-5 is the manual where most commonly discussed and researched information about this particular topic of abnormalities is included. There are various conditions that have been included in this manual and continue to be added to the DSM-5. The causes of many of these diseases are derived from variables such as genetic, biological, socio-cultural, systemic, and biopsychosocial factors. There are also various counseling theories that support and help explain the findings related to each illness. In North America this is the Diagnostic and Statistical Manual of the American Psychiatric Association. The current version of the book is known as the DSM-5. It lists a set of disorders and provides detailed descriptions on what constitutes a mental disorder.
The DSM-5 identifies three key elements that must be present to constitute a mental disorder. These elements include:
Symptoms that involve disturbances in behavior, thoughts, or emotions.
Symptoms associated with personal distress or impairment.
Symptoms that stem from internal dysfunctions (i.e. specifically having biological and/or psychological roots).
The DSM-5 uses three main sections to organize its contents. These sections include I, II, and III. Section I includes the introduction, use, and basics of the DSM-5. Section II includes diagnostic criteria and codes. Section III includes emerging measures and models.
The DSM-5 is the text where most commonly discussed and research information about this particle topic of abnormalities are added. Psychopathology is defined to be more common than expected and liked. There are varies conditions that have been included in this text and are still been added to the DSM-5. The cause of many of these disease are derived from variables such as genetics, biological, socio-cultural, systematic, and biopsychosocial factors. There are also many theories that prove and help answer this findings of each illness.
The DSM-5 is the manual where most commonly discussed and researched information about this particular topic of abnormalities is included. Psychopathology is found to be more common than expected. There are various conditions that have been included in this manual and continue to be added to the DSM-5. The causes of many of these diseases are derived from variables such as genetic, biological, socio-cultural, systemic, and biopsychosocial factors. There are also various counseling theories that support and help explain the findings related to each illness.
Section I (DSM-5 Basics)
Section I of the DSM-5 briefly prefaces purpose, content, structure, and use. This includes basics, introductions and cautionary statements for forensic use. Information is also given about the revision and review processes as well as the DSM-5's goals to harmonize with the ICD-11. An explanation regarding the change from the previous multi-axial classification system to the current three section system is also included here.
Section II (Diagnostic Criteria and Codes)
Section II of the DSM-5 Contains a wide range of diagnostic criteria and codes used for establishing, and diagnosing the vast amount of abnormal psychological constructs. This sections replaced the bulk of the axis system in the previous DSM versions and includes the following categories:
Diagnostic Criteria and codes
Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and related Disorders
Trauma and Stressor related disorders
Dissociative Disorders
Somatic Symptom and Related Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse Control, and Conduct Disorders
Substance Related and Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Medication induced movement disorders and effects of medication.
Other Mental disorders and additional Codes
These categories are used to organize the various Abnormal psychological concepts based on their similarity.
Section III (Emerging Measures and Models)
Section III of the DSM-5 contains the various methods and strategies that are used to make clinical decisions, understand culture, and explore emerging diagnoses.
ICD-10
The major international nosologic system for the classification of mental disorders can be found in the International Classification of Diseases, 10th revision (ICD-10). The ICD-10 has been used by World Health Organization (WHO) Member States since 1994. Chapter five covers some 300 mental and behavioral disorders. The ICD-10's chapter five has been influenced by APA's DSM-IV and there is a great deal of concordance between the two. Beginning in January 2022, the ICD-11 will replace the ICD-10 in WHO member states. WHO maintains free access to the ICD-10 Online. Below are the main categories of disorders:
F00–F09 Organic, including symptomatic, mental disorders
F10–F19 Mental and behavioral disorders due to psychoactive substance use
F20–F29 Schizophrenia, schizotypal and delusional disorders
F30–F39 Mood [affective] disorders
F40–F48 Neurotic, stress-related and somatoform disorders
F50–F59 Behavioral syndromes associated with physiological disturbances and physical factors
F60–F69 Disorders of adult personality and behavior
F70–F79 Intellectual Disability
F80–F89 Disorders of psychological development
F90–F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F99 Unspecified mental disorder
ICD-11
The ICD-11 is the most recent version of the International Classification of Diseases. The Mental, behavioral, or Neurodevelopmental disorders section highlights forms of abnormal psychology.
Mental, behavioral, or Neurodevelopmental disorders
6A00-6A0Z Neurodevelopmental disorders
6A20-6A2Z Schizophrenia or other primary psychotic disorders
6A40-6A4Z Catatonia
6A60-6A8Z Mood Disorders
6B00-6B0Z Anxiety or fear related disorders
6B20-6B2Z Obsessive-compulsive or related disorders
6B40-6B4Z Disorders specifically associated with stress
6B60-6B6Z Dissociative disorders
6B80-6B8Z Feeding or eating disorders
6C00-6C0Z Elimination Disorders
6C20-6C2Z Disorders of bodily distress or bodily experience
Disorders due to substance use or addictive behaviors
6C70-6C7Z Impulse control disorders
6C90-6C9Z Disruptive behavior or dissocial disorders
6D10-6E68 personality disorders and related traits
6D30-6D3Z Paraphilic disorders
6D50-6D5Z Factitious disorders
6D70-6E0Z Neurocognitive disorders
6E20-6E2Z Mental or behavioral disorders associated with pregnancy, childbirth or the puerperium
6E40.0-6E40.Z (6E40) Psychological or behavioral factors affecting disorders or diseases classified elsewhere
6E60-6E6Z secondary mental or behavioral syndromes associated with disorders or diseases classified elsewhere
Perspectives of abnormal psychology
Psychologists may use different perspectives to try to get better understanding on abnormal psychology. Some of them may just concentrate on a single perspective. But the professionals prefer to combine two or three perspectives together in order to get significant information for better treatments.
Behavioral – the perspective focus on observable behaviors
Medical – the perspective focus on biological causes on mental illness
Cognitive – the perspective focus on how internal thoughts, perceptions and reasoning contribute to psychological disorders
Cause
Genetics
Investigated through family studies, mainly of monozygotic (identical) and dizygotic (fraternal) twins, often in the context of adoption. Monozygotic twins should be more likely than dizygotic twins to have the same disorder because they share 100% of their genetic material, whereas dizygotic twins share only 50%. For many disorders, this is exactly what research shows. But given that monozygotic twins share 100% of their genetic material, it may be expected of them to have the same disorders 100% of the time, but in fact they have the same disorders only about 50% of the time
These studies allow calculation of a heritability coefficient.
Genetic vulnerabilities (Diathesis stress Model)
Biological causal factors
Neurotransmitter [imbalances of neurotransmitters like norepinephrine, dopamine, serotonin and GABA (Gamma aminobutyric acid)] and hormonal imbalances in the brain
Constitutional liabilities [physical handicaps and temperament]
Brain dysfunction and neural plasticity
Physical deprivation or disruption [deprivation of basic physiological needs]
Socio-cultural factors
Effects of urban/rural dwelling, gender and minority status on state of mind
Generalizations about cultural practices and beliefs may fail to capture the diversity that exists within and across cultural groups, so we must be extremely careful not to stereotype individuals of any cultural group
Experiences with child physical and or sexual abuse.
Encounters with environments that involve actual or threatened death
Systemic factors
Family systems
Negatively Expressed Emotion playing a part in schizophrenic relapse and anorexia nervosa.
Biopsychosocial factors
Illness dependent on stress "triggers".
Therapies
Psychoanalysis (Freud)
Psychoanalytic theory is heavily based on the theory of the neurologist Sigmund Freud. These ideas often represented repressed emotions and memories from a patient's childhood within their unconscious. According to psychoanalytic theory, these repressions cause the disturbances that people experience in their daily lives, and by finding the source of these disturbances, one should be able to eliminate the disturbance itself. This is accomplished by a variety of methods, with some popular ones being free association, hypnosis, and insight. The goal of these methods is to induce a catharsis, or emotional release in the patient, which should indicate that the source of the problem has been tapped, and it can then be treated. Freud's psychosexual stages also played a key role in this form of therapy, as he would often believe that the problems the patient was experiencing were due to them becoming stuck, or "fixated", in a particular stage. Dreams also played a major role in this form of therapy, as Freud viewed dreams as a way to gain insight into the unconscious mind. Patients were often asked to keep dream journals to bring in for discussion during the next therapy session. There are many potential problems associated with this style of therapy, including resistance to the repressed memory or feeling, and negative transference onto the therapist. Psychoanalysis was carried on by many after Freud, including his daughter Anna Freud, and Jacques Lacan. Many others have also gone on to elaborate on Freud's original theory, and to add their own take on defense mechanisms or dream analysis. While psychoanalysis has fallen out of favor to more modern forms of therapy, it is still used by some clinical psychologists to varying degrees.
Behavioral therapy (Wolpe)
Behavior therapy relies on the principles of behaviorism, such as involving classical and operant conditioning. Behaviorism arose in the early 20th century, from the work of psychologists such as James Watson and B. F. Skinner. Behaviorism states that all behaviors humans do is because of a stimulus and reinforcement. While this reinforcement is normally for good behavior, it can also occur for maladaptive behavior. In this therapeutic view, the patients maladaptive behavior has been reinforced, which will cause the maladaptive behavior to be repeated. The goal of the therapy is to reinforce less maladaptive behaviors, so that with time, these adaptive behaviors will become the primary ones in the patient.
Humanistic therapy (Rogers)
Humanistic therapy aims to achieve self-actualization (Carl Rogers, 1961). In this style of therapy, the therapist will focus on the patient themselves, as opposed to the patient's problem. The goal of this therapy is, by treating the patient as "human", rather than "client", to get to the source of the problem, and to resolve the problem in an effective manner. Humanistic therapy has been on the rise in recent years, and has been associated with numerous positive benefits. It is considered to be one of the core elements needed for therapeutic effectiveness, and a significant contributor to not only the well-being of the patient, but society as a whole. Some say that all of the therapeutic approaches today draw from the humanistic approach in some regard, and that humanistic therapy is the best way for treat a patient. Humanistic therapy can be used on people of all ages; it is very popular among children in its variant known as "play therapy".
Cognitive behavioural therapy (Ellis and Beck)
Cognitive behavioural therapy (CBT) aims to influence thought and cognition (Beck, 1977). This form of therapy relies on not only the components of behavioral therapy as mentioned before, but also the elements of cognitive psychology. This relies on not only the clients behavioral problems that could have arisen from conditioning, but also their negative schemas and distorted perceptions of the world around them. These negative schemas may cause distress in the life of the patient; for example, the schemas may give them unrealistic expectations for how well they should perform at their job, or how they should look physically. When these expectations are not met, it will often result in maladaptive behaviors, such as depression, obsessive compulsions, and anxiety. With CBT, the goal is to change the schemas that are causing the stress in the patients life, and replace them with more realistic ones. Once the negative schemas have been replaced, it will hopefully cause a remission of the patients symptoms. CBT is considered particularly effective in the treatment of depression, and has even been used in recent years in group settings. It is felt that using CBT in a group setting aids in giving its members a sense of support, and decreasing the likelihood of them dropping out of therapy before the treatment has had time to work properly. CBT has been found to be an effective treatment for many patients, even those who do not have diseases and disorders typically thought of as psychiatric ones. For example, patients with the disease multiple sclerosis have found a lot of help using CBT. The treatment often helps the patients cope with the disorder they have, and how they can adapt to their new lives without developing new problems, such as depression, or negative schemas about themselves.
According to RAND, therapies are difficult to provide to all patients in need. A lack of funding and understanding of symptoms provides a major roadblock that is not easily avoided. Individual symptoms and responses to treatments vary, which creates a disconnect between patient, society, and care givers/professionals.
Play therapy (Humanistic)
Children are often sent to therapy due to outbursts that they have in a school or home setting; the theory is that by treating the child in a setting that is similar to the area that they are having their disruptive behavior, the child will be more likely to learn from the therapy, and have an effective outcome. In play therapy, the clinicians will "play" with their client, usually with toys, or a tea party. Playing is the typical behavior of a child, and therefore, playing with the therapist will come as a natural response to the child. In playing together, the clinician will ask the patient questions, and due to the setting, the questions seem less intrusive, more therapeutic, and more like a normal conversation. This should help the patient realize issues they have, and confess them to the therapist with less difficulty than they may experience in a traditional counselling setting.
Play therapy involves a therapist observing a child as the child plays with toys and interacts with their surrounding environment. The therapist plays an observational, as well as an interactional role, in the intervention. This process allows for the child to enact their problems through play, and speak more comfortably with the therapist. Although somewhat controversial, due to data that suggests a lack of effectiveness in children older than 10 years old, play therapy has been shown to be a valuable treatment. This therapy is particularly useful for younger children under the age of 10, who are consciously aware of their environment. Play therapy is important, seeing as many therapeutic interventions that are effective for adults have shown to be less effective for children.
Family systems therapies
Family systems therapies are based on the belief that children's problems revolve around problems that occur within the family. Family systems therapy attempts to improve the relations between multiple people involved in specific families via therapeutic intervention. For the best effect, it is recommended that the entire family be included in the therapy. The treatments include family management skill development, and child–parent attachment development. These interventions help to improve family functioning.
Family management skill development (Family systems therapy)
Family management skills can be taught by family therapists, and include methods such as improving supervision, disciplinary practices, and creating environments that allow for positive interactions between parents and children.
Child–parent attachment development (Family systems therapy)
Child–parent attachment development involves altering or creating relationships between parents and children, in attempts to create secure bases for the child, and to facilitate trust, independence, and positive perceptions of family relationships. We see these situations a lot more than we think which makes some spectrums of abnormal psychology more normal, and more common. These goals are often achieved by creating understanding regarding behaviors, creating opportunities for attachment, and increasing the family's ability to think about their history and relationships.
Stigmatization and Negative Connotations
One of the primary criticisms of the term "Abnormal Psychology" is its contribution to the stigmatization of individuals with mental health conditions. The label "abnormal" implies a deviation from a societal norm, which can reinforce negative stereotypes and social exclusion. Critics argue that such language can lead to individuals feeling marginalized, perpetuating a sense of "otherness" and reinforcing the stigma associated with mental health issues.
See also
Notes
References
Further reading
External links
Abnormal Psychology Students Practice Resources
Psychology Terms – a 600-page dictionary pdf
A Course in Abnormal Psychology
References
Clinical psychology
Behavioural sciences | 0.764369 | 0.995568 | 0.760982 |
Tinbergen's four questions | Tinbergen's four questions, named after 20th century biologist Nikolaas Tinbergen, are complementary categories of explanations for animal behaviour. These are also commonly referred to as levels of analysis. It suggests that an integrative understanding of behaviour must include ultimate (evolutionary) explanations, in particular:
behavioural adaptive functions
phylogenetic history; and the proximate explanations
underlying physiological mechanisms
ontogenetic/developmental history.
Four categories of questions and explanations
When asked about the purpose of sight in humans and animals, even elementary-school children can answer that animals have vision to help them find food and avoid danger (function/adaptation). Biologists have three additional explanations: sight is caused by a particular series of evolutionary steps (phylogeny), the mechanics of the eye (mechanism/causation), and even the process of an individual's development (ontogeny). This schema constitutes a basic framework of the overlapping behavioural fields of ethology, behavioural ecology, comparative psychology, sociobiology, evolutionary psychology, and anthropology. Julian Huxley identified the first three questions. Niko Tinbergen gave only the fourth question, as Huxley's questions failed to distinguish between survival value and evolutionary history; Tinbergen's fourth question helped resolve this problem.
Evolutionary (ultimate) explanations
First question: Function (adaptation)
Darwin's theory of evolution by natural selection is the only scientific explanation for why an animal's behaviour is usually well adapted for survival and reproduction in its environment. However, claiming that a particular mechanism is well suited to the present environment is different from claiming that this mechanism was selected for in the past due to its history of being adaptive.
The literature conceptualizes the relationship between function and evolution in two ways. On the one hand, function and evolution are often presented as separate and distinct explanations of behaviour. On the other hand, the common definition of adaptation is a central concept in evolution: a trait that was functional to the reproductive success of the organism and that is thus now present due to being selected for; that is, function and evolution are inseparable. However, a trait can have a current function that is adaptive without being an adaptation in this sense, if for instance the environment has changed. Imagine an environment in which having a small body suddenly conferred benefit on an organism when previously body size had had no effect on survival. A small body's function in the environment would then be adaptive, but it would not become an adaptation until enough generations had passed in which small bodies were advantageous to reproduction for small bodies to be selected for. Given this, it is best to understand that presently functional traits might not all have been produced by natural selection. The term "function" is preferable to "adaptation", because adaptation is often construed as implying that it was selected for due to past function. This corresponds to Aristotle's final cause.
Second question: Phylogeny (evolution)
Evolution captures both the history of an organism via its phylogeny, and the history of natural selection working on function to produce adaptations. There are several reasons why natural selection may fail to achieve optimal design (Mayr 2001:140–143; Buss et al. 1998). One entails random processes such as mutation and environmental events acting on small populations. Another entails the constraints resulting from early evolutionary development. Each organism harbors traits, both anatomical and behavioural, of previous phylogenetic stages, since many traits are retained as species evolve.
Reconstructing the phylogeny of a species often makes it possible to understand the "uniqueness" of recent characteristics: Earlier phylogenetic stages and (pre-) conditions which persist often also determine the form of more modern characteristics. For instance, the vertebrate eye (including the human eye) has a blind spot, whereas octopus eyes do not. In those two lineages, the eye was originally constructed one way or the other. Once the vertebrate eye was constructed, there were no intermediate forms that were both adaptive and would have enabled it to evolve without a blind spot.
It corresponds to Aristotle's formal cause.
Proximate explanations
Third question: Mechanism (causation)
Some prominent classes of Proximate causal mechanisms include:
The brain: For example, Broca's area, a small section of the human brain, has a critical role in linguistic capability.
Hormones: Chemicals used to communicate among cells of an individual organism. Testosterone, for instance, stimulates aggressive behaviour in a number of species.
Pheromones: Chemicals used to communicate among members of the same species. Some species (e.g., dogs and some moths) use pheromones to attract mates.
In examining living organisms, biologists are confronted with diverse levels of complexity (e.g. chemical, physiological, psychological, social). They therefore investigate causal and functional relations within and between these levels. A biochemist might examine, for instance, the influence of social and ecological conditions on the release of certain neurotransmitters and hormones, and the effects of such releases on behaviour, e.g. stress during birth has a tocolytic (contraction-suppressing) effect.
However, awareness of neurotransmitters and the structure of neurons is not by itself enough to understand higher levels of neuroanatomic structure or behaviour: "The whole is more than the sum of its parts." All levels must be considered as being equally important: cf. transdisciplinarity, Nicolai Hartmann's "Laws about the Levels of Complexity."
It corresponds to Aristotle's efficient cause.
Fourth question: Ontogeny (development)
Ontogeny is the process of development of an individual organism from the zygote through the embryo to the adult form.
In the latter half of the twentieth century, social scientists debated whether human behaviour was the product of nature (genes) or nurture (environment in the developmental period, including culture).
An example of interaction (as distinct from the sum of the components) involves familiarity from childhood. In a number of species, individuals prefer to associate with familiar individuals but prefer to mate with unfamiliar ones (Alcock 2001:85–89, Incest taboo, Incest). By inference, genes affecting living together interact with the environment differently from genes affecting mating behaviour. A simple example of interaction involves plants: Some plants grow toward the light (phototropism) and some away from gravity (gravitropism).
Many forms of developmental learning have a critical period, for instance, for imprinting among geese and language acquisition among humans. In such cases, genes determine the timing of the environmental impact.
A related concept is labeled "biased learning" (Alcock 2001:101–103) and "prepared learning" (Wilson, 1998:86–87). For instance, after eating food that subsequently made them sick, rats are predisposed to associate that food with smell, not sound (Alcock 2001:101–103). Many primate species learn to fear snakes with little experience (Wilson, 1998:86–87).
See developmental biology and developmental psychology.
It corresponds to Aristotle's material cause.
Causal relationships
The figure shows the causal relationships among the categories of explanations. The left-hand side represents the evolutionary explanations at the species level; the right-hand side represents the proximate explanations at the individual level. In the middle are those processes' end products—genes (i.e., genome) and behaviour, both of which can be analyzed at both levels.
Evolution, which is determined by both function and phylogeny, results in the genes of a population. The genes of an individual interact with its developmental environment, resulting in mechanisms, such as a nervous system. A mechanism (which is also an end-product in its own right) interacts with the individual's immediate environment, resulting in its behaviour.
Here we return to the population level. Over many generations, the success of the species' behaviour in its ancestral environment—or more technically, the environment of evolutionary adaptedness (EEA) may result in evolution as measured by a change in its genes.
In sum, there are two processes—one at the population level and one at the individual level—which are influenced by environments in three time periods.
Examples
Vision
Four ways of explaining visual perception:
Function: To find food and avoid danger.
Phylogeny: The vertebrate eye initially developed with a blind spot, but the lack of adaptive intermediate forms prevented the loss of the blind spot.
Mechanism: The lens of the eye focuses light on the retina.
Development: Neurons need the stimulation of light to wire the eye to the brain (Moore, 2001:98–99).
Westermarck effect
Four ways of explaining the Westermarck effect, the lack of sexual interest in one's siblings (Wilson, 1998:189–196):
Function: To discourage inbreeding, which decreases the number of viable offspring.
Phylogeny: Found in a number of mammalian species, suggesting initial evolution tens of millions of years ago.
Mechanism: Little is known about the neuromechanism.
Ontogeny: Results from familiarity with another individual early in life, especially in the first 30 months for humans. The effect is manifested in nonrelatives raised together, for instance, in kibbutzs.
Romantic love
Four ways of explaining romantic love have been used to provide a comprehensive biological definition (Bode & Kushnick, 2021):
Function: Mate choice, courtship, sex, pair-bonding.
Phylogeny: Evolved by co-opting mother-infant bonding mechanisms sometime in the recent evolutionary history of humans.
Mechanisms: Social, psychological mate choice, genetic, neurobiological, and endocrinological mechanisms cause romantic love.
Ontogeny: Romantic love can first manifest in childhood, manifests with all its characteristics following puberty, but can manifest across the lifespan.
Sleep
Sleep has been described using Tinbergen's four questions as a framework (Bode & Kuula, 2021):
Function: Energy restoration, metabolic regulation, thermoregulation, boosting immune system, detoxification, brain maturation, circuit reorganization, synaptic optimization, avoiding danger.
Phylogeny: Sleep exists in invertebrates, lower vertebrates, and higher vertebrates. NREM and REM sleep exist in eutheria, marsupialiformes, and also evolved in birds.
Mechanisms: Mechanisms regulate wakefulness, sleep onset, and sleep. Specific mechanisms involve neurotransmitters, genes, neural structures, and the circadian rhythm.
Ontogeny: Sleep manifests differently in babies, infants, children, adolescents, adults, and older adults. Differences include the stages of sleep, sleep duration, and sex differences.
Use of the four-question schema as "periodic table"
Konrad Lorenz, Julian Huxley and Niko Tinbergen were familiar with both conceptual categories (i.e. the central questions of biological research: 1. - 4. and the levels of inquiry: a. - g.), the tabulation was made by Gerhard Medicus. The tabulated schema is used as the central organizing device in many animal behaviour, ethology, behavioural ecology and evolutionary psychology textbooks (e.g., Alcock, 2001). One advantage of this organizational system, what might be called the "periodic table of life sciences," is that it highlights gaps in knowledge, analogous to the role played by the periodic table of elements in the early years of chemistry.
This "biopsychosocial" framework clarifies and classifies the associations between the various levels of the natural and social sciences, and it helps to integrate the social and natural sciences into a "tree of knowledge" (see also Nicolai Hartmann's "Laws about the Levels of Complexity"). Especially for the social sciences, this model helps to provide an integrative, foundational model for interdisciplinary collaboration, teaching and research (see The Four Central Questions of Biological Research Using Ethology as an Example – PDF).
References
Sources
Alcock, John (2001) Animal Behaviour: An Evolutionary Approach, Sinauer, 7th edition. .
Buss, David M., Martie G. Haselton, Todd K. Shackelford, et al. (1998) "Adaptations, Exaptations, and Spandrels," American Psychologist, 53:533–548. http://www.sscnet.ucla.edu/comm/haselton/webdocs/spandrels.html
Buss, David M. (2004) Evolutionary Psychology: The New Science of the Mind, Pearson Education, 2nd edition. .
Cartwright, John (2000) Evolution and Human Behaviour, MIT Press, .
Krebs, John R., Davies N.B. (1993) An Introduction to Behavioural Ecology, Blackwell Publishing, .
Lorenz, Konrad (1937) Biologische Fragestellungen in der Tierpsychologie (I.e. Biological Questions in Animal Psychology). Zeitschrift für Tierpsychologie, 1: 24–32.
Mayr, Ernst (2001) What Evolution Is, Basic Books. .
Gerhard Medicus (2017, chapter 1). Being Human – Bridging the Gap between the Sciences of Body and Mind, Berlin VWB
Medicus, Gerhard (2017) Being Human – Bridging the Gap between the Sciences of Body and Mind. Berlin: VWB 2015,
Nesse, Randolph M (2013) "Tinbergen's Four Questions, Organized," Trends in Ecology and Evolution, 28:681-682.
Moore, David S. (2001) The Dependent Gene: The Fallacy of 'Nature vs. Nurture''', Henry Holt. .
Pinker, Steven (1994) The Language Instinct: How the Mind Creates Language, Harper Perennial. .
Tinbergen, Niko (1963) "On Aims and Methods of Ethology," Zeitschrift für Tierpsychologie, 20: 410–433.
Wilson, Edward O. (1998) Consilience: The Unity of Knowledge'', Vintage Books. .
External links
Diagrams
The Four Areas of Biology pdf
The Four Areas and Levels of Inquiry pdf
Tinbergen's four questions within the "Fundamental Theory of Human Sciences" ppt
Tinbergen's Four Questions, organized pdf
Derivative works
On aims and methods of cognitive ethology (pdf) by Jamieson and Bekoff.
Behavioral ecology
Ethology
Evolutionary psychology
Sociobiology | 0.7742 | 0.982909 | 0.760968 |
Pulmonary rehabilitation | Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.
Medical uses
The NICE clinical guideline on chronic obstructive pulmonary disease states that “pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC [Medical Research Council] grade 3 and above)”. It is indicated not only in patients with COPD, but also for the following conditions:
Cystic fibrosis
Bronchitis
Sarcoidosis
Idiopathic pulmonary fibrosis
Before and after lung surgery
Interstitial lung disease: Pulmonary rehabilitation may be safe and may help improve functional exercise capacity, a person's short-term quality of life, and improve shortness of breath (dyspnoea).
Asthma: moderate quality evidence suggests asthmatics may have improvement in quality of life and exercise capacity.
Before and after lung transplant
Pulmonary hypertension: exercise-based pulmonary rehabilitation has been shown to reduce mean pulmonary artery pressure and increase exercise capacity.
Aim
To reduce symptoms
To improve knowledge of lung condition and promote self-management
To increase muscle strength and endurance (peripheral and respiratory)
To increase exercise tolerance
To reduce length of hospital stay
To help to function better in day-to-day life
To help in managing anxiety and depression
Benefits
Reduction in number of days spent in hospital one year following pulmonary rehabilitation.
Reduction in the number of exacerbations in patients who performed daily exercise when compared to those who did not exercise.
Reduced exacerbations post pulmonary rehabilitation.
Weaknesses addressed
Ventilatory limitation
Increased dead space ventilation
Impaired gas exchange
Increased ventilatory demands due to peripheral muscle dysfunction
Gas exchange limitation
Compromised functional inspiratory muscle strength
Compromised inspiratory muscle endurance
Cardiac dysfunction
Increase in right ventricular afterload due to increased peripheral vascular resistance.
Skeletal muscle dysfunction
Average reduction in quadriceps strength decreased by 20-30% in moderate to severe COPD
Reduction in the proportion of type I muscle fibres and an increase in the proportion of type II fibres compared to age matched normal subjects
Reduction in capillary to fibre ratio and peak oxygen consumption
Reduction in oxidative enzyme capacity and increased blood lactate levels at lower work rates compared to normal subjects
Prolonged periods of under nutrition which results in a reduction in strength and endurance
Respiratory muscle dysfunction
Background
Pulmonary rehabilitation is generally specific to the individual patient, with the objective of meeting the needs of the patient. It is a broad program and may benefit patients with lung diseases such as chronic obstructive pulmonary disease (COPD), sarcoidosis, idiopathic pulmonary fibrosis (IPF) and cystic fibrosis, among others. Although the process is focused primarily on the rehabilitation of the patient, the family is also involved. The process typically does not begin until a medical examination of the patient has been performed by a licensed physician.
The setting of pulmonary rehabilitation varies by patient; settings may include inpatient care, outpatient care, the office of a physician, or the patient's home.
Although there are no universally accepted procedure codes for pulmonary rehabilitation, providers usually use codes for general therapeutic processes.
The goal of pulmonary rehabilitation is to help improve the well-being and quality of life of the patient and their families. Accordingly, programs typically focus on several aspects of the patient's recovery and can include medication management, exercise training, breathing retraining, education about the patient's lung disease and how to manage it, nutrition counseling, and emotional support.
Pharmacologic intervention
Medications may be used in the process of pulmonary rehabilitation including: anti-inflammatory agents (inhaled steroids), bronchodilators, long-acting bronchodilators, beta-2 agonists, anticholinergic agents, oral steroids, antibiotics, mucolytic agents, oxygen therapy, or preventive healthcare (i.e., vaccination).
Exercise
Exercise is the cornerstone of pulmonary rehabilitation programs. Although exercise training does not directly improve lung function, it causes several physiological adaptations to exercise that can improve physical condition. There are three basic types of exercises to be considered. Aerobic exercise tends to improve the body's ability to use oxygen by decreasing heart rate and blood pressure. Strengthening or resistance exercises can help build strength in the respiratory muscles. Stretching and flexibility exercises like yoga and Pilates can enhance breathing coordination. As exercise can trigger shortness of breath, it is important to build up the level of exercise gradually under the supervision of health care professionals (e.g., respiratory therapist, physiotherapist, exercise physiologist). Additionally, pursed lip breathing can be used to increase oxygen level in the patient's body. Breathing games can be used to motivate patients to learn the pursed lip breathing technique.
Guidelines
Clinical practice guidelines have been issued by various regulatory authorities.
American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation has provided evidence-based guidelines in 1997 and has updated it.
British Thoracic Society Standards of Care (BTS) Subcommittee on Pulmonary Rehabilitation has published its guidelines in 2001.
Canadian Thoracic Society (CTS) 2010 Guideline: Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease.
National Institute for Health and Care Excellence (NICE) Guidelines
Contraindications
The exclusion criteria for pulmonary rehabilitation consists of the following:
Unstable cardiovascular disease
Orthopaedic contraindications
Neurological contraindication
Unstable pulmonary disease
Outcome
The clinical improvement in outcomes due to pulmonary rehabilitation is measurable through:
Exercise testing using exercise time
Walk test using the 6-minute walk test
Exertion and overall dyspnoea using the Borg scale
Respiratory specific functional status has been shown to improve using the CAT Score
References
Medical treatments
Respiratory therapy | 0.771378 | 0.986502 | 0.760966 |
Immature personality disorder | Immature personality disorder was a type of personality disorder diagnosis. It is characterized by lack of emotional development, low tolerance of stress and anxiety, inability to accept personal responsibility, and reliance on age-inappropriate defense mechanisms.
It has been noted for displaying "an absence of mental disability", and demonstrating "ineffectual responses to social, psychological and physical demands."
History
The definition borrowed by the first edition of the DSM (see Diagnosis) was originally published in the Army Service Forces's Medical 203 in 1945 under Immaturity Reactions. It had five subtypes:
Emotional instability reaction (later histrionic personality disorder): excitability, ineffectiveness, undependable judgement, poorly controlled hostility, guilt and anxiety;
Passive-dependency reaction (later dependent personality disorder): helplessness, indecisiveness, tendency to cling to others;
Passive-aggressive reaction (later passive-aggressive personality disorder): pouting, stubbornness, procrastination, inefficiency, passive obstructionism;
Aggressive reaction: irritability, temper tantrums, destructive behavior;
Immaturity with symptomatic "habit" reaction: e.g. speech disorder brought on by stress.
Diagnosis
DSM
Immature personality (321), as "Personality trait disturbance", only appeared in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), separately from personality disorders. The DSM defines the condition as follows:
Some of its subtypes became separate conditions (see History). In DSM-II "immature" became a type specifier for Other personality disorder (301.89), and remained unchanged in the DSM-III. The condition does not appear in later editions.
ICD
The International Classification of Diseases (ICD) also listed the condition as Immature personality (321) in the ICD-6 and ICD-7. The ICD-8 introduced Other personality disorder (301.8) which became the main diagnosis adding "immature" as a type specifier. This classification was shared by the ICD-9 and ICD-10. The specifier was removed in ICD-11.
Mechanics
Early explanations
The underlying mechanism of the disorder was originally explained either as fixation (certain character patterns persisting from childhood to adult life), or as a regressive reaction due to severe stress (reversion to an earlier stage of development).
Poor emotional control "require[s] quick mobilization of defense, usually explosive in nature, for the protection of the ego." In case of dependency "there is a predominant child-parent relationship." The "morbid resentment" of the aggressive type is the result of a "deep dependency" hidden by reaction formation.
Later developments
IPD involves a weakness of the ego, which limits the ability to restrain impulses or properly model anxiety. They fail to integrate the aggressive and libidinal factors at play in other people, and thus are not able to parse their own experiences.
It can be caused by a neurobiological immaturity of brain functioning, or through a childhood trauma, or other means.
Prevalence
Determining the prevalence of the disorder in the general population would be difficult because it has not had a separate diagnosis since World War II. As part of Other personality disorder it can be estimated to be a fraction of 1.6% in the United States and 2.4% in Denmark.
A Russian study of military age persons in the Tomsk region between 2016 and 2018 reported that mental and behavioral disorders were detected in 93 out of 685 recruits. 3.6% (25 of them) could be diagnosed with immature personality disorder.
In law and custom
In the 1980s, it was noted that immature personality disorder was one of the most common illnesses invoked by the Roman Catholic Church in order to facilitate annulment of undesired marriages.
In 1978, David Augustine Walton was tried in Barbados for killing two passersby who had offered his mother and girlfriend a ride following an argument, and pleaded diminished capacity resulting from his immature personality disorder; he was nevertheless convicted of murder.
In 1989, a former employee of the Wisconsin Department of Transportation had his claim of discrimination dismissed, after alleging that his employment had been terminated due to his Immature Personality Disorder alongside a sexual fetish in which he placed chocolate bars under the posteriors of women whose driving capabilities he was testing.
A 1994 Australian case regarding unemployment benefits noted that while "mere personal distaste for certain work is not relevant, but a condition (such as immature personality disorder) may foreclose otherwise suitable prospects".
A 2017 study indicated that an individual with immature personality disorder (among other people with personality disorders) was allowed to die through Belgian euthanasia laws that require a medical diagnosis of a life-long condition that could impair well-being.
Notes
References
Personality disorders | 0.767882 | 0.990982 | 0.760957 |
Frailty syndrome | Frailty is a common and clinically significant grouping of symptoms that occurs in aging and older adults. These symptoms can include decreased physical abilities such as walking, excessive fatigue, and weight and muscle loss leading to declined physical status. In addition, frailty encompasses a decline in both overall physical function and physiologic reserve of organ systems resulting in worse health outcomes for this population. This syndrome is associated with increased risk of heart disease, falls, hospitalization, and death. In addition, it has been shown that adults living with frailty face more anxiety and depression symptoms than those who do not. The presence of frailty varies based on the assessment technique, however it is estimated that 4-16% of the population over 65 years old is living with frailty.
Frailty can have impacts on public health due to the factors that comprise the syndrome affecting physical and mental health outcomes. There are several ways to identify, prevent, and mitigate the prevalence of frailty and the evaluation of frailty can be done through clinical assessments created to combine recognized signs and symptoms of frailty.
Definitions
Frailty refers to an age-related functional decline and heightened state of vulnerability. It is a worsening of functional status compared to the normal physiological process of aging. It can refer to the combination of a decline of physical and physiological aspects of a human body. The reduced reserve capacity of organ systems, muscle, and bone create a state where the body is not capable of coping with stressors such as illness or falls. Frailty can lead to increased risk of adverse side effects, complications, and mortality.
Older age by itself is not what defines frailty, it is however a syndrome found in older adults. Many adults over 65 are not living with frailty. Frailty is not one specific disease, however is a combination of many factors. Frailty does not have a specific universal criteria on which it is diagnosed; there are a combination of signs and symptoms that can lead to a diagnosis of frailty. Evaluations can be done on physical staus, weight fluctuations, or subjective symptoms. Frailty most commonly refers to physical status and is not a syndrome of mental capacity such as dementia, which is a decline in cognitive function. Although, frailty can be a risk factor for the development of dementia.
Although no universal diagnostic criteria exist, some clinical screening tools are commonly used to identify frailty. These include the Fried Frailty Phenotype and a deficit accumulation frailty index. The Fried Frailty Phenotype assesses five domains commonly affected by frailty: exhaustion, weakness, slowness, physical inactivity, and weight loss. The presence of 1-2 findings is classified as "pre-frailty", 3 or more as frailty and the presence of all 5 indicates "end-stage frailty" and is associated with poor prognosis. The deficit accumulation characterization of frailty tallies deficits present in a variety of clinical areas (including nutritional deficiency, laboratory abnormalities, disability index, cognitive and physical impairment) to create a frailty index. A higher number of deficits is associated with a worse prognosis.
Geriatric syndromes related to frailty
Major Contributors to Frailty
Decreases in skeletal muscle mass (sarcopenia) and bone density are two major contributors to developing frailty in older adults. In early to middle age, bone density and muscle mass are closely related. As adults age, skeletal muscle mass or bone density may begin to decline. This decline can lead to frailty and both have been identified as contributors to disability. The development of sarcopenia or osteoporosis alone does not establish frailty, as there are many factors that are taken into account. Studies suggest that frailty is a result of multiple body systems experiencing dysregulation, and the more body systems that are affected, the higher the risk is for developing frailty.
Sarcopenia
Sarcopenia is the degenerative loss of skeletal muscle mass, quality, and strength associated with aging. The rate of muscle loss is dependent on exercise level, co-morbidities, nutrition and other factors. Sarcopenia can lead to reduction in functional status and cause significant disability from increased weakness. The muscle loss is related to changes in muscle synthesis signalling pathways although is incompletely understood. The cellular mechanisms are distinct from other types of muscle atrophy such as cachexia, in which muscle is degraded through cytokine-mediated degradation although both conditions may co-exist.
Osteoporosis
Osteoporosis is a disease of bone mineral density loss (usually age related) that leads to an increased risk of bone fractures, especially with falls. Frailty is associated with an increased risk of osteoporosis related bone fractures.
Muscle weakness
Muscle weakness and associated muscle atrophy (muscle wasting, also known as sarcopenia) are more common in those with frailty. The prevalence of muscle weakness was more common in those with frailty in a population based study of older adults. Aging, lower levels of DHEA, testosterone, IGF-1 and increased levels of cortisol are thought to contribute to muscle wasting in those with frailty.
Heart Failure
Frailty is also common in those with heart failure. Both frailty and heart failure share similar methods of progressive health decline and often lead to worsened health conditions when combined.
Depression, Bipolar Disorder, & Anxiety Disorders
People who had mental disorders were found to be at increased risk of frailty.
Biological and physiological mechanisms
The causes of frailty are multifactorial involving dysregulation across many physiological systems. Frailty may be related to a proinflammatory state. A common interleukin elevated in this state is IL-6. A pro-inflammatory cytokine, IL-6 was found to be common in older adults with frailty. IL-6 is typically up-regulated by inflammatory mediators, such as C-reactive protein, released in the presence of chronic disease. Increased levels of inflammatory mediators are often associated with chronic disease; however, they may also be elevated even in the absence of chronic disease.
Sarcopenia, anemia, anabolic hormone deficiencies, and excess exposure to catabolic hormones such ascortisol have been associated with an increased likelihood of frailty. Other mechanisms associated with frailty include insulin resistance, increased glucose levels, compromised immune function, micronutrient deficiencies, and oxidative stress.
Mitochondrial dysfunction, including mitochondrial DNA mutations, cellular respiration dysfunction, and changes in mitochondrial hemostasis is thought to contribute to reduced cellular energy, production of reactive oxygen species and inflammation. This mitochondrial dysfunction is thought to contribute to the signs of frailty.
Researchers found that individual abnormal body functions may not be the best predictor of risk of frailty. However, they did conclude that once the number of conditions reaches a certain threshold, the risk of frailty increases. This finding suggests that treatment of frailty syndrome should not be focused on a single condition, but a multitude in order to increase the likelihood of better treatment results.
Theoretical understanding
Declines in physiologic reserves and resilience contribute to frailty. The risk of frailty increases with age and with the incidence of diseases. The development of frailty is also thought to involve declines in energy production, energy utilization and repair systems in the body, resulting in declines in the function of many different physiological systems. This decline in multiple systems affects the normal complex adaptive behavior that is essential to health and eventually results in frailty.
A comparison of peripheral blood mononuclear cells from frail older individuals to cells from healthy younger individuals showed evidence in the frail older individuals of increased oxidative stress, increased apurinic/pyrimidinic sites in DNA, increased accumulation of endogenous DNA damage and reduced ability to repair DNA double-strand breaks.
Frailty assessment
The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. Generally speaking, the empirical assessment of geriatric frailty in individuals seeks ultimately to capture this or related features, though distinct approaches to such assessment have been developed in the literature (see de Vries et al., 2011 for a comprehensive review).
Two most widely used approaches, different in their nature and scopes, are discussed below. Other approaches follow.
Physical frailty phenotype
A popular approach to the assessment of geriatric frailty encompasses the assessment of five dimensions that are hypothesized to reflect systems whose impaired regulation underlies the syndrome. These five dimensions are:
unintentional weight loss
exhaustion
muscle weakness
slowness while walking
low levels of activity
These five dimensions form specific criteria indicating adverse functioning, which are implemented using a combination of self-reported and performance-based measures. Those who meet at least three of the criteria are defined as "frail", while those not matching any of the five criteria are defined as "robust".
Frailty index/deficit accumulation
Another notable approach to the assessment of geriatric frailty in which frailty is viewed in terms of the number of health "deficits" that are manifest in the individual, leading to a continuous measure of frailty. This score is based the presence of deficits in may areas related to frailty, including symptoms of cognitive or physical impairment, laboratory abnormalities, nutritional deficits, or disability.
Four domains of frailty
A model consisting of four domains of frailty was proposed in response to an article in the BMJ. This conceptualisation could be viewed as blending the phenotypic and index models. Researchers tested this model for signal in routinely collected hospital data, and then used this signal in the development of a frailty model, finding even predictive capability across 3 outcomes of care. In the care home setting, one study indicated that not all four domains of frailty were routinely assessed in residents, giving evidence to suggest that frailty may still primarily be viewed only in terms of physical health.
SHARE Frailty Index
The SHARE-Frailty Index (SHARE-FI) assesses frailty based on five domains of the frailty phenotype:
Fatigue
Loss of appetite
Grip strength
Functional difficulties
Physical activity
Clinical Frailty Scale
The Clinical Frailty Scale (CFS) is a scale used to assess frailty which was evolved from the Canadian Study of Health and Aging. It is a 9-point scale used to assess a persons frailty level, where a score of 1 point would mean a person is very fit and robust, to a score of 9 points meaning the person is severely frail and terminally ill.
Edmonton Frail Scale
The Edmonton Frail Scale (EFS) is another method used to screen frailty. This scale is given scores of up to 17 points. It has been assessed to screen all domains of frailty, and is said to be easy to perform by clinicians. Specific tests used in this scaling system are walking tests and clock drawing.
Electronic Frail Scale (eFI)
The electronic Frail Scale (eFI) is a scale weighted out of 36 deficit points where the higher the number in the score will represent the more frail, or more prone to frailty. Each frailty-related deficit the person has is given a point and the more deficits the person is experiencing the more likely they are frail or will experience frailty in the future. The total number of deficits is divided by 36. Then, a frailty category is assigned. A person with a score of 0.00–0.12 is in the "Fit" category. A person with a score of 0.13–0.24 is in the "Mild" category. A person with a score of 0.25–0.36 is in the "Moderate" category. Finally, a person with the score of 0.36 or above is considered to be in the "Severe" category.
Prevention
As frailty arises as a result of reduced reserve capacity in a biological system and causes an individual to have heightened vulnerability to stress, avoiding known stressors (ie. surgeries, infections, etc.) and understanding mechanisms to reduce frailty can help older adults prevent worsening their frail status. Some signs of frailty include: unwanted weight loss, muscle weakness, low energy, and low grip strength. Currently, preventative interventions focus on minimizing muscle loss and improvement of overall well-being in older adults or individuals with chronic illnesses.
Identification of risk factors
When considering prevention of frailty, it is important to understand the risk factors that contribute to frailty and identify them early on. Early identification of risk factors allows for preventative interventions, reducing risks of future complications.
A 2005 observational study found associations between frailty and a number of risk factors such as: low income, advanced age, chronic medical conditions, lack of education, and smoking.
Exercise
A significant target in the prevention of frailty is physical activity. As people age, physical activity markedly drops, with the steepest declines seen in adolescence and continuing on throughout life. The lower levels of physical activity and are associated with and a key component of frailty syndrome. Therefore, exercise regimens consisting of walking, strength training, and self-directed physical activity, have been examined in a number of studies as an intervention to prevent frailty. A randomized control trial published in 2017 found significantly lower rates of frailty in older adults who were assigned an exercise regimen vs those who were in the control group. In this study, 15.3% of the control group became frail in the time frame of the study, in comparison to 4.9% of the exercise group. The exercise group also received a nutritional assessment, which is another target in frailty prevention.
Nutrition
Nutrition has also been a major target in the prevention of frailty. A healthy dietary pattern consisting of high consumption of healthy fats, fruits, vegetables, low-fat dairy products, and whole grains can contribute to maintaining a healthy weight and postpone frailty. A 2019 review paper examined a variety of studies and found evidence of nutritional intervention as an effective way of preventing frailty. Specifically, multiple studies showed adherence to the Mediterranean diet is associated with a decreased risk of incident frailty in the US.
Non-surgical management
Frailty management largely depends on an individual's classification (i.e. non-frail, pre-fail, and frail) and treatment needs. Currently, there is a lack of strong evidence-based treatment and management plans for frailty. Physicians must work closely with patients to develop a realistic management plan to ensure patient compliance, leading to better health outcomes. In clinical practice, guidelines developed by International Conference on Frailty and Sarcopenia Research (ICFSR) can be used to identify and manage frailty based on classification.
There are currently no pharmacological interventions available for frailty.
Exercise
Exercise is one of the major targets to prevent and manage frailty in older adults to improve and maintain mobility. Individuals partaking in exercise appear to have potential in preventing frailty. In 2018, a systemic review concluded that group exercise had the benefit of delaying frailty in older adults aged 65 and older.
Individualized physical therapy programs developed by physicians can help improve frail status. For example, progressive resistance strength training for older adults can be used in clinical practice or at-home as a way to regain mobility. A systematic review conducted in 2022 across multiple countries using data from twelve randomized clinical trials found evidence that mobility training can increase mobility level and functioning in older adults living in community-dwellings, such as a nursing home. However, the review also concluded little to no difference in the risk of falls.
Occupational therapy
Activities of daily living (ADLs) include activities that are necessary to sustain life. Examples are brushing teeth, getting out of bed, dressing oneself, bathing, etc. Occupational therapy provided modest improvements in elderly adults mobility to do ADLs.
Nutritional supplementation
Frailty can involve changes such as weight loss. Interventions should focus on any difficulties with supplementation and diet. For those who may be undernourished and not acquiring adequate calories, oral nutritional supplements in between meals may decrease nutritional deficits.
Vitamin D, omega-3 fatty acid, sex hormone (such as testosterone) or growth hormone supplementation have not shown benefits in physical functioning, activities of daily living or frailty.
Palliative care
Palliative care may be helpful for individuals who are experiencing an advanced state of frailty with possible other co-morbidities. Improving quality of life by reducing pain and other harmful symptoms is the goal with palliative care. One study showed the cost reduction by focusing on palliative care rather than other treatments that may be unnecessary and unhelpful.
Surgical outcomes
Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Frailty more than doubles the risk of morbidity and mortality from surgery and cardiovascular conditions. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories. One frailty scale consists of five items:
unintentional weight loss >4.5 kg in the past year
self-reported exhaustion
<20th population percentile for grip strength
slowed walking speed, defined as lowest population quartile on 4-minute walking test
low physical activity such that persons would only rarely undertake a short walk
A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
Another tool that has been used to predict frailty outcome post-surgery is the Modifies Frailty Index, or mFI-5. This scale consists of 5 key co-morbidities:
Congestive heart failure within 1 month of surgery
Diabetes mellitus
Chronic Obstruction Pulmonary Disease or pneumonia in the past
Individuals needing additional assistance to perform everyday activities of living
High blood pressure that is controlled with medication
An individual without one of these conditions would be given a score of 0 for the condition absent. An individual who does have one of the conditions would be given a score of 1 for each of the conditions present. In an initial study using the mFI-5 scale, individuals with a sum mFI-5 score of 2 or greater were predicted to experience post-surgery complications due to frailty, which was supported by the results of the study.
Frailty scales can be used to predict the risk of complications in patients before and after surgery. There is an association between frailty and delayed transplant function after a kidney transplant. Other studies note that frailty scales alone may be innacurate in predicting outcomes for people undergoing surgical procedures, and other factors such as co-morbid medical conditions need to be considered.
Epidemiology and public health
Frailty is a common geriatric syndrome. Due to the absence of international diagnostic criteria, the prevalence estimates may not be accurate. Estimates of frailty prevalence in older populations vary according to a number of factors, including the setting in which the prevalence is being estimated — e.g., nursing home (higher prevalence) vs. community (lower prevalence) — and the definition used for frailty. Using the widely used frailty phenotype framework, prevalence estimates of 7–16% have been reported in non-institutionalized, community-dwelling older adults. In a systemic review exploring the prevalence of frailty based on geographical location it was found that Africa and North and South America had the largest prevalence at 22% and 17% respectively. Europe had the lowest prevalence at 8%.
The development of frailty occurs most often in individuals with low socio-economic status, those living with obesity, female sex, a history of smoking, limited activity levels, and older age.
Epidemiologic research has also indicated that presence of multiple chronic diseases (such as cardiovascular disease, diabetes, or chronic kidney disease, anemia, atherosclerosis) depression, and cognitive impairment to be risk factors for frailty. Autonomic dysfunction, hormonal abnormalities, and obesity have also been implicated in the development of frailty. obesity, Vitamin D deficiency in men may be associated with increased risk of frailty. Environmental factors such as living space and neighborhood characteristics may also be related to frailty.
Frailty is more common in those with diabetes plus peripheral arterial disease and in those with heart failure.
Frailty is more common in those with mental health conditions including anxiety disorders, bipolar disorder and depression. The presence of frailty with these mental disorders was also associated with a poor prognosis and increased mortality
Research comparing case management trials to standard care for people living with frailty in high-income countries found that there was no difference in reducing cost or improving patient outcomes between the two approaches.
Sex and ethnicity differences in frailty
Meta-analyses have shown that the prevalence of frailty is higher in female older adults compared to male older adults. This sex difference was consistently found in pre-clinical research models as well. Studies have found that the incidence of frailty was higher in females with more medical comorbidities. In recent research where muscle-biopsies were taken from fit and weak older adults of both sexes, it was shown that there were sex-specific alterations in muscle content in association with frailty-related physical weakness.
In a population based study, Non-Hispanic Black-Americans and Hispanic-Americans had a higher incidence of frailty compared to non-Hispanic White-Americans.
Ongoing clinical trials
, ongoing clinical trials on frailty syndrome in the US include:
the impact of frailty on clinical outcomes of patients treated for abdominal aortic aneurysms
the use of "pre-habilitation," an exercise regimen used before transplant surgery, to prevent the frailty effects of kidney transplant in recipients
defining the acute changes in frailty following sepsis in the abdomen
the efficacy of the anti-inflammatory drug, Fisetin, in reducing frailty markers in elderly adults
Physical Performance Testing and Frailty in Prediction of Early Postoperative Course After Cardiac Surgery (Cardiostep)
See also
Ageing
Osteoporosis
Sarcopenia
References
External links
Frailty
Geriatrics
Gerontology | 0.767866 | 0.990878 | 0.760862 |
Disinhibition | Disinhibition, also referred to as behavioral disinhibition, is medically recognized as an orientation towards immediate gratification, leading to impulsive behaviour driven by current thoughts, feelings, and external stimuli, without regard for past learning or consideration for future consequences. It is one of five pathological personality trait domains in certain psychiatric disorders. In psychology, it is defined as a lack of restraint manifested in disregard of social conventions, impulsivity, and poor risk assessment. Hypersexuality, hyperphagia, substance abuse, money mismanagement, frequent faux pas, and aggressive outbursts are indicative of disinhibited instinctual drives.
Certain psychoactive substances that have effects on the limbic system of the brain may induce disinhibition.
Clinical concept
Disinhibition in psychology is defined as a lack of inhibitory control manifested in several ways, affecting motor, instinctual, emotional, cognitive, and perceptual aspects with signs and symptoms, such as impulsivity, disregard for others and social norms, aggressive outbursts, misconduct, and oppositional behaviors, disinhibited instinctual drives including risk-taking behaviors and hypersexuality.
Brain injury
Disinhibition is a common symptom following brain injury, or lesions, particularly to the frontal lobe and primarily to the orbitofrontal cortex. The neuropsychiatric sequelae following brain injuries could include diffuse cognitive impairment, with more prominent deficits in the rate of information processing, attention, memory, cognitive flexibility, and problem-solving. Prominent impulsivity, affective instability, and disinhibition are seen frequently, secondary to injury to frontal, temporal, and limbic areas. In association with the typical cognitive deficits, these sequelae characterize the frequently noted "personality changes" in TBI (Traumatic Brain Injury) patients.
Disinhibition syndromes, in brain injuries and insults including brain tumors, strokes and epilepsy range from mildly inappropriate social behavior, and lack of control over one's behavior to the full-blown mania, depending on the lesions to specific brain regions. The previous several studies in brain traumas and insults have demonstrated significant associations between disinhibition syndromes and dysfunction of orbitofrontal and basotemporal cortices, affecting visuospatial functions, somatosensation, spatial memory, motoric, instinctive, affective, and intellectual behaviors.
Psychiatric disorder
Disinhibition syndromes have also been reported with mania-like manifestations in old age with lesions to the orbitofrontal and basotemporal cortex involving limbic and frontal connections (orbitofrontal circuit), especially in the right hemisphere. Behavioral disinhibition as a result of damage to frontal lobe could be seen as a result of consumption of alcohol and other central nervous system (CNS) depressants (e.g., benzodiazepines that disinhibit the frontal cortex from self-regulation and control). It has also been argued that attention deficit hyperactivity disorder (ADHD), the hyperactive/impulsive subtype has a general behavioral disinhibition beyond impulsivity and many morbidities or complications of ADHD (e.g., conduct disorder, antisocial personality disorder, substance abuse, and risk-taking behaviors are all consequences of untreated behavioral disinhibition).
Substance-induced disinhibition
Certain psychoactive substances that have effects on the limbic system of the brain may induce disinhibition. It is commonly induced by GABAergic depressants such as alcohol, and benzodiazepines.
Treatment approaches
Positive Behaviour Support (PBS) is a treatment approach that looks at the best way to work with each individual with disabilities. In this treatment, a behavioural therapist conducts a functional analysis of behaviour which helps to determine ways to improve the quality of life for the person, rather than trying only to lessen problematic behaviour. Furthermore, PBS relies on the belief in humans' ability to change, and it is most commonly applied to resolving problems in educational settings.
A quick guide for staff to remind about key elements of treatment for a person with disabilities is below. There are two main objectives: reacting situationally when the behavior occurs, and then acting proactively to prevent the behaviour from occurring.
Reactive
Reactive strategies include:
Redirection: This strategy can be employed by distracting the person by offering another activity, or changing the topic of conversation. In addition, offer the person a choice of 2 or 3 things, but no more than 3, because this can be overwhelming. In offering a choice, make sure to pause to allow the person time to process the information and give a response.
Talking to the person and finding out what the problem is.
Working out what the person's behaviour is trying to communicate.
Employing crisis management tactic.
Proactive
Proactive strategies to prevent problems can include:
Changing the environment: This can include increasing opportunities for access to a variety of activities, balancing cognitively and physically demanding activities with periods of rest, providing a predictable environment in order to reduce the level of cognitive demands on the person, trying to provide consistent routines (be mindful of events that may not occur, try not to make promises that cannot be kept, if unable to go out at a particular time then say so), checking for safety in the home environment (e.g., changing/moving furniture).
Teaching a skill: This can include general skills development of useful communication strategies, coping skills (e.g. teach the person what to do when feeling angry, anxious).
Individual behaviour support plans: These involve reinforcing specific desirable behavior and ignoring the specific undesirable behavior (unless it is dangerous, the priority is to keep both people safe through a crisis plan which might involve removing sharp objects or weapons, escaping to a safe place, giving the person time to calm down), avoiding things you know upsets the person, strategies to increase engagement in activities.
Broadly speaking, when the behavior occurs, assertively in a nonjudgmental, clear, unambiguous way provide feedback that the behavior is inappropriate, and say what you prefer instead. For example, "Jane, you're standing too close when you are speaking to me, I feel uncomfortable, please take a step back", or "I don't like it when you say I look hot in front of your wife, I feel uncomfortable, I am your Attendant Carer/Support Worker, I am here to help you with your shopping". Also in non-verbal communication, communication can appear in other forms, one could say "I don't like it when you dart your eyes at me in that way". Then re-direct to the next activity. Also, try to ignore any subsequent behavior. Then generally, as almost all behavior is communication, understand what the behavior is trying to communicate and look at ways to have the need met in more appropriate ways.
See also
Boldness
Frontotemporal dementia
Online disinhibition effect
Orbitofrontal cortex
Spendthrift
References
Notes
Bibliography
External links
The Online Disinhibition Effect
Social Behaviour In Cyberspace
External Inhibition & Disinhibition
Human behavior
Abnormal psychology | 0.76391 | 0.995928 | 0.7608 |
Nursing | Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. Shortages of qualified nurses are found in many countries.
Nurses develop a plan of care, working collaboratively with physicians, therapists, patients, patients' families, and other team members that focuses on treating illness to improve quality of life.
In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe the correct medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals. In addition to providing care and support, nurses educate the public and promote health and wellness.
In the U.S., nurse practitioners are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications. They practice independently in a variety of settings in more than half of the United States. In the postwar period, nurse education has diversified, awarding advanced and specialized credentials, and many traditional regulations and roles are changing.
History
Premodern
Nursing historians face challenges of determining whether care provided to the sick or injured in antiquity is called nursing care. In the fifth century BC, for example, the Hippocratic Collection in places described skilled care and observation of patients by male "attendants," who may have provided care now provided by nurses. Around 600 BC in India, it is recorded in Sushruta Samhita, Book 3, Chapter V about the role of the nurse as "the different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, anyone desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examining its different parts."
In the Middle Ages, members of religious orders such as nuns and monks often provided nursing-like care. Examples exist in Christian, Islamic, Buddhist, and other traditions. Phoebe, mentioned in , is described in many sources as "the first visiting nurse". These traditions were influential in the development of the ethos of modern nursing. Its religious roots remain in evidence in many countries. One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse.
During the Reformation, Protestant reformers shut down monasteries and convents, allowing a few hundred municipal hospices to remain in operation in northern Europe. Nuns who had been serving as nurses were given pensions or told to marry and stay home. Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church, were removed from their positions. The nursing profession in Europe was extinguished for approximately 200 years.
19th century
During the Crimean War, Grand Duchess Elena Pavlovna called for women to join the Order of Exaltation of the Cross (Krestodvizhenskaya Obshchina) for a year of service in military hospitals. The first section of twenty-eight "sisters", headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, reached Crimea early in November 1854.
Florence Nightingale laid the foundations of professional nursing after the Crimean War, in light of a comprehensive statistical study she made of sanitation in India, leading her to emphasize the importance of sanitation. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000".
Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman could help improve the care of the ill. Her Notes on Nursing (1859) was a popular call to action. The Nightingale model of nursing education led to one of the first schools of nursing to be connected to a hospital and medical school. It spread widely in Europe and North America after 1870.
Nightingale included five factors that helped nurses in her time who worked amidst poor sanitation and little education. These factors included (1) fresh air, (2) clean water, (3) a working drainage system, (4) cleanliness, and (5) good light. Nightingale believed that a clean working environment was important in caring for patients. In the 19th century, this theory was ideal for helping patients, providing a guide for nurses to alter the environment around patients for the betterment of their health.
Nightingale's recommendations built upon the successes of Jamaican "doctresses" such as Mary Seacole, who like Nightingale, served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers and those suffering from diseases in the 19th century in the Crimea, Central America, and Jamaica. Her predecessors had great success as healers in the Colony of Jamaica in the 18th century, and they included Seacole's mother (Mrs. Grant), Sarah Adams, Cubah Cornwallis, and Grace Donne, the mistress and doctress to Jamaica's wealthiest planter, Simon Taylor.
Other important nurses in the development of the profession include:
Agnes Hunt from Shropshire was the first orthopedic nurse and was pivotal in the emergence of the orthopedic hospital, the Robert Jones & Agnes Hunt Hospital in Oswestry, Shropshire.
Valérie de Gasparin opened, with her husband Agénor de Gasparin, the world's first nursing school: La Source, in Lausanne, Switzerland.
Agnes Jones established a nurse training regime at Brownlow Hill infirmary, Liverpool, in 1865.
Linda Richards established nursing schools in the United States and Japan, and was officially the first professionally trained nurse in the US, graduating in 1873 from the New England Hospital for Women and Children in Boston.
Clarissa Harlowe "Clara" Barton was a pioneer American teacher, patent clerk, nurse, and humanitarian, and the founder of the American Red Cross.
Saint Marianne Cope was a Sister of St. Francis who opened and operated some of the first general hospitals in the United States, instituting cleanliness standards that influenced the development of America's hospital system.
Red Cross chapters, which began appearing after the establishment of the International Committee of the Red Cross in 1863, offered employment and professionalization opportunities for nurses (despite Nightingale's initial objections). Catholic orders such as Little Sisters of the Poor, Sisters of Mercy, Sisters of St. Mary, St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services during this period. The modern deaconess movement began in Germany in 1836. Within a half century, over 5,000 deaconesses had surfaced in Europe.
Formal use of nurses in the military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War, the Egyptian Campaign (1882), and the Sudan Campaign (1883).
20th century
In the 19th and early 20th century, nursing was considered a woman's profession, just as doctoring was a profession for men. With increasing expectations of workplace equality during the late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remained well below that of female physicians in the 21st century.
Hospital-based training became standard in the US in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free/inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians, and education providers.
Many nurses saw active duty in World War I, but the profession transformed again during the Second World War. British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US Army and Navy than any other occupation. The Nazis had their own Brown Nurses, numbering 40,000. Two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire.
The development of undergraduate and post-graduate nursing degrees came after the war. Nursing research and a desire for association and organization led to the formation of professional organizations and academic journals. Nursing became recognized as a distinct academic discipline, initially tasked to define the theoretical basis for practice.
Shortages
Nurses are perceived to be in short supply around the world, particularly in South East Asia and Africa. A global survey by McKinsey & Company in 2022 found that between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France said they were likely to leave their role in direct patient care in the next year. The top five factors which they said would make them stay were:
Safe working environment
Work-life balance
Caring and trusting team-mates
Meaningful work
Flexible work schedule
Pay ranked eighth on the list. A 2023 American survey found that ~30% were considering leaving patient care.
Definition
According to the traditional interpretation physicians are concerned with curing or treating medical conditions, while nurses focus on care. In healthcare settings this line is often blurred, complicating the task of distinguishing the professions. Although nursing practice varies both through its various specialties and countries, nursing organizations offer the following definitions:
Professional nursing
The practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as accountability mechanisms. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.
The nursing community worldwide aims for professional nurses to ensure quality care, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. Multiple educational paths lead to becoming a professional nurse; these vary by jurisdiction; all involve extensive study of nursing theory and practice as well as training in clinical skills.
Nurses provide care based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology.
Nurses typically hold one or more formal credentials. Roles and responsibilities follow the level of education. For example, in the United States, Licensed Practical Nurses (LPN) have less education than Registered Nurses (RN) and accordingly, a narrower scope of practice.
Diversity
Nursing is a female-dominated profession in many countries; according to the WHO's 2020 State of the World's Nursing, approximately 90% of the nursing workforce is female. For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States. This ratio is matched in many other countries. Notable exceptions include Francophone Africa, which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d'Ivoire, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and Togo, which all have more male than female nurses. In Europe, in countries such as Spain, Portugal, Czech Republic and Italy, over 20% of nurses are male. In the United Kingdom, 11% of nurses and midwives registered with the Nursing and Midwifery Council (NMC) are male. The number of male nurses in the United States doubled between 1980 and 2000. On average, male nurses in the US receive more pay than female nurses.
Theory and process
Nursing practice is the actual provision of nursing care. In providing care, nurses implement a nursing care plan defined using the nursing process. This is based around a specific nursing theory that is selected based on the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research. Many nursing theories are in use. Like other disciplines, the profession has developed multiple theories derived reflecting varying philosophical beliefs and paradigms or worldviews.
In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate outcomes. The nursing process as defined by the American Nurses Association is made up of five steps: 1) evaluate, 2) implement, 3) plan, 4) diagnose, and 5) assess.
Healthcare staffing platforms
Digital health platforms connect nurses and nurse assistants with job openings in healthcare facilities such as skilled nursing homes, home health agencies, and hospitals. Platforms offer an app to facilitate communication and allow nurses to find work opportunities based on their preferences. Healthcare partners and facilities benefit from access to qualified nurses. In 2017, the UK's National Health Service began trialing such a platform.
Platforms such as United States–based ConnectRN, Nomad Health, Gale Healthcare solutions or Lantum add resources, career development tools, and networking opportunities.
Nursing as a science
Florence Nightingale's seminal epidemiological study examining mortality among British soldiers during the Crimean War was published in 1858. With the exception of her works, nursing practice remained an oral tradition until the mid-20th century. The inaugural issue of Nursing Research, the first scientific journal specialized in nursing, came in in 1952. During the 1960s, interest in attaining PhDs increased among nurses in the US, but nursing remained a fledgling area of research, with few journals until the 1970s. Nursing research is increasingly presented as a valid discipline, although lacking a prevailing definition. The question is further complicated by the numerous interpretations of nursing's defining essence.
Evidence-based practice
During the 1980s there was an increased focus on research utilization (RU). Nursing research took an interest in clinical issues and US nursing schools began teaching research methods to facilitate interpretation and integration of scientific findings in routine practice. Several RU initiatives were active during the late 20th century, but the RU movement was superseded by evidence-based practice in the 1990s. Evidence-based practice (EBP) is about using research, but unlike RU it allows for the integration of research findings with clinical expertise and patient preferences. The EBP movement had originated in the field of medicine with Archie Cochrane publishing Effectiveness and Efficiency in 1972, leading up to the founding of the Cochrane Collaboration in 1993. The emerging area of evidence-based medicine also applies to nursing. Common barriers to the study and integration of research findings into clinical decision making include: a lack of opportunity, inexperience, and the rapid pace of evidence accumulation.
Scope of activities
Daily living assistance
Nurses manage and coordinate care to support activities of daily living (ADL). This includes assisting in patient mobility, such as moving an activity intolerant patient within a bed. They often delegate such care to nursing assistants.
Medication
Medication management and administration are common hospital nursing roles, although prescribing authority varies across jurisdictions. In many areas, RNs administer and manage medications prescribed by others. Nurses are responsible for evaluating patients throughout their care – including before and after medication administration – adjustments to medications are often made through a collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer. Legal implications may accompany an error in a prescription, and the nurse may be expected to note and report the error. In the United States, nurses have the right to refuse to administer medication that they deem to be potentially harmful. Some nurses take additional training that allows them to prescribe medications within their scope of practice.
Patient education
Effective patient/family education leads to better outcomes. Nurses explain procedure, recovery, and ongoing care, while helping everyone cope with the medical situation.
Many times, nurses are busy, leaving little time to educate patients.
Patients' families needs similar education. Educating both patient and their families increases the chance for a better outcome.
Nurses have to communicate in a way that can be understood by patients. Education techniques encompass conversations, visuals, reading materials, and demonstrations.
Specialties
Nursing is the most diverse of all health care professions. Nurses practice in a wide range of settings, but generally follows the needs of their patients.
The major specialties are:
communities/public health
family/individual care
adult-gerontology
pediatrics
obstetrics
neonatal
women's health/gender-related
mental health
informatics (eHealth)
acute care
ambulatory settings (physician offices, urgent care settings, camps, etc.)
school/college/institutional infirmaries
military
cardiac care
orthopedic care
palliative care
perioperative
oncology
telenursing
radiology
emergency care
Nurses with additional degrees allow for specialization. Nursing professions can be separated into categories by care type, age, gender, certain age group, practice setting, individually or in combination.
Settings
Nurses practice in a wide range of settings, including hospitals, private homes, schools, and pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics, physician offices, nurse-led clinics, long-term care facilities and camps. They work on cruise ships, military bases, and in combat settings.
Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in health advocacy and patient advocacy, helping in clinical and administrative domains. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court.
Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses work in informatics, acting as consultants to the creation of computerized charting programs and other software. Nurse authors publish articles and books to provide essential reference materials.
Occupational hazards
The international nursing shortage is in part due to their work environment. In a recent review of the literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. Some jurisdictions have legislation specifying acceptable nurse-to-patient ratios.
The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress among all professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including mastering new technology, emotional labor, physical labor, shift work, and high workload. This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders, depression, mortality, psychiatric disorders, stress-related illnesses, and overall poor health. Nurses are at risk of developing compassion fatigue and moral distress, which can damage mental health. They have high rates of occupational burnout (40%) and emotional exhaustion (43.2%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision.
Patient handling
Healthcare has consistently ranked among the industries with the highest rates of musculoskeletal injuries, largely related to patient handling. Anywhere from 30 to 70% of reported musculoskeletal injuries are related to patient handling. Nurses are routinely tasked with lifting, repositioning, and mobilizing patients. According to the National Institute for Occupational Safety and Health (NIOSH) the single greatest factor in overexertion injuries is the manual lifting, moving and repositioning of patients. These tasks present unique ergonomic hazards that results in a high rate of acute and cumulative musculoskeletal injuries.
The most frequently injured body part is the back, with up to 72% of nurses reporting non-specific low back pain. The US Bureau of Labor Statistics reported that for 2021-2022 the rate of overexertion injuries leading to days away from work for nurses was 45.4 per 10,000 full time employees, while nursing aids came in at 145.5 compared to the average for all industries of 26.1.
Traditionally, nurses are trained in manual patient handling techniques. The body of evidence has demonstrated, however, that such interventions area ineffective.
Workplace violence
Nurses are at risk for workplace violence and abuse. Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically is by hospital personnel. In the US in 2011, 57% of nurses reported that they had been threatened at work; 17% were physically assaulted.
The three types of workplace violence that nurses can experience are: physical violence (hitting, kicking, beating, punching, biting, and using objects); psychological violence (threats or coercion); sexual violence (attempted/completed non-consensual sex act).
Workplace violence can be in another way: interpersonal violence and organizational coercion. Interpersonal violence is committed by workers or patients and their families. Its predominant form is verbal abuse. Organizational coercion may include excessive workloads, mandatory shifts, involuntary placement in another part of the workplace, low salaries, denial of benefits/overtime, poor working environment, and other stressors. These issues affect quality of life. Managers who lack understanding of the severity of these problems and do not support workers increase worker stress.
Many factors contribute to workplace violence. These factors can be divided into environmental, organizational, and individual psychosocial. The environmental factors can include the specific setting (for example the emergency department), long patient wait times, frequent interruptions, uncertainty regarding patients' treatment, and heavy workloads. Organizational factors can include inefficient teamwork, organizational injustice, lack of aggression- and stress-management programs, and distrust between colleagues. Individual psychosocial factors may include nurses being young and inexperienced, previous experiences with violence, and a lack of communication skills. Misunderstandings may also occur due to the communication barrier between nurses and patients. An example of this could be patients' conditions being affected by medications, pain, or anxiety.
Workplace violence has many causes. The most common perpetrators of harassment or bullying of nursing students were registered nurses including preceptors, mentors, and clinical facilitators. However, the main perpetrators of workplace violence against nurses were patients. 80% of serious violent incidents in health care centers were by patients.
Workplace violence has many effects. It has negative emotional and physical impacts on nurses. They feel depersonalized, dehumanized, worn out, and stressed out. Nurses have reported burn-out due to frequent exposure to this violence.
Interventions
Interventions can mitigate these occupational hazards. They can be individual-focused or organization-focused. Individual-focused interventions include stress management programs, which can be customized to individuals. Stress management programs can reduce anxiety, sleep disorders, and other symptoms of stress. Organizational interventions focus on reducing stressful aspects of the work environment by identifying stress generators and developing solutions to them. Combining organizational and individual interventions is most effective at reducing stress. In some Japanese hospitals, powered exoskeletons are used to reduce physical loads. Lumbar supports (i.e. back belts) have been trialed.
National variations
Africa
Kenya
South Africa
Americas
United States
Canada
Latin America/Caribbean
Latin American nursing is based on three levels of training: (a) professional/registered, (b) technical, and (c) auxiliary. Nursing education in Latin America and the Caribbean includes the principles and values of universal health and primary health care. These principles are based on critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning.
Europe
European Union
In the European Union, the profession of nurse requires a specific professional qualification. The qualification of nurses responsible for general care in the EU is regulated in Directive 2005/36/EC. The list of regulated nursing professions is held in the regulated professions database.
Germany
Spain
United Kingdom
Asia
India
Hong Kong
Japan
Pakistan
Philippines
Taiwan
In Taiwan, the Ministry of Health and Welfare regulates nursing. The Taiwan Union of Nurses Association (TUNA) organizes nurses.
Australia
Middle East
Iran
Islam
Israel
Nurses in Israel has responsibilities including hospital care, patient education, wound care, prenatal and other monitoring, midwifery, and well-baby clinics.
Nurses and midwives are regulated by the Israeli Ministry of Health.
Nursing in Israeli Jewish culture traces its origins to Shifra and Puah, two Hebrew midwives depicted in the Book of Exodus helping women in ancient Egypt give birth and keep their infants safe.
Modern-day nursing was established by nurses sent to Mandatory Palestine and later Israel by the Hadassah organization, as well as at a nursing school founded by Henrietta Szold in 1918. The United Kingdom regulated midwifery in Mandatory Palestine, but nurses were not mentioned in the regulation decree.
See also
Advanced practice registered nurse
Deaconess
Emergency nursing
History of hospitals
History of medicine
History of nursing
History of Nursing in the United Kingdom
History of nursing in the United States
History of Philippine nurses in the United States
Index of nursing articles
Licensed practical nurse
List of nurses
List of nursing specialties
Men in nursing
Nightingale Pledge
Nurse uniform
Nurse–client relationship
Nurse scheduling problem
Nursing care plan
Nursing ethics
Nursing school
Nurse stereotypes
Nursing theory
Registered nurse
Transcultural nursing
Wet nurse
References
Book sources
Journal articles
External links
UNCG Library Betty H. Carter Women Veterans Historical Project: Nurse
Military supporting service occupations
Rehabilitation team
Health care occupations
Hospital staff
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Pharmakon | In critical theory, pharmakon is a concept introduced by Jacques Derrida. It is derived from the Greek source term φάρμακον (phármakon), a word that can mean either remedy, poison, or scapegoat.
In his essay "Plato's Pharmacy", Derrida explores the notion that writing is a pharmakon in a composite sense of these meanings as "a means of producing something". Derrida uses pharmakon to highlight the connection between its traditional meanings and the philosophical notion of indeterminacy. "[T]ranslational or philosophical efforts to favor or purge a particular signification of pharmakon [and to identify it as either "cure" or "poison"] actually do interpretive violence to what would otherwise remain undecidable." Whereas a straightforward view on Plato's treatment of writing (in Phaedrus) suggests that writing is to be rejected as strictly poisonous to the ability to think for oneself in dialogue with others (i.e. to anamnesis). Bernard Stiegler argues that "the hypomnesic appears as that which constitutes the condition of the anamnesic"—in other words, externalised time-bound communication is necessary for original creative thought, in part because it is the primordial support of culture.
However, with reference to the fourth "productive" sense of pharmakon, Kakoliris argues (in contrast to the rendition given by Derrida) that the contention between Theuth and the king in Plato's Phaedrus is not about whether the pharmakon of writing is a remedy or a poison, but rather, the less binary question: whether it is productive of memory or remembrance.
Indeterminacy and ambiguity are not, on this view, fundamental features of the pharmakon, but rather, of Derrida's deconstructive reading.
Relatedly, pharmakon has been theorised in connection with a broader philosophy of technology, biotechnology, immunology, enhancement, and addiction. Gregory Bateson points out that an important part of the Alcoholics Anonymous philosophy is to understand that alcohol plays a curative role for the alcoholic who has not yet begun to dry out. This is not simply a matter of providing an anesthetic, but a means for the alcoholic of "escaping from his own insane premises, which are continually reinforced by the surrounding society."
A more benign example is Donald Winnicott's concept of a "transitional object" (such as a teddy bear) that links and attaches child and mother. Even so, the mother must eventually teach the child to detach from this object, lest the child become overly dependent upon it. Stiegler claims that the transitional object is "the origin of works of art and, more generally, of the life of the mind."
Emphasizing the third sense of pharmakon as scapegoat, but touching on the other senses, Boucher and Roussel treat Quebec as a pharmakon in light of the discourse surrounding the Barbara Kay controversy and the Quebec sovereignty movement.
Persson uses the several senses of pharmakon to "pursue a kind of phenomenology of drugs as embodied processes, an approach that foregrounds the productive potential of medicines; their capacity to reconfigure bodies and diseases in multiple, unpredictable ways." Highlighting the notion (from Derrida) that the effect of the pharmakon is contextual rather than causal, Persson's basic claim – with reference to the body-shape-changing lipodystrophy experienced by some HIV patients taking anti-retroviral therapy.
It may be necessary to distinguish between "pharmacology" that operates in the multiple senses in which that term is understood here, and a further therapeutic response to the (effect of) the pharmakon in question. Referring to the hypothesis that the use of digital technology – understood as a pharmakon of attention – is correlated with "Attention Deficit Disorder", Stiegler wonders to what degree digital relational technologies can "give birth to new attentional forms". To continue the theme above on a therapeutic response: Vattimo compares interpretation to a virus; in his essay responding to this quote, Zabala says that the virus is onto-theology, and that interpretation is the "most appropriate pharmakon of onto-theology." Zabala further remarks: "I believe that finding a pharmakon can be functionally understood as the goal that many post-metaphysical philosophers have given themselves since Heidegger, after whom philosophy has become a matter of therapy rather than discovery[.]"
Notes
References
Further reading
Alexander Gerner, Philosophy of Human Technology, http://cfcul.fc.ul.pt/LT/FTH/
Alexander Gerner, Enhancement as Deviation
Rée, Jonathan (2012). Book review: You must change your life by Peter Sloterdijk, https://newhumanist.org.uk/2898/book-review-you-must-change-your-life-by-peter-sloterdijk
Concepts in social philosophy
Jacques Derrida | 0.76829 | 0.990163 | 0.760733 |
Psychodynamics | Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate to early experience. It is especially interested in the dynamic relations between conscious motivation and unconscious motivation.
The term psychodynamics is also used to refer specifically to the psychoanalytical approach developed by Sigmund Freud (1856–1939) and his followers. Freud was inspired by the theory of thermodynamics and used the term psychodynamics to describe the processes of the mind as flows of psychological energy (libido or psi) in an organically complex brain.
There are four major schools of thought regarding psychological treatment: psychodynamic, cognitive-behavioral, biological, and humanistic treatment. In the treatment of psychological distress, psychodynamic psychotherapy tends to be a less intensive (once- or twice-weekly) modality than the classical Freudian psychoanalysis treatment (of 3–5 sessions per week). Psychodynamic therapies depend upon a theory of inner conflict, wherein repressed behaviours and emotions surface into the patient's consciousness; generally, one's conflict is unconscious.
Since the 1970s, psychodynamics has largely been abandoned as not fact-based; Freudian psychoanalysis has been criticized as pseudoscience.
Overview
In general, psychodynamics is the study of the interrelationship of various parts of the mind, personality, or psyche as they relate to mental, emotional, or motivational forces especially at the unconscious level. The mental forces involved in psychodynamics are often divided into two parts: (a) the interaction of the emotional and motivational forces that affect behavior and mental states, especially on a subconscious level; (b) inner forces affecting behavior: the study of the emotional and motivational forces that affect behavior and states of mind.
Freud proposed that psychological energy was constant (hence, emotional changes consisted only in displacements) and that it tended to rest (point attractor) through discharge (catharsis).
In mate selection psychology, psychodynamics is defined as the study of the forces, motives, and energy generated by the deepest of human needs.
In general, psychodynamics studies the transformations and exchanges of "psychic energy" within the personality. A focus in psychodynamics is the connection between the energetics of emotional states in the Id, ego and super-ego as they relate to early childhood developments and processes. At the heart of psychological processes, according to Freud, is the ego, which he envisions as battling with three forces: the id, the super-ego, and the outside world. The id is the unconscious reservoir of libido, the psychic energy that fuels instincts and psychic processes. The ego serves as the general manager of personality, making decisions regarding the pleasures that will be pursued at the id's demand, the person's safety requirements, and the moral dictates of the superego that will be followed. The superego refers to the repository of an individual's moral values, divided into the conscience – the internalization of a society's rules and regulations – and the ego-ideal – the internalization of one's goals. Hence, the basic psychodynamic model focuses on the dynamic interactions between the id, ego, and superego. Psychodynamics, subsequently, attempts to explain or interpret behaviour or mental states in terms of innate emotional forces or processes.
History
Freud used the term psychodynamics to describe the processes of the mind as flows of psychological energy (libido) in an organically complex brain. The idea for this came from his first year adviser, Ernst von Brücke at the University of Vienna, who held the view that all living organisms, including humans, are basically energy-systems to which the principle of the conservation of energy applies. This principle states that "the total amount of energy in any given physical system is always constant, that energy quanta can be changed but not annihilated, and that consequently when energy is moved from one part of the system, it must reappear in another part." This principle is at the very root of Freud's ideas, whereby libido, which is primarily seen as sexual energy, is transformed into other behaviours. However, it is now clear that the term energy in physics means something quite different from the term energy in relation to mental functioning.
Psychodynamics was initially further developed by Carl Jung, Alfred Adler and Melanie Klein. By the mid-1940s and into the 1950s, the general application of the "psychodynamic theory" had been well established.
In his 1988 book Introduction to Psychodynamics – a New Synthesis, psychiatrist Mardi J. Horowitz states that his own interest and fascination with psychodynamics began during the 1950s, when he heard Ralph Greenson, a popular local psychoanalyst who spoke to the public on topics such as "People who Hate", speak on the radio at UCLA. In his radio discussion, according to Horowitz, he "vividly described neurotic behavior and unconscious mental processes and linked psychodynamics theory directly to everyday life."
In the 1950s, American psychiatrist Eric Berne built on Freud's psychodynamic model, particularly that of the "ego states", to develop a psychology of human interactions called transactional analysis which, according to physician James R. Allen, is a "cognitive-behavioral approach to treatment and that it is a very effective way of dealing with internal models of self and others as well as other psychodynamic issues.".
Around the 1970s, a growing number of researchers began departing from the psychodynamics model and Freudian subconscious. Many felt that the evidence was over-reliant on imaginative discourse in therapy, and on patient reports of their state-of-mind. These subjective experiences are inaccessible to others. Philosopher of science Karl Popper argued that much of Freudianism was untestable and therefore not scientific. In 1975 literary critic Frederick Crews began a decades-long campaign against the scientific credibility of Freudianism. This culminated in Freud: The Making of an Illusion which aggregated years of criticism from many quarters. Medical schools and psychology departments no longer offer much training in psychodynamics, according to a 2007 survey. An Emory University psychology professor explained, “I don’t think psychoanalysis is going to survive unless there is more of an appreciation for empirical rigor and testing.”
Freudian analysis
According to American psychologist Calvin S. Hall, from his 1954 Primer in Freudian Psychology:
At the heart of psychological processes, according to Freud, is the ego, which he sees battling with three forces: the id, the super-ego, and the outside world. Hence, the basic psychodynamic model focuses on the dynamic interactions between the id, ego, and superego. Psychodynamics, subsequently, attempts to explain or interpret behavior or mental states in terms of innate emotional forces or processes. In his writings about the "engines of human behavior", Freud used the German word Trieb, a word that can be translated into English as either instinct or drive.
In the 1930s, Freud's daughter Anna Freud began to apply Freud's psychodynamic theories of the "ego" to the study of parent-child attachment and especially deprivation and in doing so developed ego psychology.
Jungian analysis
At the turn of the 20th century, during these decisive years, a young Swiss psychiatrist named Carl Jung had been following Freud's writings and had sent him copies of his articles and his first book, the 1907 Psychology of Dementia Praecox, in which he upheld the Freudian psychodynamic viewpoint, although with some reservations. That year, Freud invited Jung to visit him in Vienna. The two men, it is said, were greatly attracted to each other, and they talked continuously for thirteen hours. This led to a professional relationship in which they corresponded on a weekly basis, for a period of six years.
Carl Jung's contributions in psychodynamic psychology include:
The psyche tends toward wholeness.
The self is composed of the ego, the personal unconscious, the collective unconscious. The collective unconscious contains the archetypes which manifest in ways particular to each individual.
Archetypes are composed of dynamic tensions and arise spontaneously in the individual and collective psyche. Archetypes are autonomous energies common to the human species. They give the psyche its dynamic properties and help organize it. Their effects can be seen in many forms and across cultures.
The Transcendent Function: The emergence of the third resolves the split between dynamic polar tensions within the archetypal structure.
The recognition of the spiritual dimension of the human psyche.
The role of images which spontaneously arise in the human psyche (images include the interconnection between affect, images, and instinct) to communicate the dynamic processes taking place in the personal and collective unconscious, images which can be used to help the ego move in the direction of psychic wholeness.
Recognition of the multiplicity of psyche and psychic life, that there are several organizing principles within the psyche, and that they are at times in conflict.
See also
Ernst Wilhelm Brücke
Yisrael Salantar
Cathexis
Object relations theory
Reaction formation
Robert Langs
References
Further reading
Brown, Junius Flagg & Menninger, Karl Augustus (1940). The Psychodynamics of Abnormal Behavior, 484 pages, McGraw-Hill Book Company, inc.
Weiss, Edoardo (1950). Principles of Psychodynamics, 268 pages, Grune & Stratton
Pearson Education (1970). The Psychodynamics of Patient Care Prentice Hall, 422 pgs. Stanford University: Higher Education Division.
Jean Laplanche et J.B. Pontalis (1974). The Language of Psycho-Analysis, Editeur: W. W. Norton & Company,
Shedler, Jonathan. "That was Then, This is Now: An Introduction to Contemporary Psychodynamic Therapy", PDF
PDM Task Force. (2006). Psychodynamic Diagnostic Manual. Silver Spring, MD. Alliance of Psychoanalytic Organizations.
Hutchinson, E.(ED.) (2017).Essentials of human behavior: Integrating person, environment, and the life course. Thousand Oaks, CA: Sage.
Freudian psychology
Psychoanalysis | 0.763419 | 0.996473 | 0.760726 |
Peter Pan syndrome | Peter Pan Syndrome is a pop psychology term used to describe an adult who is socially immature. It refers to “never-growing” adults who have reached an adult age, but cannot face their adult sensations and responsibilities. The term is a metaphor based on the concept of not growing up and being trapped in childhood. Individuals with Peter Pan Syndrome display behaviours associated with immaturity and a reluctance to grow up. They have difficulties in social and professional relationships because of their irresponsible behaviours and narcissistic properties. While it has often only been associated with males in the past, it can affect anyone, regardless of sex or gender.
The term has been used informally by both laypeople and some psychology professionals since the 1983 publication of The Peter Pan Syndrome: Men Who Have Never Grown Up, by Dr. Dan Kiley. While Peter Pan Syndrome is not recognised by the World Health Organization and is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it has a significant overlap with narcissistic personality disorder (NPD). Individuals with NPD exhibit a similar pattern of selfishness; however, they also tend to hold a much higher degree of self-importance and entitlement.
History
The concept gained popularity through psychoanalyst Dr. Dan Kiley in his book The Peter Pan Syndrome: Men Who Have Never Grown Up first published in 1983. His book became an international best seller and led to a wave of copycat pop-psychology books. Dr. Kiley got the idea for "The Peter Pan Syndrome" after noticing that, like the famous character in the J. M. Barrie play, many of the troubled teenage boys he treated had problems growing up and accepting adult responsibilities. This trouble continued into adulthood.
In his 1997 book, Men Who Never Grow Up, Kiley lists seven key markers of Peter Pan Syndrome:
Emotional paralysis: People may have dulled emotions or express their feelings in inappropriate ways.
Slowness: They may be apathetic, procrastinate tasks, and frequently late.
Social challenges: They may feel anxious and have difficulty forming and maintaining meaningful relationships, both romantic and platonic. Their fear of commitment and reluctance to take on adult responsibilities can hinder their ability to connect with others on a deeper level.
Avoidance of responsibility: Individuals with Peter Pan syndrome may resist or avoid taking on adult roles and responsibilities, such as pursuing a career, managing finances, or maintaining a stable long-term relationship. They may prefer to live in the moment and avoid making commitments that require long-term planning or sacrifice. They may avoid taking accountability for their mistakes and may blame others.
Female relationships: According to Kiley, people can have difficulty with maternal relationships and treat future romantic partners as “mother figures.”
Male relationships: They may feel distant from their father and have trouble with male authority figures.
Sexual relationships: They may be afraid of rejection from romantic partners and desire a partner who is dependent on them.
Critics have highlighted that these criteria are outdated, reflect patriarchal ideas of gender and sexuality, and are therefore not often used in a modern view of Peter Pan Syndrome. While earlier texts limit the diagnosis of the syndrome to only males, these characteristics can affect anyone, regardless of sex or gender.
Characteristics
Peter Pan Syndrome is a psychological term for individuals who find it difficult to grow up. They have challenges maintaining adult relationships and managing adult responsibilities and may exhibit traits such as avoiding responsibilities, resisting commitment, seeking constant fun and excitement, and displaying a lack of ambition or direction in life. They may prefer to engage in activities associated with childhood rather than taking on the responsibilities and challenges of adulthood.
The causes for this behaviour likely vary for each individual and underlying mechanisms remain unexplained; however, the issue seems to be rooted in childhood experiences, such as neglect or overprotective parenting.
Since Peter Pan Syndrome is not a clinical diagnosis, experts have not determined an official list of symptoms. However, in recent publications the following characteristics are mentioned commonly.
Signs in relationships
Individuals might have difficulties maintaining healthy romantic relationships. This includes struggling to express their emotions, listen to their partner, and play an equal role in the relationship. Individuals may place an unfair burden on their partner, avoiding every-day adult responsibilities and decision-making.
While Peter Pan Syndrome is characterised with issues maintaining long-term relationships, individuals also experience a strong fear of loneliness and rely heavily on their parents and family.
Work-related signs
People with Peter Pan Syndrome tend to struggle with job and career goals. This is because of difficulties with responsibilities and commitment. They may make little real effort to find a job and have a pattern of job loss due to lack of effort, tardiness, or skipping work or leaving jobs frequently when they feel bored, challenged, or stressed, trying to avoid criticism.
Signs in attitude, mood, and behaviour
Individuals show a pattern of unreliability and narcissistic tendencies characterised by preoccupation with self-image and prioritisation of personal needs and desires. They have no interest in personal growth and often blame others for their mistakes, avoiding negative evaluation.
They are easily irritated, having difficulties controlling impulsive behaviour, especially when facing stressful situations. To escape difficult feelings or responsibilities they might turn to substance abuse.
Similarities with Narcissistic Personality Disorder (NPD)
Peter Pan Syndrome and Narcissistic Personality Disorder (NPD) are two distinct psychological concepts, but there is some overlap in certain traits and behaviours. Both Peter Pan Syndrome and NPD involve difficulties in forming and maintaining mature, adult relationships due to struggles with commitment and empathy. Additionally, both involve a self-centred focus, though in Peter Pan Syndrome, this may stem more from a desire to maintain personal freedom and avoid responsibility, whereas in NPD, it arises from a need for admiration and validation. Individuals with either condition may struggle with accepting criticism or feedback that challenges their self-image or worldview.
While individuals with the Peter Pan Syndrome often exhibit narcissistic traits, NPD is especially characterised by devaluation and manipulation of others, which are not usually traits of the Peter Pan Syndrome.
Treatment and management
Since Peter Pan Syndrome is not a clinical diagnosis, there are no set guidelines of how to manage the behavior and feelings of the individual. It is likely that the patients are not aware of how this is affecting them and others.
Treatment for Peter Pan Syndrome depends on the underlying causes. Therapy would be an essential component in addressing this phenomenon, as it offers a safe space for individuals to explore their past experiences and emotional patterns. By delving into childhood experiences, therapists can help patients gain insight into how these factors have influenced their development and contributed to their avoidance of adult responsibilities. Therapy might assist individuals in developing coping strategies, and ultimately fostering a healthier sense of self and autonomy.
See also
Autism
Attention deficit hyperactivity disorder
Boomerang Generation
Puer aeternus
References
External links
Youth
Analytical psychology
Syndrome
1983 neologisms | 0.762039 | 0.998245 | 0.760702 |
Suicide prevention | Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.
Beyond direct interventions to stop an impending suicide, methods may include:
treating mental illness
improving coping strategies of people who are at risk
reducing risk factors for suicide, such as substance misuse, poverty and social vulnerability
giving people hope for a better life after current problems are resolved
calling a suicide hotline number
General efforts include measures within the realms of medicine, mental health, and public health. Because protective factors such as social support and social engagement—as well as environmental risk factors such as access to lethal means— play a role in suicide, suicide is not solely a medical or mental-health issue.
Detection and assessment of a risk of suicide
Warning signs
Warning signs of suicide can allow individuals to direct people who may be considering suicide to get help.
Behaviors that may be warning signs include:
Talking about wanting to die or wanting to kill themselves
Suicidal ideation: thinking, talking, or writing about suicide, planning for suicide
Substance abuse
Feelings of purposelessness
Anxiety, agitation, being unable to sleep, or sleeping all the time
Feelings of being trapped
Feelings of hopelessness
Social withdrawal
Displaying extreme mood swings, suddenly changing from sad to very calm or happy
Recklessness or impulsiveness, taking risks that could lead to death, such as driving extremely fast
Mood changes including depression
Feelings of uselessness
Settling outstanding affairs, giving away prized or valuable possessions, or making amends when they are otherwise not expected to die (as an example, this behavior would be typical in a terminal cancer patient but not a healthy young adult)
Strong feelings of pain, either emotional or physical
Considering oneself burdensome
Increased use of drugs, including alcohol
Direct talk for assessment
An effective way to assess suicidal thoughts is to talk with the person directly, to ask about depression, and assess suicide plans as to how and when it might be attempted. Contrary to popular misconceptions, talking with people about suicide does not plant the idea in their heads. However, such discussions and questions should be asked with care, concern and compassion. The tactic is to reduce sadness and provide assurance that other people care. The WHO advises to not say everything will be all right nor make the problem seem trivial, nor give false assurances about serious issues. The discussions should be gradual and specifically executed when the person is comfortable about discussing their feelings. ICARE (Identify the thought, Connect with it, Assess evidence for it, Restructure the thought in positive light, Express or provide room for expressing feelings from the restructured thought) is a model of approach used here.
Risk factors
All people can be at risk of suicide. Risk factors that contribute to someone feeling suicidal or making a suicide attempt may include:
Depression, other mental disorders, or substance abuse disorder
Certain medical conditions
Chronic pain
A prior suicide attempt
Family history of a mental disorder or substance abuse
Family history of suicide
Family violence, including physical or sexual abuse
Psychiatric Abuse
Benzodiazepines
Having guns or other firearms in the home
Having recently been released from prison, jail or mental asylum
Self-harm
Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities
Being male
Food insecurity
There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide.
Strategies for detection and assessment
The traditional approach has been to identify the risk factors that increase suicide or self-harm, though meta-analysis studies suggest that suicide risk assessment might not be useful and recommend immediate hospitalization of the person with suicidal feelings as the healthy choice. In 2001, the U.S. Department of Health and Human Services, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document, and its 2012 revision, calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal ideation throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual). The ability to recognize warning signs of suicide allows individuals who may be concerned about someone they know to direct them to help.
Suicide gesture and suicidal desire (a vague wish for death without any actual intent to kill oneself) are potentially self-injurious behaviors that a person may use to attain some other ends, like to seek help, punish others, or to receive attention. This behavior has the potential to aid an individual's capability for suicide and can be considered as a suicide warning, when the person shows intent through verbal and behavioral signs.
Screening
The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents. There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires have been tested and found to be effective for use among adolescents and young adults. There is however a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview. The predictive quality of these screening questionnaires has not been conclusively validated so it is not possible to determine if those identified at risk of suicide will actually die by suicide. Asking about or screening for suicide does not create or increase the risk.
In approximately 75 percent of suicides, the individuals had seen a physician within the year before their death, including 45 to 66 percent within the prior month. Approximately 33 to 41 percent of those who died by suicide had contact with mental health services in the prior year, including 20 percent within the prior month. These studies suggest an increased need for effective screening. Many suicide risk assessment measures are not sufficiently validated, and do not include all three core suicidality attributes (i.e., suicidal affect, behavior, and cognition). A study published by the University of New South Wales has concluded that asking about suicidal thoughts cannot be used as a reliable predictor of suicide risk.
Underlying condition
The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms, with some estimates stating that upwards of 50% may have an undiagnosed medical condition which, if not causing, is exacerbating their psychiatric symptoms. Illegal drugs and prescribed medications may also produce psychiatric symptoms. Effective diagnosis and, if necessary, medical testing, which may include neuroimaging to diagnose and treat any such medical conditions or medication side effects, may reduce the risk of suicidal ideation as a result of psychiatric symptoms. Most often including depression, which are present in up to 90–95% of cases. The calification of a case as psychiatric frequently implies more rigid treatments.
Methods of intervention
Restriction of lethal means
Restriction of dangerous means — reducing the odds that a person attempting suicide will use highly lethal means — is an important component of suicide prevention. This practice is also called "means restriction". It has been demonstrated that restricting lethal means can help reduce suicide rates, as delaying action until the desire to die has passed. In general, strong evidence supports the effectiveness of means restriction in preventing suicides. There is also strong evidence that restricted access at so-called suicide hotspots, such as bridges and cliffs, reduces suicides, whereas other interventions such as placing signs or increasing surveillance at these sites appears less effective.
One of the most famous historical examples of means reduction is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, comprised over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning. A 2020 Cochrane review on means restrictions for jumping found tentative evidence of reductions in frequency.
In the United States, firearm access is associated with increased suicide completion. About 85% of suicide attempts with a gun result in death, while most other widely used suicide attempt methods result in death less than 5% of the time. Matthew Miller, M.D., Sc.D. conducted research comparing the number of suicides in states with the highest rates of gun ownership, to the number of suicides in states with the lowest rates of gun ownership. He found that men were 3.7 times more likely to die by firearm suicide and women were 7.9 times more likely to die by firearm suicide living in states with high rates of gun ownership. There was no difference in non-firearm suicides. Although restrictions on access to firearms have reduced firearm suicide rates in other countries, such restrictions are difficult in the United States because the Second Amendment to the United States Constitution limits restrictions on weapons.
For those who decide to end their lives impulsively, a 24-hour waiting period for firearm access could substantially reduce suicide success rates. Contrary to the popular notion that suicidal people will simply find another way to kill themselves, many people who survive suicide attempts go on to lead long lives. "In 2023, more than 42,967 people died from gun related injuries. Over half of those deaths were suicides" in the United States.
Spiritual counseling
The majority of known religions consider that suicide is a sin (or an equivalent fault). Their priests are available to guide in this problem and their circumstances.
Psychological counseling
There are multiple talking therapies that reduce suicidal thoughts and behaviors.
In the group therapies, suicides can participate with other people (usually other patients with whom the patient of suicidal tendence would talk without major problems). The rest of the patients can have the same psychological problem or any other. A psychologist would direct the chat.
Psychotherapies that have been shown most successful, or evidence based, are dialectical behavior therapy (DBT), which has shown to be helpful in reducing suicide attempts and reducing hospitalizations for suicidal ideation, and cognitive behavioral therapy for suicide prevention (CBT-SP), a form of DBT that is adapted for adolescents at high risk for repeated suicide attempts, and has shown to improve problem-solving and coping abilities.
The brief intervention and contact technique developed by the World Health Organization also has shown benefit.
Crisis hotlines and associations that provide help
Crisis hotlines connect a person in distress to either a volunteer or staff member of an association that provides comfort and help. This may occur via telephone, online chat, or in person. Even though crisis hotlines are common, they have not been well studied. One study found a decrease in psychological pain, hopelessness, and desire to die from the beginning of the call through the next few weeks; however, the desire to die did not decrease long term.
Direct conversation for intervention
It cannot be despised that a reliable person talks directly with the person with suicidal tendences.
Some guides about conversation with suicidal patients have been distributed between people with certain probabilities to find that situation.
Caring letters
The "Caring Letters" model of suicide prevention involved mailing short letters that expressed the researchers' interest in the recipients without pressuring them to take any action. The intervention reduced deaths by suicide, as proven through a randomized controlled trial.
The technique involves letters sent from a researcher who had spoken at length with the recipient during a suicidal crisis. The typewritten form letters were brief – sometimes as short as two sentences – personally signed by the researcher, and expressed interest in the recipient without making any demands. They were initially sent monthly, eventually decreasing in frequency to quarterly letters; if the recipient wrote back, then an additional personal letter was mailed. The approach was partly inspired by Jerome Motto's experience of receiving letters during World War II from a young woman he had met before being deployed. Motto was the psychiatrist who first devised the experiment. Although the exact mechanisms have been debated, researchers generally think that the letters communicate a genuine interest and social connection that the recipients find helpful.
Caring letters are inexpensive and either the only, or one of very few, approaches to suicide prevention that has been scientifically proven to work during the first years after a suicide attempt that resulted in hospitalization.
Coping planning
Coping planning is an intervention that is based in the strengths of patient for solving the problems or at least reducing and damping their impact. It aims to meet the needs of people who ask for help, including those experiencing suicidal ideation. By addressing why someone asks for help, the risk assessment and management stays on what the person needs, and the needs assessment focuses on the individual needs of each person. The coping planning approach to suicide prevention draws on the health-focused theory of coping. Coping is normalized as a normal and universal human response to unpleasant emotions, and interventions are considered a change continuum of low intensity (e.g., self-soothing) to high intensity support (e.g. professional help). By planning for coping, it supports people who are distressed and provides a sense of belongingness and resilience in treatment of illness. The proactive coping planning approach overcomes implications of ironic process theory. The biopsychosocial strategy of training people in healthy coping improves emotional regulation and decreases memories of unpleasant emotions. A good coping planning strategically reduces the inattentional blindness for a person while developing resilience and regulation strengths.
Improval of the physical condition
According to researches, a proper diet, correct sleeping and physical exercise have a positive influence in the mood and the activity of the person.
In diet
About 50% of people who die of suicide have a mood disorder such as major depression. Sleep and diet may play a role in depression (major depressive disorder), and interventions in these areas may be an effective add-on to conventional methods.
According to Healthdirect, the national health advice service in Australia, risk of depression may be reduced with a healthy diet "high in fruits, vegetables, nuts, and legumes; moderate amounts of poultry, eggs, and dairy products; and only occasional red meat". Consuming oily fish (e.g., salmon, perch, tuna, mackerel, sardines and herring) may also help as they contain omega-3 fats. Consuming too much refined carbohydrates (e.g., snack foods) may increase the risk of depression symptoms. The mechanism on how diet improves or worsens mental health is still not fully understood. Blood glucose levels alterations, inflammation, or effects on the gut microbiome have been suggested. More information about food (e.g. oily fish with omega-3 fats, a class of PUFA), drink (e.g. water), healthy, balanced diet and mental health can be found on Healthdirect’s website.
Vitamin B2, B6 and B12 deficiency may cause depression in females.
Vitamin B12, for humans, is the only vitamin that must be sourced from animal-derived foods or from supplements. Only some archaea and bacteria can synthesize vitamin B12. Foods containing vitamin B12 include meat, clams, liver, fish, poultry, eggs, and dairy products. Many breakfast cereals are fortified with the vitamin.
Sources of Vitamin B2 (riboflavin):
Sources of Vitamin B6:
Access of health professionals
Contact with health professionals is important in the fight against suicide, because it makes possible to detect suicidal intentions and attempts.
Medication
Common treatments may include antidepressants, antianxiety, antipsychotics, stimulants, mood stabilizers, and all kinds of SSRI medications. Alongside medications, a health team often includes therapy and other beneficial resources to support good outcomes for individuals and their communities.
The medication lithium may be useful in certain situations to reduce the risk of suicide. Specifically, it is effective at lowering the risk of suicide in those with bipolar disorder and major depressive disorder. Some antidepressant medications may increase suicidal ideation in some patients under certain conditions. Medical professionals advise supervision and communication during the usage of these medications. In case of a psychiatrist prescribes any of the medications, the problem would be taken to the field of psychiatry, with its own contexts and plannings, that are usually more rigid than those of other fields.
It is also important that, in a proportion of cases of use of drugs to prevent suicide, a "paradoxical reaction" can happen, consisting of an increase in suicidal intention, mainly on the following occasions: the beginning of the period of taking the medication, any change of dose to adjust it, and the end of its intake period (its abandonment or discontinuation). Therefore, a bigger caution is recommended at that times.
Barriers and physical protections
Physical protection systems, such as barriers and anti-suicide nets, are sometimes installed in bridges, buildings and other dangerous points, to prevent suicides in them. The decision can be influenced by the frequent use for suicide attempts of those dangerous points, and the possibility of hurting someone else in those attempts (something very feasible if jumping from skyscrapers and similar situations). Sometimes, the problem is not a possible use of those points for suicide, but a simple lack of security in them that makes people to be involuntarily exposed to the danger of accident.
Preventive programs to reduce the cause
Some plans try to avoid suicide by avoiding previous problems that could produce it. For example: violence in a relationship, in the family, school bullying, workplace mobbing, and any other.The World Health Organization recommends "specific skills should be available in the education system to prevent bullying and violence in and around the school".
Information campaigns
Prevention of suicide also implies informing to the general public, or only to a sector, about the signs of suicide, to be able to detect them, and about the existing means of help. Informative campaigns must be correctly made to work as planned. In a review of communication campaigns against suicide, only two studies of three considered that the effect of those campaigns was positive.
Inappropriate mentions to suicide could increase its amount.
Media guidelines
Recommendations around media reporting of suicide include not sensationalizing the event or attributing it to a single cause. It is also recommended that media messages include suicide prevention messages such as stories of hope and links to further resources. Particular care is recommended when the person who died is famous. Including specific details of the method or the location is not recommended.
There is little evidence, however, regarding the benefit of providing resources for those looking for help, and the evidence for media guidelines generally is mixed at best.
TV shows and news media may also be able to help prevent suicide by linking suicide with negative outcomes such as pain for the person who has attempted suicide and their survivors, conveying that the majority of people choose something other than suicide to solve their problems, avoiding mentioning suicide epidemics, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide.
General strategies for society
In the United States, the 2012 National Strategy for Suicide Prevention promotes various specific suicide prevention efforts including:
Developing groups led by professionally trained individuals for broad-based support for suicide prevention.
Promoting community-based suicide prevention programs.
Screening and reducing at-risk behavior through psychological resilience programs that promotes optimism and connectedness.
Education about suicide, including risk factors, warning signs, stigma related issues and the availability of help through social campaigns.
Increasing the proficiency of health and welfare services at responding to people in need. e.g., sponsored training for helping professionals, increased access to community linkages, employing crisis counseling organizations.
Reducing domestic violence and substance abuse through legal and empowerment means are long-term strategies.
Reducing access to convenient means of suicide and methods of self-harm. e.g., toxic substances, poisons, handguns.
Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g., aspirin.
School-based competency promoting and skill enhancing programs.
Interventions and usage of ethical surveillance systems targeted at high-risk groups.
Improving reporting and portrayals of negative behavior, suicidal behavior, mental illness and substance abuse in the entertainment and news media.
Research on protective factors & development of effective clinical and professional practices.
Specific strategies in society
Suicide prevention strategies focus on reducing the risk factors and intervening strategically to reduce the level of risk. Risk and protective factors unique to the individual can be assessed by a qualified mental health professional.Some of the specific strategies used to address are:
Crisis intervention.
Structured counseling and psychotherapy.
Hospitalization for those with low adherence to collaboration for help and those who require monitoring and secondary symptom treatment.
Supportive therapy like substance abuse treatment, psychotropic medication, family psychoeducation and access to emergency phone call care with emergency rooms, suicide prevention hotlines, etc.
Restricting access to lethality of suicide means through policies and laws.
Creating and using crisis cards, an easy-to-read uncluttered card that describes a list of activities one should follow in crisis until the positive behavior responses settles in the personality.
Person-centered life skills training. e.g., Problem solving.
Registering with support groups like Alcoholics Anonymous, Suicide Bereavement Support Group, a religious group with flow rituals, etc.
Therapeutic recreational therapy that improves mood.
Motivating self-care activities like physical exercises and meditative relaxation.
After a suicide
Postvention is for people affected by an individual's suicide. This intervention facilitates grieving, guides to reduce guilt, guides to reduce anxiety and depression, and helps to decrease the effects of trauma. Bereavement is ruled out and promoted for catharsis and supporting their adaptive capacities before intervening depression and any psychiatric disorders. Postvention is also provided to minimize the risk of imitative or copycat suicides, but there is a lack of evidence based standard protocol. The general goal of the mental health practitioner is to decrease the likelihood of others identifying with the suicidal behavior of the deceased as a coping strategy in dealing with adversity.
Legislation
Support organizations
Many non-profit organizations exist, such as the American Foundation for Suicide Prevention in the United States, which serve as crisis hotlines; it has benefited from at least one crowd-sourced campaign. The first documented program aimed at preventing suicide was initiated in 1906 in both New York, the National Save-A-Life League, and in London, the Suicide Prevention Department of the Salvation Army.
Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population. To identify, review, and disseminate information about best practices to address specific objectives of the National Strategy Best Practices Registry (BPR) was initiated. The Best Practices Registry of Suicide Prevention Resource Center is a registry of various suicide intervention programs maintained by the American Association of Suicide Prevention. The programs are divided, with those in Section I listing evidence-based programs: interventions which have been subjected to in depth review and for which evidence has demonstrated positive outcomes. Section III programs have been subjected to review.
Examples of support organizations
American Foundation for Suicide Prevention
Befrienders Worldwide
Campaign Against Living Miserably
Crisis Text Line
International Association for Suicide Prevention
The Jed Foundation
National Suicide Prevention Lifeline
Samaritans
Suicide Prevention Action Network USA
Trans Lifeline
The Trevor Project
Economics
In the United States it is estimated that a suicide results in costs of about $1.3 million. The loss of productivity from the deceased individual accounts for 97 percent of these costs. The remaining 3 percent of the costs were from medical expenses. Money spent on intervention programs is estimated to result in a decrease in economic losses that are 2.5-fold greater than the amount spent.
See also
References
Further reading
American Psychological Association
Suicide prevention and assessment handbook, Centre for Addiction and Mental Health, 2011.
External links
CDC website on Suicide Prevention
The Suicide Prevention Resource Center (SPRC) provides prevention support, training, and resources to assist organizations and individuals to develop suicide prevention programs, interventions and policies, and to advance the National Strategy for Suicide Prevention.
Centre for Suicide Prevention (CSP), Canada
Suicide Prevention:Effectiveness and Evaluation A 32-page guide from SPAN USA, the National Center for Injury Prevention and Control, and Education Development Center, Inc.
International Association for Suicide Prevention Organization co-sponsors World Suicide Prevention Day on September 10 every year with the World Health Organization (WHO).
U.S. Surgeon General – Suicide Prevention
Suicide Risk Assessment Guide – VA Reference Manual
Practice Guidelines for Suicide prevention, APA
Counseling | 0.762833 | 0.997193 | 0.760691 |
Community Mental Health Act | The Community Mental Health Act of 1963 (CMHA) (also known as the Community Mental Health Centers Construction Act, Mental Retardation Facilities and Construction Act, Public Law 88-164, or the Mental Retardation and Community Mental Health Centers Construction Act of 1963) was an act to provide federal funding for community mental health centers and research facilities in the United States. This legislation was passed as part of John F. Kennedy's New Frontier. It led to considerable deinstitutionalization.
In 1955, Congress passed the Mental Health Study Act, leading to the establishment of the Joint Commission on Mental Illness and Mental Health. That Commission issued a report in 1961, which would become the basis of the 1963 Act.
The CMHA provided grants to states for the establishment of local mental health centers, under the overview of the National Institute of Mental Health. The NIH also conducted a study involving adequacy in mental health issues. The purpose of the CMHA was to build mental health centers to provide for community-based care, as an alternative to institutionalization. At the centers, patients could be treated while working and living at home.
Only half of the proposed centers were ever built; none was fully funded, and the act didn't provide money to operate them long-term. Some states closed expensive state hospitals, but never spent money to establish community-based care. Deinstitutionalization accelerated after the adoption of Medicaid in 1965. During the Reagan administration, the remaining funding for the act was converted into a mental-health block grants for states. Since the CMHA was enacted, 90 percent of beds have been cut at state hospitals, but they have not been replaced by community resources.
The CMHA proved to be a mixed success. Many patients, formerly warehoused in institutions, were released into the community. However, not all communities have had the facilities or expertise to deal with them. In many cases, patients wound up in adult homes or with their families, or homeless in large cities, and without the mental health care they needed. Without community support, mentally ill people have more trouble getting treatment, maintaining medication regimens, and supporting themselves. They make up a large proportion of the homeless and an increasing proportion of people in jail.
See also
Community mental health service
Psychiatric hospital
Involuntary commitment
Outpatient commitment
Treatment Advocacy Center
Political abuse of psychiatry
Global Mental Health
Notes
Further reading
External links
Mental health law in the United States
United States federal disability legislation
United States federal health legislation
Deinstitutionalization in the United States
1963 in American law
88th United States Congress
Presidency of John F. Kennedy | 0.778042 | 0.977683 | 0.760679 |
Reflective practice | Reflective practice is the ability to reflect on one's actions so as to take a critical stance or attitude towards one's own practice and that of one's peers, engaging in a process of continuous adaptation and learning. According to one definition it involves "paying critical attention to the practical values and theories which inform everyday actions, by examining practice reflectively and reflexively. This leads to developmental insight". A key rationale for reflective practice is that experience alone does not necessarily lead to learning; deliberate reflection on experience is essential.
Reflective practice can be an important tool in practice-based professional learning settings where people learn from their own professional experiences, rather than from formal learning or knowledge transfer. It may be the most important source of personal professional development and improvement. It is also an important way to bring together theory and practice; through reflection a person is able to see and label forms of thought and theory within the context of his or her work. A person who reflects throughout his or her practice is not just looking back on past actions and events, but is taking a conscious look at emotions, experiences, actions, and responses, and using that information to add to his or her existing knowledge base and reach a higher level of understanding.
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Buka, P. (2020) Essential law and ethics in nursing: Patients, rights and decision making. 3rd Ed. London: Routledge, Taylor and amp Francis Group
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History and background
Donald Schön's 1983 book The Reflective Practitioner introduced concepts such as reflection-on-action and reflection-in-action which explain how professionals meet the challenges of their work with a kind of improvisation that is improved through practice. However, the concepts underlying reflective practice are much older. Earlier in the 20th century, John Dewey was among the first to write about reflective practice with his exploration of experience, interaction and reflection. Soon thereafter, other researchers such as Kurt Lewin and Jean Piaget were developing relevant theories of human learning and development. Some scholars have claimed to find precursors of reflective practice in ancient texts such as Buddhist teachings and the Meditations of Stoic philosopher Marcus Aurelius.
Central to the development of reflective theory was interest in the integration of theory and practice, the cyclic pattern of experience and the conscious application of lessons learned from experience. Since the 1970s, there has been a growing literature and focus around experiential learning and the development and application of reflective practice.
As adult education professor David Boud and his colleagues explained: "Reflection is an important human activity in which people recapture their experience, think about it, mull it over and evaluate it. It is this working with experience that is important in learning." When a person is experiencing something, he or she may be implicitly learning; however, it can be difficult to put emotions, events, and thoughts into a coherent sequence of events. When a person rethinks or retells events, it is possible to categorize events, emotions, ideas, etc., and to compare the intended purpose of a past action with the results of the action. Stepping back from the action permits critical reflection on a sequence of events.
The emergence in more recent years of blogging has been seen as another form of reflection on experience in a technological age.
Models
Many models of reflective practice have been created to guide reasoning about action. However, they are not without their criticisms, and need to be understood within the context within which they were written.
Borton 1970
Terry Borton's 1970 book Reach, Touch, and Teach popularized a simple learning cycle inspired by Gestalt therapy composed of three questions which ask the practitioner: What, So what, and Now what? Through this analysis, a description of a situation is given which then leads into the scrutiny of the situation and the construction of knowledge that has been learnt through the experience. Subsequently, practitioners reflect on ways in which they can personally improve and the consequences of their response to the experience. Borton's model was later adapted by practitioners outside the field of education, such as the field of nursing and the helping professions.
Kolb and Fry 1975
Learning theorist David A. Kolb was highly influenced by the earlier research conducted by John Dewey and Jean Piaget. Kolb's reflective model, which also draws from the works of Kurt Lewin, highlights the concept of experiential learning and is centered on the transformation of information into knowledge. This takes place after a situation has occurred, and entails a practitioner reflecting on the experience, gaining a general understanding of the concepts encountered during the experience, and then testing these general understandings in a new situation. In this way, the knowledge that is formed from a situation is continuously applied and reapplied, building on a practitioner's prior experiences and knowledge.
Argyris and Schön 1978
Management researchers Chris Argyris and Donald Schön introduced the "theory of action", which emerged out of their previous research on relationship between people and organizations. This theory defines learning as detection and correction of error. It included the distinction between single-loop learning and double-loop learning in 1978. Single-loop learning is when a practitioner or organisation, even after an error has occurred and a correction is made, continues to rely on current strategies, techniques or policies when a situation again comes to light. Double-loop learning involves the modification of objectives, strategies or policies so that when a similar situation arises a new framing system is employed.
Schön claimed to derive the notions of "reflection-on-action, reflection-in-action, responding to problematic situations, problem framing, problem solving, and the priority of practical knowledge over abstract theory" from the writings of John Dewey, although education professor Harvey Shapiro has argued that Dewey's writings offer "more expansive, more integrated notions of professional growth" than do Schön's.
Schön advocated two types of reflective practice. Firstly, reflection-on-action, which involves reflecting on an experience that you have already had, or an action that you have already taken, and considering what could have been done differently, as well as looking at the positives from that interaction. The other type of reflection Schön notes is reflection-in-action, or reflecting on your actions as you are doing them, and considering issues like best practice throughout the process.
For Schön, professional growth really begins when a person starts to view things with a critical lens, by doubting his or her actions. Doubt brings about a way of thinking that questions and frames situations as "problems". Through careful planning and systematic elimination of other possible problems, doubt is settled, and people are able to affirm their knowledge of the situation. Then people are able to think about possible situations and their outcomes, and deliberate about whether they carried out the right actions.
Gibbs 1988
Learning researcher Graham Gibbs discussed the use of structured debriefing to facilitate the reflection involved in Kolb's experiential learning cycle. Gibbs presents the stages of a full structured debriefing as follows:
(Initial experience)
Description
"What happened? Don't make judgements yet or try to draw conclusions; simply describe."
Feelings
"What were your reactions and feelings? Again don't move on to analysing these yet."
Evaluation
"What was good or bad about the experience? Make value judgements."
Analysis
"What sense can you make of the situation? Bring in ideas from outside the experience to help you."
"What was really going on?"
"Were different people's experiences similar or different in important ways?"
Conclusions (general)
"What can be concluded, in a general sense, from these experiences and the analyses you have undertaken?"
Conclusions (specific)
"What can be concluded about your own specific, unique, personal situation or way of working?"
Personal action plans
"What are you going to do differently in this type of situation next time?"
"What steps are you going to take on the basis of what you have learnt?"
Gibbs' suggestions are often cited as "Gibbs' reflective cycle" or "Gibbs' model of reflection", and simplified into the following six distinct stages to assist in structuring reflection on learning experiences:
Description
Feelings
Evaluation
Analysis
Conclusions
Action plan
Johns 1995
Professor of nursing Christopher Johns designed a structured mode of reflection that provides a practitioner with a guide to gain greater understanding of his or her practice. It is designed to be carried out through the act of sharing with a colleague or mentor, which enables the experience to become learnt knowledge at a faster rate than reflection alone.
Johns highlights the importance of experienced knowledge and the ability of a practitioner to access, understand and put into practice information that has been acquired through empirical means. Reflection occurs through "looking in" on one's thoughts and emotions and "looking out" at the situation experienced. Johns draws on the work of Barbara Carper to expand on the notion of "looking out" at a situation. Five patterns of knowing are incorporated into the guided reflection: the aesthetic, personal, ethical, empirical and reflexive aspects of the situation. Johns' model is comprehensive and allows for reflection that touches on many important elements.
Brookfield 1998
Adult education scholar Stephen Brookfield proposed that critically reflective practitioners constantly research their assumptions by seeing practice through four complementary lenses: the lens of their autobiography as learners of reflective practice, the lens of other learners' eyes, the lens of colleagues' experiences, and the lens of theoretical, philosophical and research literature. Reviewing practice through these lenses makes us more aware of the power dynamics that infuse all practice settings. It also helps us detect hegemonic assumptions—assumptions that we think are in our own best interests, but actually work against us in the long run. Brookfield argued that these four lenses will reflect back to us starkly different pictures of who we are and what we do.
Lens 1: Our autobiography as a learner. Our autobiography is an important source of insight into practice. As we talk to each other about critical events in our practice, we start to realize that individual crises are usually collectively experienced dilemmas. Analyzing our autobiographies allows us to draw insight and meanings for practice on a deep visceral emotional level.
Lens 2: Our learners' eyes. Seeing ourselves through learners' eyes, we may discover that learners are interpreting our actions in the way that we mean them. But often we are surprised by the diversity of meanings people read into our words and actions. A cardinal principle of seeing ourselves through learners' eyes is that of ensuring the anonymity of their critical opinions. We have to make learners feel safe. Seeing our practice through learners' eyes helps us teach more responsively.
Lens 3: Our colleagues' experiences. Our colleagues serve as critical mirrors reflecting back to us images of our actions. Talking to colleagues about problems and gaining their perspective increases our chance of finding some information that can help our situation.
Lens 4: Theoretical literature. Theory can help us "name" our practice by illuminating the general elements of what we think are idiosyncratic experiences.
Nguyen Nhat Quang's iceberg of reflection 2022
Reflection is not linear, uniform, and homogeneous. Nguyen Nhat Quang (2022) adopts Fleck (2012)'s classification of reflective practices into an iceberg of reflection. That is, reflection consists of different layers representing four stages. Descriptive reflection is the tip of the iceberg as it manifests as narratives of reality without any multilateral accounts and analyses to bring forward a change in individual perspective. Dialogic reflection, just below water surface, represents the interdependence and correlations of experiences through iterative self- questioning cycles seeking reasons for an action. After identifying these reasons, this process can provide the reflectors with alternative interpretations. Following repeated cycles of dialogic reflection, transformative reflection allows the reflective practitioners to revisit issues with alternative solutions that may create more transformative and welcomed outcomes compared to those in the past. Critical reflection, the deepest level of reflection, goes beyond the reflection-on-action process by looking at what, why, and how an incident or series of incidents happened through an ecological well-rounded lens inclusive of social, historical, political, and cultural factors. It is important to note that not all reflective practices are able to reach all four layers as the depth of reflection is subjective to reflectors' cognitive, metacognitive ability as well as their sociocultural background.
Gibbs' cycle review Galli-New (GGN) 2022
The GGN reflective practice model is based on a revision of the original Gibbs'cycle model. Differently from the previous one, a step has been inserted in the cycle, dedicated to emotions, their perception, and their contextualization. The GGN model, through the clear differentiation between feelings and emotions, gives value to self-awareness and critical thinking of personal perception. Monitoring emotions as well as feelings aims to be a tool for observing and developing mental well-being, stress management, growth of emotional intelligence, critical thinking, as well as professional and personal development.
Application
Reflective practice has been described as an unstructured or semi-structured approach directing learning, and a self-regulated process commonly used in health and teaching professions, though applicable to all professions. Reflective practice is a learning process taught to professionals from a variety of disciplines, with the aim of enhancing abilities to communicate and making informed and balanced decisions. Professional associations such as the American Association of Nurse Practitioners are recognizing the importance of reflective practice and require practitioners to prepare reflective portfolios as a requirement to be licensed, and for yearly quality assurance purposes.
Education
The concept of reflective practice has found wide application in the field of education, for learners, teachers and those who teach teachers (teacher educators). Tsangaridou & O'Sullivan (1997) define reflection in education as "the act of thinking about, analyzing, assessing, or altering educational meanings, intentions, beliefs, decisions, actions, or products by focusing on the process of achieving them … The primary purpose of this action is to structure, adjust, generate, refine, restructure, or alter knowledge and actions that inform practice. Microreflection gives meaning to or informs day-to-day practice, and macroreflection gives meaning to or informs practice over time". Reflection is the key to successful learning for teachers and for learners.
Students
Students can benefit from engaging in reflective practice as it can foster the critical thinking and decision making necessary for continuous learning and improvement. When students are engaged in reflection, they are thinking about how their work meets established criteria; they analyze the effectiveness of their efforts, and plan for improvement. Rolheiser and et al. (2000) assert that "Reflection is linked to elements that are fundamental to meaningful learning and cognitive development: the development of metacognition – the capacity for students to improve their ability to think about their thinking; the ability to self-evaluate - the capacity for students to judge the quality of their work based on evidence and explicit criteria for the purpose of doing better work; the development of critical thinking, problem-solving, and decision-making; and the enhancement of teacher understanding of the learner." (p 31-32)
When teachers teach metacognitive skills, it promotes student self-monitoring and self-regulation that can lead to intellectual growth, increase academic achievement, and support transfer of skills so that students are able to use any strategy at any time and for any purpose. Guiding students in the habits of reflection requires teachers to approach their role as that of "facilitator of meaning-making" – they organize instruction and classroom practice so that students are the producers, not just the consumers, of knowledge. Rolheiser and colleagues (2000) state that "When students develop their capacity to understand their own thinking processes, they are better equipped to employ the necessary cognitive skills to complete a task or achieve a goal. Students who have acquired metacognitive skills are better able to compensate for both low ability and insufficient information." (p. 34)
The Ontario Ministry of Education (2007) describes many ways in which educators can help students acquire the skills required for effective reflection and self-assessment, including: modelling and/or intentionally teaching critical thinking skills necessary for reflection and self-assessment practices; addressing students' perceptions of self-assessment; engaging in discussion and dialogue about why self-assessment is important; allowing time to learn self-assessment and reflection skills; providing many opportunities to practice different aspects of the self-assessment and reflection process; and ensuring that parents/guardians understand that self-assessment is only one of a variety of assessment strategies that is utilized for student learning.
Teachers
The concept of reflective practice is now widely employed in the field of teacher education and teacher professional development and many programs of initial teacher education claim to espouse it. Education professor Hope Hartman has described reflective practice in education as teacher metacognition, indicating there is broad consensus that teaching effectively requires a reflective approach. Attard & Armour explain that "teachers who are reflective systematically collect evidence from their practice, allowing them to rethink and potentially open themselves to new interpretations". Teaching and learning are complex processes, and there is not one right approach. Reflecting on different approaches to teaching, and reshaping the understanding of past and current experiences, can lead to improvement in teaching practices. Schön's reflection-in-action can help teachers explicitly incorporate into their decision-making the professional knowledge that they gain from their experience in the classroom.
As professor of education Barbara Larrivee argues, reflective practice moves teachers from their knowledge base of distinct skills to a stage in their careers where they are able to modify their skills to suit specific contexts and situations, and eventually to invent new strategies. In implementing a process of reflective practice teachers will be able to move themselves, and their schools, beyond existing theories in practice. Larrivee concludes that teachers should "resist establishing a classroom culture of control and become a reflective practitioner, continuously engaging in a critical reflection, consequently remaining fluid in the dynamic environment of the classroom". It is important to note that, "the reflective process should eventually help the teacher to change, adapt and modify his/her teaching to the particular context. This does not happen in stages, but is a continuum of reflection, leading to change ... and further reflection".
Without reflection, teachers are not able to look objectively at their actions or take into account the emotions, experience, or consequences of actions to improve their practice. It is argued that, through the process of reflection, teachers are held accountable to the standards of practice for teaching, such as those in Ontario: commitment to students and student learning, professional knowledge, professional practice, leadership in learning communities, and ongoing professional learning. Overall, through reflective practice, teachers look back on their practice and reflect on how they have supported students by treating them "equitably and with respect and are sensitive to factors that influence individual student learning".
Teacher educators
For students to acquire necessary skills in reflection, their teachers need to be able to teach and model reflective practice (see above); similarly, teachers themselves need to have been taught reflective practice during their initial teacher education, and to continue to develop their reflective skills throughout their career.
However, Mary Ryan has noted that students are often asked to "reflect" without being taught how to do so, or without being taught that different types of reflection are possible; they may not even receive a clear definition or rationale for reflective practice. Many new teachers do not know how to transfer the reflection strategies they learned in college to their classroom teaching.
Some writers have advocated that reflective practice needs to be taught explicitly to student teachers because it is not an intuitive act; it is not enough for teacher educators to provide student teachers with "opportunities" to reflect: they must explicitly "teach reflection and types of reflection" and "need explicitly to facilitate the process of reflection and make transparent the metacognitive process it entails". Larrivee noted that (student) teachers require "carefully constructed guidance" and "multifaceted and strategically constructed interventions" if they are to reflect effectively on their practice.
Rod Lane and colleagues listed strategies by which teacher educators can promote a habit of reflective practice in pre-service teacher education, such as discussions of a teaching situation, reflective interviews or essays about one's teaching experiences, action research, or journaling or blogging.
Neville Hatton and David Smith, in a brief literature review, concluded that teacher education programs do use a wide range of strategies with the aim of encouraging students teachers to reflect (e.g. action research, case studies, video-recording or supervised practicum experiences), but that "there is little research evidence to show that this [aim] is actually being achieved".
The implication of all this is that teacher educators must also be highly skilled in reflective practice. Andrea Gelfuso and Danielle Dennis, in a report on a formative experiment with student teachers, suggested that teaching how to reflect requires teacher educators to possess and deploy specific competences. However, Janet Dyment and Timothy O'Connell, in a small-scale study of experienced teacher educators, noted that the teacher educators they studied had received no training in using reflection themselves, and that they in turn did not give such training to their students; all parties were expected to know how to reflect.
Many writers advocate for teacher educators themselves to act as models of reflective practice. This implies that the way that teacher educators teach their students needs to be congruent with the approaches they expect their students to adopt with pupils; teacher educators should not only model the way to teach, but should also explain why they have chosen a particular approach whilst doing so, by reference to theory; this implies that teacher educators need to be aware of their own tacit theories of teaching and able to connect them overtly to public theory. However, some teacher educators do not always "teach as they preach"; they base their teaching decisions on "common sense" more than on public theory and struggle with modelling reflective practice.
Tom Russell, in a reflective article looking back on 35 years as teacher educator, concurred that teacher educators rarely model reflective practice, fail to link reflection clearly and directly to professional learning, and rarely explain what they mean by reflection, with the result that student teachers may complete their initial teacher education with "a muddled and negative view of what reflection is and how it might contribute to their professional learning". For Russell, these problems result from the fact that teacher educators have not sufficiently explored how theories of reflective practice relate to their own teaching, and so have not made the necessary "paradigmatic changes" which they expect their students to make.
Challenges
Reflective practice "is a term that carries diverse meaning" and about which there is not complete consensus. Professor Tim Fletcher of Brock University argues forward-thinking is a professional habit, but we must reflect on the past to inform how it translates into the present and future. Always thinking about 'what's next' rather than 'what just happened' can constrain an educator's reflective process. The concept of reflection is difficult as beginning teachers are stuck between "the conflicting values of schools and universities" and "the contradictory values at work within schools and within university faculties and with the increasing influence of factors external to school and universities such as policy makers". Conflicting opinions make it difficult to direct the reflection process, as it is hard to establish what values you are trying to align with. It is important to acknowledge reflective practice "follows a twisting path that involves false starts and detours". Meaning once you reflect on an issue it cannot be set aside as many assume. Newman refers to Gilroy's assertion that "the 'knowledge' produced by reflection can only be recognized by further reflection, which in turn requires reflection to recognize it as knowledge". In turn, reflective practice cannot hold one meaning, it is contextual based on the practitioner. It is argued that the term 'reflection' shouldn't be used as there are associations to it being "more of a hindrance than a help". It is suggested the term is referred to 'critical practice' or 'practical philosophy' to "suggest an approach which practitioners can adopt in the different social context in which they find themselves". Meanwhile, Oluwatoyin discusses some disadvantages and barriers to reflective practice as, feeling stress by reflecting on negative issues and frustration from not being able to solve those identified issues, and time constraints. With reflection often taking place independently, educators lack the motivation and assistance in tackling these difficult problems. It is suggested that teachers communicate with one another, or have an indicated individual to talk to, this way there is external informed feedback. Overall, before engaging in reflective practice it is important to be aware of the challenges.
Health professionals
Reflective practice is viewed as an important strategy for health professionals who embrace lifelong learning. Due to the ever-changing context of healthcare and the continual growth of medical knowledge, there is a high level of demand on healthcare professionals' expertise. Due to this complex and continually changing environment, healthcare professionals could benefit from a program of reflective practice.
Adrienne Price explained that there are several reasons why a healthcare practitioner would engage in reflective practice: to further understand one's motives, perceptions, attitudes, values, and feelings associated with client care; to provide a fresh outlook to practice situations and to challenge existing thoughts, feelings, and actions; and to explore how the practice situation may be approached differently. In the field of nursing there is concern that actions may run the risk of habitualisation, thus dehumanizing patients and their needs. In using reflective practice, nurses are able to plan their actions and consciously monitor the action to ensure it is beneficial to their patient.
The act of reflection is seen as a way of promoting the development of autonomous, qualified and self-directed professionals, as well as a way of developing more effective healthcare teams. Engaging in reflective practice is associated with improved quality of care, stimulating personal and professional growth and closing the gap between theory and practice. Medical practitioners can combine reflective practice with checklists (when appropriate) to reduce diagnostic error.
Reflective practice can also help improve cultural sensitivity of healthcare workers. Equality diversity and inclusion reflective practice groups have been shown to be beneficial for improving mental health professionals reflexivity and awareness of equality diversity and inclusion related issues within both direct clinical work with patients, families and systems, as well as professional supervision.
Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education across a variety of health professions. Professor of medical education Karen Mann and her colleagues found through a 2009 literature review that in practicing professionals the process of reflection appears to include a number of different aspects, and practicing professionals vary in their tendency and ability to reflect. They noted that the evidence to support curricular interventions and innovations promoting reflective practice remains largely theoretical.
Samantha Davies identified benefits as well as limitations to reflective practice:
Benefits to reflective practice include:
Increased learning from an experience or situation
Promotion of deep learning
Identification of personal and professional strengths and areas for improvement
Identification of educational needs
Acquisition of new knowledge and skills
Further understanding of own beliefs, attitudes and values
Encouragement of self-motivation and self-directed learning
Could act as a source of feedback
Possible improvements of personal and clinical confidence
Limitations to reflective practice include:
Not all practitioners may understand the reflective process
May feel uncomfortable challenging and evaluating own practice
Could be time-consuming
May have confusion as to which situations/experiences to reflect upon
May not be adequate to resolve clinical problems
Environmental management and sustainability
The use of reflective practice in environmental management, combined with system monitoring, is often called adaptive management. There is some criticism that traditional environmental management, which simply focuses on the problem at hand, fails to integrate into the decision making the wider systems within which an environment is situated. While research and science must inform the process of environmental management, it is up to the practitioner to integrate those results within these wider systems. In order to deal with this and to reaffirm the utility of environmental management, Bryant and Wilson propose that a "more reflective approach is required that seeks to rethink the basic premises of environmental management as a process". This style of approach has been found to be successful in sustainable development projects where participants appreciated and enjoyed the educational aspect of utilizing reflective practice throughout. However, the authors noted the challenges with melding the "circularity" of reflective practice theory with the "doing" of sustainability.
Leadership positions
Reflective practice provides a development opportunity for those in leadership positions. Managing a team of people requires a delicate balance between people skills and technical expertise, and success in this type of role does not come easily. Reflective practice provides leaders with an opportunity to critically review what has been successful in the past and where improvement can be made.
Reflective learning organizations have invested in coaching programs for their emerging and established leaders. Leaders frequently engage in self-limiting behaviours because of their over-reliance on their preferred ways of reacting and responding. Coaching can help support the establishment of new behaviours, as it encourages reflection, critical thinking and transformative learning. Adults have acquired a body of experience throughout their life, as well as habits of mind that define their world. Coaching programs support the process of questioning and potentially rebuilding these pre-determined habits of mind. The goal is for leaders to maximize their professional potential, and in order to do this, there must be a process of critical reflection on current assumptions.
Other professions
Reflective practice can help any individual to develop personally, and is useful for professions other than those discussed above. It allows professionals to continually update their skills and knowledge and consider new ways to interact with their colleagues. David Somerville and June Keeling suggested eight simple ways that professionals can practice more reflectively:
Seek feedback: Ask "Can you give me some feedback on what I did?"
Ask yourself "What have I learnt today?" and ask others "What have you learnt today?"
Value personal strengths: Identify positive accomplishments and areas for growth
View experiences objectively: Imagine the situation is on stage and you are in the audience
Empathize: Say out loud what you imagine the other person is experiencing
Keep a journal: Record your thoughts, feelings and future plans; look for emerging patterns
Plan for the future: Plan changes in behavior based on the patterns you identified
Create your own future: Combine the virtues of the dreamer, the realist, and the critic
Human activity and work in general
Reflective practices can also be applied to areas of human activity, in particular work, and include considering the impacts of one's (or a workforce's) actions. Relevant considerations could include ethical values, environmental impacts and efficiency and could be determinants of one's choice of activity or work during lifetime. Reflective capacities could be strengthened by education and possibly other means.
See also
Moral intelligence
Video-based reflection
Notes
References
External links
Personal development
Education theory
Vocational education
Learning theory (education)
Learning methods
Experiential learning
Nursing education | 0.767607 | 0.990947 | 0.760658 |
Health technology | Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.
Development
Pre-digital era
During the pre-digital era, patients suffered from inefficient and faulty clinical systems, processes, and conditions. Many medical errors happened in the past due to undeveloped health technologies. Some examples of these medical errors included adverse drug events and alarm fatigue. When many alarms are repeatedly triggered or activated, especially for unimportant events, workers may become desensitized to the alarms. Healthcare professionals who have alarm fatigue may ignore an alarm believing it to be insignificant, which could lead to death and dangerous situations. With technological development, an intelligent program of integration and physiologic sense-making was developed and helped reduce the number of false alarms.
Also, with greater investment in health technologies, fewer medical errors happened. Outdated paper records were replaced in many healthcare organizations by electronic health records (EHR). According to studies, this has brought many changes to healthcare. Drug administration has improved, healthcare providers can now access medical information easier, provide better treatments and faster results, and save more costs.
Improvement
To help promote and expand the adoption of health information technology, Congress passed the HITECH act as part of the American Recovery and Reinvestment Act of 2009. HITECH stands for Health Information Technology for Economic and Clinical Health Act. It gave the department of health and human services the authority to improve healthcare quality and efficiency through the promotion of health IT. The act provided financial incentives or penalties to organizations to motivate healthcare providers to improve healthcare. The purpose of the act was to improve quality, safety, efficiency, and ultimately to reduce health disparities.
One of the main parts of the HITECH act was setting the meaningful use requirement, which required EHRs to allow for the electronic exchange of health information and to submit clinical information. The purpose of HITECH is to ensure the sharing of electronic information with patients and other clinicians are secure. HITECH also aimed to help healthcare providers have more efficient operations and reduce medical errors. The program consisted of three phases. Phase one aimed to improve healthcare quality, safety and efficiency. Phase two expanded on phase one and focused on clinical processes and ensuring the meaningful use of EHRs. Lastly, phase three focused on using Certified Electronic Health Record Technology (CEHRT) to improve health outcomes.
In 2014, the implementation of electronic records in US hospitals rose from a low percentage of 10% to a high percentage of 70%.
At the beginning of 2018, healthcare providers who participated in the Medicare Promoting Interoperability Program needed to report on Quality Payment Program requirements. The program focused more on interoperability and aimed to improve patient access to health information.
Privacy of health data
Phones that can track one's whereabouts, steps and more can serve as medical devices, and medical devices have much the same effect as these phones. According to one study, people were willing to share personal data for scientific advancements, although they still expressed uncertainty about who would have access to their data. People are naturally cautious about giving out sensitive personal information. Phones add an extra level of threat. Mobile devices continue to increase in popularity each year. The addition of mobile devices serving as medical devices increases the chances for an attacker to gain unauthorized information.
In 2015 the Medical Access and CHIP Reauthorization Act (MACRA) was passed, pushing towards electronic health records. In the article "Health Information Technology: Integration, Patient Empowerment, and Security", K. Marvin provided multiple different polls based on people's views on different types of technology entering the medical field most answers were responded with somewhat likely and very few completely disagreed on the technology being used in medicine. Marvin discusses the maintenance required to protect medical data and technology against cyber attacks as well as providing a proper data backup system for the information.
Patient Protection and Affordable Care Act (ACA) also known as Obamacare and health information technology health care is entering the digital era. Although with this development it needs to be protected. Both health information and financial information now made digital within the health industry might become a larger target for cyber-crime. Even with multiple different types of safeguards hackers somehow still find their way in so the security that is in place needs to constantly be updated to prevent these breaches.
Policy
With the increased use of IT systems, privacy violations were increasing rapidly due to the easier access and poor management. As such, the concern of privacy has become an important topic in healthcare. Privacy breaches happen when organizations do not protect the privacy of people's data. There are four types of privacy breaches, which include unintended disclosure by authorized personnel, intended disclosure by authorized personnel, privacy data loss or theft, and virtual hacking. It became more important to protect the privacy and security of patients' data because of the high negative impact on both individuals and organizations. Stolen personal information can be used to open credit cards or other unethical behaviors. Also, individuals have to spend a large amount of money to rectify the issue. The exposure of sensitive health information also can have negative impacts on individuals' relationships, jobs, or other personal areas. For the organization, the privacy breach can cause loss of trust, customers, legal actions, and monetary fines.
HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. It is a U.S. healthcare legislation to direct how patient data is used and includes two major rules which are privacy and security of data. The privacy rule protects people's rights to privacy and security rule determines how to protect people's privacy.
According to the HIPAA Security Rule, it ensures that protected health information has three characteristics: confidentiality, availability, and integrity. Confidentiality indicates keeping the data confidential to prevent data loss or individuals who are unauthorized to access that protected health information. Availability allows people who are authorized to access the systems and networks when and where that information is in fact needed, such as natural disasters. In cases like this, protected health information is mostly backed up on to a separate server or printed out in paper copies, so people can access it. Lastly, integrity ensures not using inaccurate information and improperly modified data due to a bad design system or process to protect the permanence of the patient data. The consequences of using inaccurate or improperly modified data could become useless or even dangerous.
Health Organizations of HIPAA also created administrative safeguards, physical safeguards, technical safeguards, to help protect the privacy of patients. Administrative safeguards typically include security management process, security personnel, information access management, workforce training and management, and evaluation of security policies and procedures. Security management processes are one of the important administrative safeguards' examples. It is essential to reduce the risks and vulnerabilities of the system. The processes are mostly the standard operating procedures written out as training manuals. The purpose is to educate people on how to handle protected health information in proper behavior.
Physical safeguards include lock and key, card swipe, positioning of screens, confidential envelopes, and shredding of paper copies. Lock and key are common examples of physical safeguards. They can limit physical access to facilities. Lock and key are simple, but they can prevent individuals from stealing medical records. Individuals must have an actual key to access to the lock.
Lastly, technical safeguards include access control, audit controls, integrity controls, and transmission security. The access control mechanism is a common example of technical safeguards. It allows the access of authorized personnel. The technology includes authentication and authorization. Authentication is the proof of identity that handles confidential information like username and password, while authorization is the act of determining whether a particular user is allowed to access certain data and perform activities in a system like add and delete.
Assessment
The concept of health technology assessment (HTA) was first coined in 1967 by the U.S. Congress in response to the increasing need to address the unintended and potential consequences of health technology, along with its prominent role in society. It was further institutionalized with the establishment of the congressional Office of Technology Assessment (OTA) in 1972–1973. HTA is defined as a comprehensive form of policy research that examines short- and long-term consequences of the application of technology, including benefits, costs, and risks. Due to the broad scope of technology assessment, it requires the participation of individuals besides scientists and health care practitioners such as managers and even the consumers.
Several American organizations provide health technology assessments and these include the Centers for Medicare and Medicaid Services (CMS) and the Veterans Administration through its VA Technology Assessment Program (VATAP). The models adopted by these institutions vary, although they focus on whether a medical technology being offered is therapeutically relevant. A study conducted in 2007 noted that the assessments still did not use formal economic analyses.
Aside from its development, however, assessment in the health technology industry has been viewed as sporadic and fragmented Issues such as the determination of products that needed to be developed, cost, and access, among others, also emerged. These, some argue, need to be included in the assessment since health technology is never purely a matter of science but also of beliefs, values, and ideologies. One of the mechanisms being suggested either as an element of or an alternative to the current TAs is bioethics, which is also referred to as the "fourth-generation" evaluation framework. There are at least two dimensions to an ethical HTA. The first involves the incorporation of ethics in the methodological standards employed to assess technologies while the second is concerned with the use of ethical framework in research and judgment on the part of the researchers who produce information used in the industry.
In the future
The practice of medicine in the United States is currently in a major transition. This transition is due to many factors, but primarily because of the implementation and integration of health technologies into healthcare. In recent years, the widespread adoption of electronic health records (EHR) has greatly impacted healthcare. In his book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age, Robert Wachter aims to inform readers about this transition. Wachter states that there will be fewer hospitals in the future, and due to the advancement of technologies, people will be more likely to go to hospitals for major surgeries or critical illness. In the future, nurse call buttons will not be needed in hospitals. Instead, robots will deliver medication, take care of patients, and administer the system. In addition, the electronic health record will look different. Healthcare providers will be able to enter the notes via speech-to-text transcriptions in real-time.
Wachter stated that information will be edited collaboratively across the patient-care team to improve the quality. Also, natural language processing will be more developed to help parse out keywords. In the future, patient data will reside in the cloud, and patients as well as authorized providers and individuals will be able to access their data from any device or location. Big data analysis will constantly be improving. Artificial intelligence and machine learning will be constantly improving and developing as it receives new data. Alerts will also be more intelligent and efficient than the current systems.
Medical technology
Medical technology, or "medtech", encompasses a wide range of healthcare products and is used to treat diseases and medical conditions affecting humans. Such technologies are intended to improve the quality of healthcare delivered through earlier diagnosis, less invasive treatment options and reduction in hospital stays and rehabilitation times. Recent advances in medical technology have also focused on cost reduction. Medical technology may broadly include medical devices, information technology, biotech, and healthcare services.
The impacts of medical technology involve social and ethical issues. For example, physicians can seek objective information from technology rather than read subjective patient reports.
A major driver of the sector's growth is the consumerization of medtech. Supported by the widespread availability of smartphones and tablets, providers can reach a large audience at low cost, a trend that stands to be consolidated as wearable technologies spread throughout the market.
In the years 2010–2015, venture funding has grown 200%, allowing US$11.7 billion to flow into health tech businesses from over 30,000 investors in the space.
Types of technology
Medical technology has evolved into smaller portable devices, for instance, smartphones, touchscreens, tablets, laptops, digital ink, voice and face recognition and more. With this technology, innovations like electronic health records (EHR), health information exchange (HIE), Nationwide Health Information Network (NwHIN), personal health records (PHRs), patient portals, nanomedicine, genome-based personalized medicine, Geographical Positioning System (GPS), radio frequency identification (RFID), telemedicine, clinical decision support (CDS), mobile home health care and cloud computing came to exist.
Medical imaging and magnetic resonance imaging (MRI) have been long used and proven medical technologies for medical research, patient reviewing, and treatment analyzing. With the advancement of imagining technologies, including the use of faster and more data, higher resolution images, and specialist automation software, the capabilities of medical imaging technology are growing and yielding better results. As the imaging hardware and software evolve this means that patients will need to use less contrasting agents, and also spend less time and money.
Further advancement in healthcare is electromagnetic (EM) technology guidance systems, used in medical procedures, allowing real-time visualization and navigation for the placement of medical devices inside the human body. For example, a neuro-navigated catheter is inserted into the brain, or a feeding tube placement in the stomach or small intestine, as demonstrated by the ENvue System. ENvue is an advanced electromagnetic navigation system for enteral feeding tube placement. The system uses a field generator and several EM sensors enabling proper scaling of the display to the patient’s body contour, and real-time view of the feeding tube tip location and direction, which helps the medical staff ensure correct placement and avoid placement of the tube in the lungs.
3D printing is another major development in healthcare. It can be used to produce specialized splints, prostheses, parts for medical devices and inert implants. The end goal of 3D printing is being able to print out customized replaceable body parts. In the following section, it will explain more about 3D printing in healthcare. New types of technologies also include artificial intelligence and robots.
3D printing
3D printing is the use of specialized machines, software programs and materials to automate the process of building certain objects. It is having a rapid growth in the prosthesis, medical implants, novel drug formulations and the bioprinting of human tissues and organs.
Companies such as Surgical Theater provide new technology that is capable of capturing 3D virtual images of patients' brains to use as practice for operations. 3D printing allows medical companies to produce prototypes to practice before an operation created with artificial tissue.
3D printing technologies are great for bio-medicine because the materials that are used to make allow the fabrication with control over many design features. 3D printing also has the benefits of affordable customization, more efficient designs, and saving more time. 3D printing is precise to design pills to house several drugs due to different release times. The technology allows the pills to transport to the targeted area and degrade safely in the body. As such, pills can be designed more efficiently and conveniently. In the future, doctors might be giving a digital file of printing instructions instead of a prescription.
Besides, 3D printing will be more useful in medical implants. An example includes a surgical team that has designed a tracheal splint made by 3D printing to improve the respiration of a patient. This example shows the potential of 3D printing, which allows physicians to develop new implant and instrument designs easily.
Overall, in the future of medicine, 3D printing will be crucial as it can be used in surgical planning, artificial and prosthetic devices, drugs, and medical implants.
Artificial intelligence
The scale and capabilities of artificial intelligence (AI) systems are growing rapidly, notably due to advances in big data. In healthcare, it is expected to provide easier accessibility of information, and to improve treatments while reducing cost. The integration of AI in healthcare tends to improve the quality and efficiency of complex tasks.
Risks related to AI include the potential lack of accuracy, and privacy concerns related to the collected data. Delegating decisions to AI systems may also undermine accountability. Moreover, AI systems sometimes learn undesired behaviors from their training data. For example, an AI trained to detect skin diseases was found to have a strong tendency to classify images containing a ruler as cancerous, since pictures of malignancies typically include a ruler to show the scale.
Applications
AI brings many benefits to the healthcare industry. AI helps to detect diseases, administer chronic conditions, deliver health services, and discover the drug. Furthermore, AI has the potential to address important health challenges. In healthcare organizations, AI is able to plan and relocate resources. AI is able to match patients with healthcare providers that meet their needs. AI also helps improve the healthcare experience by using an app to identify patients' anxieties. In medical research, AI helps to analyze and evaluate the patterns and complex data. For instance, AI is important in drug discovery because it can search relevant studies and analyze different kinds of data. In clinical care, AI helps to detect diseases, analyze clinical data, publications, and guidelines. As such, AI aids to find the best treatments for the patients. Other uses of AI in clinical care include medical imaging, echocardiography, screening, and surgery. The ability of AlphaFold to predict how proteins fold also significantly accelerated medical research.
Education
Medical virtual reality provides doctors multiple surgical scenarios that could happen and allows them to practice and prepare themselves for these situations. It also permits medical students a hands-on experience of different procedures without the consequences of making potential mistakes. ORamaVR is one of the leading companies that employ such medical virtual reality technologies to transform medical education (knowledge) and training (skills) to improve patient outcomes, reduce surgical errors and training time and democratize medical education and training.
Robots
Modern robotics have made huge progress and contribution to healthcare. Robots can help doctors in performing variety tasks. Robotics adoption is increasing tremendously in hospitals. The following are different ways to improve healthcare by using robots:
Surgical robots are one of the robotic systems, which allows a surgeon to bend and rotate tissues in a more flexible and efficient way. The system is equipped with a3D magnification vision system that can translate the hand movements of the surgeon to be precise in-order to perform a surgery with minimal incisions. Other robotics systems include the ability to diagnose and treat cancers. Many scientists began working on creating a next-generation robot system to assist the surgeon in performing knee and other bone replacement surgeries.
Assistant robots will also be important to help reduce the workload for regular medical staff. They can help nurses with simple and time-consuming tasks like carrying multiple racks of medicines, lab specimen or other sensitive materials.
Shortly, robotic pills are expected to reduce the number of surgeries. They can be moved inside a patient and delivered to the desired area. In addition, they can conduct biopsies, film the area and clear clogged arteries.
Overall, medical robots are extremely useful in assisting physicians; however, it might take time to be professionally trained working with medical robots and for the robots to respond to a clinician's instructions. As such, many researchers and startups were working constantly to provide solutions to these challenges.
Assistive technologies
Assistive technologies are products designed to provide accessibility to individuals who have physical or cognitive problems or disabilities. They aim to improve the quality of life with assistive technologies. The range of assistive technologies is broad, ranging from low-tech solutions to physical hardware, to technical devices. There are four areas of assistive technologies, which include visual impairment, hearing impairment, physical limitations, cognitive limitations. There are many benefits of assistive technologies. They enable individuals to care for themselves, work, study, access information easily, improve independence and communication, and lastly participate fully in community life.
Consumer-driven healthcare software
As part of an ongoing trend towards consumer-driven healthcare, websites or apps which provide more information on health care quality and price to help patients choose their providers have grown. As of 2017, the sites with the most number of reviews in descending order included Healthgrades, Vitals.com, and RateMDs.com. Yelp, Google, and Facebook also host reviews with a large amount of traffic, although as of 2017 they had fewer medical reviews per doctor. Disputes around online reviews can lead to websites by health professionals alleging defamation. In 2018 Vitals.com was purchased by WebMD which is owned by Internet Brands.
Patient safety organizations and government programs which have historically assessed quality have made their data more accessible over the internet; notable examples include the HospitalCompare by CMS and the LeapFrog Group's hospitalsafetygrade.org.
Patient-oriented software may also help in other ways, including general education and appointments.
Disclosure of legal disputes including medical license complaints or malpractice lawsuits has also been made easier. Every state discloses license status and at least some disciplinary action to the public, but as of 2018, this was not accessible via the internet for a few states. Consumers can look up medical licenses in a national database, DocInfo.org, maintained by the medical licensing organizations which contains limited details. Other tools include DocFinder at docfinder.docboard.org and certificationmatters.org from the American Board of Medical Specialties. In some cases more information is available from a mailed or walk-in request than the internet; for example, the Medical Board of California removes dismissed accusations from website profiles, but these are still available from a written or walk-in request, or a lookup in a separate database. The trend to disclosure is controversial and generate significant public debate, particularly about opening up the National Practitioner Data Bank. In 1996, Massachusetts became the first state to require detailed disclosure of malpractice claims.
Self-monitoring
Smartphones, tablets, and wearable computers have allowed people to monitor their health. These devices run numerous applications that are designed to provide simple health services and the monitoring of one's health with finding as critical problems to health as possible. An example of this is Fitbit, a fitness tracker that is worn on the user's wrist. This wearable technology allows people to track their steps, heart rate, floors climbed, miles walked, active minutes, and even sleep patterns. The data collected and analyzed allow users not just to keep track of their health but also help manage it, particularly through its capability to identify health risk factors.
There is also the case of the Internet, which serves as a repository of information and expert content that can be used to "self-diagnose" instead of going to their doctor. For instance, one need only enumerate symptoms as search parameters at Google and the search engine could identify the illness from the list of contents uploaded to the World Wide Web, particularly those provided by expert/medical sources. These advances may eventually have some effect on doctor visits from patients and change the role of the health professionals from "gatekeeper to secondary care to facilitator of information interpretation and decision-making." Apart from basic services provided by Google in Search, there are also companies such as WebMD that already offer dedicated symptom-checking apps.
Technology testing
All medical equipment introduced commercially must meet both United States and international regulations. The devices are tested on their material, effects on the human body, all components including devices that have other devices included with them, and the mechanical aspects.
The Medical Device User Fee and Modernization Act of 2002 was created to speed up the FDA's approval process of medical technology by introducing sponsor user fees for a faster review time with predetermined performance targets for review time. In addition, 36 devices and apps were approved by the FDA in 2016.
Careers
There are numerous careers in health technology in the US. Listed below are some job titles and average salaries.
Athletic trainer, mean salary: $41,340. Athletic trainers treat athletes and other individuals who have sustained injuries. They also teach people how to prevent injuries. They perform their job under the supervision of physicians.
Dental hygienist, mean salary: $67,340. Dental hygienists provide preventive dental care and teach patients how to maintain good oral health. They usually work under dentists' supervision.
Clinical laboratory scientists, technicians, and technologists, mean salary: $51,770. Lab technicians and technologists perform laboratory tests and procedures. Technicians work under the supervision of a laboratory technologist or laboratory manager.
Nuclear medicine technologist, mean salary: $67,910. Nuclear medicine technologists prepare and administer radiopharmaceuticals, radioactive drugs, to patients to treat or diagnose diseases.
Pharmacy technician, mean salary: $28,070. Pharmacy technicians assist pharmacists with the preparation of prescription medications for customers.
Allied professions
The term medical technology may also refer to the duties performed by clinical laboratory professionals or medical technologists in various settings within the public and private sectors. The work of these professionals encompasses clinical applications of chemistry, genetics, hematology, immunohematology (blood banking), immunology, microbiology, serology, urinalysis, and miscellaneous body fluid analysis. Depending on location, educational level, and certifying body, these professionals may be referred to as biomedical scientists, medical laboratory scientists (MLS), medical technologists (MT), medical laboratory technologists and medical laboratory technicians.
References
Health care occupations
Biomedical engineering
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Professional development | Professional development, also known as professional education, is learning that leads to or emphasizes education in a specific professional career field or builds practical job applicable skills emphasizing praxis in addition to the transferable skills and theoretical academic knowledge found in traditional liberal arts and pure sciences education. It is used to earn or maintain professional credentials such as professional certifications or academic degrees through formal coursework at institutions known as professional schools, or attending conferences and informal learning opportunities to strengthen or gain new skills.
Professional education has been described as intensive and collaborative, ideally incorporating an evaluative stage. There is a variety of approaches to professional development or professional education, including consultation, coaching, communities of practice, lesson study, case study, capstone project, mentoring, reflective supervision and technical assistance.
Participants
A wide variety of people, such as teachers, military officers and non-commissioned officers, health care professionals, architects, lawyers, accountants and engineers engage in professional development. Individuals may participate in professional development because of an interest in lifelong learning, a sense of moral obligation, to maintain and improve professional competence, to enhance career progression, to keep abreast of new technology and practices, or to comply with professional regulatory requirements. In the training of school staff in the United States, "[t]he need for professional development ... came to the forefront in the 1960s". Many American states have professional development requirements for school teachers. For example, Arkansas teachers must complete 60 hours of documented professional development activities annually. Professional development credits are named differently from state to state. For example, teachers in Indiana are required to earn 90 Continuing Renewal Units (CRUs) per year; in Massachusetts, teachers need 150 Professional Development Points (PDPs); and in Georgia, teachers must earn 10 Professional Learning Units (PLUs). American and Canadian nurses, as well as those in the United Kingdom, have to participate in formal and informal professional development (earning credit based on attendance of education that has been accredited by a regulatory agency) in order to maintain professional registration.
Approaches
In a broad sense, professional development may include formal types of vocational education, typically post-secondary or poly-technical training leading to qualification or credential required to obtain or retain employment. Professional development may also come in the form of pre-service or in-service professional development programs. These programs may be formal, or informal, group or individualized. Individuals may pursue professional development independently, or programs may be offered by human resource departments. Professional development on the job may develop or enhance process skills, sometimes referred to as leadership skills, as well as task skills. Some examples for process skills are 'effectiveness skills', 'team functioning skills', and 'systems thinking skills'.
Professional development opportunities can range from a single workshop to a semester-long academic course, to services offered by a medley of different professional development providers and varying widely with respect to the philosophy, content, and format of the learning experiences. Some examples of approaches to professional development include:
Case Study Method – The case method is a teaching approach that consists in presenting the students with a case, putting them in the role of a decision maker facing a problem – See Case method.
Consultation – to assist an individual or group of individuals to clarify and address immediate concerns by following a systematic problem-solving process.
Coaching – to enhance a person's competencies in a specific skill area by providing a process of observation, reflection, and action.
Communities of Practice – to improve professional practice by engaging in shared inquiry and learning with people who have a common goal
Lesson Study – to solve practical dilemmas related to intervention or instruction through participation with other professionals in systematically examining practice
Mentoring – to promote an individual's awareness and refinement of his or her own professional development by providing and recommending structured opportunities for reflection and observation
Reflective Supervision – to support, develop, and ultimately evaluate the performance of employees through a process of inquiry that encourages their understanding and articulation of the rationale for their own practices
Technical Assistance – to assist individuals and their organization to improve by offering resources and information, supporting networking and change efforts.
The World Bank's 2019 World Development Report on the future of work argues that professional development opportunities for those both in and out of work, such as flexible learning opportunities at universities and adult learning programs, enable labor markets to adjust to the future of work.
Initial
Initial professional development (IPD) is defined as "a period of development during which an individual acquires a level of competence necessary in order to operate as an autonomous professional". Professional associations may recognise the successful completion of IPD by the award of chartered or similar status. Examples of professional bodies that require IPD prior to the award of professional status are the Institute of Mathematics and its Applications, the Institution of Structural Engineers, and the Institution of Occupational Safety and Health.
Continuing
Continuing professional development (CPD) or continuing professional education (CPE) is continuing education to maintain knowledge and skills. Most professions have CPD obligations. Examples are the Royal Institution of Chartered Surveyors, American Academy of Financial Management, safety professionals with the International Institute of Risk & Safety Management (IIRSM) or the Institution of Occupational Safety and Health (IOSH), and medical and legal professionals, who are subject to continuing medical education or continuing legal education requirements, which vary by jurisdiction.
CPD authorities in the United Kingdom include the CPD Standards Office who work in partnership with the CPD Institute, and also the CPD Certification Service. For example, CPD by the Institute of Highway Engineers is approved by the CPD Standards Office, and CPD by the Chartered Institution of Highways and Transportation is approved by the CPD Certification Service.
A systematic review published in 2019 by the Campbell Collaboration found little evidence of the effectiveness of continuing professional development (CPD).
See also
References
External links
Personal development
Vocational education
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Psychoactive drug | A psychoactive drug, mind-altering drug, or consciousness-altering drug is a chemical substance that changes brain function and results in alterations in perception, mood, consciousness, cognition, or behavior. The term psychotropic drug is often used interchangeably, while some sources present narrower definitions. These substances may be used medically; recreationally; to purposefully improve performance or alter one's consciousness; as entheogens for ritual, spiritual, or shamanic purposes; or for research, including psychedelic therapy. Some categories of psychoactive drugs, which have therapeutic value, are prescribed by physicians and other healthcare practitioners. Examples include anesthetics, analgesics, anticonvulsant and antiparkinsonian drugs as well as medications used to treat neuropsychiatric disorders, such as antidepressants, anxiolytics, antipsychotics, and stimulant medications. Some psychoactive substances may be used in the detoxification and rehabilitation programs for persons dependent on or addicted to other psychoactive drugs.
Psychoactive substances often bring about subjective changes in consciousness and mood (although these may be objectively observed) that the user may find rewarding and pleasant (e.g., euphoria or a sense of relaxation) or advantageous in an objectively observable or measurable way (e.g. increased alertness), thus the effects are reinforcing to varying degrees. Substances which are rewarding and thus positively reinforcing have the potential to induce a state of addiction – compulsive drug use despite negative consequences. In addition, sustained use of some substances may produce physical or psychological dependence or both, associated with somatic or psychological-emotional withdrawal states respectively. Drug rehabilitation attempts to reduce addiction, through a combination of psychotherapy, support groups, and other psychoactive substances. Conversely, certain psychoactive drugs may be so unpleasant that the person will never use the substance again. This is especially true of certain deliriants (e.g. Jimson weed), powerful dissociatives (e.g. Salvia divinorum), and classic psychedelics (e.g. LSD, psilocybin), in the form of a "bad trip".
Psychoactive drug misuse, dependence, and addiction have resulted in legal measures and moral debate. Governmental controls on manufacture, supply, and prescription attempt to reduce problematic medical drug use; worldwide efforts to combat trafficking in psychoactive drugs are commonly termed the "war on drugs". Ethical concerns have also been raised about the overuse of these drugs clinically and about their marketing by manufacturers. Popular campaigns to decriminalize or legalize the recreational use of certain drugs (e.g., cannabis) are also ongoing.
History
Psychoactive drug use can be traced to prehistory. Archaeological evidence of the use of psychoactive substances, mostly plants, dates back at least 10,000 years; historical evidence indicates cultural use 5,000 years ago. There is evidence of the chewing of coca leaves, for example, in Peruvian society 8,000 years ago.
Psychoactive substances have been used medicinally and to alter consciousness. Consciousness altering may be a primary drive, akin to the need to satiate thirst, hunger, or sexual desire. This may be manifest in the long history of drug use, and even even children's desire for spinning, swinging, or sliding, suggesting that the drive to alter one's state of mind is universal.
In The Hasheesh Eater (1857), American author Fitz Hugh Ludlow was one of the first to describe in modern terms the desire to change one's consciousness through drug use:
During the 20th century, the majority of countries initially responded to the use of recreational drugs by prohibiting production, distribution, or use through criminalization. A notable example occurred with Prohibition in the United States, where alcohol was made illegal for 13 years. In recent decades, an emerging view among governments and law enforcement holds that illicit drug use cannot be stopped through prohibition. One organization with that opinion, Law Enforcement Against Prohibition (LEAP), concluded that "[in] fighting a war on drugs the government has increased the problems of society and made them far worse. A system of regulation rather than prohibition is a less harmful, more ethical and a more effective public policy."
In some countries, there has been a move toward harm reduction by health services, where the use of illicit drugs is neither condoned nor promoted, but services and support are provided to ensure users have adequate factual information readily available, and that the negative effects of their use be minimized. Such is the case of the Portuguese drug policy of decriminalization, which achieved its primary goal of reducing the adverse health effects of drug abuse.
Terminology
Psychoactive and psychotropic are often used interchangeably in general and academic sources, to describe substances that act on the brain to alter cognition and perception; some sources make a distinction between the terms. One narrower definition of psychotropic refers to drugs used to treat mental disorders, such as anxiolytic sedatives, antidepressants, antimanic agents, and neuroleptics. Another use of psychotropic refers to substances with a high likelihood of abuse, including stimulants, hallucinogens, opioids, and sedatives/hypnotics including alcohol. In international drug control, "psychotropic substances" refers to the substances specified in the Convention on Psychotropic Substances, which does not include narcotics.
The term "drug" has become a skunked term; Drugs can have a negative connotation, often associated with illegal substances like cocaine or heroin. This is despite the fact that the terms "drug" and "medicine" are sometimes used interchangeably.
Novel psychoactive substances (NPS), also known as "designer drugs" are a category of psychoactive drugs (substances) that are designed to mimic the effects of often illegal drugs, usually in efforts to circumvent existing drug laws.
Types
Psychoactive drugs are divided according to their pharmacological effects. Common subtypes include:
Anxiolytics are medicinally used to reduce the symptoms of anxiety, and sometimes insomnia.
Example: benzodiazepines such as Xanax and Valium; barbiturates
Empathogen–entactogens alter one's emotional state, often resulting in an increased sense of empathy, closeness, and emotional communication.
Example: MDMA (ecstasy), MDA, 6-APB, AMT
Stimulants increase activity, or arousal, of the central nervous system, used to enhance alertness, attention, cognition, mood and physical performance. Some stimulants are used medicinally to treat individuals with ADHD and narcolepsy.
Examples: amphetamines, caffeine, cocaine, nicotine
Depressants reduce (or depress) activity and stimulation in the central nervous system. Drugs within this classification encompass a spectrum of substances with sedative, soporific, and anesthetic properties, and include sedatives, hypnotics, and opioids.
Examples: ethanol (alcohol), opioids such as morphine, fentanyl, and codeine, cannabis, barbiturates, and benzodiazepines
Hallucinogens, including psychedelics, dissociatives and deliriants, encompass substances that produce distinct alterations in perception, sensation of space and time, and emotional state.
Examples: Dextromethorphan, psilocybin, LSD, DMT (N,N-Dimethyltryptamine), mescaline, Salvia divinorum, datura, scopolamine
Uses
Use of psychoactive substances vary widely between cultures. Some substances may have controlled or illegal uses, others may have shamanic purposes, and others are used medicinally. Examples would be social drinking, nootropic supplements, and sleep aids. Caffeine is the world's most widely consumed psychoactive substance: it is legal and unregulated in nearly all jurisdictions; in North America, 90% of adults consume caffeine daily.
Mental disorders
Psychiatric medications are psychoactive drugs prescribed for the management of mental and emotional disorders, or to aid in overcoming challenging behavior. There are six major classes of psychiatric medications:
Antidepressants treat disorders such as clinical depression, dysthymia, anxiety, eating disorders, and borderline personality disorder.
Stimulants, used to treat disorders such as attention deficit hyperactivity disorder and narcolepsy, and for weight reduction.
Antipsychotics, used to treat psychotic symptoms, such as those associated with schizophrenia or severe mania, or as adjuncts to relieve clinical depression.
Mood stabilizers, used to treat bipolar disorder and schizoaffective disorder.
Anxiolytics, used to treat anxiety disorders.
Depressants, used as hypnotics, sedatives, and anesthetics, depending upon dosage.
In addition, several psychoactive substances are currently employed to treat various addictions. These include acamprosate or naltrexone in the treatment of alcoholism, or methadone or buprenorphine maintenance therapy in the case of opioid addiction.
Exposure to psychoactive drugs can cause changes to the brain that counteract or augment some of their effects; these changes may be beneficial or harmful. However, there is a significant amount of evidence that the relapse rate of mental disorders negatively corresponds with the length of properly followed treatment regimens (that is, relapse rate substantially declines over time), and to a much greater degree than placebo.
Military
Drugs used by militaries
Militaries worldwide have used or are using various psychoactive drugs to treat pain and to improve performance of soldiers by suppressing hunger, increasing the ability to sustain effort without food, increasing and lengthening wakefulness and concentration, suppressing fear, reducing empathy, and improving reflexes and memory-recall among other things.
Both military and civilian American intelligence officials are known to have used psychoactive drugs while interrogating captives apprehended in its "war on terror". In July 2012 Jason Leopold and Jeffrey Kaye, psychologists and human rights workers, had a Freedom of Information Act request fulfilled that confirmed that the use of psychoactive drugs during interrogation was a long-standing
practice. Captives and former captives had been reporting medical staff collaborating with interrogators to drug captives with powerful psychoactive drugs prior to interrogation since the very first captives release.
In May 2003 recently released Pakistani captive Sha Mohammed Alikhel described the routine use of psychoactive drugs. He said that Jihan Wali, a captive kept in a nearby cell, was rendered catatonic through the use of these drugs.
The first documented case of a soldier overdosing on methamphetamine during combat, was the Finnish corporal Aimo Koivunen, a soldier who fought in the Winter War and the Continuation War.
Psychochemical warfare
Psychoactive drugs have been used in military applications as non-lethal weapons.
Pain management
Psychoactive drugs are often prescribed to manage pain. The subjective experience of pain is primarily regulated by endogenous opioid peptides. Thus, pain can often be managed using psychoactives that operate on this neurotransmitter system, also known as opioid receptor agonists. This class of drugs can be highly addictive, and includes opiate narcotics, like morphine and codeine. NSAIDs, such as aspirin and ibuprofen, are also analgesics. These agents also reduce eicosanoid-mediated inflammation by inhibiting the enzyme cyclooxygenase.
Anesthesia
General anesthetics are a class of psychoactive drug used on people to block physical pain and other sensations. Most anesthetics induce unconsciousness, allowing the person to undergo medical procedures like surgery, without the feelings of physical pain or emotional trauma. To induce unconsciousness, anesthetics affect the GABA and NMDA systems. For example, Propofol is a GABA agonist, and ketamine is an NMDA receptor antagonist.
Performance-enhancement
Performance-enhancing substances, also known as performance-enhancing drugs (PEDs), are substances that are used to improve any form of activity performance in humans. A well-known example of cheating in sports involves doping in sport, where banned physical performance-enhancing drugs are used by athletes and bodybuilders. Athletic performance-enhancing substances are sometimes referred as ergogenic aids. Cognitive performance-enhancing drugs, commonly called nootropics, are sometimes used by students to improve academic performance. Performance-enhancing substances are also used by military personnel to enhance combat performance.
Recreation
Many psychoactive substances are used for their mood and perception altering effects, including those with accepted uses in medicine and psychiatry. Examples of psychoactive substances include caffeine, alcohol, cocaine, LSD, nicotine, cannabis, and dextromethorphan. Classes of drugs frequently used recreationally include:
Stimulants, which activate the central nervous system. These are used recreationally for their euphoric effects.
Hallucinogens (psychedelics, dissociatives and deliriants), which induce perceptual and cognitive alterations.
Hypnotics, which depress the central nervous system.
Opioid analgesics, which also depress the central nervous system. These are used recreationally because of their euphoric effects.
Inhalants, in the forms of gas aerosols, or solvents, which are inhaled as a vapor because of their stupefying effects. Many inhalants also fall into the above categories (such as nitrous oxide which is also an analgesic).
In some modern and ancient cultures, drug usage is seen as a status symbol. Recreational drugs are seen as status symbols in settings such as at nightclubs and parties. For example, in ancient Egypt, gods were commonly pictured holding hallucinogenic plants.
Because there is controversy about regulation of recreational drugs, there is an ongoing debate about drug prohibition. Critics of prohibition believe that regulation of recreational drug use is a violation of personal autonomy and freedom. In the United States, critics have noted that prohibition or regulation of recreational and spiritual drug use might be unconstitutional, and causing more harm than is prevented.
Some people who take psychoactive drugs experience drug or substance induced psychosis. A 2019 systematic review and meta-analysis by Murrie et al. found that the pooled proportion of transition from substance-induced psychosis to schizophrenia was 25% (95% CI 18%–35%), compared with 36% (95% CI 30%–43%) for brief, atypical and not otherwise specified psychoses. Type of substance was the primary predictor of transition from drug-induced psychosis to schizophrenia, with highest rates associated with cannabis (6 studies, 34%, CI 25%–46%), hallucinogens (3 studies, 26%, CI 14%–43%) and amphetamines (5 studies, 22%, CI 14%–34%). Lower rates were reported for opioid (12%), alcohol (10%) and sedative (9%) induced psychoses. Transition rates were slightly lower in older cohorts but were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up.
Ritual and spiritual
Offerings
Alcohol and tobacco (nicotine) have been and are used as offerings in various religions and spiritual practices. Coca leaves have been used as offerings in rituals.
Alcohol
According to the Catholic Church, the sacramental wine used in the Eucharist must contain alcohol. Canon 924 of the present Code of Canon Law (1983) states:
§3 The wine must be natural, made from grapes of the vine, and not corrupt.
Psychoactive use
Entheogen
Certain psychoactives, particularly hallucinogens, have been used for religious purposes since prehistoric times. Native Americans have used peyote cacti containing mescaline for religious ceremonies for as long as 5700 years. The muscimol-containing Amanita muscaria mushroom was used for ritual purposes throughout prehistoric Europe.
The use of entheogens for religious purposes resurfaced in the West during the counterculture movements of the 1960s and 70s. Under the leadership of Timothy Leary, new spiritual and intention-based movements began to use LSD and other hallucinogens as tools to access deeper inner exploration. In the United States, the use of peyote for ritual purposes is protected only for members of the Native American Church, which is allowed to cultivate and distribute peyote. However, the genuine religious use of peyote, regardless of one's personal ancestry, is protected in Colorado, Arizona, New Mexico, Nevada, and Oregon.
Psychedelic therapy
Psychedelic therapy (or psychedelic-assisted therapy) refers to the proposed use of psychedelic drugs, such as psilocybin, MDMA, LSD, and ayahuasca, to treat mental disorders. As of 2021, psychedelic drugs are controlled substances in most countries and psychedelic therapy is not legally available outside clinical trials, with some exceptions.
Psychonautics
The aims and methods of psychonautics, when state-altering substances are involved, is commonly distinguished from recreational drug use by research sources. Psychonautics as a means of exploration need not involve drugs, and may take place in a religious context with an established history. Cohen considers psychonautics closer in association to wisdom traditions and other transpersonal and integral movements.
Self-medication
Self-medication, sometime called do-it-yourself (DIY) medicine, is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological conditions, for example headaches or fatigue.
The substances most widely used in self-medication are over-the-counter drugs and dietary supplements, which are used to treat common health issues at home. These do not require a doctor's prescription to obtain and, in some countries, are available in supermarkets and convenience stores.
Sex
Sex and drugs date back to ancient humans and have been interlocked throughout human history. Both legal and illegal, the consumption of drugs and their effects on the human body encompasses all aspects of sex, including desire, performance, pleasure, conception, gestation, and disease.
There are many different types of drugs that are commonly associated with their effects on sex, including alcohol, cannabis, cocaine, MDMA, GHB, amphetamines, opioids, antidepressants, and many others.
Social movements
Cannabis
In the US, NORML (National Organization for the Reform of Marijuana Laws) has led since the 1970s a movement to legalize cannabis nationally. The so-called "420 movement" is the global association of the number 420 with cannabis consumption: April 20th – fourth month, twentieth day – has become an international counterculture holiday based on the celebration and consumption of cannabis; 4:20 pm on any day is a time to consume cannabis.
Operation Overgrow
Operation Overgrow is the name, given by cannabis activists, of an "operation" to spread marijuana seeds wildly "so it grows like weed". The thought behind the operation is to draw attention to the debate about legalization/decriminalization of marijuana.
Suicide
A drug overdose involves taking a dose of a drug that exceeds safe levels. In the UK (England and Wales) until 2013, a drug overdose was the most common suicide method in females. In 2019 in males the percentage is 16%. Self-poisoning accounts for the highest number of non-fatal suicide attempts. In the United States about 60% of suicide attempts and 14% of suicide deaths involve drug overdoses. The risk of death in suicide attempts involving overdose is about 2%.
Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide, with alcoholism present in between 15% and 61% of cases. Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide. About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide. Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past. In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.
Overdose attempts using painkillers are among the most common, due to their easy availability over-the-counter.
Route of administration
Psychoactive drugs are administered via oral ingestion as a tablet, capsule, powder, liquid, and beverage; via injection by subcutaneous, intramuscular, and intravenous route; via rectum by suppository and enema; and via inhalation by smoking, vaporizing, and snorting. The efficiency of each method of administration varies from drug to drug.
The psychiatric drugs fluoxetine, quetiapine, and lorazepam are ingested orally in tablet or capsule form. Alcohol and caffeine are ingested in beverage form; nicotine and cannabis are smoked or vaporized; peyote and psilocybin mushrooms are ingested in botanical form or dried; and crystalline drugs such as cocaine and methamphetamine are usually inhaled or snorted.
Determinants of effects
The theory of dosage, set, and setting is a useful model in dealing with the effects of psychoactive substances, especially in a controlled therapeutic setting as well as in recreational use. Dr. Timothy Leary, based on his own experiences and systematic observations on psychedelics, developed this theory along with his colleagues Ralph Metzner, and Richard Alpert (Ram Dass) in the 1960s.
Dosage
The first factor, dosage, has been a truism since ancient times, or at least since Paracelsus who said, "Dose makes the poison." Some compounds are beneficial or pleasurable when consumed in small amounts, but harmful, deadly, or evoke discomfort in higher doses.
Set
The set is the internal attitudes and constitution of the person, including their expectations, wishes, fears, and sensitivity to the drug. This factor is especially important for the hallucinogens, which have the ability to make conscious experiences out of the unconscious. In traditional cultures, set is shaped primarily by the worldview, health and genetic characteristics that all the members of the culture share.
Setting
The third aspect is setting, which pertains to the surroundings, the place, and the time in which the experiences transpire.
This theory clearly states that the effects are equally the result of chemical, pharmacological, psychological, and physical influences. The model that Timothy Leary proposed applied to the psychedelics, although it also applies to other psychoactives.
Effects
Psychoactive drugs operate by temporarily affecting a person's neurochemistry, which in turn causes changes in a person's mood, cognition, perception and behavior. There are many ways in which psychoactive drugs can affect the brain. Each drug has a specific action on one or more neurotransmitter or neuroreceptor in the brain.
Drugs that increase activity in particular neurotransmitter systems are called agonists. They act by increasing the synthesis of one or more neurotransmitters, by reducing its reuptake from the synapses, or by mimicking the action by binding directly to the postsynaptic receptor. Drugs that reduce neurotransmitter activity are called antagonists, and operate by interfering with synthesis or blocking postsynaptic receptors so that neurotransmitters cannot bind to them.
Exposure to a psychoactive substance can cause changes in the structure and functioning of neurons, as the nervous system tries to re-establish the homeostasis disrupted by the presence of the drug (see also, neuroplasticity). Exposure to antagonists for a particular neurotransmitter can increase the number of receptors for that neurotransmitter or the receptors themselves may become more responsive to neurotransmitters; this is called sensitization. Conversely, overstimulation of receptors for a particular neurotransmitter may cause a decrease in both number and sensitivity of these receptors, a process called desensitization or tolerance. Sensitization and desensitization are more likely to occur with long-term exposure, although they may occur after only a single exposure. These processes are thought to play a role in drug dependence and addiction. Physical dependence on antidepressants or anxiolytics may result in worse depression or anxiety, respectively, as withdrawal symptoms. Unfortunately, because clinical depression (also called major depressive disorder) is often referred to simply as depression, antidepressants are often requested by and prescribed for patients who are depressed, but not clinically depressed.
Affected neurotransmitter systems
The following is a brief table of notable drugs and their primary neurotransmitter, receptor or method of action. Many drugs act on more than one transmitter or receptor in the brain.
Addiction and dependence
Psychoactive drugs are often associated with addiction or drug dependence. Dependence can be divided into two types: psychological dependence, by which a user experiences negative psychological or emotional withdrawal symptoms (e.g., depression) and physical dependence, by which a user must use a drug to avoid physically uncomfortable or even medically harmful physical withdrawal symptoms. Drugs that are both rewarding and reinforcing are addictive; these properties of a drug are mediated through activation of the mesolimbic dopamine pathway, particularly the nucleus accumbens. Not all addictive drugs are associated with physical dependence, e.g., amphetamine, and not all drugs that produce physical dependence are addictive drugs, e.g., oxymetazoline.
Many professionals, self-help groups, and businesses specialize in drug rehabilitation, with varying degrees of success, and many parents attempt to influence the actions and choices of their children regarding psychoactives.
Common forms of rehabilitation include psychotherapy, support groups and pharmacotherapy, which uses psychoactive substances to reduce cravings and physiological withdrawal symptoms while a user is going through detox. Methadone, itself an opioid and a psychoactive substance, is a common treatment for heroin addiction, as is another opioid, buprenorphine. Recent research on addiction has shown some promise in using psychedelics such as ibogaine to treat and even cure drug addictions, although this has yet to become a widely accepted practice.
Legality
The legality of psychoactive drugs has been controversial through most of recent history; the Second Opium War and Prohibition are two historical examples of legal controversy surrounding psychoactive drugs. However, in recent years, the most influential document regarding the legality of psychoactive drugs is the Single Convention on Narcotic Drugs, an international treaty signed in 1961 as an Act of the United Nations. Signed by 73 nations including the United States, the USSR, Pakistan, India, and the United Kingdom, the Single Convention on Narcotic Drugs established Schedules for the legality of each drug and laid out an international agreement to fight addiction to recreational drugs by combatting the sale, trafficking, and use of scheduled drugs. All countries that signed the treaty passed laws to implement these rules within their borders. However, some countries that signed the Single Convention on Narcotic Drugs, such as the Netherlands, are more lenient with their enforcement of these laws.
In the United States, the Food and Drug Administration (FDA) has authority over all drugs, including psychoactive drugs. The FDA regulates which psychoactive drugs are over the counter and which are only available with a prescription. However, certain psychoactive drugs, like alcohol, tobacco, and drugs listed in the Single Convention on Narcotic Drugs are subject to criminal laws. The Controlled Substances Act of 1970 regulates the recreational drugs outlined in the Single Convention on Narcotic Drugs. Alcohol is regulated by state governments, but the federal National Minimum Drinking Age Act penalizes states for not following a national drinking age. Tobacco is also regulated by all fifty state governments. Most people accept such restrictions and prohibitions of certain drugs, especially the "hard" drugs, which are illegal in most countries.
In the medical context, psychoactive drugs as a treatment for illness is widespread and generally accepted. Little controversy exists concerning over the counter psychoactive medications in antiemetics and antitussives. Psychoactive drugs are commonly prescribed to patients with psychiatric disorders. However, certain critics believe that certain prescription psychoactives, such as antidepressants and stimulants, are overprescribed and threaten patients' judgement and autonomy.
Effect on animals
A number of animals consume different psychoactive plants, animals, berries and even fermented fruit, becoming intoxicated. An example of this is cats after consuming catnip. Traditional legends of sacred plants often contain references to animals that introduced humankind to their use. Animals and psychoactive plants appear to have co-evolved, possibly explaining why these chemicals and their receptors exist within the nervous system.
Widely used psychoactive drugs
This is a list of commonly used drugs that contain psychoactive ingredients. Please note that the following lists contains legal and illegal drugs (based on the country's laws).
Common legal drugs
The most widely consumed psychotropic drugs worldwide are:
Caffeine
Alcohol
Nicotine
Common prescribed drugs
benzodiazepines
cannabis
opioids
amphetamines
ssri
Common street drugs
See also
Contact high
Counterculture of the 1960s
Demand reduction
Designer drug
Drug
Drug addiction
Drug checking
Drug rehabilitation
Hamilton's Pharmacopeia
Hard and soft drugs
Harm reduction
Neuropsychopharmacology
Psychopharmacology
Poly drug use
Project MKULTRA
Psychedelic plants
Psychoactive fish
Recreational drug use
Responsible drug use
Self-medication
Notes
References
External links
Neuroscience of Psychoactive Substance Use and Dependence by the WHO
fi:Psykoaktiivinen aine | 0.761484 | 0.998661 | 0.760464 |
Extrapyramidal symptoms | Extrapyramidal symptoms (EPS) are symptoms that are archetypically associated with the extrapyramidal system of the brain's cerebral cortex. When such symptoms are caused by medications or other drugs, they are also known as extrapyramidal side effects (EPSE). The symptoms can be acute (short-term) or chronic (long-term). They include movement dysfunction such as dystonia (continuous spasms and muscle contractions), akathisia (may manifest as motor restlessness), parkinsonism characteristic symptoms such as rigidity, bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements). Extrapyramidal symptoms are a reason why subjects drop out of clinical trials of antipsychotics; of the 213 (14.6%) subjects that dropped out of one of the largest clinical trials of antipsychotics (the CATIE trial [Clinical Antipsychotic Trials for Intervention Effectiveness], which included 1460 randomized subjects), 58 (27.2%) of those discontinuations were due to EPS.
Causes
Medications
Extrapyramidal symptoms are most commonly caused by typical antipsychotic drugs that antagonize dopamine D2 receptors. The most common typical antipsychotics associated with EPS are haloperidol and fluphenazine. Atypical antipsychotics have lower D2 receptor affinity or higher serotonin 5-HT2A receptor affinity which lead to lower rates of EPS.
Other anti-dopaminergic drugs, like the antiemetic metoclopramide, can also result in extrapyramidal side effects. Short and long-term use of antidepressants such as selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) have also resulted in EPS. Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of EPS.
Non-medication-related
Other causes of extrapyramidal symptoms can include brain damage and meningitis. However, the term "extrapyramidal symptoms" generally refers to medication-induced causes in the field of psychiatry.
Diagnosis
Since it is difficult to measure extrapyramidal symptoms, rating scales are commonly used to assess the severity of movement disorders. The Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS), and Extrapyramidal Symptom Rating Scale (ESRS) are rating scales frequently used for such assessment and are not weighted for diagnostic purposes; these scales can help clinicians weigh the benefit/expected benefit of a medication against the degree of distress which the side effects are causing the patient, aiding in the decision to maintain, reduce, or discontinue the causative medication(s).
Classification
Acute dystonic reactions: painful, muscular spasms of neck, jaw, back, extremities, eyes, throat, and tongue; highest risk in young men.
Oculogyric crisis is a kind of acute dystonic reaction that involves the prolonged involuntary upward deviation of the eyes.
Akathisia: A feeling of internal motor restlessness that can present as tension, nervousness, or anxiety. Clinical manifestations include pacing and an inability to sit still.
Pseudoparkinsonism: drug-induced parkinsonism (rigidity, bradykinesia, tremor, masked facies, shuffling gait, stooped posture, sialorrhoea, and seborrhoea; greater risk in the elderly). Although Parkinson's disease is primarily a disease of the nigrostriatal pathway and not the extrapyramidal system, loss of dopaminergic neurons in the substantia nigra leads to dysregulation of the extrapyramidal system. Since this system regulates posture and skeletal muscle tone, a result is the characteristic bradykinesia of Parkinson's.
Tardive dyskinesia: involuntary muscle movements in the lower face and distal extremities; this can be a chronic condition associated with long-term use of antipsychotics.
Treatment
Medications are used to reverse the symptoms of extrapyramidal side effects caused by antipsychotics or other drugs, by either directly or indirectly increasing dopaminergic neurotransmission. The treatment varies by the type of the EPS, but may involve anticholinergic agents such as procyclidine, benztropine, diphenhydramine, and trihexyphenidyl. Certain medications such as dopamine agonists are not used, as they may worsen psychotic symptoms to those taking neuroleptic drugs.
If the EPS are induced by an antipsychotic, EPS may be reduced by decreasing the dose of the antipsychotic or by switching from a typical antipsychotic to an (or to a different) atypical antipsychotic, such as aripiprazole, ziprasidone, quetiapine, olanzapine, risperidone, or clozapine. These medications possess an additional mode of action that is believed to mitigate their effect on the nigrostriatal pathway, which means they are associated with fewer extrapyramidal side-effects than "conventional" antipsychotics (chlorpromazine, haloperidol, etc.)
Dystonia
Anticholinergic medications are used to reverse acute dystonia. If the symptoms are particularly severe, the anticholinergic medication may be administered by injection into a muscle to rapidly reverse the dystonia.
Akathisia
Certain second-generation antipsychotics, such as lurasidone and the partial D2-agonist aripiprazole, are more likely to cause akathisia compared to other second-generation antipsychotics. If akathisia occurs, switching to an antipsychotic with a lower risk of akathisia may improve symptoms. Beta blockers (like propranolol) are frequently used to treat akathisia. Other medications that are sometimes used include clonidine, mirtazapine, or even benzodiazepines. Anticholinergic medications are not helpful for treating akathisia.
Pseudoparkinsonism
Medication interventions are generally reserved for cases in which withdrawing the medication that caused the pseudoparkinsonism is either ineffective or infeasible. Anticholinergic medications are sometimes used to treat pseudoparkinsonism, but they can be difficult to tolerate when given chronically. Amantadine is sometimes used as well. It is rare for dopamine agonists to be used for antipsychotic-induced EPS, as they may exacerbate psychosis.
Tardive dyskinesia
When other measures fail or are not feasible, medications are used to treat tardive dyskinesia. These include the vesicular monoamine transporter 2 inhibitors tetrabenazine and deutetrabenazine.
History
Extrapyramidal symptoms (also called extrapyramidal side effects) get their name because they are symptoms of disorders in the extrapyramidal system, which regulates posture and skeletal muscle tone. This is in contrast to symptoms originating from the pyramidal tracts.
See also
Neuroleptic malignant syndrome
Rabbit syndrome
References
External links
Extrapyramidal and movement disorders
Syndromes | 0.762152 | 0.99778 | 0.76046 |
Disability abuse | Disability abuse is when a person with a disability is abused physically, financially, sexually and/or psychologically due to the person having a disability. This type of abuse has also been considered a hate crime. The abuse is not limited to those who are visibly disabled or physically deformed, but also includes those with learning, intellectual and developmental disabilities or mental illnesses.
Risk factors for abuse
According to the World Health Organization (WHO) persons with disabilities make up around 15% of the world's population. Children with disabilities are three times more likely to face violence than non-disabled children, and there is an approximate 50% increased risk of experiencing violence for adults with mental health conditions.
Persons with disabilities are easy targets for predators as they may not have the resources or abilities to escape an abusive situation or communicate about the occurrences. Hard of hearing persons are placed at twice the risk for neglect and emotional abuse in comparison to other disabilities and nearly four times in regards to physical abuse.
Abuse can occur in multiple ways, most commonly seen as physical, emotional, or sexual. Those in the disability population tend to be at higher risk due to lacking skills to protect themselves. Examples include: deficits in communication, limited social environment, disempowerment, and intimate contact required for hygiene dependency. Further, as there can be tendencies for caretakers to overprotect individuals during their youth, they can more easily be exploited due to a lack of preparation. In facets such as school there is often a lack of efficient sex education for youth with disabilities and in combination of improper training for professionals working with these children, risks increase. Notably there also tends to be overlap between abuse and neglect as childhood care often results in full dependency on care providers due to need for assistance throughout daily activities.
A community-based participatory research study to assess abuse and current physical and mental health of 350 members within varying disabilities found a significant correlation with depressive symptoms and significant relations between childhood abuse and depression, PTSD, and negative physical health outcomes in adulthood. The main finding was that interaction of childhood and adult abuse predicted increased negative physical and psychological health rates for those with developmental disabilities.
Forms of abuse
Bullying
A 2012 survey by the Interactive Autism Network found that 63% of children with autism are bullied in the United States. Over a third of autistic adults said they had been bullied at work in a survey by the UK's National Autistic Society.
82% of children with a learning disability in the UK are bullied, according to Mencap, and 79% are scared to go out in case they are bullied.
A survey that was done shows that roughly seven out of ten people with disabilities have been abused, and that it is an ongoing problem. It was found that bullying people with disabilities is a problem in various other countries, and lacks attention.
Bullying is not always physical. Verbal bullying and cyberbullying occur often. Catherine Thornberry and Karin Olson claim that carers often dehumanize disabled people, taking away their abilities and qualities that make them a person and lowering them to the level of just an object or a thing. They found that the caregivers or assistants are often the ones who are unintentionally bullying the disabled individuals. The caregivers look at the individuals at lower standard than they do other people, leading to Thornberry and Olson labeling abuse of disabled individuals as a hate crime.
Sexual abuse
According to Valenti-Hein & Schwartz, only 3% of sexual abuse cases involving developmentally disabled people are ever reported; more than 90% of developmentally disabled people will experience sexual abuse at some point in their lives, and 49% will experience 10 or more abusive incidents.
A study published in the British Journal of Psychiatry by Sequeira, Howlin, & Hollins found that sexual abuse is associated with a higher incidence of psychiatric and behavioural disorder in people with learning disabilities in a case-control study. Sexual abuse was associated with increased rates of mental illness and behavioural problems, and with symptoms of post-traumatic stress. Psychological reactions to abuse were similar to those observed in the general population, but with the addition of stereotypical behavior. The more serious the abuse, the more severe the symptoms that were reported.
Sexual abuse is less likely to be reported by individuals with disabilities. The people that surround these individuals are often found to be less likely to report these cases of abuse. Many societies still view disabled people as weak and vulnerable, making it easy for the abuser to feel no remorse or to shift the blame away from themselves. More often than not, people figure they can trust their physicians or doctors who provide care for these individuals. In a clinical study it was found that the physicians would provide poor quality of care to individuals with disabilities. They would suppress the problems instead of addressing them by giving them drugs to make them be quiet. It was also found that physicians were less likely to report sexual abuse or any abuse that they found present on these individuals. They justified these actions by believing that disabled people are less valuable.
Institutional abuse
Institutional abuse overwhelmingly impacts people with disabilities, as those with intellectual disabilities and some physical disabilities often live in institutional settings. Hospitals and care homes can both be settings where abuse occurs. Severe disability is a factor that increases the likelihood of elder abuse and neglect in nursing homes in Portugal.
Impacts of abuse
There was one study done that shows 60 per cent of the children with disabilities come forth about being bullied regularly, versus 25 per cent of the students who are being bullied with no disabilities. This can also affect their learning and school and education. Their grades are more at risk in dropping, they have a more difficult time concentrating, and there is no interest in school and the learning material. All of this can lead to the child dropping out of school.
Current policies and research
There are policies such as Article 16 of the United Nations Convention on the Rights of Persons With Disabilities which calls for appropriate measures needed to protect all persons with disabilities in all locations, from all forms of abuse. WHO made a statement emphasizing poor public health surveillance of child maltreatment across the world which has been conveyed through examples such as the Adverse Childhood Experience questionnaire which has been used to gain better understanding of the prevalence of abuse occurring worldwide, but comparisons can be challenging due to differing policies between regions.
Additional policies like the United States Child Abuse Prevention and Treatment Act passed in 1974 and reauthorized in 2019 created a state-based child abuse reporting and response system that requires professionals to be legally mandated to make a government report if a child alludes to the possibility of abuse or neglect to see if an investigation is needed.
See also
Ableism
Developmental disability abuse and vulnerability
Disability hate crime
Institutional abuse
Sexual abuse of people with developmental disabilities
Violence against people with disabilities
Disability draft
Freak
References
Further reading
Baumhoefner, Arlen Financial Abuse of the Deaf And Hard of Hearing Exposed (2006)
Fitzsimons, Nancy M. & Sobsey, Dick Combating Violence & Abuse of People With Disabilities: A Call to Action (2009)
Abuse
Disability
Hate crime
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Madness and Civilization | Madness and Civilization: A History of Insanity in the Age of Reason (, 1961) is an examination by Michel Foucault of the evolution of the meaning of madness in the cultures and laws, politics, philosophy, and medicine of Europe—from the Middle Ages until the end of the 18th century—and a critique of the idea of history and of the historical method.
Although he uses the language of phenomenology to describe the influence of social structures in the history of the Othering of insane people from society, Madness and Civilization is Foucault's philosophic progress from phenomenology toward something like structuralism (a label Foucault himself always adamantly rejected).
Background
Philosopher Michel Foucault developed Madness and Civilization from his earlier works in the field of psychology, his personal psychological difficulties, and his professional experiences working in a mental hospital. He wrote the book between 1955 and 1959, when he worked cultural-diplomatic and educational posts in Poland and Germany, as well as in Sweden as director of a French cultural centre at the University of Uppsala.
Summary
In Madness and Civilization, Foucault traces the cultural evolution of the concept of insanity (madness) in three phases:
the Renaissance;
the Classical Age; and
the Modern era
Middle Ages
In the Middle Ages, society distanced lepers from itself, while in the "Classical Age" the object of social segregation was moved from lepers to madmen, but in a different way. The lepers of the Middle Ages were certainly considered dangerous, but they were not the object of a radical rejection, as would be demonstrated by the fact that leper hospitals were almost always located near the city gates, far but not invisible from the community. The relative presence of the leper reminded everyone of the duty of Christian charity, and therefore played a positive role in society.
Renaissance
In the Renaissance, art portrayed insane people as possessing wisdom (knowledge of the limits of the world), whilst literature portrayed the insane as people who reveal the distinction between what men are and what men pretend to be. Renaissance art and literature further depicted insane people as intellectually engaged with reasonable people, because their madness represented the mysterious forces of cosmic tragedy. Foucault contrasts the Renaissance image of the ship of fools with later conceptions of confinement. The Renaissance, rather than locking up madmen, ensured their circulation, so that the madman as a "passenger" and "passing being" became the symbol of the human condition: "Madness is the anticipation of death".
Yet Renaissance intellectualism began to develop an objective way of thinking about and describing reason and unreason, compared with the subjective descriptions of madness from the Middle Ages.
Classical Age
At the dawn of the Age of Reason in the 17th century, there occurred "the Great Confinement" of insane people in the countries of Europe; the initial management of insane people was to segregate them to the margins of society, and then to physically separate them from society by confinement, with other anti-social people (prostitutes, vagrants, blasphemers, et al.) into new institutions, such as the General Hospital of Paris. According to Foucault, the creation of the "general hospital" corresponds to Descartes's Meditations, and the desire to eliminate the irrational from philosophical discourse. "Classical reason" would have produced a "fracture" in the history of madness. Moreover, Christian European society perceived such anti-social people as being in moral error, for having freely chosen lives of prostitution, vagrancy, blasphemy, unreason, etc. To revert such moral errors, society's new institutions to confine outcast people featured way-of-life regimes composed of punishment-and-reward programs meant to compel the inmates to choose to reverse their choices of lifestyle.
The socio-economic forces that promoted this institutional confinement included the legalistic need for an extrajudicial social mechanism with the legal authority to physically separate socially undesirable people from mainstream society; and for controlling the wages and employment of poor people living in workhouses, whose availability lowered the wages of freeman workers. The conceptual distinction, between the mentally insane and the mentally sane, was a social construct produced by the practices of the extrajudicial separation of a human being from free society to institutional confinement. In turn, institutional confinement conveniently made insane people available to medical doctors then beginning to view madness as a natural object of study, and then as an illness to be cured.
Modern era
The Modern era began at the end of the 18th century, with the creation of medical institutions for confining mentally insane people under the supervision of medical doctors. Those institutions were product of two cultural motives: (i) the new goal of curing the insane away from poor families; and (ii) the old purpose of confining socially undesirable people to protect society. Those two, distinct social purposes soon were forgotten, and the medical institution became the only place for the administration of therapeutic treatments for madness. Although nominally more enlightened in scientific and diagnostic perspective, and compassionate in the clinical treatment of insane people, the modern medical institution remained as cruelly controlling as were mediaeval treatments for madness. In the preface to the 1961 edition of Madness and Civilization, Foucault said that:
Reception
In the critical volume, Foucault (1985), the philosopher José Guilherme Merquior said that the value of Madness and Civilization as intellectual history was diminished by errors of fact and of interpretation that undermine Foucault's thesis—how social forces determine the meanings of madness and society's responses to the mental disorder of the person. Specifically problematic was his selective citation of data, which ignored contradictory historical evidence of preventive imprisonment and physical cruelty towards insane people during the historical periods when Foucault said society perceived the mad as wise people—institutional behaviors allowed by the culture of Christian Europeans who considered madness worse than sin. Nonetheless, Merquior said that, like the book Life Against Death (1959), by Norman O. Brown, Foucault's book about Madness and Civilization is "a call for the liberation of the Dionysian id"; and gave inspiration for Anti-Oedipus: Capitalism and Schizophrenia (1972), by the philosopher Gilles Deleuze and the psychoanalyst Félix Guattari.
In his 1994 essay "Phänomenologie des Krankengeistes" ('Phenomenology of the Sick Spirit'), philosopher Gary Gutting said:[T]he reactions of professional historians to Foucault's Histoire de la folie [1961] seem, at first reading, ambivalent, not to say polarized. There are many acknowledgements of its seminal role, beginning with Robert Mandrou's early review in [the Annales d'Histoire Economique et Sociale], characterizing it as a "beautiful book" that will be "of central importance for our understanding of the Classical period." Twenty years later, Michael MacDonald confirmed Mandrou's prophecy: "Anyone who writes about the history of insanity in early modern Europe must travel in the spreading wake of Michael Foucault's famous book, Madness and Civilization."
Later endorsements included Jan Goldstein, who said: "For both their empirical content and their powerful theoretical perspectives, the works of Michel Foucault occupy a special and central place in the historiography of psychiatry;" and Roy Porter: "Time has proved Madness and Civilization [to be by] far the most penetrating work ever written on the history of madness." However, despite Foucault being herald of "the new cultural history", there was much criticism.
In Psychoanalysis and Male Homosexuality (1995), Kenneth Lewes said that Madness and Civilization is an example of the "critique of the institutions of psychiatry and psychoanalysis" that occurred as part of the "general upheaval of values in the 1960s." That the history Foucault presents in Madness and Civilization is similar to, but more profound than The Myth of Mental Illness (1961) by Thomas Szasz.
See also
Anti-psychiatry
Cogito and the History of Madness
The Archaeology of Knowledge
Notes
References
External links
Some images and paintings that appear in the book
1961 non-fiction books
Anti-psychiatry books
French-language books
French non-fiction books
Books about mental health
Plon (publisher) books
Books about social history
Works by Michel Foucault | 0.765331 | 0.993594 | 0.760429 |
Cognitive disengagement syndrome | Cognitive disengagement syndrome (CDS) is a syndrome characterized by developmentally-inappropriate, impairing and persistent levels of decoupled attentional processing from the ongoing external context and resultant hypoactivity. Symptoms often manifest in difficulties with staring, mind blanking, withdrawal, mental confusion and maladaptive mind wandering alongside delayed, sedentary or slow motor movements. To scientists in the field, it has reached the threshold of evidence and recognition as a distinct syndrome.
Since 1798, the medical literature on disorders of attention has distinguished between at least two kinds, one a disorder of distractibility, lack of sustained attention, and poor inhibition (that is now known as ADHD) and the other a disorder of low power, arousal, or oriented/selective attention (now known as CDS).
Although it implicates attention, CDS is distinct from ADHD. Unlike ADHD, which is the result of deficient executive functioning and self-regulation, CDS presents with problems in arousal, maladaptive daydreaming, and oriented or selective attention (distinguishing what is important from unimportant in information that has to be processed rapidly), as opposed to poor persistence or sustained attention, inhibition and self-regulation. In educational settings, CDS tends to result in decreased work accuracy, while ADHD impairs productivity.
CDS can also occur as a comorbidity with ADHD in some people, leading to substantially higher impairment than when either condition occurs alone.
In contemporary science today, it is clear that this set of symptoms is important because it is associated with unique impairments, above and beyond ADHD. CDS independently has a negative impact on functioning (such as a diminished quality of life, increased stress and suicidal behaviour, as well as lower educational attainment and socioeconomic status). CDS is clinically relevant as multiple randomised controlled clinical trials (RCTs) have shown that it responds poorly to methylphenidate.
Originally, CDS was thought to represent about one in three persons with the inattentive presentation of ADHD, as a psychiatric misdiagnosis, and to be incompatible with hyperactivity. Subsequent research established that it can be comorbid with ADHD – and present in individuals without ADHD as well. Therefore, and due to many other lines of evidence, there is a scientific consensus that the condition is a distinct syndrome.
If CDS and ADHD coexist together, the problems are additive: Those with both (ADHD + CDS) had higher levels of impairment and inattention than adults with ADHD only, and were more likely to be unmarried, out of work or on disability. CDS alone is also present in the population and can be quite impairing in educational and occupational settings, even if it is not as pervasively impairing as ADHD. The studies on medical treatments are limited, however, research suggests that atomoxetine and lisdexamfetamine may be used to treat CDS.
The condition was previously called Sluggish Cognitive Tempo (SCT). The terms concentration deficit disorder (CDD) or cognitive disengagement syndrome (CDS) have recently been preferred to SCT because they better and more accurately explain the condition and thus eliminate confusion.
Signs and symptoms
ADHD is the only disorder of attention currently defined by the DSM-5 or ICD-10. Formal diagnosis is made by a qualified professional. It includes demonstrating six or more of the following symptoms of inattention or hyperactivity-impulsivity (or both).
The symptoms must also
be age-inappropriate,
start before age 12,
occur often and be present in at least two settings,
clearly interfere with social, school, or work functioning,
and not be better explained by another mental disorder.
Based on the above symptoms, three types of ADHD are defined:
a predominantly inattentive presentation (ADHD-I)
a predominantly hyperactive-impulsive presentation (ADHD-HI)
a combined presentation (ADHD-C)
The predominantly inattentive presentation (ADHD-I) is restricted to the official inattention symptoms (see table above) and only to those. They capture problems with persistence, distractibility and disorganization. However, it fails to include these other, qualitatively different attention symptoms:
As a comparison of both tables shows, there is no overlap between the official ADHD inattention symptoms and the CDS symptoms. That means that both symptom clusters do not refer to the same attention problems. They may exist in parallel within the same person but do also occur alone. However, one problem is still that some individuals who actually have CDS are currently misdiagnosed with the inattentive presentation.
Social behaviour
In many ways, those who have a CDS profile have some of the opposite symptoms of those with predominantly hyperactive-impulsive or combined presentation of ADHD: instead of being hyperactive, extroverted, obtrusive, excessively energetic and risk takers, those with CDS are drifting, absent-minded, listless, introspective and daydreamy. They feel like they are "in the fog" and seem "out of it".
The comorbid psychiatric problems often associated with CDS are more often of the internalizing types, such as anxiety, unhappiness or depression. Most consistent across studies was a pattern of reticence and social withdrawal in interactions with peers. Their typically shy nature and slow response time has often been misinterpreted as aloofness or disinterest by others. In social group interactions, those with CDS may be ignored and neglected. People with classic ADHD are more likely to be rejected in these situations because of their social intrusiveness or aggressive behavior. Compared to children with CDS, they are also much more likely to show antisocial behaviours like substance abuse, oppositional-defiant disorder or conduct disorder (frequent lying, stealing, fighting etc.). Fittingly, in terms of personality, ADHD seems to be associated with sensitivity to reward and fun seeking while CDS may be associated with punishment sensitivity.
Attention deficits
Individuals with CDS symptoms may show a qualitatively different kind of attention deficit that is more typical of a true information processing problem; such as poor focusing of attention on details or the capacity to distinguish important from unimportant information rapidly. In contrast, people with ADHD have more difficulties with persistence of attention and action toward goals coupled with impaired resistance to responding to distractions. Unlike CDS, those with classic ADHD have problems with inhibition but have no difficulty selecting and filtering sensory input.
Some think that CDS and ADHD produce different kinds of inattention: While those with ADHD can engage their attention but fail to sustain it over time, people with CDS seem to have difficulty with engaging their attention to a specific task. Accordingly, the ability to orient attention has been found to be abnormal in CDS.
Both disorders interfere significantly with academic performance but may do so by different means. CDS may be more problematic with the accuracy of the work a child does in school and lead to making more errors. Conversely, ADHD may more adversely affect productivity which represents the amount of work done in a particular time interval. Children with CDS seem to have more difficulty with consistently remembering things that were previously learned and make more mistakes on memory retrieval tests than do children with ADHD. They have been found to perform much worse on psychological tests involving perceptual-motor speed or hand-eye coordination and speed. They also have a more disorganized thought process, a greater degree of sloppiness, and lose things more easily. The risk for additional learning disabilities seems equal in both ADHD and CDS (23–50%), but math disorders may be more frequent in the CDS group.
A key behavioral characteristic of those with CDS symptoms is that they are more likely to appear to be lacking motivation and may even have an unusually higher frequency of daytime sleepiness. They seem to lack energy to deal with mundane tasks and will consequently seek to concentrate on things that are mentally stimulating perhaps because of their underaroused state. Alternatively, CDS may involve a pathological form of excessive mind-wandering.
Executive function
The executive system of the human brain provides for the cross-temporal organization of behavior towards goals and the future and coordinates actions and strategies for everyday goal-directed tasks. Essentially, this system permits humans to self-regulate their behavior so as to sustain action and problem solving toward goals specifically and the future more generally. Dysexecutive syndrome is defined as a "cluster of impairments generally associated with damage to the frontal lobes of the brain" which includes "difficulties with high-level tasks such as planning, organising, initiating, monitoring and adapting behaviour". Such executive deficits pose serious problems for a person's ability to engage in self-regulation over time to attain their goals and anticipate and prepare for the future.
Adele Diamond postulated that the core cognitive deficit of those with ADHD-I is working memory, or, as she coined in a paper on the subject, "childhood-onset dysexecutive syndrome". However, two more recent studies by Barkley found that while children and adults with CDS had some deficits in executive functions (EF) in everyday life activities, they were primarily of far less magnitude and largely centered around problems with self-organization and problem-solving. Even then, analyses showed that most of the difficulties with EF deficits were the result of overlapping ADHD symptoms that may co-exist with CDS rather than being attributable to CDS itself. More research on the link of CDS to EF deficits is clearly indicated—but, as of this time, CDS does not seem to be as strongly associated with EF deficits as is ADHD.
Causes
Unlike ADHD, the general causes of CDS symptoms are almost unknown, though one recent study of twins suggested that the condition appears to be nearly as heritable or genetically influenced in nature as ADHD.
Little is known about the neurobiology of CDS. However, symptoms of CDS seem to indicate that the posterior attention networks may be more involved here than the prefrontal cortex region of the brain and difficulties with working memory so prominent in ADHD. This hypothesis gained greater support following a 2015 neuroimaging study comparing ADHD inattentive symptoms and CDS symptoms in adolescents: It found that CDS was associated with a decreased activity in the left superior parietal lobule (SPL), whereas inattentive symptoms were associated with other differences in activation. A 2018 study showed an association between CDS and specific parts of the frontal lobes, differing from classical ADHD neuroanatomy.
A study showed a small link between thyroid functioning and CDS symptoms suggesting that thyroid dysfunction is not the cause of CDS. High rates of CDS were observed in children who had prenatal alcohol exposure and in survivors of acute lymphoblastic leukemia, where they were associated with cognitive late effects.
Diagnosis
CDS is included, with its previous name of sluggish cognitive tempo, as a diagnostic descriptor in the current International Classification of Diseases (ICD) released in 2022 under the World Health Organization (WHO). However, it is not included as a separate disorder in the ICD or current Diagnostic and Statistical Manual of Mental Disorders (DSM) (2013) although it may be in subsequent editions; to scientists in the field, it has reached the threshold of evidence and recognition as a distinct syndrome and is diagnosed by some professional practices. Screening tools have been created to assess CDS symptoms. Although some symptoms of other conditions are partially shared with CDS, they are distinct conditions.
Treatment
Treatment of CDS has not been well investigated. Initial drug studies were done only with the ADHD medication methylphenidate, and even then only with children who were diagnosed as ADD without hyperactivity (using DSM-III criteria) and not specifically for CDS. The research seems to have found that most children with ADD (attention deficit disorder) with Hyperactivity (currently ADHD combined presentation) responded well at medium-to-high doses. However, a sizable percentage of children with ADD without hyperactivity (currently ADHD inattentive presentation, therefore the results may apply to CDS) did not gain much benefit from methylphenidate, and when they did benefit, it was at a much lower dose.
However, one study and a retrospective analysis of medical histories found that the presence or absence of CDS symptoms made no difference in response to methylphenidate in children with ADHD-I. These studies did not specifically and explicitly examine the effect of the drug on CDS symptoms in children. Atomoxetine may be used to treat CDS, as multiple randomised controlled clinical trials (RCTs) have found that it is an effective treatment. In contrast, multiple other RCTs have shown that it responds poorly to methylphenidate.
Only one study has investigated the use of behavior modification methods at home and school for children with predominantly CDS symptoms and it found good success.
In April 2014, The New York Times reported that sluggish cognitive tempo is the subject of pharmaceutical company clinical drug trials, including ones by Eli Lilly that proposed that one of its biggest-selling drugs, Strattera, could be prescribed to treat proposed symptoms of sluggish cognitive tempo. Other researchers believe that there is no effective treatment for CDS.
Prognosis
The prognosis of CDS is unknown. In contrast, much is known about the adolescent and adult outcomes of children having ADHD. Those with CDS symptoms typically show a later onset of their symptoms than do those with ADHD, perhaps by as much as a year or two later on average. Both groups had similar levels of learning problems and inattention, but CDS children had less externalizing symptoms and higher levels of unhappiness, anxiety/depression, withdrawn behavior, and social dysfunction. They do not have the same risks for oppositional defiant disorder, conduct disorder, or social aggression and thus may have different life course outcomes compared to children with ADHD-HI and Combined subtypes who have far higher risks for these other "externalizing" disorders.
However, unlike ADHD, there are no longitudinal studies of children with CDS that can shed light on the developmental course and adolescent or adult outcomes of these individuals.
Epidemiology
Recent studies indicate that the symptoms of CDS in children form two dimensions: daydreamy-spacey and sluggish-lethargic, and that the former are more distinctive of the disorder from ADHD than the latter. This same pattern was recently found in the first study of adults with CDS by Barkley and also in more recent studies of college students. These studies indicated that CDS is probably not a subtype of ADHD but a distinct disorder from it. Yet it is one that overlaps with ADHD in 30–50% of cases of each disorder, suggesting a pattern of comorbidity between two related disorders rather than subtypes of the same disorder. Nevertheless, CDS is strongly correlated with ADHD inattentive and combined subtypes. According to a Norwegian study, "[CDS] correlated significantly with inattentiveness, regardless of the subtype of ADHD."
History
Early observations
There have been descriptions in literature for centuries of children who are very inattentive and prone to foggy thought.
Symptoms similar to ADHD were first systematically described in 1775 by Melchior Adam Weikard and in 1798 by Alexander Crichton in their medical textbooks. Although Weikard mainly described a single disorder of attention resembling the combined presentation of ADHD, Crichton postulates an additional attention disorder, described as a "morbid diminution of its power or energy", and further explores possible "corporeal" and "mental" causes for the disorder (including "irregularities in diet, excessive evacuations, and the abuse of corporeal desires"). However, he does not further describe any symptoms of the disorder, making this an early but certainly non-specific reference to a CDS-like syndrome.
One example from fictional literature is Heinrich Hoffmann's character of "Johnny Head-in-Air" (Hanns Guck-in-die-Luft), in Struwwelpeter (1845). (Some researchers see several characters in this book as showing signs of child psychiatric disorders).
The Canadian pediatrician Guy Falardeau, besides working with hyperactive children, also wrote about very dreamy, quiet and well-behaved children that he encountered in his practice.
First research efforts
In more modern times, research surrounding attention disorders has traditionally focused on hyperactive symptoms, but began to newly address inattentive symptoms in the 1970s. Influenced by this research, the DSM-III (1980) allowed for the first time a diagnosis of an ADD subtype that presented without hyperactivity. Researchers exploring this subtype created rating scales for children which included questions regarding symptoms such as short attention span, distractibility, drowsiness, and passivity. In the mid-1980s, it was proposed that as opposed to the then accepted dichotomy of ADD with or without hyperactivity (ADD/H, ADD/noH), instead a three-factor model of ADD was more appropriate, consisting of hyperactivity-impulsivity, inattention-disorganization, and slow tempo subtypes.
In the 1990s, Weinberg and Brumback proposed a new disorder: "primary disorder of vigilance" (PVD). Characteristic symptoms of it were difficulty sustaining alertness and arousal, daydreaming, difficulty focusing attention, losing one's place in activities and conversation, slow completion of tasks and a kind personality. The most detailed case report in their article looks like a prototypical representation of CDS. The authors acknowledged an overlap of PVD and ADHD but argued in favor of considering PVD to be distinct in its unique cognitive impairments. Problematic with the paper is that it dismissed ADHD as a nonexistent disorder (despite it having several thousand research studies by then) and preferred the term PVD for this CDS-like symptom complex. A further difficulty with the PVD diagnosis is that not only is it based merely on 6 cases instead of the far larger samples of CDS children used in other studies but the very term implies that science has established the underlying cognitive deficits giving rise to CDS symptoms, and this is hardly the case.
With the publication of DSM-IV in 1994, the disorder was labeled as ADHD, and was divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Of the proposed CDS-specific symptoms discussed while developing the DSM-IV, only "forgetfulness" was included in the symptom list for ADHD-I, and no others were mentioned. However, several of the proposed CDS symptoms were included in the diagnosis of "ADHD, not otherwise specified".
Prior to 2001, there were a total of four scientific journal articles specifically addressing symptoms of CDS. But then a researcher suggested that sluggish tempo symptoms (such as inconsistent alertness and orientation) were, in fact, adequate for the diagnosis of ADHD-I. Thus, he argued, their exclusion from DSM-IV was inappropriate. The research article and its accompanying commentary urging the undertaking of more research on CDS spurred the publication of over 30 scientific journal articles to date which specifically address symptoms of CDS.
However, with the publication of DSM-5 in 2013, ADHD continues to be classified as predominantly inattentive, predominantly hyperactive-impulsive, and combined type and there continues to be no mention of CDS as a diagnosis or a diagnosis subtype anywhere in the manual. The diagnosis of "ADHD, not otherwise specified" also no longer includes any mention of CDS symptoms. Similarly, ICD-10, the medical diagnostic manual, has no diagnosis code for CDS. Although CDS is not recognized as a disorder at this point, researchers continue to debate its usefulness as a construct and its implications for further attention disorder research.
Controversy
Significant skepticism has been raised within the medical and scientific communities as to whether CDS, currently considered a "symptom cluster," actually exists as a distinct disorder.
Allen Frances, emeritus professor of psychiatry at Duke University, argues: "We're seeing a fad in evolution: Just as ADHD has been the diagnosis du jour for 15 years or so, this is the beginning of another. This is a public health experiment on millions of kids...I have no doubt there are kids who meet the criteria for this thing, but nothing is more irrelevant. The enthusiasts here are thinking of missed patients. What about the mislabeled kids who are called patients when there's nothing wrong with them? They are not considering what is happening in the real world."
UCLA researcher and Journal of Abnormal Child Psychology editorial board member Steve S. Lee expresses concern that based on CDS's close relationship to ADHD, a pattern of overdiagnosis of the latter has "already grown to encompass too many children with common youthful behavior, or whose problems are derived not from a neurological disorder but from inadequate sleep, a different learning disability or other sources." Lee states: "The scientist part of me says we need to pursue knowledge, but we know that people will start saying their kids have [cognitive disengagement syndrome], and doctors will start diagnosing it and prescribing for it long before we know whether it's real...ADHD has become a public health, societal question, and it's a fair question to ask of [CDS]."
Adding to the controversy are potential conflicts of interest among the condition's proponents, including the funding of prominent CDS researchers' work by the global pharmaceutical company Eli Lilly. When referring to the "increasing clinical referrals occurring now and more rapidly in the near future driven by increased awareness of the general public in [CDS]", Dr. Barkley writes: "The fact that [CDS] is not recognized as yet in any official taxonomy of psychiatric disorders will not alter this circumstance given the growing presence of information on [CDS] at various widely visited internet sites such as YouTube and Wikipedia, among others."
See also
Attention deficit hyperactivity disorder controversies
Bradyphrenia (slowness of thought)
Clouding of consciousness
Cognitive Tempo
Sluggish schizophrenia
Type B personality
References
External links
ADHD in Adults: Sluggish cognitive tempo and ADHD
Neurological disorders
Mental disorders diagnosed in childhood
Attention disorders
Educational psychology
Special education | 0.761467 | 0.998353 | 0.760213 |
Age appropriateness | Age appropriateness refers to people behaving as predicted by their perspective timetable of development. The perspective timetable is embedded throughout people's social life, primarily based on socially-agreed age expectations and age norms. For a given behavior, such as crawling, learning to walk, learning to talk, etc., there are years within which the behavior is regarded appropriate. By contrast, if the behavior falls out of the age range, it will be considered age-inappropriate. Most people are adhered to these age norms and are aware of whether their timing is "early," "delayed," or "on time."
Age appropriateness is considered essential for children's skills development. Children's motor, cognitive and social skills are formed through several development stages. Looking at a child's functional development involves observing whether or not the child has mastered certain developmental milestones and expectations for their age. Lack of exposure to age-appropriate activities and experiences in a specific stage is thought to prevent a child from gaining the skills necessary for their current and thus their next stage of development.
There are various sanctions associated with age inappropriateness, ranging from social isolation, damage to physical health and cognitive development, and forming of improper behaviour.
Social participation
Application
Age-appropriate social skills and communication with peers can be interpreted in terms of cause and effect. Insufficient sets of age-appropriate social skills result in difficulty establishing social relations, and lack of social ties can worsen the underdeveloped set of social skills.
Students prefer to associate with those similar to them in various dimensions, such as age, gender, race, educational attainment, values, interests and/or beliefs, etc. This phenomenon is termed homophily. Therefore, normal students with age-appropriate social skills are more likely to gather together, building up friendships and cohesive groups within peers.
Sanctions of age-inappropriateness
Students with special needs, especially those with autism spectrum disorders and serious behavioural disorders, experience severe obstacles in social participation, which involves building up friendships or relationships, contacts or interactions, social self-perception, and being accepted by classmates.
These experiences of segregation in the early school years may threaten children's social development directly. Their lack of contact with peers, underdevelopment of age-appropriate social skills, and negative self-concepts result in externalizing, such as aggression, and internalizing problems, such as anxiety.
School entry
Applications
School is an institute designed to provide students with learning spaces and environments under the guidance of teachers, where students lay the foundation and get prepared for future skill development. Therefore, it is vital that children enter school at an appropriate age.
Some students are older-within-cohort, which means they fall outside their cohort's standard 12-month age range, either because they are forced to hold back or voluntarily postpone the entry. Forced grade retention occurs because students fail to catch up with peers or their families fail to support their studies. Voluntary late access to school is termed "academic redshirting." Redshirting happens among students who have a relatively late birthday just before the cutoff date or those considered relatively immature for school. Both forced and voluntary retention aims to spare time for the students to catch up or get prepared.
There are four views comparing the strengths and weaknesses of delayed and on-time entry.
The nativist view states that children should be adequately mature when entering school.
The environmental view holds that children's readiness for school is evaluated by the amount of common knowledge they have.
The social constructivist view states that school readiness depends on individual, social, and cultural backgrounds.
The interactionist view considers readiness as bi-directional, regarding both students' readiness and the capacity of the school to meet the child's needs.
The nativist and social constructivist stand for retention since they believe it prepares children for school, predicting better academic performance. On the other hand, the environmental and interactionist views are often the basis for on-time schooling because it is age-appropriate for children to do so, and school will accommodate variations in students.
Sanctions of age-inappropriateness
Research has shown that retention or "redshirting" generates few academic advantages. Though delayed entry could generate statistically significant improvements in academic performance in the short run (usually in the first three years), the progress loses its significance in the long run. Long-term speaking, markedly older-for-cohort students were higher in school disengagement, lower in positive intentions, lower in homework completion, and lower in performance scores. These findings stand for environmental and interactionist views, enhancing the importance of age appropriateness in children's development.
Playing
Application
It is crucial that parents select appropriate toys for children to aid their development and ensure their safety. Various guidelines have been published to ensure toy safety, such as U.S. Consumer Product Safety Commission (CPSC) in the US, Guidance on Toy Safety by EU Commission, etc.
Importance of age-appropriateness
Research has shown that appropriate playing enhances children's development in 4 dimensions:
physical development
cognitive development (creativity, discovery, language skills, verbal judgment and reasoning, symbolic thought, problem-solving skills, and the ability to focus and control behaviour),
emotional development (awareness, sensitivity to others, emotional strength and stability, spontaneity, humour, and feelings about self)
social development (social learning)
These toys match with children's current developmental skills and abilities, further encouraging the development of new skills.
In determining toy safety, the toy's characteristics, how the toy might be used or abused, and the amount of supervision needed for playing safely should be considered. Typical risky toys may include high-powered magnetic objects, toys with small parts that could cause a potentially fatal choking hazard, etc.
Exposure to media
Application
Various content rating systems have been developed to prevent the harm that age-inappropriate media presentations bring to children. The two main categories of rating are the evaluating rating system based on age appropriateness and the descriptive rating system based on the content description.
Examples of evaluating rating systems include the Canadian Home Video Rating System, Korea Media Rating Board, the Movie and Television Review and Classification Board of the Philippines, the Office of Film and Literature Classification (New Zealand), the British Board of Film Classification, the Australian Classification Board, and the Film Classification and Rating Organization (Eirin) of Japan.
Impact of age-inappropriateness
See Effects of violence in mass media.
See also
Adultism
Ageism
Elsagate
Family-friendly
Lie-to-children
Status offense
Children's Online Privacy Protection Act
References
External links
Toys safety guidance by U.S. Consumer Product Safety Commission(CPSC)
Guidance on Toy Safety by EU Commission
Canadian Home Video Rating System
Office of Film and Literature Classification (New Zealand)
British Board of Film Classification
Australian Classification Board
Film Classification and Rating Organization
Child development
Educational stages
Educational psychology
Ageism
Child safety | 0.775106 | 0.980744 | 0.760181 |
Therapeutic relationship | The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.
In psychoanalysis the therapeutic relationship has been theorized to consist of three parts: the working alliance, transference/countertransference, and the real relationship. Evidence on each component's unique contribution to the outcome has been gathered, as well as evidence on the interaction between components. In contrast to a social relationship, the focus of the therapeutic relationship is on the client's needs and goals.
Therapeutic Alliance / Working Alliance
The therapeutic alliance, or the working alliance may be defined as the joining of a client's reasonable side with a therapist's working or analyzing side. Bordin conceptualized the working alliance as consisting of three parts: tasks, goals and bond. Tasks are what the therapist and client agree need to be done to reach the client's goals. Goals are what the client hopes to gain from therapy, based on their presenting concerns. The bond forms from trust and confidence that the tasks will bring the client closer to their goals.
Research on the working alliance suggests that it is a strong predictor of psychotherapy or counseling client outcome. Also, the way in which the working alliance unfolds has been found to be related to client outcomes. Generally, an alliance that experiences a rupture that is repaired is related to better outcomes than an alliance with no ruptures, or an alliance with a rupture that is not repaired. Also, in successful cases of brief therapy, the working alliance has been found to follow a high-low-high pattern over the course of the therapy. Therapeutic alliance has been found to be effective in treating adolescents with PTSD, with the strongest alliances were associated with the greatest improvement in PTSD symptoms. Regardless of other treatment procedures, studies have shown that the degree to which traumatized adolescents feel a connection with their therapist greatly affects how well they do during treatment.
Necessary and sufficient conditions
In the Humanistic approach, Carl Rogers identified a number of necessary and sufficient conditions that are required for therapeutic change to take place. Rogers stated that there are six necessary and sufficient conditions required for therapeutic change:
Therapist–client psychological contact: A relationship between client and therapist must exist, and it must be a relationship in which each person's perception of the other is important.
Client incongruence: That incongruence exists between the client's experience and awareness.
Therapist congruence, or genuineness: The therapist is congruent within the therapeutic relationship. The therapist is deeply involved, they are not 'acting' and they can draw on their own experiences (self-disclosure) to facilitate the relationship.
Therapist unconditional positive regard: The therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted or denied.
Therapist empathic understanding: The therapist experiences an empathic understanding of the client's internal frame of reference. Accurate empathy on the part of the therapist helps the client believe the therapist's unconditional regard for them.
Client perception: That the client perceives, to at least a minimal degree, the therapist's unconditional positive regard and empathic understanding.
Transference and Counter-Transference
The concept of therapeutic relationship was described by Freud (1912) as "friendly affectionate feeling" in the form of a positive transference. However, transferences, or more correctly here, the therapist's 'counter-transferences' can also be negative. Today transference (from the client) and counter-transference (from the therapist), is understood as subconsciously associating a person in the present, with a person from a past relationship. For example, you meet a new client who reminds you of a former lover. This would be a counter-transference, in that the therapist is responding to the client with thoughts and feelings attached to a person in a past relationship. Ideally, the therapeutic relationship will start with a positive transference for the therapy to have a good chance of effecting positive therapeutic change.
Operationalization and Measurement
Several scales have been developed to assess the patient-professional relationship in therapy, including the Working Alliance Inventory (WAI), the Barrett-Lennard Relationship Inventory, and the California Psychotherapy Alliance Scales (CALPAS). The Scale To Assess Relationships (STAR) was specifically developed to measure the therapeutic relationship in community psychiatry, or within care in the community settings.
See also
Acting in
Acting out
Body-centred countertransference
Clinical Psychology
Counselling
Counseling Psychology
Countertransference
Existential counselling
Existential Therapy
Gestalt Therapy
Humanistic Psychology
Intersubjectivity
Interpersonal psychoanalysis
Intersubjective psychoanalysis
Negative therapeutic reaction
Object relations theory
Parallel process
Person-centered therapy
Psychoanalysis
Psychoanalytic Theory
Psychodynamics
Psychodynamic psychotherapy
Psychology
Psychotherapy
Relational psychoanalysis
Relational psychodynamics
Systemic therapy
Systems psychology
Therapeutic alliance
Transference
Transpersonal Psychology
References
Psychoanalytic theory | 0.769068 | 0.988425 | 0.760166 |
Psychodrama | Psychodrama is an action method, often used as a psychotherapy, in which clients use spontaneous dramatization, role playing, and dramatic self-presentation to investigate and gain insight into their lives. Developed by Jacob L. Moreno and his wife Zerka Toeman Moreno, psychodrama includes elements of theater, often conducted on a stage, or a space that serves as a stage area, where props can be used. A psychodrama therapy group, under the direction of a licensed psychodramatist, reenacts real-life, past situations (or inner mental processes), acting them out in present time. Participants then have the opportunity to evaluate their behavior, reflect on how the past incident is getting played out in the present and more deeply understand particular situations in their lives.
Psychodrama offers a creative way for an individual or group to explore and solve personal problems. It may be used in a variety of clinical and community-based settings in which other group members (audience) are invited to become therapeutic agents (stand-ins) to populate the scene of one client. Besides benefits to the designated client, "side-benefits" may accrue to other group members, as they make relevant connections and insights to their own lives from the psychodrama of another. A psychodrama is best conducted and produced by a person trained in the method, called a psychodrama director.
In a session of psychodrama, one client of the group becomes the protagonist, and focuses on a particular, personal, emotionally problematic situation to enact on stage. A variety of scenes may be enacted, depicting, for example, memories of specific happenings in the client's past, unfinished situations, inner dramas, fantasies, dreams, preparations for future risk-taking situations, or unrehearsed expressions of mental states in the here and now. These scenes either approximate real-life situations or are externalizations of inner mental processes. Other members of the group may become auxiliaries and support the protagonist by playing other significant roles in the scene, or they may step in as a "double" who plays the role of the protagonist.
A core tenet of psychodrama is Moreno's theory of "spontaneity-creativity". Moreno believed that the best way for an individual to respond creatively to a situation is through spontaneity, that is, through a readiness to improvise and respond in the moment. By encouraging an individual to address a problem in a creative way, reacting spontaneously and based on impulse, they may begin to discover new solutions to problems in their lives and learn new roles they can inhabit within it. Moreno's focus on spontaneous action within the psychodrama was developed in his Theatre of Spontaneity, which he directed in Vienna in the early 1920s. Disenchanted with the stagnancy he observed in conventional, scripted theatre, he found himself interested in the spontaneity required in improvisational work. He founded an improvisational troupe in the 1920s. This work in the theatre impacted the development of his psychodramatic theory.
Methods
In psychodrama, participants explore internal conflicts by acting out their emotions and interpersonal interactions on stage. A psychodrama session (typically 90 minutes to 2 hours) focuses principally on a single participant, known as the protagonist. Protagonists examine their relationships by interacting with the other actors and the leader, known as the director. This is done using specific techniques, including mirroring, doubling, soliloquy, and role reversal. The session is often broken up into three phases: the warm-up, the action, and the post-discussion.
During a typical psychodrama session, a number of clients gather together. One of these clients is chosen by the group as the protagonist, and the director calls on the other clients to assist the protagonist's "performance," either by portraying other characters, or by utilizing mirroring, doubling, or role reversal. The clients act out a number of scenes in order to allow the protagonist to work through certain scenarios. This is obviously beneficial for the protagonist, but also is helpful to the other group members, allowing them to assume the role of another person and apply that experience to their own life. The focus during the session is on the acting out of different scenarios, rather than simply talking through them. All of the different elements of the session (stage, props, lighting, etc.) are used to heighten the reality of the scene.
The three sections of a typical session are the warm-up, the action, and the sharing. During the warm-up, the actors are encouraged to enter into a state of mind where they can be present in and aware of the current moment and are free to be creative. This is done through the use of different ice-breaker games and activities. Next, the action section of the psychodrama session is the time in which the actual scenes themselves take place. Finally, in the post-discussion, the different actors are able to comment on the action, coming from their personal point of view, not as a critique, sharing their empathy and experiences with the protagonist of the scene.
The following are core psychodramatic techniques:
Mirroring: The protagonist is first asked to act out an experience. After this, the client steps out of the scene and watches as another actor steps into their role and portrays them in the scene.
Doubling: The job of the double is to make conscious any thoughts or feelings that another person is unable to express whether it is because of shyness, guilt, inhibition, politeness, fear, anger, etc. In many cases, the person is unaware of these thoughts or at least is unable to form the words to express how they are feeling. Therefore, the Double attempts to make conscious and give form to the unconscious and/or under expressed material. The person being doubled has the full right to disown any of the Double's statements and to correct them as necessary. In this way, doubling itself can never be wrong.
Role playing: The client portrays a person or object that is problematic to him or her.
Soliloquy: The client speaks his or her thoughts aloud in order to build self-knowledge.
Role reversal: The client is asked to portray another person while a second actor portrays the client in the particular scene. This not only prompts the client to think as the other person but also has some of the benefits of mirroring, as the client see themselves as portrayed by the second actor.
Psychological applications
Psychodrama can be used in both non-clinical and clinical arenas. In the non-clinical field, psychodrama is used in business, education, and professional training. In the clinical field, psychodrama may be used to alleviate the effects of emotional trauma and PTSD. One specific application in clinical situations is for people suffering from dysfunctional attachments. For this reason, it is often utilized in the treatment of children who have suffered emotional trauma and abuse. Using role-play and story telling, children may be able to express themselves emotionally and reveal truths about their experience they are not able to openly discuss with their therapist, and rehearse new ways of behavior. Moreno's theory of child development offers further insight into psychodrama and children. Moreno suggested that child development is divided into four stages: finding personal identity (the double), recognizing oneself (the mirror stage), the auxiliary ego (finding the need to fit in), and recognizing the other person (the role-reversal stage). Mirroring, role-playing and other psychodramatic techniques are based on these stages. Moreno believed that psychodrama could be used to help individuals continue their emotional development through the use of these techniques.
Related concepts
Sociometry
Moreno's term sociometry is often used in relation to psychodrama. By definition, sociometry is the study of social relations between individuals—interpersonal relationships. It is, more broadly, a set of ideas and practices that are focused on promoting spontaneity in human relations. Classically, sociometry involves techniques for identifying, organizing, and giving feedback on specific interpersonal preferences an individual has. For example, in a psychodrama session, allowing the group to decide whom the protagonist shall be employs sociometry.
Moreno is also credited for founding sociodrama. Though sociodrama, like psychodrama, utilizes the theatrical form as means of therapy, the terms are not synonymous. While psychodrama focuses on one patient within the group unit, sociodrama addresses the group as a whole. The goal is to explore social events, collective ideologies, and community patterns within a group in order to bring about positive change or transformation within the group dynamic. Moreno also believed that sociodrama could be used as a form of micro-sociology—that by examining the dynamic of a small group of individuals, patterns could be discovered that manifest themselves within the society as a whole, such as in Alcoholics Anonymous. Sociodrama can be divided into three main categories: crisis sociodrama, which deals with group responses after a catastrophic event, political sociodrama, which attempts to address stratification and inequality issues within a society, and diversity sociodrama, which considers conflicts based on prejudice, racism or stigmatization.
Drama therapy
The other creative arts therapies modality drama therapy, which was established and developed in the second half of the past century, shows multiple similarities in its approach to psychodrama, as to using theatre methods to achieve therapeutic goals. Both concepts however, describe different modalities. Drama therapy lets the patient explore fictional stories, such as fairytales, myths or improvised scenes, whereas psychodrama is focused on the patient's real-life experience to practice "new and more effective roles and behaviors" (ASGPP).
History
Jacob L. Moreno (1889–1974) is the founder of psychodrama and sociometry, and one of the forerunners of the group psychotherapy movement. Around 1910, he developed the Theater of Spontaneity, which is based on the acting out of improvisational impulses. The focus of this exercise was not originally on the therapeutic effects of psychodrama; these were seen by Moreno to simply be positive side-effects.
A poem by Moreno reveals ideas central to the practice of psychodrama, and describes the purpose of mirroring:
In 1912, Moreno attended one of Sigmund Freud's lectures. In his autobiography, he recalled the experience: "As the students filed out, he singled me out from the crowd and asked me what I was doing. I responded, 'Well, Dr. Freud, I start where you leave off. You meet people in the artificial setting of your office. I meet them on the street and in their homes, in their natural surroundings. You analyze their dreams. I give them the courage to dream again. You analyze and tear them apart. I let them act out their conflicting roles and help them to put the parts back together again.'"
While a student at the University of Vienna in 1913–14, Moreno gathered a group of prostitutes as a way of discussing the social stigma and other problems they faced, starting what might be called the first "support group". From experiences like that, and as inspired by psychoanalysts such as Wilhelm Reich and Freud, Moreno began to develop psychodrama. After moving to the United States in 1925, Moreno introduced his work with psychodrama to American psychologists. He began this work with children, and then eventually moved on to large group psychodrama sessions that he held at Impromptu Group Theatre at Carnegie Hall. These sessions established Moreno's name, not only in psychological circles, but also among non-psychologists. Moreno continued to teach his method of psychodrama, leading sessions until his death in 1974.
From 1980, Hans-Werner Gessmann developed the Humanistic Psychodrama (HPD) at the Bergerhausen Psychotherapeutic Institute in Duisburg, Germany.
It is based on the human image of humanistic psychology <ref>Gessmann Hans-Werner. Die Humanistische Psychologie und das Humanistische Psychodrama. In: Humanistisches Psychodrama. Band IV, Verlag des Psychotherapeutischen Instituts Bergerhausen, Duisburg 1996, .</ref> All rules and methods follow the axioms of humanistic psychology. The HPD sees itself as development-oriented psychotherapy and has completely moved away from the psychoanalytic catharsist theory. Self-awareness and self-actualization are essential aspects in the therapeutic process. Subjective experiences, feelings and thoughts and one's own experiences are the starting point for a change or reorientation in experience and behavior towards more self-acceptance and satisfaction. The examination of the biography of the individual is closely related to the sociometry of the group.
Another important practitioner in the field of psychodrama is Carl Hollander. Hollander was the 37th director certified by Moreno in psychodrama. He is known primarily for his creation of the Hollander Psychodrama Curve, which may be utilized as a way to understand how a psychodrama session is structured. Hollander uses the image of a curve to explain the three parts of a psychodrama session: the warm-up, the activity, and the integration. The warm-up exists to put patients into a place of spontaneity and creativity in order to be open in the act of psychodrama. The "activity" is the actual enactment of the psychodrama process. Finally, the "curve" moves to integration. It serves as closure and discussion of the session, and considers how the session can be brought into real life – a sort of debriefing.
Although psychodrama is not widely practiced, the work done by practitioners of psychodrama has opened the doors to research possibilities for other psychological concepts such as group therapy and expansion of the work of Sigmund Freud. The growing field of drama therapy utilizes psychodrama as one of its main elements. The methods of psychodrama are also used by group therapy organizations and also find a place in other types of therapy, such as post-divorce counseling for children.
See also
Educational Psychodrama
Diamond of opposites
Gestalt therapy
Play therapy
Playback Theatre
Sociodrama
Sociometry
Theraplay
Citations
General references
Baim, C.; J. Burmeister, and M. Maciel, Psychodrama: Advances in Theory and Practice. Taylor and Frances: USA. .
Yablonsky, Lewis. Psychodrama: Resolving Emotional Problems Through Role-playing. New York: Gardner, 1981. .
Further reading
Carnabucci, Karen: Show and Tell Psychodrama, Nusanto Publishing, United States, 2014.
Gessmann, Hans-Werner: Humanistic Psychodrama''. Vol. I–IV. PIB Publisher, Duisburg, Germany, 1994.
Gessmann, Hans-Werner: Empirical Research about Effectiveness of Psychodramatic Therapygroupwork of Patients with Neurosis (ICD-10: F3, F4). Zeitschrift für Psychodrama und Soziometrie, Sonderheft Empirische Forschung. VS Verlag für Sozialwissenschaften - Sonderheft Empirische Forschung, 2011.
External links
American Society of Group Psychotherapy and Psychodrama
Australian and Aotearoa New Zealand Psychodrama Association
British Psychodrama Association
Federation of European Psychodrama Training Organisations
International Association for Group Psychotherapy and Group Processes
Psychodrama Aotearoa New Zealand
Creative arts therapies
Role-playing | 0.766867 | 0.991209 | 0.760125 |
Neuropsychiatry | Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychology factors. Within neuropsychiatry, the mind is considered "as an emergent property of the brain", whereas other behavioral and neurological specialties might consider the two as separate entities. Those disciplines are typically practiced separately.
Currently, neuropsychiatry has become a growing subspecialty of psychiatry as it closely relates the fields of neuropsychology and behavioral neurology, and attempts to utilize this understanding to better understand autism, ADHD, Tourette's syndrome, etc.
The case for the rapprochement of neurology and psychiatry
Given the considerable overlap between these subspecialities, there has been a resurgence of interest and debate relating to neuropsychiatry in academia over the last decade.
Most of this work argues for a rapprochement of neurology and psychiatry, forming a specialty above and beyond a subspecialty of psychiatry. For example, Professor Joseph B. Martin, former Dean of Harvard Medical School and a neurologist by training, has summarized the argument for reunion: "the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway." These points and some of the other major arguments are detailed below.
Mind/brain monism
Neurologists have focused objectively on organic nervous system pathology, especially of the brain, whereas psychiatrists have laid claim to illnesses of the mind. This antipodal distinction between brain and mind as two different entities has characterized many of the differences between the two specialties. However, it has been argued that this division is fictional; evidence from the last century of research has shown that our mental life has its roots in the brain. Brain and mind have been argued not to be discrete entities but just different ways of looking at the same system (Marr, 1982). It has been argued that embracing this mind/brain monism may be useful for several reasons. First, rejecting dualism implies that all mentation is biological, which provides a common research framework in which understanding and treatment of mental disorders can be advanced. Second, it mitigates widespread confusion about the legitimacy of mental illness by suggesting that all disorders should have a footprint in the brain.
In sum, a reason for the division between psychiatry and neurology was the distinction between mind or first-person experience and the brain. That this difference is taken to be artificial by proponents of mind/brain monism supports a merge between these specialties.
Causal pluralism
One of the reasons for the divide is that neurology traditionally looks at the causes of disorders from an "inside-the-skin" perspective (neuropathology, genetics) whereas psychiatry looks at "outside-the-skin" causation (personal, interpersonal, cultural). This dichotomy is argued not to be instructive and authors have argued that it is better conceptualized as two ends of a causal continuum. The benefits of this position are: firstly, understanding of etiology will be enriched, in particular between brain and environment. One example is eating disorders, which have been found to have some neuropathology (Uher and Treasure, 2005) but also show increased incidence in rural Fijian school girls after exposure to television (Becker, 2004). Another example is schizophrenia, the risk for which may be considerably reduced in a healthy family environment (Tienari et al., 2004).
It is also argued that this augmented understanding of etiology will lead to better remediation and rehabilitation strategies through an understanding of the different levels in the causal process where one can intervene. It may be that non-organic interventions, like cognitive behavioral therapy (CBT), better attenuate disorders alone or in conjunction with drugs. Linden's (2006) demonstration of how psychotherapy has neurobiological commonalities with pharmacotherapy is a pertinent example of this and is encouraging from a patient perspective as the potentiality for pernicious side effects is decreased while self-efficacy is increased.
In sum, the argument is that an understanding of the mental disorders must not only have a specific knowledge of brain constituents and genetics (inside-the-skin) but also the context (outside-the-skin) in which these parts operate (Koch and Laurent, 1999). Only by joining neurology and psychiatry, it is argued, can this nexus be used to reduce human suffering.
Organic basis
To further sketch psychiatry's history shows a departure from structural neuropathology, relying more upon ideology (Sabshin, 1990). A good example of this is Tourette syndrome, which Ferenczi (1921), although never having seen a patient with Tourette syndrome, suggested was the symbolic expression of masturbation caused by sexual repression. However, starting with the efficacy of neuroleptic drugs in attenuating symptoms (Shapiro, Shapiro and Wayne, 1973) the syndrome has gained pathophysiological support (e.g. Singer, 1997) and is hypothesized to have a genetic basis too, based on its high inheritability (Robertson, 2000). This trend can be seen for many hitherto traditionally psychiatric disorders (see table) and is argued to support reuniting neurology and psychiatry because both are dealing with disorders of the same system.
Improved patient care
Further, it is argued that this nexus will allow a more refined nosology of mental illness to emerge thus helping to improve remediation and rehabilitation strategies beyond current ones that lump together ranges of symptoms. However, it cuts both ways: traditionally neurological disorders, like Parkinson's disease, are being recognized for their high incidence of traditionally psychiatric symptoms, like psychosis and depression (Lerner and Whitehouse, 2002). These symptoms, which are largely ignored in neurology, can be addressed by neuropsychiatry and lead to improved patient care. In sum, it is argued that patients from both traditional psychiatry and neurology departments will see their care improved following a reuniting of the specialties.
Better management model
Schiffer et al. (2004) argue that there are good management and financial reasons for rapprochement.
US institutions
"Behavioral Neurology & Neuropsychiatry" fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS; www.ucns.org), in a manner analogous to the accreditation of psychiatry and neurology residencies in the United States by the American Board of Psychiatry and Neurology (ABPN).
The American Neuropsychiatric Association (ANPA) was established in 1988 and is the American medical subspecialty society for neuropsychiatrists. ANPA holds an annual meeting and offers other forums for education and professional networking amongst subspecialists in behavioral neurology and neuropsychiatry as well as clinicians, scientists, and educators in related fields. American Psychiatric Publishing, Inc. publishes the peer-reviewed Journal of Neuropsychiatry and Clinical Neurosciences, which is the official journal of ANPA.
International organizations
The International Neuropsychiatric Association was established in 1996. INA holds congresses biennially in countries around the world and partners with regional neuropsychiatric associations around the world to support regional neuropsychiatric conferences and to facilitate the development of neuropsychiatry in the countries/regions where those conferences are held. Prof. Robert Haim Belmaker is the current President of the organization whereas Prof. Ennapadam S Krishnamoorthy serves as President-Elect with Dr. Gilberto Brofman as Secretary-Treasurer.
The British NeuroPsychiatry Association (BNPA) was founded in 1987 and is the leading academic and professional body for medical practitioners and professionals allied to medicine in the UK working at the interface of the clinical and cognitive neurosciences and psychiatry.
In 2011, a non-profit professional society named Neuropsychiatric Forum (NPF) was founded. NPF aims to support effective communication and interdisciplinary collaboration, develop education schemes and research projects, organize neuropsychiatric conferences and seminars.
See also
Cognitive neuropsychiatry
Neurology
Neurogenetics
Neuropsychology
Psychiatry
Psychiatric genetics
Psychoneuroimmunology
References
Arciniegas DB, Kaufer DI; Joint Advisory Committee on Subspecialty Certification of the American Neuropsychiatric Association; Society for Behavioral and Cognitive Neurology. Core Curriculum for Training in Behavioral Neurology and Neuropsychiatry. J Neuropsychiatry Clin Neurosci. 2006 Winter;18(1):6-13.
Barrett, T.B., Hauger, R.L., Kennedy, J.L., Sadovnick, A.D., Remick, R.A. & Keck, P.E, McElroy, S L, Alexander, L., Shaw, S.H., & Kelsoe, J. (2003) Evidence that a single nucleotide polymorphism in the promoter of the G protein receptor kinase 3 gene is associated with bipolar disorder" Molecular Psychiatry 8, 546−557.
Becker, A.E. (2004) Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity During Rapid Social Change. Culture, Medicine and Psychiatry, 28(4): 533–559.
Bell, V., Halligan, P.W., Ellis, H.D. (2006). Explaining delusions: a cognitive perspective. Trends in Cognitive Sciences,10(5), 219–26.
Ferenczi, S. (1921) Psychoanalytical observations on tic. International Journal of Psychoanalysis, 2: 1-30.
Gamazo-Garran, P., Soutullo, C.A. & Ortuno, F. (2002) Obsessive compulsive disorder secondary to brain dysgerminoma in an adolescent boy: a positron emission tomography case report. Journal of Child and Adolescent Psychopharmacology, 12, 259–263.
Green, M.F. (2001) Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton.
Kaye, W.H., Bailer, U.F., Frank, G.K., Wagner, A., & Henry, S.E. (2005). Brain imaging of serotonin after recovery from anorexia and bulimia nervosa. Physiology & Behaviour, 86(1-2), 15-7
Koch, C. & Laurent, G. (1999). Complexity and the nervous system" Science 284(5411), 96–8.
Lerner, A.J., & Whitehouse, P.J. (2002) Neuropsychiatric aspects of dementias associated with motor dysfunction. Washington, DC: American Psychiatric (pp 931–937)
Linden, D. E. J. (2006). How psychotherapy changes the brain – the contribution of functional neuroimaging" Molecular Psychiatry 11, 528–38.
Marr, D. (1982). Vision: A Computational Approach. San Francisco: Freeman & Co.
Mayberg, H.S. (1997). Limbic-cortical dysregulation: a proposed model of depression. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 471–481.
Mocellin, R., Walterfang, M., & Velakoulis, D. (2006) Neuropsychiatry of complex visual hallucinations. Australian and New Zealand Journal of Australian and New Zealand Journal of Psychiatry, 40, 742-751
Rempel-Clower, N.L., Zola, S.M., Squire, L.R., & Amaral, D.G. (1996). Three cases of enduring memory impairment after bilateral damage limited to the hippocampal formation" Journal of Neuroscience 16, 5233–5255
Robertson, M.M. (2000). Tourette syndrome, associated conditions and the complexities of treatment" Brain 123(3), 425–462.
Ross, C.A., Margolis, R.L., Reading, S.A.J., Pletnikov, M., & Coyle, J.T (2006). Neurobiology of Schizophrenia" Neuron 52, 139–153.
Sabshin, M. (1990). Turning points in twentieth-century American psychiatry" American Journal of Psychiatry 147(10),1267-1274.
Sachdev, P.S. (2005). Whither Neuropsychiatry? Journal of Neuropsychiatry and Clinical Neurosciences,17,140-141.
Saxena, S., Brody, A.L., Schwartz, T.M., & Baxter, L.R. (1998). Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. British Journal of Psychiatry,173(35), 26–37.
Schiffer, R.B, Bowen, B., Hinderliter, J., Hurst, D.L., Lajara-Nanson, W.A., & Packard, R.C. (2004). Neuropsychiatry: A Management Model for Academic Medicine. Journal of Neuropsychiatry and Clinical Neurosciences, 16, 336–341.
Shapiro, A.K., Shapiro, E., Wayne, H., & Clarkin, J. (1973). Organic factors in Gilles de la Tourette's syndrome. British Journal of Psychiatry, 122, 659–664.
Shergill, S. S., Brammer, M. J., Williams, S., Murray, R.M., & McGuire, P.K. (2000). Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging" Archives of General Psychiatry 57, 1033 -1038.
Singer, H.S. (1997). Neurobiology of Tourette syndrome. Neurologic Clinics, 15, 357–379.
Tienari, P., Wynne, L. C., Sorri, A., Lahti, I., Läksy, K., Moring, J., Naarala., M, Nieminen, P., & Wahlberg K. (2004) Genotype–environment interaction in schizophrenia-spectrum disorder: long-term follow-up study of Finnish adoptees. British Journal of Psychiatry, 184, 216–222.
Uher, R., & Treasure, J. (2005) Brain lesions and eating disorders. Journal of Neurology, Neurosurgery & Psychiatry, 76, 852–7.
Vawter, M.P., Freed, W.J., & Kleinman, J.E. (2000). Neuropathology of bipolar disorder" Biological Psychiatry 48, 486–504.
External links
Subspecialty Certification
Behavioral Neurology & Neuropsychiatry, United Council for Neurologic Subspecialties, US
Journals
The Journal of Neuropsychiatry and Clinical Neurosciences
Neuropsychiatric Disease and Treatment
Clinical Neuropsychiatry: Journal of Treatment Evaluation
Cognitive Neuropsychiatry
International/national organizations
Neuropsychiatric forum
American Neuropsychiatric Association
The British Neuropsychiatry Association
Royal College of Psychiatrists, Special Interest Group in Neuropsychiatry (SIGN)
International Neuropsychiatric Association
Neuropsychiatry in New Zealand
Society for Behavioral and Cognitive Neurology
Specific neuropsychiatry programs
Royal Melbourne Hospital Neuropsychiatry Unit
Neuropsychiatry Program, British Columbia, Canada
University of Pennsylvania Neuropsychiatry Program
University of Chicago Neuropsychiatry Program
Neuropsychiatry Program at Sheppard Pratt, US
Neurology
Psychiatric specialities
Treatment of bipolar disorder | 0.765996 | 0.99233 | 0.760121 |
Direct support professional | Direct Support Professionals (DSPs) are professionals who work directly with people with intellectual and developmental disabilities, with the aim of assisting the individual to become integrated into their community or the least restrictive environment.
DSPs share similar job duties with professional caregivers; they may assist with activities of daily living, transportation, ambulatory transfers, medication assistance under a delegating nurse, food preparation, and other as-needed duties. Given the possible challenging behaviors displayed by some individuals with developmental disabilities, including self-injurious and assaultive behavior, DSPs may also have experience in de-escalation and positive behavior support. However, their job broadly centers around assisting their clients to lead their most independent, autonomous, and socially participatory lives. A DSP provides support with community integration, competitive integrated employment, and acts as an advocate in communicating the wants, needs, and goals of the disabled individuals that they work for.
Duties
DSPs work directly with individuals. This means they'll often spend extended hours in the home or care facilities of their clients, and help provide day-to-day care with activities such as showering, toileting, eating, traveling, scheduling appointments, handling finances, taking medications, and more. The client is encouraged and expected to do all of these things to the best of their ability. Moreover, DSPs are not the guardians or medical professionals of the clients, and must defer to the expertise and opinions of those legally responsible for aspects of the client's life, including the client.
According to the National Alliance for Direct Support Professionals, "(t)he job duties of a DSP may resemble those of teachers, nurses, social workers, counselors, physical or occupational therapists, dieticians, chauffeurs, personal trainers, and others." The United States Department of Labor lists DSP duties as supporting engagement with the community, using creative thinking for accommodations to help people with disabilities be more independent, providing caregiving and support with activities of daily living, working with the people they support to advocate for rights and services, and providing emotional support.
Much of the emphasis on autonomy and independence came from the public outcry against overcrowded and underfunded institutions for the developmentally disabled, intellectually disabled, and mentally ill. Scandals such as the "last great disgrace" of the Willowbrook State School fueled the disability rights movement for self-advocacy and community living.
Standards of care
In 2010, the United States Department of Labor established a federal standard for DSP apprenticeship. Still, the standards of each organization are unique. College experience is unnecessary, but many employers require a high school diploma or GED. Some employers require certifications, while others offer certifying training on the job. The organization may require DSPs to become licensed in first aid, right response, nursing assistant registered, nursing assistant certified, home care aide, and more relevant healthcare-related certifications. DSPs may also be required by their company to carry a valid driver's license with a clean driver's record.
Before hiring, employers may require background checks, drug tests, mental health tests, physical exams, and other screening procedures to determine the competency of a potential candidate.
See also
Caregiver
Friendly caller program
References
San Francisco Chronicle Series
California State Assembly Bill 2780
Federal Level: H.R. 1279 – Direct Support Professionals Fairness and Security Act of 2007
External links
Illinois Council on Developmental Disabilities
College for Direct Support Professionals
WhoWillCare.net, H.R. 1279 – Direct Support Professionals Fairness and Security Act of 2007 Advocacy and Awareness
YouNeedToKnowMe.org – H.R. 1279 – Direct Support Professionals Fairness and Security Act of 2007 Advocacy and Awareness
www.collegeofdirectsupport.com
Caregiving
Disability
Social care in the United States
Personal care and service occupations | 0.779292 | 0.975369 | 0.760097 |
Macdonald triad | The Macdonald triad (also known as the triad of sociopathy or the homicidal triad) is a set of three factors, the presence of any two of which are considered to be predictive of, or associated with, violent tendencies, particularly with relation to serial offenses. The triad was first proposed by psychiatrist J. M. Macdonald in "The Threat to Kill", a 1963 article in the American Journal of Psychiatry. Small-scale studies conducted by psychiatrists Daniel Hellman and Nathan Blackman, and then FBI agents John E. Douglas and Robert K. Ressler along with Ann Burgess, claimed substantial evidence for the association of these childhood patterns with later predatory behavior. Although it remains an influential and widely taught hypothesis, subsequent research has generally not validated this line of thinking.
The triad links cruelty to animals, obsession with fire-setting, and persistent bedwetting past the age of five, to violent behaviors, particularly homicidal behavior and sexually predatory behavior. However, other studies claim not to have found statistically significant links between the triad and violent offenders.
Further studies have suggested that these behaviors are actually more linked to childhood experience of parental neglect, brutality, or abuse. Some argue this in turn results in "homicidal proneness." The "triad" concept as a particular combination of behaviors linked to violence may not have any particular validity, however, and it has been called an urban legend.
According to Douglas and his fellow researchers, while the triad behaviors are not causal when examining a relationship with later predatory behavior, they are nonetheless predictive of an increased likelihood of the future emergence of such violent behavior patterns, and can give professionals a chance to halt these patterns before they progress.
Arson
Arson or fire-setting is theorized to be a less severe or first shot at releasing aggression. Extensive periods of humiliation have been found to be present in the childhoods of several adult serial killers. These repetitive episodes of humiliation can lead to feelings of frustration and anger, which need to somehow be released in order to return to a normal state of self-worth. However, the triad combination has been questioned in this regard also, and a review has suggested that this behavior is just one that can occur in the context of childhood antisocial behavior and is not necessarily predictive of later violence.
Cruelty to animals
FBI special agent Alan Brantly believed that some offenders kill animals as a rehearsal for killing human victims. Cruelty to animals is mainly used to vent frustration and anger the same way firesetting is. Extensive amounts of humiliation were also found in the childhoods of children who engaged in acts of cruelty to animals. During childhood, serial killers could not retaliate toward those who caused them humiliation, so they chose animals because they were viewed as weak and vulnerable. Future victim selection is already in the process at a young age. Studies have found that those who engaged in childhood acts of cruelty to animals used the same method of killing on their human victims as they did on their animal victims.
Wright and Hensley (2003) named three recurring themes in their study of five cases of serial murderers: As children, they vented their frustrations because the person causing them anger or humiliation was too powerful to take down; they felt as if they regained some control and power over their lives through the torture and killing of the animals; they gained the power and control they desired by causing pain and suffering of a weaker, more vulnerable animal – escalating to humans in the future.
In a study of 45 male prison inmates who were deemed violent offenders, McClellan (2007) found that 56% admitted to having committed acts of violence against animals. It was also found that children who abused animals were more often the victims of parental abuse than children who did not abuse animals.
In a 2004 study, which considered not one-off events but patterns of repeat violence, Tallichet and Hensley found a link between repeated animal cruelty and violence against humans. They examined prisoners in maximum or medium security prisons. However, overgeneralizing possible links between animal violence and human violence can have unwanted consequences such as detracting focus from other possible predictors or causes.
Enuresis
Enuresis is "unintentional bed-wetting during sleep, persistent after the age of five." The bed-wetting must continue twice a week for at least three consecutive months.
Some authors continue to speculate that enuresis may be related to firesetting and animal cruelty. One argument is that because persistent bed-wetting beyond the age of five can be humiliating for a child, especially if they are belittled by a parental figure or other adult as a result, the child could use firesetting or cruelty to animals as an outlet for their frustration. Bedwetting into the tween and teen years has also been used as an indicator of possible childhood sexual abuse. Enuresis, firesetting, and cruelty to animals are more likely indicators of sustained physical or emotional abuse toward the child, or underlying mental illness that will, in turn, cause those behaviors. One researcher notes that enuresis is an "unconscious, involuntary, and nonviolent act and therefore linking it to violent crime is more problematic than doing so with animal cruelty or firesetting."
See also
Dark triad
Personality development disorder
Psychopathy
Zoosadism
References
Further reading
3 (number)
Anti-social behaviour
Mental health law
Personality typologies | 0.762049 | 0.997376 | 0.76005 |
Cognitive behavioral analysis system of psychotherapy | The cognitive behavioral analysis system of psychotherapy (CBASP) is a talking therapy, a synthesis model of interpersonal and cognitive and behavioral therapies developed by James P. McCullough Jr. of Virginia Commonwealth University specifically for the treatment of all varieties of DSM-IV chronic depression. McCullough writes that chronic depression (i.e., depressive disorder in adults that lasts continuously for two or more years, or one year continuously in adolescents), particularly the type beginning during adolescence (early-onset), is essentially a refractory mood disorder arising from traumatic experiences or interpersonal psychological insults delivered by the patient's significant others (nuclear or extended family).
Basic assumptions
Absence of felt interpersonal safety in patients. Chronic mood (e.g., chronic depression) denotes an absence of felt safety as regards (a) the precipitating (original) trauma event(s) or on a less sudden and violent level, (b) maltreating-hurtful significant others who have inflicted psychological insults on the individual through interpersonal rejection, harsh punishment, censure, or emotional abandonment/neglect. The lack of felt safety (c) has been transferred to a generalized fear of interpersonal relationships. For patients, more often than not, "people are hell" to borrow a phrase from Jean-Paul Sartre. Whether the etiology includes sudden trauma or psychological insults, the predominant coping strategy that maintains the dysphoric mood condition is an interpersonal avoidance of persons in the home, at work, or in the social environment. The patient's successful situational and interpersonal avoidance pattern is the major treatment issue when the chronically depressed individual enters psychotherapy.
No change is possible as long as interpersonal avoidance patterns remain. As noted above, no emotional modification or termination of the chronic depression mood is possible apart from terminating patient interpersonal avoidance by enabling them to encounter the original precipitating trauma (violent/sudden event) or the psychological insults that stem from chronic interpersonal punishment, abuse or emotional neglect. The active arena where change processes are targeted and occur in CBASP psychotherapy involves the current interpersonal milieu within which the patient functions.
Treatment strategies
In-session focus exercises in an atmosphere of felt safety help patients confront the feared stimuli and modify the Pavlovian fear driving the refractory emotional state. Learning appropriate non-avoidant ways to deal with the fear stimuli also decreases Skinnerian avoidance behavior and prepares the way for mood change. In the beginning of therapy, it should be remembered that the chronic mood associated with trauma or psychological insults may involve stimulus events that remain tacit knowledge (out of awareness) for patients (i.e., the pain, fear and anxiety are clearly observable but the actual precipitating and maintaining stimuli may not be clearly understood or recognized by the patient). Material derived from the Significant Other History (SOH) often illustrates the tacit knowledge dimension of the patient's avoidance patterns. In summary, another way to describe what's going on in the beginning of therapy is to say that patients are avoiding others (including the therapist) and not responding to the interpersonal environment. Interpersonal avoidance always dictates that the patient's primary focus remains on himself or herself (i.e., patients stay "in their heads"). In such a psychosocial functioning state, these individuals remain helpless and hopeless and continue to respond to themselves in a solitary and never-ending circle of pain, fear, anxiety (and depression); hence, they are unable to connect with their interpersonal world in any informing way.
Therapist role
A feature of CBASP is the interpersonal role of the psychotherapist. CBASP clinicians enact a "disciplined personal involvement role" to heal the injurious interpersonal traumas and psychological insults patients have received at the hands of harmful significant others.
Outcome goals of treatment and beyond
The goals of CBASP treatment are (1) to connect patients perceptually and behaviorally to the interpersonal world they live in so that their behavior is informed by environmental (interpersonal) influences; (2) CBASP teaches patients how to make themselves feel better emotionally as well as how to maintain affective control; (3) patients are taught to negotiate interpersonal relationships successfully which means that patients acquire the requisite skills to obtain desirable interpersonal goals; (4) finally, patients learn the crucial importance of "maintaining" the treatment gains after psychotherapy ends. Maintaining the gains requires daily practice of the in-session learning which protects (perpetuates) the extinction of the old pathological patterns of behavior. Post-therapy practice for the rest of their lives holds in abeyance the ever-present danger of relapse and recurrence.
Combination treatment
A large-scale study, published in 2000 by Martin Keller of Brown Medical School and others, compared the (then available) antidepressant Serzone with CBASP. 681 patients with severe chronic depression (some with other psychiatric illnesses) were enrolled in the trial, and were assigned to either Serzone, CBASP, or combination Serzone-CBASP for 12 weeks. The response rates to either Serzone or CBASP alone were 55 percent and 52 percent, respectively, for the 76 percent who completed the study. In other words, a little more than half of the completers in those two arms of the trial reduced their depression by 50 percent or better.
The Serzone findings roughly correspond with many other trial results for antidepressants, and underscore a major weakness in these drugs—that while they are effective, the benefit is often marginal and the treatment outcome problematic. Similarly, the CBASP findings validate other studies finding talking therapy about equal in efficacy to taking antidepressants.
The results for the combination drug-therapy group, however, were surprising, with 85 percent of the completing patients achieving a 50 percent reduction in symptoms or better. 42 percent in the combination group achieved remission (a virtual elimination of all depressive symptoms) compared to 22 percent in the Serzone group and 24 percent in the CBASP group.
The authors of the frequently cited study noted that "the rates of response and remission in the combined-treatment group were substantially higher than those that might have been anticipated on the basis of the outcomes of previous trials in similar patients." Their figures show that treating depression with a combination of both an anti-depressant drug and a form of cognitive behavior therapy can be highly effective, giving substantially better results than other methods of dealing with depression.
Notes
Further reading
External links
Cognitive Behavioral Analysis System of Psychotherapy
International CBASP Society
Psychotherapy by type | 0.784851 | 0.968391 | 0.760043 |
Iatrogenesis | Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. First used in this sense in 1924, the term was introduced to sociology in 1976 by Ivan Illich, alleging that industrialized societies impair quality of life by overmedicalizing life. Iatrogenesis may thus include mental suffering via medical beliefs or a practitioner's statements. Some iatrogenic events are obvious, like amputation of the wrong limb, whereas others, like drug interactions, can evade recognition. In a 2013 estimate, about 20 million negative effects from treatment had occurred globally. In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990.
Iatrogenic avenues
Risk associated with medical interventions
Adverse effects of prescription drugs or vaccines
Overuse of drugs (causing, for example, antibiotic resistance in bacteria)
Prescription drug interaction
Medical errors
Incorrect prescription, perhaps due to illegible handwriting or computer typos
Faulty procedures, techniques, information, methods, or equipment
Negligence
Hospital-acquired infections
Causes and consequences
Medical error and negligence
Iatrogenic conditions need not result from medical errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy, such as a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment are iatrogenic. For example, radiation therapy and chemotherapy—necessarily aggressive for therapeutic effect – frequently produce such iatrogenic effects as hair loss, hemolytic anemia, diabetes insipidus, vomiting, nausea, brain damage, lymphedema, infertility, etc. The loss of function resulting from the required removal of a diseased organ is iatrogenic, as in the case of diabetes consequential to the removal of all or part of the pancreas.
The incidence of iatrogenesis may be misleading in some cases. For example, a ruptured aortic aneurysm is fatal in most cases; the survival rate for treatment of a ruptured aortic aneurysm is under 25%. Patients who die during or after an operation will still be considered iatrogenic deaths, but the procedure itself remains a better bet than the probability of death if left untreated.
Other situations may involve actual negligence or faulty procedures, such as when pharmacotherapists produce handwritten prescriptions for drugs.
Another situation may involve negligence where patients are brushed off and not given proper care due to providers holding prejudice for reasons such as sexual orientation, ethnicity, religion, immigration status, etc. This can cause mistrust between patients and providers, leading to patients to not go in for treatment, resulting in more deaths.
Adverse effects
Adverse reactions, such as allergic reactions to drugs, even when unexpected by pharmacotherapists, are also classified as iatrogenic.
The evolution of antibiotic resistance in bacteria is iatrogenic as well. Bacterial strains resistant to antibiotics have evolved in response to the over prescription of antibiotic drugs.
Certain drugs and vaccines are toxic in their own right in therapeutic doses because of their mechanism of action. Alkylating antineoplastic agents, for example, cause DNA damage, which is more harmful to cancer cells than regular cells. However, alkylation causes severe side-effects and is actually carcinogenic in its own right, with potential to lead to the development of secondary tumors. In a similar manner, arsenic-based medications like melarsoprol, used to treat trypanosomiasis, can cause arsenic poisoning.
Adverse effects can appear mechanically. The design of some surgical instruments may be decades old, hence certain adverse effects (such as tissue trauma) may never have been properly characterized.
Psychiatry
In psychiatry, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition, as was the case of hystero-epilepsy). An example of a potentially iatrogenic circumstance is misdiagnosis of bipolar disorder for another disorder, especially in pediatric patients considered to have major depressive disorder and prescribed stimulants or antidepressants. Other conditions such as somatoform disorder are theorized to have significant sociocultural and iatrogenic components. Chronic Fatigue Syndrome/Myalgic Encephalomyelitis was historically viewed as a psychiatric/somatoform condition, and the now-outdated treatment of Graded Exercise Therapy is known to have caused iatrogenic harm. Post-traumatic stress disorder is hypothesized to be prone to iatrogenic complications based on treatment modality. Certain antipsychotics have been shown to reduce brain volumes in animals and in humans over long-term use.
Some populations may be at risk of underdiagnosis or misdiagnosis of psychiatric disorders, including those identified as having substance abuse disorders. At the other end of the spectrum, dissociative identity disorder is considered by a minority of theorists to be a wholly iatrogenic disorder with the bulk of diagnoses arising from a tiny fraction of practitioners.
The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial. The over-diagnosis of psychiatric conditions (with the assignment of mental illness terminology) may relate primarily to clinician dependence on subjective criteria. The assignment of pathological nomenclature is rarely a benign process and can easily rise to the level of emotional iatrogenesis, especially when no alternatives outside of the diagnostic naming process have been considered. Many former patients come to the conclusion that their difficulties are largely the result of the power relationships inherent in psychiatric treatment, which has led to the rise of the anti-psychiatry movement.
Iatrogenic poverty
Meessen et al. used the term "iatrogenic poverty" to describe impoverishment induced by medical care. Impoverishment is described for households exposed to catastrophic health expenditure or to hardship financing. Every year, worldwide, over 100,000 households fall into poverty due to health care expenses. A study reported that in the United States in 2001, illness and medical debt caused half of all personal bankruptcies. Especially in countries in economic transition, the willingness to pay for health care is increasing, and the supply side does not stay behind and develops very fast. But the regulatory and protective capacity in those countries is often lagging behind. Patients easily fall into a vicious cycle of illness, ineffective therapies, consumption of savings, indebtedness, sale of productive assets, and eventually poverty.
Social and cultural iatrogenesis
The 20th-century social critic Ivan Illich broadened the concept of medical iatrogenesis in his 1974 book Medical Nemesis: The Expropriation of Health by defining it at three levels.
First, clinical iatrogenesis is the injury done to patients by ineffective, unsafe, and erroneous treatments as described above. In this regard, he described the need for evidence-based medicine 20 years before the term was coined (the concept itself had been known and followed for centuries).
Second, at another level social iatrogenesis is the medicalization of life in which medical professionals, pharmaceutical companies, and medical device companies have a vested interest in sponsoring sickness by creating unrealistic health demands that require more treatments or treating non-diseases that are part of the normal human experience, such as age-related declines. In this way, aspects of medical practice and medical industries can produce social harm in which society members ultimately become less healthy or excessively dependent on institutional care. He argued that medical education of physicians contributes to medicalization of society because they are trained predominantly for diagnosing and treating illness, therefore they focus on disease rather than on health. Iatrogenic poverty (above) can be considered a specific manifestation of social iatrogenesis.
Third, cultural iatrogenesis refers to the destruction of traditional ways of dealing with, and making sense of, death, suffering, and sickness. In this way the medicalization of life leads to cultural harm as society members lose their autonomous coping skills. It is worth noting that in these critiques "Illich does not reject all benefits of modern society but rejects those that involve unwarranted dependency and exploitation."
Epidemiology
Globally it is estimated that 142,000 people died in 2013 from adverse effects of medical treatment, an increase of 51 percent from 94,000 in 1990. In the United States, estimated deaths per year include:
12,000 due to unnecessary surgery
7,000 due to medication errors in hospitals
20,000 due to other errors in hospitals
80,000 due to nosocomial infections in hospitals
106,000 due to non-error, negative effects of drugs
Based on these figures, iatrogenesis may cause as many as 225,000 deaths per year in the United States (excluding recognizable error). An earlier Institute of Medicine report estimated 230,000 to 284,000 iatrogenic deaths annually.
History
The term "iatrogenesis" means brought forth by a healer, from the Greek (, "healer") and (, "origin"); as such, in its earlier forms, it could refer to good or bad effects.
Since at least the time of Hippocrates, people have recognized the potentially damaging effects of medical intervention. "First do no harm" (primum non nocere) is a primary Hippocratic mandate in modern medical ethics. Iatrogenic illness or death caused purposefully or by avoidable error or negligence on the healer's part became a punishable offense in many civilizations.
The transfer of pathogens from the autopsy room to maternity patients, leading to shocking historical mortality rates of puerperal fever (also known as "childbed fever") at maternity institutions in the 19th century, was a major iatrogenic catastrophe of the era. The infection mechanism was first identified by Ignaz Semmelweis.
With the development of scientific medicine in the 20th century, it could be expected that iatrogenic illness or death might be more easily avoided. Antiseptics, anesthesia, antibiotics, better surgical techniques, evidence-based protocols and best practices continue to be developed to decrease iatrogenic side effects and mortality.
See also
Adverse drug reaction
Antifragile
Bioethics
Bloodletting
Cascade effect
Classification of Pharmaco-Therapeutic Referrals
Fatal Care: Survive in the U.S. Health System
Hospital-acquired infection
Journal of Negative Results in Biomedicine
List of medicine contamination incidents
Medical malpractice
Medicalization
Nassim Nicholas Taleb
Nocebo
Paradoxical reaction
Patient safety
Placebo
Polypharmacy
Pressure ulcer
Quaternary prevention
Risk–benefit ratio
Sentinel event
References
External links
Patient Safety Network (US)
Medical ethics
Health care quality
Medical error
Social problems in medicine | 0.763117 | 0.995922 | 0.760005 |
Diathesis–stress model | The diathesis-stress model, also known as the vulnerability–stress model, is a psychological theory that attempts to explain a disorder, or its trajectory, as the result of an interaction between a predispositional vulnerability, the diathesis, and stress caused by life experiences. The term diathesis derives from the Greek term (διάθεσις) for a predisposition or sensibility. A diathesis can take the form of genetic, psychological, biological, or situational factors. A large range of differences exists among individuals' vulnerabilities to the development of a disorder.
The diathesis, or predisposition, interacts with the individual's subsequent stress response. Stress is a life event or series of events that disrupt a person's psychological equilibrium and may catalyze the development of a disorder. Thus the diathesis-stress model serves to explore how biological or genetic traits (diatheses) interact with environmental influences (stressors) to produce disorders such as depression, anxiety, or schizophrenia. The diathesis-stress model asserts that if the combination of the predisposition and the stress exceeds a threshold, the person will develop a disorder.
The use of the term diathesis in medicine and in the specialty of psychiatry dates back to the 1800s. However, the diathesis-stress model was not introduced and used to describe the development of psychopathology until it was applied to explaining schizophrenia in the 1960s by Paul Meehl.
The diathesis-stress model is used in many fields of psychology, specifically for studying the development of psychopathology. It is useful for the purposes of understanding the interplay of nature and nurture in the susceptibility to psychological disorders throughout the lifespan. Diathesis-stress models can also assist in determining who will develop a disorder and who will not. For example, in the context of depression, the diathesis-stress model can help explain why Person A may become depressed while Person B does not, even when exposed to the same stressors. More recently, the diathesis-stress model has been used to explain why some individuals are more at risk for developing a disorder than others. For example, children who have a family history of depression are generally more vulnerable to developing a depressive disorder themselves. A child who has a family history of depression and who has been exposed to a particular stressor, such as exclusion or rejection by their peers, would be more likely to develop depression than a child with a family history of depression that has an otherwise positive social network of peers. The diathesis-stress model has also served as useful in explaining other poor (but non-clinical) developmental outcomes.
Protective factors, such as positive social networks or high self-esteem, can counteract the effects of stressors and prevent or curb the effects of the disorder. Many psychological disorders have a window of vulnerability, during which time an individual is more likely to develop a disorder than others. Diathesis–stress models are often conceptualized as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. The differential susceptibility hypothesis is a recent theory that has stemmed from the diathesis–stress model.
Diathesis
The term diathesis is synonymous with vulnerability, and variants such as "vulnerability-stress" are common within psychology. A vulnerability makes it more or less likely that an individual will succumb to the development of psychopathology if certain stress is encountered. Diatheses are considered inherent within the individual and are typically conceptualized as being stable, but not unchangeable, over the lifespan. They are also often considered latent (i.e., dormant) because they are harder to recognize unless provoked by stressors.
Diatheses are understood to include genetic, biological, physiological, cognitive, and personality-related factors. Some examples of diatheses include genetic factors, such as abnormalities in some genes or variations in multiple genes that interact to increase vulnerability. Other diatheses include early life experiences such as the loss of a parent or high neuroticism. Diatheses can also be conceptualized as situational factors, such as low socioeconomic status or having a parent with depression.
Stress
Stress can be conceptualized as a life event that disrupts the equilibrium of a person's life. For instance, a person may be vulnerable to becoming depressed but will not develop depression unless he or she is exposed to a specific stress, which may trigger a depressive disorder. Stressors can take the form of a discrete event, such as the divorce of parents or a death in the family, or can be more chronic factors such as having a long-term illness or ongoing marital problems. Stresses can also be related to more daily hassles, such as school assignment deadlines. This also parallels the popular (and engineering) usage of stress, but note that some literature defines stress as the response to stressors, especially where usage in biology influences neuroscience.
It has been long recognized that psychological stress plays a significant role in understanding how psychopathology develops in individuals. However, psychologists have also identified that not all individuals who are stressed, or go through stressful life events, develop a psychological disorder. To understand this, theorists and researchers explored other factors that affected the development of a disorder and proposed that some individuals under stress develop a disorder and others do not. As such, some individuals are more vulnerable than others to developing a disorder once the stress has been introduced. This led to the formulation of the diathesis-stress model.
Genetics
Stress is known to be a mast cell activator. Mast cells are long-lived tissue-resident cells with an important role in many inflammatory settings, including host defense against parasitic infection and in allergic reactions.
There is evidence that "children exposed to prenatal stress may experience resilience driven by epigenome-wide interactions". Early life stress interactions with the epigenome show potential mechanisms driving vulnerability towards psychiatric illness. Ancestral stress alters lifetime mental health trajectories via epigenetic regulation.
Carriers of congenital adrenal hyperplasia have a predisposition to stress due to the unique nature of this gene. True rates of prevalence are not known, but common genetic variants of the human Steroid 21-Hydroxylase Gene (CYP21A2) are related to differences in circulating hormone levels in the population.
Psychological distress significantly impacts the quality of life of affected individuals. It is a known feature of generalized joint hypermobility (gJHM), as well as of its most common syndromic presentation, namely Ehlers–Danlos syndrome, hypermobility type (also known as joint hypermobility syndrome, JHS/EDS-HT). Interestingly, in addition to the confirmation of a tight link between anxiety and gJHM, preliminary connections with depression, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and obsessive–compulsive personality disorder (OCPD) were also found.
Sensory processing sensitivity (SPS) is a personality trait involving "an increased sensitivity of the central nervous system and a deeper cognitive processing of physical, social and emotional stimuli". The trait is characterized by "a tendency to 'pause to check' in novel situations, greater sensitivity to subtle stimuli, and the engagement of deeper cognitive processing strategies for employing coping actions, all of which are driven by heightened emotional reactivity, both positive and negative". SPS captures sensitivity to the environment in a heritable, evolutionary-conserved trait associated with increased information processing in the brain, moderating sensitivity to environments in a for-better-and-for-worse fashion. Interaction with negative experiences increases the risk for psychopathology, whereas interaction with positive experiences (including interventions) increases positive outcomes.
Protective factors
Protective factors, while not an inherent component of the diathesis–stress model, are of importance when considering the interaction of diatheses and stress. Protective factors can mitigate or provide a buffer against the effects of major stressors by providing an individual with developmentally adaptive outlets to deal with stress. Examples of protective factors include a positive parent-child attachment relationship, a supportive peer network, and individual social and emotional competence.
Throughout the lifespan
Many models of psychopathology generally suggest that all people have some level of vulnerability towards certain mental disorders but posit a large range of individual differences in the point at which a person will develop a certain disorder. For example, an individual with personality traits that tend to promote relationships, such as extroversion and agreeableness, may engender strong social support, which may later serve as a protective factor when experiencing stressors or losses that may delay or prevent the development of depression. Conversely, an individual who finds it difficult to develop and maintain supportive relationships may be more vulnerable to developing depression following a job loss because they do not have protective social support. An individual's threshold is determined by the interaction of diatheses and stress.
Windows of vulnerability for developing specific psychopathologies are believed to exist at different points of the lifespan. Moreover, different diatheses and stressors are implicated in different disorders. For example, breakups and other severe or traumatic life stressors are implicated in the development of depression. Stressful events can also trigger the manic phase of bipolar disorder, and stressful events can then prevent recovery and trigger relapse. Having a genetic disposition for becoming addicted and later engaging in binge drinking in college are implicated in the development of alcoholism. A family history of schizophrenia combined with the stressor of being raised in a dysfunctional family raises the risk of developing schizophrenia.
Diathesis-stress models are often conceptualized as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. For example, a child with a family history of depression likely has a genetic vulnerability to depressive disorder. This child has also been exposed to environmental factors associated with parental depression that increase their vulnerability to developing depression as well. Protective factors, such as a strong peer network, involvement in extracurricular activities, and a positive relationship with the non-depressed parent, interact with the child's vulnerabilities in determining the progression to psychopathology versus normative development.
Some theories have branched from the diathesis-stress model, such as the differential susceptibility hypothesis, which extends the model to include a vulnerability to positive environments as well as negative environments or stress. A person could have a biological vulnerability that, when combined with a stressor, could lead to psychopathology (diathesis–stress model); but that same person with a biological vulnerability, if exposed to a particularly positive environment, could have better outcomes than a person without the vulnerability.
See also
Biopsychosocial model
Environmental sensitivity
Gene–environment interaction
Genetic predisposition
Heritability
Human behavior genetics
References
External links
Psychological theories
Psychological stress
Schizophrenia
Environmental sensitivity | 0.765319 | 0.993006 | 0.759967 |
Carphologia | Carphologia (or carphology) is a lint-picking behavior that is often a symptom of a delirious state.
Often seen in delirious or semiconscious patients, carphologia describes the actions of picking or grasping at imaginary objects, as well as the patient's own clothes or bed linens. This can be a grave symptom in cases of extreme exhaustion or approaching death.
Etymology
The word carphology is derived from the ancient Greek "" (karphologia), as a compound of the two Greek elements: "κάρϕος" (karphos, "straw"), and "λέγειν" (legein), here in its sense of "to collect" rather than the more usual sense of "to say, profess". Thus, carphology literally means "to behave as though one were collecting straw". This refers to the involuntary picking or grasping movements sometimes seen in delirious patients in exhaustion, stupor, or high fever.
Synonyms
The Latin-derived equivalent is floccillation which derives from , "a piece of wool or straw". The late Latin crocydismus, still used in continental European psychiatry, is also synonymous and derived from the ancient Greek "κροκύς" (krokus, "bit of fluff" or "dust"). It appears first in the writings of Aretaeus and later of Galen.
References
The Compact Edition of the Oxford English Dictionary, Oxford University Press, 1971, p. 343.
Medical aspects of death
Symptoms and signs of mental disorders | 0.771798 | 0.984664 | 0.759961 |
Sick building syndrome | Sick building syndrome (SBS) is a condition in which people develop symptoms of illness or become infected with chronic disease from the building in which they work or reside. In scientific literature, SBS is also known as building-related illness (BRI), building-related symptoms (BRS), or idiopathic environmental intolerance (IEI).
The main identifying observation is an increased incidence of complaints of such symptoms as headache, eye, nose, and throat irritation, fatigue, dizziness, and nausea. The 1989 Oxford English Dictionary defines SBS in that way. The World Health Organization created a 484-page tome on indoor air quality 1984, when SBS was attributed only to non-organic causes, and suggested that the book might form a basis for legislation or litigation.
The outbreaks may or may not be a direct result of inadequate or inappropriate cleaning. SBS has also been used to describe staff concerns in post-war buildings with faulty building aerodynamics, construction materials, construction process, and maintenance. Some symptoms tend to increase in severity with the time people spend in the building, often improving or even disappearing when people are away from the building. The term SBS is also used interchangeably with "building-related symptoms", which orients the name of the condition around patients' symptoms rather than a "sick" building.
Attempts have been made to connect sick building syndrome to various causes, such as contaminants produced by outgassing of some building materials, volatile organic compounds (VOC), improper exhaust ventilation of ozone (produced by the operation of some office machines), light industrial chemicals used within, and insufficient fresh-air intake or air filtration (see "Minimum efficiency reporting value"). Sick building syndrome has also been attributed to heating, ventilation, and air conditioning (HVAC) systems, an attribution about which there are inconsistent findings.
Signs and symptoms
Human exposure to aerosols has a variety of adverse health effects. Building occupants complain of symptoms such as sensory irritation of the eyes, nose, or throat; neurotoxic or general health problems; skin irritation; nonspecific hypersensitivity reactions; infectious diseases; and odor and taste sensations. Poor lighting has caused general malaise.
Extrinsic allergic alveolitis has been associated with the presence of fungi and bacteria in the moist air of residential houses and commercial offices. A study in 2017 correlated several inflammatory diseases of the respiratory tract with objective evidence of damp-caused damage in homes.
The WHO has classified the reported symptoms into broad categories, including mucous-membrane irritation (eye, nose, and throat irritation), neurotoxic effects (headaches, fatigue, and irritability), asthma and asthma-like symptoms (chest tightness and wheezing), skin dryness and irritation, and gastrointestinal complaints.
Several sick occupants may report individual symptoms that do not seem connected. The key to discovery is the increased incidence of illnesses in general with onset or exacerbation in a short period, usually weeks. In most cases, SBS symptoms are relieved soon after the occupants leave the particular room or zone. However, there can be lingering effects of various neurotoxins, which may not clear up when the occupant leaves the building. In some cases, including those of sensitive people, there are long-term health effects.
Cause
ASHRAE has recognized that polluted urban air, designated within the United States Environmental Protection Agency (EPA)'s air quality ratings as unacceptable, requires the installation of treatment such as filtration for which the HVAC practitioners generally apply carbon-impregnated filters and their likes. Different toxins will aggravate the human body in different ways. Some people are more allergic to mold, while others are highly sensitive to dust. Inadequate ventilation will exaggerate small problems (such as deteriorating fiberglass insulation or cooking fumes) into a much more serious indoor air quality problem.
Common products such as paint, insulation, rigid foam, particle board, plywood, duct liners, exhaust fumes and other chemical contaminants from indoor or outdoor sources, and biological contaminants can be trapped inside by the HVAC AC system. As this air is recycled using fan coils the overall oxygenation ratio drops and becomes harmful. When combined with other stress factors such as traffic noise, poor lighting, inhabitants of buildings located in a polluted urban area can quickly become ill as their immune system is overwhelmed.
Certain VOCs, considered toxic chemical contaminants to humans, are used as adhesives in many common building construction products. These aromatic carbon rings / VOCs can cause acute and chronic health effects in the occupants of a building, including cancer, paralysis, lung failure, and others. Bacterial spores, fungal spores, mold spores, pollen, and viruses are types of biological contaminants and can all cause allergic reactions or illness described as SBS. In addition, pollution from outdoors, such as motor vehicle exhaust, can enter buildings, worsen indoor air quality, and increase the indoor concentration of carbon monoxide and carbon dioxide. Adult SBS symptoms were associated with a history of allergic rhinitis, eczema and asthma.
A 2015 study concerning the association of SBS and indoor air pollutants in office buildings in Iran found that, as carbon dioxide increased in a building, nausea, headaches, nasal irritation, dyspnea, and throat dryness also rose. Some work conditions have been correlated with specific symptoms: brighter light, for example was significantly related to skin dryness, eye pain, and malaise. Higher temperature is correlated with sneezing, skin redness, itchy eyes, and headache; lower relative humidity has been associated with sneezing, skin redness, and eye pain.
In 1973, in response to the oil crisis and conservation concerns, ASHRAE Standards 62-73 and 62-81 reduced required ventilation from per person to per person, but this was found to be a contributing factor to sick building syndrome. As of the 2016 revision, ASHRAE ventilation standards call for 5 to 10 cubic feet per minute of ventilation per occupant (depending on the occupancy type) in addition to ventilation based on the zone floor area delivered to the breathing zone.
Workplace
Excessive work stress or dissatisfaction, poor interpersonal relationships and poor communication are often seen to be associated with SBS, recent studies show that a combination of environmental sensitivity and stress can greatly contribute to sick building syndrome.
Greater effects were found with features of the psycho-social work environment including high job demands and low support. The report concluded that the physical environment of office buildings appears to be less important than features of the psycho-social work environment in explaining differences in the prevalence of symptoms. However, there is still a relationship between sick building syndrome and symptoms of workers regardless of workplace stress.
Specific work-related stressors are related with specific SBS symptoms. Workload and work conflict are significantly associated with general symptoms (headache, abnormal tiredness, sensation of cold or nausea). While crowded workspaces and low work satisfaction are associated with upper respiratory symptoms. Work productivity has been associated with ventilation rates, a contributing factor to SBS, and there's a significant increase in production as ventilation rates increase, by 1.7% for every two-fold increase of ventilation rate. Printer effluent, released into the office air as ultra-fine particles (UFPs) as toner is burned during the printing process, may lead to certain SBS symptoms. Printer effluent may contain a variety of toxins to which a subset of office workers are sensitive, triggering SBS symptoms.
Specific careers are also associated with specific SBS symptoms. Transport, communication, healthcare, and social workers have highest prevalence of general symptoms. Skin symptoms such as eczema, itching, and rashes on hands and face are associated with technical work. Forestry, agriculture, and sales workers have the lowest rates of sick building syndrome symptoms.
From the assessment done by Fisk and Mudarri, 21% of asthma cases in the United States were caused by wet environments with mold that exist in all indoor environments, such as schools, office buildings, houses and apartments. Fisk and Berkeley Laboratory colleagues also found that the exposure to the mold increases the chances of respiratory issues by 30 to 50 percent. Additionally, studies showing that health effects with dampness and mold in indoor environments found that increased risk of adverse health effects occurs with dampness or visible mold environments.
Milton et al. determined the cost of sick leave specific for one business was an estimated $480 per employee, and about five days of sick leave per year could be attributed to low ventilation rates. When comparing low ventilation rate areas of the building to higher ventilation rate areas, the relative risk of short-term sick leave was 1.53 times greater in the low ventilation areas.
Home
Sick building syndrome can be caused by one's home. Laminate flooring may release more SBS-causing chemicals than do stone, tile, and concrete floors. Recent redecorating and new furnishings within the last year are associated with increased symptoms; so are dampness and related factors, having pets, and cockroaches. Mosquitoes are related to more symptoms, but it is unclear whether the immediate cause of the symptoms is the mosquitoes or the repellents used against them.
Mold
Sick building syndrome may be associated with indoor mold or mycotoxin contamination. However, the attribution of sick building syndrome to mold is controversial and supported by little evidence.
Indoor temperature
Indoor temperature under 18 °C (64 °F) has been shown to be associated with increased respiratory and cardiovascular diseases, increased blood levels, and increased hospitalization.
Diagnosis
While sick building syndrome (SBS) encompasses a multitude of non-specific symptoms, building-related illness (BRI) comprises specific, diagnosable symptoms caused by certain agents (chemicals, bacteria, fungi, etc.). These can typically be identified, measured, and quantified. There are usually four causal agents in BRi: immunologic, infectious, toxic, and irritant. For instance, Legionnaire's disease, usually caused by Legionella pneumophila, involves a specific organism which could be ascertained through clinical findings as the source of contamination within a building.
Prevention
Reduction of time spent in the building
If living in the building, moving to a new place
Fixing any deteriorated paint or concrete deterioration
Regular inspections to indicate for presence of mold or other toxins
Adequate maintenance of all building mechanical systems
Toxin-absorbing plants, such as sansevieria
Roof shingle non-pressure cleaning for removal of algae, mold, and Gloeocapsa magma
Using ozone to eliminate the many sources, such as VOCs, molds, mildews, bacteria, viruses, and even odors. However, numerous studies identify high-ozone shock treatment as ineffective despite commercial popularity and popular belief.
Replacement of water-stained ceiling tiles and carpeting
Only using paints, adhesives, solvents, and pesticides in well-ventilated areas or only using these pollutant sources during periods of non-occupancy
Increasing the number of air exchanges; the American Society of Heating, Refrigeration and Air-Conditioning Engineers recommend a minimum of 8.4 air exchanges per 24-hour period
Increased ventilation rates that are above the minimum guidelines
Proper and frequent maintenance of HVAC systems
UV-C light in the HVAC plenum
Installation of HVAC air cleaning systems or devices to remove VOCs and bioeffluents (people odors)
Central vacuums that completely remove all particles from the house including the ultrafine particles (UFPs) which are less than 0.1 μm
Regular vacuuming with a HEPA filter vacuum cleaner to collect and retain 99.97% of particles down to and including 0.3 micrometers
Placing bedding in sunshine, which is related to a study done in a high-humidity area where damp bedding was common and associated with SBS
Lighting in the workplace should be designed to give individuals control, and be natural when possible
Relocating office printers outside the air conditioning boundary, perhaps to another building
Replacing current office printers with lower emission rate printers
Identification and removal of products containing harmful ingredients
Management
SBS, as a non-specific blanket term, does not have any specific cause or cure. Any known cure would be associated with the specific eventual disease that was cause by exposure to known contaminants. In all cases, alleviation consists of removing the affected person from the building associated. BRI, on the other hand, utilizes treatment appropriate for the contaminant identified within the building (e.g., antibiotics for Legionnaire's disease).
Improving the indoor air quality (IAQ) of a particular building can attenuate, or even eliminate, the continued exposure to toxins. However, a Cochrane review of 12 mold and dampness remediation studies in private homes, workplaces and schools by two independent authors were deemed to be very low to moderate quality of evidence in reducing adult asthma symptoms and results were inconsistent among children. For the individual, the recovery may be a process involved with targeting the acute symptoms of a specific illness, as in the case of mold toxins. Treating various building-related illnesses is vital to the overall understanding of SBS. Careful analysis by certified building professionals and physicians can help to identify the exact cause of the BRI, and help to illustrate a causal path to infection. With this knowledge one can, theoretically, remediate a building of contaminants and rebuild the structure with new materials. Office BRI may more likely than not be explained by three events: "Wide range in the threshold of response in any population (susceptibility), a spectrum of response to any given agent, or variability in exposure within large office buildings."
Isolating any one of the three aspects of office BRI can be a great challenge, which is why those who find themselves with BRI should take three steps, history, examinations, and interventions. History describes the action of continually monitoring and recording the health of workers experiencing BRI, as well as obtaining records of previous building alterations or related activity. Examinations go hand in hand with monitoring employee health. This step is done by physically examining the entire workspace and evaluating possible threats to health status among employees. Interventions follow accordingly based on the results of the Examination and History report.
Epidemiology
Some studies have found that women have higher reports of SBS symptoms than men. It is not entirely clear, however, if this is due to biological, social, or occupational factors.
A 2001 study published in the Journal Indoor Air, gathered 1464 office-working participants to increase the scientific understanding of gender differences under the Sick Building Syndrome phenomenon. Using questionnaires, ergonomic investigations, building evaluations, as well as physical, biological, and chemical variables, the investigators obtained results that compare with past studies of SBS and gender. The study team found that across most test variables, prevalence rates were different in most areas, but there was also a deep stratification of working conditions between genders as well. For example, men's workplaces tend to be significantly larger and have all-around better job characteristics. Secondly, there was a noticeable difference in reporting rates, specifically that women have higher rates of reporting roughly 20% higher than men. This information was similar to that found in previous studies, thus indicating a potential difference in willingness to report.
There might be a gender difference in reporting rates of sick building syndrome, because women tend to report more symptoms than men do. Along with this, some studies have found that women have a more responsive immune system and are more prone to mucosal dryness and facial erythema. Also, women are alleged by some to be more exposed to indoor environmental factors because they have a greater tendency to have clerical jobs, wherein they are exposed to unique office equipment and materials (example: blueprint machines, toner-based printers), whereas men often have jobs based outside of offices.
History
In the late 1970s, it was noted that nonspecific symptoms were reported by tenants in newly constructed homes, offices, and nurseries. In media it was called "office illness". The term "sick building syndrome" was coined by the WHO in 1986, when they also estimated that 10–30% of newly built office buildings in the West had indoor air problems. Early Danish and British studies reported symptoms.
Poor indoor environments attracted attention. The Swedish allergy study (SOU 1989:76) designated "sick building" as a cause of the allergy epidemic as was feared. In the 1990s, therefore, extensive research into "sick building" was carried out. Various physical and chemical factors in the buildings were examined on a broad front.
The problem was highlighted increasingly in media and was described as a "ticking time bomb". Many studies were performed in individual buildings.
In the 1990s "sick buildings" were contrasted against "healthy buildings". The chemical contents of building materials were highlighted. Many building material manufacturers were actively working to gain control of the chemical content and to replace criticized additives. The ventilation industry advocated above all more well-functioning ventilation. Others perceived ecological construction, natural materials, and simple techniques as a solution.
At the end of the 1990s came an increased distrust of the concept of "sick building". A dissertation at the Karolinska Institute in Stockholm 1999 questioned the methodology of previous research, and a Danish study from 2005 showed these flaws experimentally. It was suggested that sick building syndrome was not really a coherent syndrome and was not a disease to be individually diagnosed, but a collection of as many as a dozen semi-related diseases. In 2006 the Swedish National Board of Health and Welfare recommended in the medical journal Läkartidningen that "sick building syndrome" should not be used as a clinical diagnosis. Thereafter, it has become increasingly less common to use terms such as sick buildings and sick building syndrome in research. However, the concept remains alive in popular culture and is used to designate the set of symptoms related to poor home or work environment engineering. Sick building is therefore an expression used especially in the context of workplace health.
Sick building syndrome made a rapid journey from media to courtroom where professional engineers and architects became named defendants and were represented by their respective professional practice insurers. Proceedings invariably relied on expert witnesses, medical and technical experts along with building managers, contractors and manufacturers of finishes and furnishings, testifying as to cause and effect. Most of these actions resulted in sealed settlement agreements, none of these being dramatic. The insurers needed a defense based upon Standards of Professional Practice to meet a court decision that declared that in a modern, essentially sealed building, the HVAC systems must produce breathing air for suitable human consumption. ASHRAE (American Society of Heating, Refrigeration and Air Conditioning Engineers, currently with over 50,000 international members) undertook the task of codifying its indoor air quality (IAQ) standard.
ASHRAE empirical research determined that "acceptability" was a function of outdoor (fresh air) ventilation rate and used carbon dioxide as an accurate measurement of occupant presence and activity. Building odors and contaminants would be suitably controlled by this dilution methodology. ASHRAE codified a level of 1,000 ppm of carbon dioxide and specified the use of widely available sense-and-control equipment to assure compliance. The 1989 issue of ASHRAE 62.1-1989 published the whys and wherefores and overrode the 1981 requirements that were aimed at a ventilation level of 5,000 ppm of carbon dioxide (the OSHA workplace limit), federally set to minimize HVAC system energy consumption. This apparently ended the SBS epidemic.
Over time, building materials changed with respect to emissions potential. Smoking vanished and dramatic improvements in ambient air quality, coupled with code compliant ventilation and maintenance, per ASHRAE standards have all contributed to the acceptability of the indoor air environment.
See also
Aerotoxic syndrome
Air purifier
Asthmagen
Cleanroom
Electromagnetic hypersensitivity
Havana syndrome
Healthy building
Indoor air quality
Lead paint
Multiple chemical sensitivity
NASA Clean Air Study
Nosocomial infection
Particulates
Power tools
Renovation
Somatization disorder
Fan death
References
Further reading
Martín-Gil J., Yanguas M. C., San José J. F., Rey-Martínez and Martín-Gil F. J. "Outcomes of research into a sick hospital". Hospital Management International, 1997, pp. 80–82. Sterling Publications Limited.
Åke Thörn, The Emergence and preservation of sick building syndrome, KI 1999.
Charlotte Brauer, The sick building syndrome revisited, Copenhagen 2005.
Michelle Murphy, Sick Building Syndrome and the Problem of Uncertainty, 2006.
Johan Carlson, "Gemensam förklaringsmodell för sjukdomar kopplade till inomhusmiljön finns inte" [Unified explanation for diseases related to indoor environment not found]. Läkartidningen 2006/12.
Bulletin of the Transilvania University of Braşov, Series I: Engineering Sciences • Vol. 5 (54) No. 1 2012 "Impact of Indoor Environment Quality on Sick Building Syndrome in Indian Leed Certified Buildings". by Jagannathan Mohan
External links
Best Practices for Indoor Air Quality when Remodeling Your Home, US EPA
Renovation and Repair, Part of Indoor Air Quality Design Tools for Schools, US EPA
Addressing Indoor Environmental Concerns During Remodeling, US EPA
Dust FAQs, UK HSE
CCOHS: Welding - Fumes And Gases | Health Effect of Welding Fumes
Syndromes of unknown causes
Building biology
Environmental toxicology
Indoor air pollution
Building defects
Syndromes | 0.763147 | 0.995804 | 0.759945 |
Functional symptom | A functional symptom is a medical symptom with no known physical cause. In other words, there is no structural or pathologically defined disease to explain the symptom. The use of the term 'functional symptom' does not assume psychogenesis, only that the body is not functioning as expected. Functional symptoms are increasingly viewed within a framework in which 'biological, psychological, interpersonal and healthcare factors' should all be considered to be relevant for determining the aetiology and treatment plans.
Historically, there has often been fierce debate about whether certain problems are predominantly related to an abnormality of structure (disease) or are psychosomatic in nature (secondary gain), and what are at one stage posited to be functional symptoms are sometimes later reclassified as organic, as investigative techniques improve. It is well established that psychosomatic symptoms are a real phenomenon, so this potential explanation is often plausible, however the commonality of a range of psychological symptoms and functional weakness does not imply that one causes the other. For example, symptoms associated with migraine, epilepsy, schizophrenia, multiple sclerosis, stomach ulcers, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Lyme disease and many other conditions have all tended historically at first to be explained largely as physical manifestations of the patient's psychological state of mind; until such time as new physiological knowledge is eventually gained. Another specific example is functional constipation, which may have psychological or psychiatric causes. However, one type of apparently functional constipation, anismus, may have a neurological (physical) basis.
This is also an issue when the patient is involved in litigation such as injuries from motor vehicle accidents or work injuries involving workers compensation benefits and disputes. Studies have shown that unsettled claims affect level of complaints and many medical studies do not include data from cases where outcomes may have been tainted by inclusion of patients involved in worker's compensation cases.
Whilst misdiagnosis of functional symptoms does occur, in neurology, for example, this appears to occur no more frequently than of other neurological or psychiatric syndromes. However, in order to be quantified, misdiagnosis has to be recognized as such, which can be problematic in such a challenging field as medicine.
A common trend is to see functional symptoms and syndromes such as fibromyalgia, irritable bowel syndrome and functional neurological symptoms such as functional weakness as symptoms in which both biological and psychological factors are relevant, without one necessarily being dominant.
Weakness
Functional weakness is weakness of an arm or leg without evidence of damage or a disease of the nervous system. Patients with functional weakness experience symptoms of limb weakness which can be disabling and frightening such as problems walking or a 'heaviness' down one side, dropping things or a feeling that a limb just doesn't feel normal or 'part of them'. Functional weakness may also be described as functional neurological symptom disorder (FNsD), Functional Neurological Disorder (FND) or functional neurological symptoms. If the symptoms are caused by a psychological trigger, it may be diagnosed as 'dissociative motor disorder' or conversion disorder (CD).
To the patient and the doctor it often looks as if there has been a stroke or have symptoms of multiple sclerosis. However, unlike these conditions, with functional weakness there is no permanent damage to the nervous system which means that it can get better or even go away completely.
The diagnosis should usually be made by a consultant neurologist so that other neurological causes can be excluded. The diagnosis should be made on the basis of positive features in the history and the examination (such as Hoover's sign). It is dangerous to make the diagnosis simply because tests are normal. Neurologists usually diagnose wrongly about 5% of the time (which is the same for many other conditions.)
The most effective treatment is physiotherapy, however it is also helpful for patients to understand the diagnosis, and some may find CBT helps them to cope with the emotions associated with being unwell. For those with conversion disorder, psychological therapy is key to their treatment as it is emotional or psychological factors which are causing their symptoms.
Giveway weakness
Giveway weakness (also "give-away weakness", "collapsing weakness", etc.) refers to a symptom where a patient's arm, leg, can initially provide resistance against an examiner's touch, but then suddenly "gives way" and provides no further muscular resistance. It can also be seen if the examinee is not cooperating with the exam and does not produce a full effort. This may sometimes be associated with secondary gain from being injured.
See also
Functional disorder
Functional neurological symptom disorder
Idiopathy
References
Further reading
External links
Medical terminology | 0.793447 | 0.957769 | 0.75994 |
Wernicke–Korsakoff syndrome | Wernicke-Korsakoff syndrome (WKS) is the combined presence of Wernicke encephalopathy (WE) and alcoholic Korsakoff syndrome (AKS ). Due to the close relationship between these two disorders, people with either are usually diagnosed with WKS as a single syndrome. It mainly causes vision changes, ataxia and impaired memory.
The cause of the disorder is thiamine (vitamin B1) deficiency. This can occur due to Wernicke encephalopathy, eating disorders, malnutrition, and alcohol abuse. These disorders may manifest together or separately. WKS is usually secondary to prolonged alcohol abuse.
Wernicke encephalopathy and WKS are most commonly seen in people with an alcohol use disorder. Failure in diagnosis of WE and thus treatment of the disease leads to death in approximately 20% of cases, while 75% are left with permanent brain damage associated with WKS. Of those affected, 25% require long-term institutionalization in order to receive effective care.
Signs and symptoms
The syndrome is a combined manifestation of two namesake disorders, Wernicke encephalopathy and Korsakoff syndrome. It involves an acute Wernicke-encephalopathy phase, followed by the development of a Korsakoff syndrome phase.
Wernicke encephalopathy
WE is characterized by the presence of a triad of symptoms:
Ocular disturbances (ophthalmoplegia)
Changes in mental state (confusion)
Unsteady stance and gait (ataxia)
This triad of symptoms results from a deficiency in vitamin B1 which is an essential coenzyme. The aforementioned changes in mental state occur in approximately 82% of patients' symptoms of which range from confusion, apathy, inability to concentrate, and a decrease in awareness of the immediate situation they are in. If left untreated, WE can lead to coma or death. In about 29% of patients, ocular disturbances consist of nystagmus and paralysis of the lateral rectus muscles or other muscles in the eye. A smaller percentage of patients experience a decrease in reaction time of the pupils to light stimuli and swelling of the optic disc which may be accompanied by retinal hemorrhage. Finally, the symptoms involving stance and gait occur in about 23% of patients and result from dysfunction in the cerebellum and vestibular system. Other symptoms that have been present in cases of WE are stupor, low blood pressure (hypotension), elevated heart rate (tachycardia), as well as hypothermia, epileptic seizures and a progressive loss of hearing.
About 19% of patients have none of the symptoms in the classic triad at first diagnosis of WE; however, usually one or more of the symptoms develops later as the disease progresses.
Korsakoff syndrome
The DSM-5 classifies Korsakoff syndrome under Substance/Medication-Induced Major or Mild Neurocognitive Disorders, specifically alcohol-induced amnestic confabulatory. The diagnostic criteria defined as necessary for diagnosis includes prominent amnesia, forgetting quickly, and difficulty learning. Presence of thiamine deficient encephalopathy can occur in conjunction with these symptoms.
Despite the assertion that alcoholic Korsakoff syndrome must be caused by the use of alcohol, there have been several cases where it has developed from other instances of thiamine deficiency resulting from gross malnutrition due to conditions such as stomach cancer, anorexia nervosa, and gastrectomy.
Cognitive effects
Several cases have been documented where Wernicke-Korsakoff syndrome has been seen on a large scale. In 1947, 52 cases of WKS were documented in a prisoner of war hospital in Singapore where the prisoners' diets included less than 1 mg of thiamine per day. Such cases provide an opportunity to gain an understanding of what effects this syndrome has on cognition. In this particular case, cognitive symptoms included insomnia, anxiety, difficulties in concentration, loss of memory for the immediate past, and gradual degeneration of mental state; consisting of confusion, confabulation, and hallucinations. In other cases of WKS, cognitive effects such as severely disrupted speech, giddiness, and heavy-headedness have been documented. In addition to this, it has been noted that some patients displayed an inability to focus, and the inability of others to catch patients' attention.
In a study conducted in 2003 by Brand et al. on the cognitive effects of WKS, the researchers used a neuropsychological test battery which included tests of intelligence, speed of information processing, memory, executive function and cognitive estimation. They found that subjects with WKS showed impairments in all aspects of this test battery but most noticeably, on the cognitive estimation tasks. This task required subjects to estimate a physical quality such as size, weight, quantity or time (e.g. What is the average length of a shower?) of a particular item. Patients with WKS performed worse than normal control participants on all of the tasks in this category. The patients found estimations involving time to be the most difficult, whereas quantity was the easiest estimation to make. Additionally, the study included a category for classifying "bizarre" answers, which included any answer that was far outside of the normal range of expected responses. WKS patients did give answers that could fall into such a category, such as 15 seconds or 1 hour for the estimated length of a shower, or 4 kg or 15 tonnes as the weight of a car.
Memory deficits
The amnesic symptoms of WKS include both retrograde and anterograde amnesia. The retrograde deficit has been demonstrated through an inability of WKS patients to recall or recognize information for recent public events. The anterograde memory loss is demonstrated through deficits in tasks that involve encoding and then recalling lists of words and faces, as well as semantic learning tasks. WKS patients have also demonstrated difficulties in perseveration as evidenced by a deficit in performance on the Wisconsin Card Sorting Test. The retrograde amnesia that accompanies WKS can extend as far back as twenty to thirty years, and there is generally a temporal gradient seen, where earlier memories are recalled better than more recent memories. It has been widely accepted that the critical structures that lead to the memory impairment in WKS are the mammillary bodies, and the thalamic regions. Despite the aforementioned memory deficits, non-declarative memory functions appear to be intact in WKS patients. This has been demonstrated through measures that assess perceptual priming.
Other studies have shown deficits in recognition memory and stimulus-reward associative functions in patients with WKS. The deficit in stimulus-reward functions was demonstrated by Oscar-Berman and Pulaski who presented patients with reinforcements for certain stimuli but not others, and then required the patients to distinguish the rewarded stimuli from the non-rewarded stimuli. WKS patients displayed significant deficits in this task. The researchers were also successful in displaying a deficit in recognition memory by having patients make a yes/no decision as to whether a stimulus was familiar (previously seen) or novel (not previously seen). The patients in this study also showed a significant deficit in their ability to perform this task.
Confabulation
People with WKS often show confabulation, spontaneous confabulation being seen more frequently than provoked confabulation. Spontaneous confabulations refer to incorrect memories that the patient holds to be true, and may act on, arising spontaneously without any provocation. Provoked confabulations can occur when a patient is cued to give a response, this may occur in test settings. The spontaneous confabulations viewed in WKS are thought to be produced by an impairment in source memory, where they are unable to remember the spatial and contextual information for an event, and thus may use irrelevant or old memory traces to fill in for the information that they cannot access. It has also been suggested that this behaviour may be due to executive dysfunction where they are unable to inhibit incorrect memories or because they are unable to shift their attention away from an incorrect response.
Causes
It is generally agreed that Wernicke-Korsakoff syndrome results from severe acute deficiency of thiamine (vitamin B1) whilst Korsakoff's psychosis is a chronic neurologic sequela of Wernicke encephalopathy and is usually found in people who have used alcohol chronically. The metabolically active form of thiamine is thiamine pyrophosphate, which plays a major role as a cofactor or coenzyme in glucose metabolism. The enzymes that are dependent on thiamine pyrophosphate are associated with the citric acid cycle (also known as the Krebs cycle), and catalyze the oxidation of pyruvate, α-ketoglutarate and branched chain amino acids. Thus, anything that encourages glucose metabolism will exacerbate an existing clinical or sub-clinical thiamine deficiency.
As stated above, Wernicke-Korsakoff syndrome in the United States is usually found in malnourished chronic alcoholics, though it is also found in patients who undergo prolonged intravenous (IV) therapy without vitamin B1 supplementation, gastric stapling, intensive care unit (ICU) stays, hunger strikes, or people with eating disorders. In some regions, physicians have observed thiamine deficiency brought about by severe malnutrition, particularly in diets consisting mainly of polished rice, which is thiamine-deficient. The resulting nervous system ailment is called beriberi. In individuals with sub-clinical thiamine deficiency, a large dose of glucose (either as sweet food or glucose infusion) can precipitate the onset of overt encephalopathy.
Wernicke-Korsakoff syndrome in people with chronic alcohol use particularly is associated with atrophy/infarction of specific regions of the brain, especially the mammillary bodies. Other regions include the anterior region of the thalamus (accounting for amnesic symptoms), the medial dorsal thalamus, the basal forebrain, the median and dorsal raphe nuclei, and the cerebellum.
One as-yet-unreplicated study has associated susceptibility to this syndrome with a hereditary deficiency of transketolase, an enzyme that requires thiamine as a coenzyme.
Post-gastrectomy
The fact that gastrointestinal surgery can lead to the development of WKS was demonstrated in a study that was completed on three patients who recently undergone a gastrectomy. These patients had developed WKS but were not alcoholics and had never suffered from dietary deprivation. WKS developed between 2 and 20 years after the surgery. There were small dietary changes that contributed to the development of WKS but overall the lack of absorption of thiamine from the gastrointestinal tract was the cause. Therefore, it must be ensured that patients who have undergone gastrectomy have a proper education on dietary habits, and carefully monitor their thiamine intake. Additionally, an early diagnosis of WKS, should it develop, is very important.
Alcohol-thiamine interactions
Strong evidence suggests that ethanol interferes directly with thiamine uptake in the gastrointestinal tract. Ethanol also disrupts thiamine storage in the liver and the transformation of thiamine into its active form. The role of alcohol consumption in the development of WKS has been experimentally confirmed through studies in which rats were subjected to alcohol exposure and lower levels of thiamine through a low-thiamine diet. In particular, studies have demonstrated that clinical signs of the neurological problems that result from thiamine deficiency develop faster in rats that have received alcohol and were also deficient in thiamine than rats who did not receive alcohol. In another study, it was found that rats that were chronically fed alcohol had significantly lower liver thiamine stores than control rats. This provides an explanation for why alcoholics with liver cirrhosis have a higher incidence of both thiamine deficiency and WKS.
Pathophysiology
The vitamin thiamine, also referred to as vitamin B1, is required by three different enzymes to allow for conversion of ingested nutrients into energy. Thiamine can not be produced in the body and must be obtained through diet and supplementation. The duodenum is responsible for absorbing thiamine. The liver can store thiamine for 18 days. Prolonged and frequent consumption of alcohol causes a decreased ability to absorb thiamine in the duodenum. Thiamine deficiency is also related to malnutrition from poor diet, impaired use of thiamine by the cells and impaired storage in the liver. Without thiamine the Krebs cycle enzymes pyruvate dehydrogenase complex (PDH) and alpha-ketoglutarate dehydrogenase (alpha-KGDH) are impaired. The impaired functioning of the Krebs cycle results in inadequate production of adenosine triphosphate (ATP) or energy for the cells functioning. Energy is required by the brain for proper functioning and use of its neurotransmitters. Injury to the brain occurs when neurons that require high amounts of energy from thiamine dependent enzymes are not supplied with enough energy and die.
Brain atrophy associated with WKS occurs in the following regions of the brain:
the mammillary bodies,
the thalamus,
the periaqueductal grey,
the walls of the 3rd ventricle,
the floor of the 4th ventricle,
the cerebellum, and
the frontal lobe.
In addition to the damage seen in these areas there have been reports of damage to cortex, although it was noted that this may be due to the direct toxic effects of alcohol as opposed to thiamine deficiency that has been attributed as the underlying cause of Wernicke-Korsakoff Syndrome.
The amnesia that is associated with this syndrome is a result of the atrophy in the structures of the diencephalon (the thalamus, hypothalamus and mammillary bodies), and is similar to amnesia that is presented as a result of other cases of damage to the medial temporal lobe. It has been argued that the memory impairments can occur as a result of damage along any part of the mammillo-thalamic tract, which explains how WKS can develop in patients with damage exclusively to either the thalamus or the mammillary bodies.
Diagnosis
Diagnosis of Wernicke-Korsakoff syndrome is by clinical impression and can sometimes be confirmed by a formal neuropsychological assessment. Wernicke encephalopathy typically presents with ataxia and nystagmus, and Korsakoff's psychosis with anterograde and retrograde amnesia and confabulation upon relevant lines of questioning.
Frequently, secondary to thiamine deficiency and subsequent cytotoxic edema in Wernicke encephalopathy, patients will have marked degeneration of the mammillary bodies. Thiamine (vitamin B1) is an essential coenzyme in carbohydrate metabolism and is also a regulator of osmotic gradient. Its deficiency may cause swelling of the intracellular space and local disruption of the blood-brain barrier. Brain tissue is very sensitive to changes in electrolytes and pressure and edema can be cytotoxic. In Wernicke this occurs specifically in the mammillary bodies, medial thalami, tectal plate, and periaqueductal areas. People with the condition may also exhibit a dislike for sunlight and so may wish to stay indoors with the lights off. The mechanism of this degeneration is unknown, but it supports the current neurological theory that the mammillary bodies play a role in various "memory circuits" within the brain. An example of a memory circuit is the Papez circuit.
Prevention
As described, Korsakoff syndrome usually follows or accompanies Wernicke encephalopathy. If treated quickly, it may be possible to prevent the development of WKS with thiamine treatments. This treatment is not guaranteed to be effective and the thiamine needs to be administered adequately in both dose and duration. A study on Wernicke-Korsakoff syndrome showed that with consistent thiamine treatment there were noticeable improvements in mental status after only 2–3 weeks of therapy. Thus, there is hope that with treatment Wernicke encephalopathy will not necessarily progress to WKS.
In order to reduce the risk of developing WKS it is important to limit the intake of alcohol in order to ensure that proper nutrition needs are met. A healthy diet is imperative for proper nutrition which, in combination with thiamine supplements, may reduce the chance of developing WKS. This prevention method may specifically help heavy drinkers who refuse to or are unable to quit.
A number of proposals have been put forth to fortify alcoholic beverages with thiamine to reduce the incidence of WKS among those heavily abusing alcohol. To date, no such proposals have been enacted.
Daily recommendations of thiamine requirements are 0.66 mg per of food energy intake—approximately equivalent to 1.2 mg for men and 1.1 mg for women.
Treatment
The onset of Wernicke encephalopathy is considered a medical emergency. Prompt administration of thiamine can prevent the disorder from developing into Wernicke-Korsakoff syndrome, or reduce its severity. Treatment can also reduce the progression of the deficits caused by WKS, but will not completely reverse existing deficits. WKS will continue to be present, at least partially, in 80% of patients. Banana bags, a bag of intravenous fluids containing vitamins and minerals, may be used as a treatment.
Epidemiology
WKS occurs more frequently in men than women and has the highest prevalence in the ages 55–65. Approximately 71% are unmarried.
Internationally, the prevalence rates of WKS are relatively standard, being anywhere between zero and two percent. Despite this, specific sub-populations seem to have higher prevalence rates including people who are homeless, older individuals (especially those living alone or in isolation), and psychiatric inpatients. Additionally, studies show that prevalence is not connected to alcohol consumption per capita. For example, in France, a country that is well known for its consumption and production of wine, prevalence was only 0.4% in 1994, while Australia had a prevalence of 2.8%.
History
Wernicke encephalopathy
Carl Wernicke discovered Wernicke encephalopathy in 1881. His first diagnosis noted symptoms including paralyzed eye movements, ataxia, and mental confusion. Also noticed were hemorrhages in the gray matter around the third and fourth ventricles and the cerebral aqueduct. Brain atrophy was only found upon post-mortem autopsy. Wernicke believed these hemorrhages were due to inflammation and thus the disease was named polioencephalitis haemorrhagica superior. Later, it was found that Wernicke encephalopathy and alcoholic Korsakoff syndrome are products of the same cause.
Korsakoff syndrome
Sergei Korsakoff was a Russian physician after whom the disease "Korsakoff's syndrome" was named. In the late 1800s Korsakoff was studying long-term alcoholic patients and began to notice a decline in their memory function. At the 13th International Medical Congress in Moscow in 1897, Korsakoff presented a report called: "On a special form of mental illness combined with degenerative polyneuritis". After the presentation of this report the term "Korsakoff's syndrome" was coined.
Although WE and AKS were discovered separately, these two syndromes are usually referred to under one name, Wernicke-Korsakoff syndrome, due to the fact that they are part of the same cause and because the onset of AKS usually follows WE if left untreated.
Society and culture
The British neurologist Oliver Sacks describes case histories of some of his patients with the syndrome in the book The Man Who Mistook His Wife for a Hat (1985).
Frontman and lead vocalist of the hard rock band Breaking Benjamin, Benjamin Burnley, is well known to be living with Wernicke-Korsakoff syndrome due to his past alcoholism. He has written multiple songs about addiction and his experiences with alcohol, with many of such songs being found on the band's 2009 album Dear Agony as it was the first album Burnley had written and recorded completely sober.
See also
Alcoholic dementia
Dementia
Malabsorption
References
External links
Central nervous system disorders
Memory disorders
Addiction psychiatry
Syndromes affecting the nervous system
Health effects of alcohol
Abducens nerve
Thiamine
Rare syndromes
Substance-related disorders | 0.760579 | 0.999144 | 0.759928 |
Acquired brain injury | Acquired brain injury (ABI) is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal hypoxia. ABI can result in cognitive, physical, emotional, or behavioural impairments that lead to permanent or temporary changes in functioning. These impairments result from either traumatic brain injury (e.g. physical trauma due to accidents, assaults, neurosurgery, head injury etc.) or nontraumatic injury derived from either an internal or external source (e.g. stroke, brain tumours, infection, poisoning, hypoxia, ischemia, encephalopathy or substance abuse). ABI does not include damage to the brain resulting from neurodegenerative disorders.
While research has demonstrated that thinking and behavior may be altered in virtually all forms of ABI, brain injury is itself a very complex phenomenon having dramatically varied effects. No two persons can expect the same outcome or resulting difficulties. The brain controls every part of human life: physical, intellectual, behavioral, social and emotional. When the brain is damaged, some part of a person's life will be adversely affected.
Consequences of ABI often require a major life adjustment around the person's new circumstances, and making that adjustment is a critical factor in recovery and rehabilitation. While the outcome of a given injury depends largely upon the nature and severity of the injury itself, appropriate treatment plays a vital role in determining the level of recovery.
Signs and symptoms
Symptoms:
Anhedonia
Apraxia
Aphasia
Amnesia
Behavioral manifestations:
Adynamia
Disinhibition
Emotional flooding
Perseveration
Emotional
ABI has been associated with a number of emotional difficulties such as depression, issues with self-control, managing anger impulses and challenges with problem-solving, these challenges also contribute to psychosocial concerns involving social anxiety, loneliness and lower levels of self esteem. These psychosocial problems have been found to contribute to other dilemmas such as reduced frequency of social contact and leisure activities, unemployment, family problems and marital difficulties.
How the patient copes with the injury has been found to influence the level at which they experience the emotional complications correlated with ABI. Three coping strategies for emotions related to ABI have presented themselves in the research, approach-oriented coping, passive coping and avoidant coping. Approach-oriented coping has been found to be the most effective strategy, as it has been negatively correlated with rates of apathy and depression in ABI patients; this coping style is present in individuals who consciously work to minimize the emotional challenges of ABI. Passive coping has been characterized by the person choosing not to express emotions and a lack of motivation which can lead to poor outcomes for the individual. Increased levels of depression have been correlated to avoidance coping methods in patients with ABI; this strategy is represented in people who actively evade coping with emotions. These challenges and coping strategies should be kept in consideration when seeking to understand individuals with ABI.
Memory
Following acquired brain injury it is common for people to experience memory loss; memory disorders are one of the most prevalent cognitive deficits experienced in affected people. However, because some aspects of memory are directly linked to attention, it can be challenging to assess what components of a deficit are caused by memory and which are fundamentally attention problems. There is often partial recovery of memory functioning following the initial recovery phase; however, permanent handicaps are often reported with ABI patients reporting significantly more memory difficulties when compared people without an acquired brain injury.
In order to cope more efficiently with memory disorders many people with ABI use memory aids; these included external items such as diaries, notebooks and electronic organizers, internal strategies such as visual associations, and environmental adaptations such as labelling kitchen cupboards. Research has found that ABI patients use an increased number of memory aids after their injury than they did prior to it and these aids vary in their degree of effectiveness. One popular aid is the use of a diary. Studies have found that the use of a diary is more effective if it is paired with self-instructional training, as training leads to more frequent use of the diary over time and thus more successful use as a memory aid.
Causes
Management
Rehabilitation following an acquired brain injury does not follow a set protocol, due to the variety of mechanisms of injury and structures affected. Rather, rehabilitation is an individualized process that will often involve a multi-disciplinary approach. The rehabilitation team may include but is not limited to nurses, neurologists, physiotherapists, psychiatrists (particularly those specialized in Brain Injury Medicine), occupational therapists, speech-language pathologists, music therapists, and rehabilitation psychologists. Physical therapy and other professions may be utilized post- brain injury in order to control muscle tone, regain normal movement patterns, and maximize functional independence. Rehabilitation should be patient-centered and guided by the individual's needs and goals.
There is some evidence that rhythmic auditory stimulation is beneficial in gait rehabilitation following a brain injury. Music therapy may assist patients to improve gait, arm swing while walking, communication, and quality of life after experiencing a stroke. Newer treatment methods such as virtual reality and robotics remain under-researched; however, there is reason to believe that virtual reality in upper limb rehabilitation may be useful, following an acquired brain injury.
Due to few random control trials and generally weak evidence, more research is needed to gain a complete understanding of the ideal type and parameters of therapeutic interventions for treatment of acquired brain injuries.
For more information on therapeutic interventions for acquired brain injury, see stroke and traumatic brain injury.
Memory
Some strategies for rehabilitating the memory of those affected by ABI have used repetitive tasks to attempt to increase the patients' ability to recall information. While this type of training increases performance on the task at hand, there is little evidence that the skills translate to improved performance on memory challenges outside of the laboratory. Awareness of memory strategies, motivation and dedication to increasing memory have been related to successful increases in memory capability among patients an example of this could be the use of attention process training and brain injury education in patients with memory disorders related to brain injury. These have been shown to increase memory functioning in patients based on self-report measures.
Another strategy for improvement amongst individuals with poor memory functioning is the use of elaboration to improve encoding of items, one form of this strategy is called self-imagining whereby the patient imagines the event to be recalled from a more personal perspective. Self-imagining has been found to improve recognition memory by coding the event in a manner that is more individually salient to the subject. This effect has been found to improve recall in individuals with and without memory disorders.
There is research evidence to suggest that rehabilitation programs that are geared toward the individual may have greater results than group-based interventions for improving memory in ABI patients because they are tailored to the symptoms experienced by the individual.
More research is necessary in order to draw conclusions on how to improve memory among individuals with ABI that experience memory loss.
Special population
Children
In children and youth with pediatric acquired brain injury the cognitive and emotional difficulties that stem from their injury can negatively impact their level of participation in home, school and other social situations, participation in structured events has been found to be especially hindered under these circumstances. Involvement in social situations is important for the normal development of children as a means of gaining an understanding of how to effectively work together with others. Furthermore, young people with ABI are often reported as having insufficient problem solving skills. This has the potential to hinder their performance in various academic and social settings further. It is important for rehabilitation programs to deal with these challenges specific to children who have not fully developed at the time of their injury.
Notable cases
There have been many popularized cases of various forms of ABI such as:
Phineas Gage's case of traumatic brain injury that greatly stimulated discussion on brain function and physiology
Henry Molaison, formerly known as patient H.M., underwent neurosurgery to remove scar tissue in his brain that was causing debilitating epileptic seizures, neurosurgeon William Beecher Scoville performed the surgery which created bilateral lesions near the hippocampus. These lesions helped remove symptoms of the epilepsy in Molaison but resulted in anterograde amnesia. Molaison has been studied by hundreds of researchers since this time, most notably Brenda Milner, and has been greatly influential in the study of memory and the brain.
Zasetsky injured in the Battle of Smolensk, bullet entered his left parieto-occipital area and resulted in a long coma. Following this, he developed a form of agnosia and became unable to perceive the right side of things.
See also
Brain damage
Chronic traumatic encephalopathy
Concussion
Head injury
Neurodegeneration
Rehabilitation psychology
Traumatic brain injury
References
External links
World Federation of Neurorehabilitation
United Kingdom Acquired Brain Injury Forum
The Brain Injury Hub – information and practical advice to parents and family members of children with acquired brain injury
Brain disorders | 0.772891 | 0.983141 | 0.75986 |
Applied behavior analysis | Applied behavior analysis (ABA), also called behavioral engineering, is a scientific discipline that applies the principles of learning based upon respondent and operant conditioning to change behavior of social significance. ABA is the applied form of behavior analysis; the other two are radical behaviorism (or the philosophy of the science) and the experimental analysis of behavior (or basic experimental research).
The term applied behavior analysis has replaced behavior modification because the latter approach suggested changing behavior without clarifying the relevant behavior-environment interactions. In contrast, ABA changes behavior by first assessing the functional relationship between a targeted behavior and the environment, a process known as a functional behavior assessment. Further, the approach seeks to develop socially acceptable alternatives for maladaptive behaviors, often through administering differential reinforcement contingencies.
Although service delivery providers commonly implement empirically validated interventions for individuals with autism, ABA has been utilized in a range of other areas, including applied animal behavior, organizational behavior management, substance abuse, behavior management in classrooms, acceptance and commitment therapy, and athletic exercise, among others.
ABA has been rejected or strongly criticized by the most members in the autism rights movement due to the perception that it reinforces autistic people in behaving like a non-autistic person and suppresses autistic traits instead of acceptance of autistic behaviors such as hand flapping or other visible forms of stimming. Also, some forms of ABA and its predecessors in the past used aversives, such as electric shocks.
Definition
ABA is an applied science devoted to developing procedures which will produce observable changes in behavior. It is to be distinguished from the experimental analysis of behavior, which focuses on basic experimental research, but it uses principles developed by such research, in particular operant conditioning and classical conditioning. Behavior analysis adopts the viewpoint of radical behaviorism, treating thoughts, emotions, and other covert activity as behavior that is subject to the same responses as overt behavior. This represents a shift away from methodological behaviorism, which restricts behavior-change procedures to behaviors that are overt, and was the conceptual underpinning of behavior modification.
Behavior analysts also emphasize that the science of behavior must be a natural science as opposed to a social science. As such, behavior analysts focus on the observable relationship of behavior with the environment, including antecedents and consequences, without resort to "hypothetical constructs".
History
The beginnings of ABA can be traced back to Teodoro Ayllon and Jack Michael's study "The psychiatric nurse as a behavioral engineer" (1959) that they published in the Journal of the Experimental Analysis of Behavior (JEAB). Ayllon and Michael were training the staff at a psychiatric hospital how to use a token economy based on the principles of operant conditioning for patients with schizophrenia and intellectual disability, which led to researchers at the University of Kansas to start the Journal of Applied Behavior Analysis (JABA) in 1968.
A group of researchers at the University of Washington, including Donald Baer, Sidney W. Bijou, Bill Hopkins, Jay Birnbrauer, Todd Risley, and Montrose Wolf, applied the principles of behavior analysis to treat autism, manage the behavior of children and adolescents in juvenile detention centers, and organize employees who required proper structure and management in businesses. In 1968, Baer, Bijou, Risley, Birnbrauer, Wolf, and James Sherman joined the Department of Human Development and Family Life at the University of Kansas, where they founded the Journal of Applied Behavior Analysis.
Notable graduate students from the University of Washington include Robert Wahler, James Sherman, and Ivar Lovaas. Lovaas established the UCLA Young Autism Project while teaching at the University of California, Los Angeles. In 1965, Lovaas published a series of articles that described a pioneering investigation of the antecedents and consequences that maintained a problem behavior, including the use of electric shock on autistic children to suppress stimming and meltdowns (described as "self-stimulatory behavior" and "tantrum behaviors" respectively) and to coerce "affectionate" behavior, and relied on the methods of errorless learning which was initially used by Charles Ferster to teach nonverbal children to speak. Lovaas also described how to use social (secondary) reinforcers, teach children to imitate, and what interventions (including electric shocks) may be used to reduce aggression and life-threatening self-injury.
In 1987, Lovaas published the study, "Behavioral treatment and normal educational and intellectual functioning in young autistic children". The experimental group in this study received an average of 40 hours per week in a 1:1 teaching setting at a table using errorless discrete trial training (DTT). The treatment is done at home with parents involved, and the curriculum is highly individualized with a heavy emphasis on teaching eye contact, fine and gross motor imitation, academics, and language. The use of aversives and reinforcement were used to motivate learning and reduce non-desired behaviors. Early development of the therapy in the 1960s involved use of electric shocks, scolding, and the withholding of food. By the time the children were enrolled in this study, such aversives were abandoned, and a loud "no", electric shock, or slap to the thigh were used only as a last resort to reduce aggressive and self-stimulatory behaviors. The outcome of this study indicated 47% of the experimental group (9/19) went on to lose their autism diagnosis and were described as indistinguishable from their typically developing adolescent peers. This included passing general education without assistance and forming and maintaining friendships. These gains were maintained as reported in the 1993 study, "Long-term outcome for children with autism who received early intensive behavioral treatment". Lovaas' work went on to be recognized by the US Surgeon General in 1999, and his research were replicated in university and private settings. The "Lovaas Method" went on to become known as early intensive behavioral intervention (EIBI).
Over the years, "behavior analysis" gradually superseded "behavior modification"; that is, from simply trying to alter problematic behavior, behavior analysts sought to understand the function of that behavior, what reinforcement histories (i.e., attention seeking, escape, sensory stimulation, etc.) promote and maintain it, and how it can be replaced by successful behavior. ABA's priority on compliance and behavioral modification over that of an individual's needs can lead to harmful consequences, including prompt dependency, loss of intrinsic motivation, and even psychological trauma. Curtailing of self-soothing behaviors is potentially classifiable as a form of abuse.
While ABA seems to be intrinsically linked to autism intervention, it is also used in a broad range of other areas. Recent notable areas of research in the Journal of Applied Behavior Analysis include autism, classroom instruction with typically developing students, pediatric feeding therapy, and substance use disorders. Other applications of ABA include applied animal behavior, consumer behavior analysis, forensic behavior analysis, behavioral medicine, behavioral neuroscience, clinical behavior analysis, organizational behavior management, schoolwide positive behavior interventions and support, and contact desensitization for phobias.
Characteristics
Baer, Wolf, and Risley's 1968 article is still used as the standard description of ABA. It lists the following seven characteristics of ABA. Another resource for the characteristics of applied behavior analysis is the textbook Behavior Modification: Principles and Procedures.
Applied: ABA focuses on the social significance of the behavior studied. For example, a non-applied researcher may study eating behavior because this research helps to clarify metabolic processes, whereas the applied researcher may study eating behavior in individuals who eat too little or too much, trying to change such behavior so that it is more acceptable to the persons involved. It is also based on trying to improve the everyday life of clients that are receiving it.
Behavioral: ABA is pragmatic; it asks how it is possible to get an individual to do something effectively. To answer this question, the behavior itself must be objectively measurable and observable. This is designed so that when someone is trying to determine a target behavior, it is able to be observed and understood by anyone. Verbal descriptions are treated as behavior in themselves, and not as substitutes for the behavior described.
Analytic: Behavior analysis is successful when the analyst understands and can manipulate the events that control a target behavior. This may be relatively easy to do in the lab, where a researcher is able to arrange the relevant events, but it is not always easy, or ethical, in an applied situation. In order to consider something to fall under the spectrum of analytic, it must demonstrate a functional relationship and it must be provable. Baer et al. outline two methods that may be used in applied settings to demonstrate control while maintaining ethical standards. These are the reversal design and the multiple baseline design. In the reversal design, the experimenter first measures the behavior of choice, introduces an intervention, and then measures the behavior again. Then, the intervention is removed, or reduced, and the behavior is measured yet again. The intervention is effective to the extent that the behavior changes and then changes back in response to these manipulations. The multiple baseline method may be used for behaviors that seem irreversible. Here, several behaviors are measured and then the intervention is applied to each in turn. The effectiveness of the intervention is revealed by changes in just the behavior to which the intervention is being applied.
Technological: The description of analytic research must be clear and detailed, so that any competent researcher can repeat it accurately. The goal is to make sure that anyone can implement and understand what is being explained. Cooper et al. describe a good way to check this: Have a person trained in applied behavior analysis read the description and then act out the procedure in detail. If the person makes any mistakes or has to ask any questions then the description needs improvement.
Conceptually Systematic: Behavior analysis should not simply produce a list of effective interventions. Rather, to the extent possible, these methods should be grounded in the principles of applied behavioral analysis. This is aided by the use of theoretically meaningful terms, such as "secondary reinforcement" or "errorless discrimination" where appropriate.
Effective: Though analytic methods should be theoretically grounded, they must be effective. Interventions also must be relevant to the client and/or culture. An analyst must ask themselves if the intervention is working. The intervention must also contain a positive change. If an intervention does not produce a large enough effect for practical use, then the analysis has failed
Generality: Behavior analysts should aim for interventions that are generally applicable; the methods should work in different environments, apply to more than one specific behavior, and have long-lasting effects. This generalizability should be implemented from the very beginning of the intervention. When first starting a new intervention, it is a good idea for that to take place in a natural environment for the client.
Other proposed characteristics
In 2005, Heward et al. suggested the addition of the following five characteristics:
Accountable: To be accountable means that ABA must be able to demonstrate that its methods are effective. This requires repeatedly measuring the effect of interventions (success, failure or no effect at all), and, if necessary, making changes that improve their effectiveness.
Public: The methods, results, and theoretical analyses of ABA must be published and open to scrutiny. There are no hidden treatments or mystical, metaphysical explanations.
Doable: To be generally useful, interventions should be available to a variety of individuals, who might be teachers, parents, therapists, or even those who wish to modify their own behavior. With proper planning and training, many interventions can be applied by almost anyone willing to invest the effort.
Empowering: ABA provides tools that give the practitioner feedback on the results of interventions. These allow clinicians to assess their skill level and build confidence in their effectiveness.
Optimistic: According to several leading authors, behavior analysts have cause to be optimistic that their efforts are socially worthwhile, for the following reasons:
The behaviors impacted by behavior analysis are largely determined by learning and controlled by manipulable aspects of the environment.
Practitioners can improve performance by direct and continuous measurements.
As a practitioner uses behavioral techniques with positive outcomes, they become more confident of future success.
The literature provides many examples of success in teaching individuals considered previously unteachable.
Use as therapy for autism
Although BCBA certification does not require any autism training, a large majority of ABA practitioners specialize in autism, and ABA itself is often mistakenly considered synonymous with therapy for autism. Practitioners often use ABA-based techniques to teach adaptive behaviors to, or diminish challenging behaviors presented by, individuals with autism.
Despite many years of research indicating that early intensive behavioral intervention—the traditional form of ABA that relies on discrete trial training—improves the intellectual performance of those with ASD, most of these studies lack random assignment and there is need for larger sample sizes. A 2018 Cochrane review of five controlled trials found weak evidence indicating that ABA may be effective for some autistic children, noting a high risk of bias in the studies included in the review. The effectiveness of ABA therapies for autism may be overall limited by diagnostic severity, age of intervention, and IQ. Despite this, however, ABA has nevertheless been recommended for people with intellectual disabilities.
In 2018, a Cochrane meta-analysis database concluded that some recent research is beginning to suggest that because of the heterology of ASD, there are two different ABA teaching approaches to acquiring spoken language: children with higher receptive language skills respond to 2.5 – 20 hours per week of the naturalistic approach, whereas children with lower receptive language skills need 25 hours per week of discrete trial training—the structured and intensive form of ABA. A 2023 multi-site randomized control trial study of 164 participants showed similar findings.
Quality of evidence
Conflicts of interest, methodological concerns, and a high risk of bias pervade most ABA studies. A 2019 meta-analysis noted that "methodological rigor remains a pressing concern" in research into ABA's use as therapy for autism; while the authors found some evidence in favour of behavioral interventions, the effects disappeared when they limited the scope of their review to randomized controlled trial designs and outcomes for which there was no risk of detection bias.
One study revealed extensive undisclosed conflicts of interest (COI) in published ABA studies. 84% of studies published in top behavioral journals over a period of one year had at least one author with a COI involving their employment, either as an ABA clinical provider or a training consultant to ABA clinical providers. However, only 2% of these studies disclosed the COI.
Low-quality evidence is likewise a concern in some research reporting on the potential harms of ABA on autistic children.
Another concern is that ABA research only measures behavior as a means of success, which has led to a lack of qualitative research about autistic experiences of ABA, a lack of research examining the internal effects of ABA and a lack of research for autistic children who are non-speaking or have comorbid intellectual disabilities (which is concerning considering this is one of the major populations that intensive ABA focuses on). Research is also lacking about whether ABA is effective long-term and very little longitudinal outcomes have been studied.
Ethical concerns
Researchers and advocates have denounced the ABA ethical code as too lenient, citing its failure to restrict or clarify the use of aversives, the absence of an autism or child development education requirement for ABA therapists, and its emphasis on parental consent rather than the consent of the person receiving services. This emphasis on parental consent stems from ABA viewing the parent as the client, a stance which has been criticized for centering benefits to the parent, not the child, in behavioral interventions. Numerous researchers have argued that ABA is abusive and can increase symptoms of post-traumatic stress disorder (PTSD) in people undergoing the intervention. Some bioethicists argue that employing ABA violates the principles of justice and nonmaleficence and infringes on the autonomy of both autistic children and their parents.
Two 2020 reviews found that very few studies directly reported on or investigated possible harms; although a significant number of studies mentioned adverse events in their analysis of why people withdrew from them, there was no effort to monitor or collect data on adverse outcomes.
Justin B. Leaf and others examined and responded to several of these criticisms of ABA in three papers published in 2018, 2019, and 2022, respectively, in which they questioned the evidence for such criticisms, concluding that the claim that all ABA is abusive has no basis in the published literature. Others have published similar responses.
Use of aversives
Lovaas incorporated aversives into some of the ABA practices he developed, including employing electric shocks, slapping, and shouting to modify undesirable behavior. Although the use of aversives in ABA became less common over time, and in 2012 their use was described as inconsistent with contemporary practice, aversives persisted in some ABA programs. In comments made in 2014 to the US Food and Drug Administration (FDA), a clinician previously employed by the Judge Rotenberg Educational Center claimed that "all textbooks used for thorough training of applied behavior analysts include an overview of the principles of punishment, including the use of electrical brain stimulation."
Views of the autistic community
Proponents of neurodiversity dispute the value of eliminating autistic behaviors, maintaining that it forces autistic people to mask their true personalities and conform to a narrow conception of normality. Masking is associated with suicidality and poor long-term mental health. Some autistic advocates contend that it is cruel to try to make autistic people behave as if they were non-autistic without consideration for their well-being, criticizing ABA's framing of autism as a tragedy in need of treatment. Instead, these critics advocate for increased social acceptance of harmless autistic traits and therapies focused on improving quality of life. The Autistic Self Advocacy Network, for example, campaigns against the use of ABA in autism. The European Council of Autistic People (EUCAP) published a 2024 position statement expressing deep concern about the harm caused by ABA being overlooked. They emphasize that most surveyed autistic individuals view ABA as harmful, abusive, and counterproductive to their well-being. EUCAP advocates for a variety of support methods and the inclusion of autistic individuals in decision-making processes regarding their care.
A 2020 study examined perspectives of autistic adults that received ABA as children and found that the overwhelming majority reported that "behaviorist methods create painful lived experiences", that ABA led to the "erosion of the true actualizing self", and that they felt they had a "lack of self-agency within interpersonal experiences".
Concepts
Behavior
Behavior refers to the movement of some part of an organism that changes some aspect of the environment. Often, the term behavior refers to a class of responses that share physical dimensions or functions, and in that case a response is a single instance of that behavior. If a group of responses have the same function, this group may be called a response class. Repertoire refers to the various responses available to an individual; the term may refer to responses that are relevant to a particular situation, or it may refer to everything a person can do.
Operant conditioning
Operant behavior is the so-called "voluntary" behavior that is sensitive to, or controlled by its consequences. Specifically, operant conditioning refers to the three-term contingency that uses stimulus control, in particular an antecedent contingency called the discriminative stimulus (SD) that influences the strengthening or weakening of behavior through such consequences as reinforcement or punishment. The term is used quite generally, from reaching for a candy bar, to turning up the heat to escape an aversive chill, to studying for an exam to get good grades.
Respondent (classical) conditioning
Respondent (classical) conditioning is based on innate stimulus-response relationships called reflexes. In his experiments with dogs, Pavlov usually used the salivary reflex, namely salivation (unconditioned response) following the taste of food (unconditioned stimulus). Pairing a neutral stimulus, for example a bell (conditioned stimulus) with food caused the dog to elicit salivation (conditioned response). Thus, in classical conditioning, the conditioned stimulus becomes a signal for a biologically significant consequence. Note that in respondent conditioning, unlike operant conditioning, the response does not produce a reinforcer or punisher (e.g., the dog does not get food because it salivates).
Reinforcement
Reinforcement is the key element in operant conditioning and in most behavior change programs. It is the process by which behavior is strengthened. If a behavior is followed closely in time by a stimulus and this results in an increase in the future frequency of that behavior, then the stimulus is a positive reinforcer. If the removal of an event serves as a reinforcer, this is termed negative reinforcement. There are multiple schedules of reinforcement that affect the future probability of behavior. "[H]e would get Beth to comply by hugging him and giving her food as a reward."
Punishment
Punishment is a process by which a consequence immediately follows a behavior which decreases the future frequency of that behavior. As with reinforcement, a stimulus can be added (positive punishment) or removed (negative punishment). Broadly, there are three types of punishment: presentation of aversive stimuli (e.g., pain), response cost (removal of desirable stimuli as in monetary fines), and restriction of freedom (as in a 'time out'). Punishment in practice can often result in unwanted side effects. Some other potential unwanted effects include resentment over being punished, attempts to escape the punishment, expression of pain and negative emotions associated with it, and recognition by the punished individual between the punishment and the person delivering it. ABA therapist state that they use punishment is used infrequently as a last resort or when there is a direct threat caused by the behavior.
Extinction
Extinction is the technical term to describe the procedure of withholding/discontinuing reinforcement of a previously reinforced behavior, resulting in the decrease of that behavior. The behavior is then set to be extinguished (Cooper et al.). Extinction procedures are often preferred over punishment procedures, as many punishment procedures are deemed unethical and in many states prohibited. Nonetheless, extinction procedures must be implemented with utmost care by professionals, as they are generally associated with extinction bursts. An extinction burst is the temporary increase in the frequency, intensity, and/or duration of the behavior targeted for extinction. Other characteristics of an extinction burst include an extinction-produced aggression—the occurrence of an emotional response to an extinction procedure often manifested as aggression; and b) extinction-induced response variability—the occurrence of novel behaviors that did not typically occur prior to the extinction procedure. These novel behaviors are a core component of shaping procedures.
Discriminated operant and three-term contingency
In addition to a relation being made between behavior and its consequences, operant conditioning also establishes relations between antecedent conditions and behaviors. This differs from the S–R formulations (If-A-then-B), and replaces it with an AB-because-of-C formulation. In other words, the relation between a behavior (B) and its context (A) is because of consequences (C), more specifically, this relationship between AB because of C indicates that the relationship is established by prior consequences that have occurred in similar contexts. This antecedent–behavior–consequence contingency is termed the three-term contingency. A behavior which occurs more frequently in the presence of an antecedent condition than in its absence is called a discriminated operant. The antecedent stimulus is called a discriminative stimulus (SD). The fact that the discriminated operant occurs only in the presence of the discriminative stimulus is an illustration of stimulus control. More recently behavior analysts have been focusing on conditions that occur prior to the circumstances for the current behavior of concern that increased the likelihood of the behavior occurring or not occurring. These conditions have been referred to variously as "Setting Event", "Establishing Operations", and "Motivating Operations" by various researchers in their publications.
Verbal behavior
B. F. Skinner's classification system of behavior analysis has been applied to treatment of a host of communication disorders. Skinner's system includes:
Tact – a verbal response evoked by a non-verbal antecedent and maintained by generalized conditioned reinforcement.
Mand – behavior under control of motivating operations maintained by a characteristic reinforcer.
Intraverbals – verbal behavior for which the relevant antecedent stimulus was other verbal behavior, but which does not share the response topography of that prior verbal stimulus (e.g., responding to another speaker's question).
Autoclitic – secondary verbal behavior which alters the effect of primary verbal behavior on the listener. Examples involve quantification, grammar, and qualifying statements (e.g., the differential effects of "I think..." vs. "I know...")
Skinner's use of behavioral techniques was famously critiqued by the linguist Noam Chomsky through an extensive breakdown of how Skinner's view of language as behavioral simply cannot explain the complexity of human language. This suggests that while behaviorist techniques can teach language, it is a very poor measure to explain language fundamentals. Considering Chomsky's critiques, it may be more appropriate to teach language through a Speech language pathologist instead of a behaviorist.
For an assessment of verbal behavior from Skinner's system, see Assessment of Basic Language and Learning Skills.
Measuring behavior
When measuring behavior, there are both dimensions of behavior and quantifiable measures of behavior. In applied behavior analysis, the quantifiable measures are a derivative of the dimensions. These dimensions are repeatability, temporal extent, and temporal locus.
Repeatability
Response classes occur repeatedly throughout time—i.e., how many times the behavior occurs.
Count is the number of occurrences in behavior.
Rate/frequency is the number of instances of behavior per unit of time.
Celeration is the measure of how the rate changes over time.
Temporal extent
Schirmer, Meck & Penney explore the ‘timing’ of temporal information that seeks out the rhythm and duration of the behavior. Given the expressions of behavior, an emotional meaning is obtained through the duration in correspondence with body and vocal expressions. Using the striatal beat frequency (SBF) model, this highlights the essential role of the striatum’s timing that synchronizes cortical oscillations. At onset of the event, ventral tegmental inputs reset the cortical phase that initiates the timing. During the event, the oscillations are monitored by neurons which is an identifier of the unique phase patterns for different durations of behavior. And when finished, the striatum decodes the patterns to aid in memory storage and comparison of event durations. Researchers discovered socio-temporal processes that attach social meaning to time, allowing the social significance to impact the perception and timing of acts.
Temporal locus
Latency specifically measures the time that elapses between the event of a stimulus and the behavior that follows. This is important in behavioral research because it quantifies how quickly an individual may respond to external stimuli, providing insights into their perceptual and cognitive processing rates. There are two measurements that are able to define temporal locus, they are response latency and interresponse time.
Response latency in children, when being treated with morphine they exhibit a longer time to the response latency in delayed matching of a simple task, and these children seem to have a harder time with social ability. This means that these children require more time to remember things when given the stimulus.
Interresponse time refers to the duration of time that occurs between two instances of behavior, and it helps in understanding patterns and frequency of a certain behavior on a period of time. Use of psychiatric medications may reduce the rate of response, but on the other hand lengthen the duration of interresponse time. The usage of these medications effectively reduces interest as the reaction declines as well.
Derivative measures
Derivative measures are additional metrics derived from primary data, often by combining or transforming dimensional quantities to offer deeper insights into a phenomenon. Despite not being directly tied to specific dimensions, these measures provide valuable supplemental information. In applied behavior analysis (ABA), for example, percentage is a derivative measure that quantifies the ratio of specific responses to total responses, offering a nuanced understanding of behavior and assisting in evaluating progress and intervention effectiveness.
Trials-to-criterion, another ABA derivative measure, tracks the number of response opportunities needed to achieve a set level of performance. This metric aids behavior analysts in assessing skill acquisition and mastery, influencing decisions on program adjustments and teaching methods.
Applied behavior analysis relies on meticulous measurement and impartial evaluation of observable behavior as a foundational principle. Without accurate data collection and analysis, behavior analysts lack the essential information to assess intervention effectiveness and make informed decisions about program modifications. Therefore, precise measurement and assessment play a pivotal role in ABA practice, guiding practitioners to enhance behavioral outcomes and drive significant change.
Behavior analysts utilize a few distinct techniques to gather information. A portion of the ways of collect data information include:
Frequency
This technique refers to the times that an objective way of behaving was noticed and counted. In the published article On Terms: Frequency and Rate in Applied Behavior Analysis, the authors state that two major texts, one being the Behavior Analyst Certification Board pair the word "frequency" with two different words—one text pairing with "count" and the other "rate". Despite one major text using the word "count" interchangeably with "frequency", both texts advise readers they should not be using counts of behavior without referencing the time base of the observation. Additionally, when given that context of advice, the count and time information provide data rate. The authors of this article suggest that when looking at applied behavior analysis (ABA) and accessing behavior measurement, you should be using the term "rate" instead of "count" to reference frequency. Any references to counts without information about observation time should be avoided.
In Annals of Clinical Psychiatry article Applied Behavioral Analytic Interventions for children with Autism: A Description and Review of Treatment Research, they point out how frequency is used to keep track of adaptive and maladaptive behaviors. By doing so, ABA therapists and clinicians are able to create a customized program for that patient. The author notes that tracking frequency, in cases specifically looking at frequency of requesting behaviors during play, language, imitation and socialization, can also be a variable to predict treatment outcome.
Rate
Same as frequency, yet inside a predefined time limit.
Duration
This estimation alludes to how much time that somebody participated in a way of behaving.
Fluency
Fluency, is a gauge on how smooth a behavior is performed. Fluency is associated with behaviors that we use over a long duration and be able to perform it with confidence. The three outcomes associated with fluency:
The ability to retain the behavior or action
Maintain the behavior while there are disruptions
The ability to transfer the behavior to other applications
Fluency will increase the response speed and accuracy of a behavior. However, when introduced to a new stimulus different from their usual behavior, there will be a decrease in reaction time or increased response time but with more false alarms. Fluency relies on repeated action so the amount of required effort for the behavior is lessened to an extent where the individual could focus more on the other factors of the behavior.
There are two types of approaches to fluency:
Unassisted approach - Individual practice of certain behavior. Set a target of response speed and accuracy under a timeframe and readjust accordingly depending on the difficulty.
Assisted approach - Behavior assisted by a teacher or an individual.
The unassisted approach would need to perform their reached target behavior to someone. The assisted learning approach have a limitation that it would need an individual to assist them which could be time-consuming for both individuals
Response latency
Latency refers to how much time after a particular boost has been given before the objective way of behaving happens.
Analyzing behavior change
Experimental control
In applied behavior analysis, all experiments should include the following:
At least one participant
At least one behavior (dependent variable)
At least one setting
A system for measuring the behavior and ongoing visual analysis of data
At least one treatment or intervention condition
Manipulations of the independent variable so that its effects on the dependent variable may be quantitatively or qualitatively analyzed
An intervention that will benefit the participant in some way (behavioral cusp)
Methodologies developed through ABA research
Task analysis
Task analysis is a process in which a task is analyzed into its component parts so that those parts can be taught through the use of chaining: forward chaining, backward chaining and total task presentation. Task analysis has been used in organizational behavior management, a behavior analytic approach to changing the behaviors of members of an organization (e.g., factories, offices, or hospitals). Behavioral scripts often emerge from a task analysis. Bergan conducted a task analysis of the behavioral consultation relationship and Thomas Kratochwill developed a training program based on teaching Bergan's skills. A similar approach was used for the development of microskills training for counselors. Ivey would later call this "behaviorist" phase a very productive one and the skills-based approach came to dominate counselor training during 1970–90. Task analysis was also used in determining the skills needed to access a career. In education, Englemann (1968) used task analysis as part of the methods to design the direct instruction curriculum.
Chaining
The skill to be learned is broken down into small units for easy learning. For example, a person learning to brush teeth independently may start with learning to unscrew the toothpaste cap. Once they have learned this, the next step may be squeezing the tube, etc.
For problem behavior, chains can also be analyzed and the chain can be disrupted to prevent the problem behavior. Some behavior therapies, such as dialectical behavior therapy, make extensive use of behavior chain analysis, but is not philosophically behavior analytic.
There are two types of chain in the ABA world: forward chain and backward chain. Forward chain starts with the first step and continues until the final step, while backward chain begins with the last step and moves backward until the first step.
Prompting
A prompt is a cue that is used to encourage a desired response from an individual. Prompts are often categorized into a prompt hierarchy from most intrusive to least intrusive, although there is some controversy about what is considered most intrusive, those that are physically intrusive or those that are hardest prompt to fade (e.g., verbal). In order to minimize errors and ensure a high level of success during learning, prompts are given in a most-to-least sequence and faded systematically. During this process, prompts are faded as quickly as possible so that the learner does not come to depend on them and eventually behaves appropriately without prompting.
Types of prompts
Prompters might use any or all of the following to suggest the desired response:
Vocal prompts: Words or other vocalizations
Visual prompts: A visual cue or picture
Gestural prompts: A physical gesture
Positional prompt: e.g., the target item is placed close to the individual.
Modeling: Modeling the desired response. This type of prompt is best suited for individuals who learn through imitation and can attend to a model.
Physical prompts: Physically manipulating the individual to produce the desired response. There are many degrees of physical prompts, from quite intrusive (e.g., the teacher places a hand on the learner's hand) to minimally intrusive (e.g., a slight tap).
This is not an exhaustive list of prompts; the nature, number, and order of prompts are chosen to be the most effective for a particular individual.
Fading
The overall goal is for an individual to eventually not need prompts. As an individual gains mastery of a skill at a particular prompt level, the prompt is faded to a less intrusive prompt. This ensures that the individual does not become overly dependent on a particular prompt when learning a new behavior or skill.
One of the primary choices that was made while showing another way of behaving is the manner by which to fade the prompts or prompts. An arrangement should be set up to fade the prompts in an organized style. For instance, blurring the actual brief of directing a kid's hands might follow this succession: (a) supporting wrists, (b) contacting hands softly, (c) contacting lower arm or elbow, and (d) pulling out actual contact through and through. Fading guarantees that the kid does not turn out to be excessively subject to a specific brief while mastering another expertise.
Thinning a reinforcement schedule
Thinning is often confused with fading. Fading refers to a prompt being removed, where thinning refers to an increase in the time or number of responses required between reinforcements. Periodic thinning that produces a 30% decrease in reinforcement has been suggested as an efficient way to thin. Schedule thinning is often an important and neglected issue in contingency management and token economy systems, especially when these are developed by unqualified practitioners (see professional practice of behavior analysis).
Generalization
Generalization is the expansion of a student's performance ability beyond the initial conditions set for acquisition of a skill. Generalization can occur across people, places, and materials used for teaching. For example, once a skill is learned in one setting, with a particular instructor, and with specific materials, the skill is taught in more general settings with more variation from the initial acquisition phase. For example, if a student has successfully mastered learning colors at the table, the teacher may take the student around the house or school and generalize the skill in these more natural environments with other materials. Behavior analysts have spent considerable amount of time studying factors that lead to generalization.
Shaping
Shaping involves gradually modifying the existing behavior into the desired behavior. If the student engages with a dog by hitting it, then they could have their behavior shaped by reinforcing interactions in which they touch the dog more gently. Over many interactions, successful shaping would replace the hitting behavior with patting or other gentler behavior. Shaping is based on a behavior analyst's thorough knowledge of operant conditioning principles and extinction. Recent efforts to teach shaping have used simulated computer tasks.
One teaching technique found to be effective with some students, particularly children, is the use of video modeling (the use of taped sequences as exemplars of behavior). It can be used by therapists to assist in the acquisition of both verbal and motor responses, in some cases for long chains of behavior.
Another example of shaping is when a toddler learns to walk. The child is reinforced by crawling, standing, taking a few steps, and then eventually walking. When a child is learning to walk, they are praised by a lot of claps and excitements.
Interventions based on an FBA
Functional behavioral assessment (FBA) is an individualized critical thinking process that may be used to address problem behavior. An evaluation is initiated to distinguish the causality of a problem behavior. This interactive evaluation includes gathering data about the ecological circumstances that occur prior to an identified conduct issue and the resulting rewards that reinforce the behavior. The data that is collected is then used to recognize and execute individualized interventions pointed toward lessening problem behaviors and expanding positive behavior outcomes.
Critical to behavior analytic interventions is the concept of a systematic behavioral case formulation with a functional behavioral assessment or analysis at the core. This approach should apply a behavior analytic theory of change (see Behavioral change theories). This formulation should include a thorough functional assessment, a skills assessment, a sequential analysis (behavior chain analysis), an ecological assessment, a look at existing evidenced-based behavioral models for the problem behavior (such as Fordyce's model of chronic pain) and then a treatment plan based on how environmental factors influence behavior. Some argue that behavior analytic case formulation can be improved with an assessment of rules and rule-governed behavior. Some of the interventions that result from this type of conceptualization involve training specific communication skills to replace the problem behaviors as well as specific setting, antecedent, behavior, and consequence strategies.
Other species
ABA has been successfully used in other species. Morris uses ABA to reduce feather-plucking in the black vulture (Coragyps atratus).
Major journals
Applied behavior analysts publish in many journals. Some examples of "core" behavior analytic journals are:
Applied Animal Behaviour Science
Behavioral Health and Medicine
Behavior Analysis: Research and Practice
Behavior and Philosophy
Behavior and Social Issues
Behavior Modification
Behavior Therapy
Journal of Applied Behavior Analysis
Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention
Journal of Behavior Analysis of Sports, Health, Fitness, and Behavioral Medicine
Journal of Contextual Behavioral Science
Journal of Early and Intensive Behavior Interventions
Journal of Organizational Behavior Management
Journal of Positive Behavior Interventions
Journal of the Experimental Analysis of Behavior
Perspectives on Behavior Science (formerly The Behavior Analyst until 2018)
The Behavioral Development Bulletin
The Behavior Analyst Today
The International Journal of Behavioral Consultation and Therapy
The Journal of Behavioral Assessment and Intervention in Children
The Journal of Speech-Language Pathology and Applied Behavior Analysis
The Psychological Record
See also
Association for Behavior Analysis International
Behavior analysis of child development
Behavior therapy
Behavioral activation
Educational psychology
Parent management training
Professional practice of behavior analysis
References
Sources
Further reading
External links
Applied Behavior Analysis: Overview and Summary of Scientific Support
Functional Behavioral Assessment, The IRIS Center – U.S. Department of Education, Office of Special Education Programs Grant and Vanderbilt University
Behavior analysis
Behavior
Behavior modification
Behavioral concepts
Behaviorism
Life coaching
Mind control
Industrial and organizational psychology
Personal development
Autism pseudoscience | 0.761387 | 0.997976 | 0.759846 |
Pleonasm | Pleonasm (; , ) is redundancy in linguistic expression, such as in "black darkness," "burning fire," "the man he said," or "vibrating with motion." It is a manifestation of tautology by traditional rhetorical criteria. Pleonasm may also be used for emphasis, or because the phrase has become established in a certain form. Tautology and pleonasm are not consistently differentiated in literature.
Usage
Most often, pleonasm is understood to mean a word or phrase which is useless, clichéd, or repetitive, but a pleonasm can also be simply an unremarkable use of idiom. It can aid in achieving a specific linguistic effect, be it social, poetic or literary. Pleonasm sometimes serves the same function as rhetorical repetition—it can be used to reinforce an idea, contention or question, rendering writing clearer and easier to understand. Pleonasm can serve as a redundancy check; if a word is unknown, misunderstood, misheard, or if the medium of communication is poor—a static-filled radio transmission or sloppy handwriting—pleonastic phrases can help ensure that the meaning is communicated even if some of the words are lost.
Idiomatic expressions
Some pleonastic phrases are part of a language's idiom, like tuna fish, chain mail and safe haven in American English. They are so common that their use is unremarkable for native speakers, although in many cases the redundancy can be dropped with no loss of meaning.
When expressing possibility, English speakers often use potentially pleonastic expressions such as It might be possible or perhaps it's possible, where both terms (verb might or adverb perhaps along with the adjective possible) have the same meaning under certain constructions. Many speakers of English use such expressions for possibility in general, such that most instances of such expressions by those speakers are in fact pleonastic. Others, however, use this expression only to indicate a distinction between ontological possibility and epistemic possibility, as in "Both the ontological possibility of X under current conditions and the ontological impossibility of X under current conditions are epistemically possible" (in logical terms, "I am not aware of any facts inconsistent with the truth of proposition X, but I am likewise not aware of any facts inconsistent with the truth of the negation of X"). The habitual use of the double construction to indicate possibility per se is far less widespread among speakers of most other languages (except in Spanish; see examples); rather, almost all speakers of those languages use one term in a single expression:
French: or .
Portuguese: , lit. "What is it that", a more emphatic way of saying "what is"; usually suffices.
Romanian: or .
Typical Spanish pleonasms
– I am going to go up upstairs, "" not being necessary.
– enter inside, "" not being necessary.
Turkish has many pleonastic constructs because certain verbs necessitate objects:
– to eat food.
– to write writing.
– to exit outside.
– to enter inside.
– to play a game.
In a satellite-framed language like English, verb phrases containing particles that denote direction of motion are so frequent that even when such a particle is pleonastic, it seems natural to include it (e.g. "enter into").
Professional and scholarly use
Some pleonastic phrases, when used in professional or scholarly writing, may reflect a standardized usage that has evolved or a meaning familiar to specialists but not necessarily to those outside that discipline. Such examples as "null and void", "terms and conditions", "each and every" are legal doublets that are part of legally operative language that is often drafted into legal documents. A classic example of such usage was that by the Lord Chancellor at the time (1864), Lord Westbury, in the English case of Gorely, when he described a phrase in an Act as "redundant and pleonastic". This type of usage may be favored in certain contexts. However, it may also be disfavored when used gratuitously to portray false erudition, obfuscate, or otherwise introduce verbiage, especially in disciplines where imprecision may introduce ambiguities (such as the natural sciences).
Of the aforementioned phrases, "terms and conditions" may not be pleonastic in some legal systems, as they refer not to a set provisions forming part of a contract, but rather to the specific terms conditioning the effect of the contract or a contractual provision to a future event. In these cases, terms and conditions imply respectively the certainty or uncertainty of said event (e.g., in Brazilian law, a testament has the initial term for coming into force the death of the testator, while a health insurance has the condition of the insured suffering a, or one of a set of, certain injurie(s) from a or one of a set of certain causes).
Stylistic preference
In addition, pleonasms can serve purposes external to meaning. For example, a speaker who is too terse is often interpreted as lacking ease or grace, because, in oral and sign language, sentences are spontaneously created without the benefit of editing. The restriction on the ability to plan often creates many redundancies. In written language, removing words that are not strictly necessary sometimes makes writing seem stilted or awkward, especially if the words are cut from an idiomatic expression.
On the other hand, as is the case with any literary or rhetorical effect, excessive use of pleonasm weakens writing and speech; words distract from the content. Writers who want to obfuscate a certain thought may obscure their meaning with excess verbiage. William Strunk Jr. advocated concision in The Elements of Style (1918):
Literary uses
Examples from Baroque, Mannerist, and Victorian provide a counterpoint to Strunk's advocacy of concise writing:
"This was the most unkindest cut of all." — William Shakespeare, Julius Caesar (Act 3, Scene 2, 183)
"I will be brief: your noble son is mad:/Mad call I it; for, to define true madness,/What is't but to be nothing else but mad?" — Hamlet (Act 2, Scene 2)
"Let me tell you this, when social workers offer you, free, gratis and for nothing, something to hinder you from swooning, which with them is an obsession, it is useless to recoil ..." — Samuel Beckett, Molloy
Types
There are various kinds of pleonasm, including bilingual tautological expressions, syntactic pleonasm, semantic pleonasm and morphological pleonasm:
Bilingual tautological expressions
A bilingual tautological expression is a phrase that combines words that mean the same thing in two different languages. An example of a bilingual tautological expression is the Yiddish expression mayim akhroynem vaser. It literally means "water last water" and refers to "water for washing the hands after meal, grace water". Its first element, mayim, derives from the Hebrew ['majim] "water". Its second element, vaser, derives from the Middle High German word "water".
According to Ghil'ad Zuckermann, Yiddish abounds with both bilingual tautological compounds and bilingual tautological first names.
The following are examples of bilingual tautological compounds in Yiddish:
fíntster khóyshekh "very dark", literally "dark darkness", traceable back to the Middle High German word "dark" and the Hebrew word חושך ħōshekh "darkness".
khameréyzļ "womanizer", literally "donkey-donkey", traceable back to the Hebrew word חמור [ħă'mōr] "donkey" and the Middle High German word "donkey".
The following are examples of bilingual tautological first names (anthroponyms) in Yiddish:
Dov-Ber, literally "bear-bear", traceable back to the Hebrew word dov "bear" and the Middle High German word "bear".
Tsvi-Hirsh, literally "deer-deer", traceable back to the Hebrew word tsvi "deer" and the Middle High German word "deer".
Ze'ev-Volf, literally "wolf-wolf", traceable back to the Hebrew word ze'ev "wolf" and the Middle High German word "wolf".
Arye-Leyb, literally "lion-lion", traceable back to the Hebrew word arye "lion" and the Middle High German word "lion".
Examples occurring in English-language contexts include:
River Avon, literally "River River", from Welsh.
the Sahara Desert, literally "the The Desert Desert", from Arabic.
the La Brea Tar Pits, literally "the The Tar Tar Pits", from Spanish.
the Los Angeles Angels, literally "the The Angels Angels", from Spanish.
the hoi polloi, literally "the the many", from Greek.
Carmarthen Castle, may actually have "castle" in it three times: In its Welsh form, Castell Caerfyrddin, "Caer" means fort, while "fyrddin" is thought to be derived from the Latin Moridunum ("sea fort") making Carmarthen Castle "fort sea-fort castle".
Mount Maunganui, Lake Rotoroa, and Motutapu Island in New Zealand are "Mount Mount Big", "Lake Lake Long", and "Island Sacred Island" respectively, from Māori.
Syntactic pleonasm
Syntactic pleonasm occurs when the grammar of a language makes certain function words optional. For example, consider the following English sentences:
"I know you're coming."
"I know that you're coming."
In this construction, the conjunction that is optional when joining a sentence to a verb phrase with know. Both sentences are grammatically correct, but the word that is pleonastic in this case. By contrast, when a sentence is in spoken form and the verb involved is one of assertion, the use of that makes clear that the present speaker is making an indirect rather than a direct quotation, such that he is not imputing particular words to the person he describes as having made an assertion; the demonstrative adjective that also does not fit such an example. Also, some writers may use "that" for technical clarity reasons. In some languages, such as French, the word is not optional and should therefore not be considered pleonastic.
The same phenomenon occurs in Spanish with subject pronouns. Since Spanish is a null-subject language, which allows subject pronouns to be deleted when understood, the following sentences mean the same:
""
""
In this case, the pronoun ('I') is grammatically optional; both sentences mean "I love you" (however, they may not have the same tone or intention—this depends on pragmatics rather than grammar). Such differing but syntactically equivalent constructions, in many languages, may also indicate a difference in register.
The process of deleting pronouns is called pro-dropping, and it also happens in many other languages, such as Korean, Japanese, Hungarian, Latin, Italian, Portuguese, Swahili, Slavic languages, and the Lao language.
In contrast, formal English requires an overt subject in each clause. A sentence may not need a subject to have valid meaning, but to satisfy the syntactic requirement for an explicit subject a pleonastic (or dummy pronoun) is used; only the first sentence in the following pair is acceptable English:
"It's raining."
"Is raining."
In this example the pleonastic "it" fills the subject function, but it contributes no meaning to the sentence. The second sentence, which omits the pleonastic it is marked as ungrammatical although no meaning is lost by the omission. Elements such as "it" or "there", serving as empty subject markers, are also called (syntactic) expletives, or dummy pronouns. Compare:
"There is rain."
"Today is rain."
The pleonastic , expressing uncertainty in formal French, works as follows:
""('I fear it may rain.')
""('These ideas are harder to understand than I thought.')
Two more striking examples of French pleonastic construction are and .
The word / is translated as 'today', but originally means "on the day of today" since the now obsolete means "today". The expression (translated as "on the day of today") is common in spoken language and demonstrates that the original construction of is lost. It is considered a pleonasm.
The phrase meaning 'What's that?' or 'What is it?', while literally, it means "What is it that it is?".
There are examples of the pleonastic, or dummy, negative in English, such as the construction, heard in the New England region of the United States, in which the phrase "So don't I" is intended to have the same positive meaning as "So do I."
When Robert South said, "It is a pleonasm, a figure usual in Scripture, by a multiplicity of expressions to signify one notable thing", he was observing the Biblical Hebrew poetic propensity to repeat thoughts in different words, since written Biblical Hebrew was a comparatively early form of written language and was written using oral patterning, which has many pleonasms. In particular, very many verses of the Psalms are split into two halves, each of which says much the same thing in different words. The complex rules and forms of written language as distinct from spoken language were not as well-developed as they are today when the books making up the Old Testament were written. See also parallelism (rhetoric).
This same pleonastic style remains very common in modern poetry and songwriting (e.g., "Anne, with her father / is out in the boat / riding the water / riding the waves / on the sea", from Peter Gabriel's "Mercy Street").
Types of syntactic pleonasm
Overinflection: Many languages with inflection, as a result of convention, tend to inflect more words in a given phrase than actually needed in order to express a single grammatical property. Take for example the German, ("The old women speak"). Even though the use of the plural form of the noun ("woman", plural ) shows the grammatical number of the noun phrase, agreement in the German language still dictates that the definite article , attributive adjective , and the verb must all also be in the plural. Not all languages are quite as redundant however, and will permit inflection for number when there is an obvious numerical marker, as is the case with Hungarian, which does have a plural proper, but would express two flowers as two flower. (The same is the case in Celtic languages, where numerical markers precede singular nouns.) The main contrast between Hungarian and other tongues such as German or even English (to a lesser extent) is that in either of the latter, expressing plurality when already evident is not optional, but mandatory; making the neglect of these rules result in an ungrammatical sentence. As well as for number, our aforementioned German phrase also overinflects for grammatical case.
Multiple negation: In some languages, repeated negation may be used for emphasis, as in the English sentence, "There ain't nothing wrong with that". While a literal interpretation of this sentence would be "There is not nothing wrong with that", i.e. "There is something wrong with that", the intended meaning is, in fact, the opposite: "There is nothing wrong with that" or "There isn't anything wrong with that." The repeated negation is used pleonastically for emphasis. However, this is not always the case. In the sentence "I don't not like it", the repeated negative may be used to convey ambivalence ("I neither like nor dislike it") or even affirmation ("I do like it"). (Rhetorically, this becomes the device of litotes; it can be difficult to distinguish litotes from pleonastic double negation, a feature which may be used for ironic effect.) Although the use of "double negatives" for emphatic purposes is sometimes discouraged in standard English, it is mandatory in other languages like Spanish or French. For example, the Spanish phrase ('It is nothing') contains both a negated verb ("") and another negative, the word for nothing ("").
Multiple affirmations: In English, repeated affirmation can be used to add emphasis to an affirmative statement, just as repeated negation can add emphasis to a negative one. A sentence like I do love you, with a stronger intonation on the do, uses double affirmation. This is because English, by default, automatically expresses its sentences in the affirmative and must then alter the sentence in one way or another to express the opposite. Therefore, the sentence I love you is already affirmative, and adding the extra do only adds emphasis and does not change the meaning of the statement.
Double possession: The double genitive of English, as with a friend of mine, is seemingly pleonastic, and therefore has been stigmatized, but it has a long history of use by careful writers and has been analyzed as either a partitive genitive or an appositive genitive.
Multiple quality gradation: In English, different degrees of comparison (comparatives and superlatives) are created through a morphological change to an adjective (e.g., "prettier", "fastest") or a syntactic construction (e.g., "more complex", "most impressive"). It is thus possible to combine both forms for additional emphasis: "more bigger" or "bestest". This may be considered ungrammatical but is common in informal speech for some English speakers. "The most unkindest cut of all" is from Shakespeare's Julius Caesar. Musical notation has a repeated Italian superlative in fortississimo and pianississimo.
Not all uses of constructions such as "more bigger" are pleonastic, however. Some speakers who use such utterances do so in an attempt, albeit a grammatically unconventional one, to create a non-pleonastic construction: A person who says "X is more bigger than Y" may, in the context of a conversation featuring a previous comparison of some object Z with Y, mean "The degree by which X exceeds Y in size is greater than the degree by which Z exceeds Y in size". This usage amounts to the treatment of "bigger than Y" as a single grammatical unit, namely an adjective itself admitting of degrees, such that "X is more bigger than Y" is equivalent to "X is more bigger-than-Y than Z is."[alternatively, "X is bigger than Y more than Z is."] Another common way to express this is: "X is even bigger than Z."
Semantic pleonasm
Semantic pleonasm is a question more of style and usage than of grammar. Linguists usually call this redundancy to avoid confusion with syntactic pleonasm, a more important phenomenon for theoretical linguistics. It usually takes one of two forms: Overlap or prolixity.
Overlap: One word's semantic component is subsumed by the other:
"Receive a free gift with every purchase."; a gift is usually already free.
"A tuna fish sandwich."
"The plumber fixed our hot water heater." (This pleonasm was famously attacked by American comedian George Carlin, but is not truly redundant; a device that increases the temperature of cold water to room temperature would also be a water heater.)
The Big Friendly Giant (title of a children's book by Roald Dahl); giants are inherently already "big".
Prolixity: A phrase may have words which add nothing, or nothing logical or relevant, to the meaning.
"I'm going down south."(South is not really "down", it is just drawn that way on maps by convention.)
"You can't seem to face up to the facts."
"He entered into the room."
"Every mother's child" (as in 'The Christmas Song' by Nat King Cole', also known as 'Chestnuts roasting...'). (Being a child, or a human at all, generally implies being the child of/to a mother. So the redundancy here is used to broaden the context of the child's curiosity regarding the sleigh of Santa Claus, including the concept of maternity. The full line goes: "And every mother's child is gonna spy, to see if reindeer really know how to fly". One can furthermore argue that the word "mother" is included for the purpose of lyrical flow, adding two syllables, which make the line sound complete, as "every child" would be too short to fit the lyrical/rhyme scheme.)
"What therefore God hath joined together, let no man put asunder."
"He raised up his hands in a gesture of surrender."
"Where are you at?"
"Located" or similar before a preposition: "the store is located on Main St." The preposition contains the idea of locatedness and does not need a servant.
"The house itself" for "the house", and similar: unnecessary re-specifiers.
"Actual fact": fact.
"On a daily basis": daily.
"This particular item": this item.
"Different" or "separate" after numbers: for example:
"Four different species" are merely "four species", as two non-different species are together one same species. (However, in "a discount if you buy ten different items", "different" has meaning, because if the ten items include two packets of frozen peas of the same weight and brand, those ten items are not all different.)
"Nine separate cars": cars are always separate.
"Despite the fact that": although.
An expression like "tuna fish", however, might elicit one of many possible responses, such as:
It will simply be accepted as synonymous with "tuna".
It will be perceived as redundant (and thus perhaps silly, illogical, ignorant, inefficient, dialectal, odd, and/or intentionally humorous).
It will imply a distinction. A reader of "tuna fish" could properly wonder: "Is there a kind of tuna which is not a fish? There is, after all, a dolphin mammal and a dolphin fish." This assumption turns out to be correct, as a "tuna" can also mean a prickly pear. Further, "tuna fish" is sometimes used to refer to the flesh of the animal as opposed to the animal itself (similar to the distinction between beef and cattle). Similarly, while all sound-making horns use air, an "air horn" has a special meaning: one that uses compressed air specifically; while most clocks tell time, a "time clock" specifically means one that keeps track of workers' presence at the workplace.
It will be perceived as a verbal clarification, since the word "tuna" is quite short, and may, for example, be misheard as "tune" followed by an aspiration, or (in dialects that drop the final -r sound) as "tuner".
Careful speakers, and writers, too, are aware of pleonasms, especially with cases such as "tuna fish", which is normally used only in some dialects of American English, and would sound strange in other variants of the language, and even odder in translation into other languages.
Similar situations are:
"Ink pen" instead of merely "pen" in the southern United States, where "pen" and "pin" are pronounced similarly.
"Extra accessories" which must be ordered separately for a new camera, as distinct from the accessories provided with the camera as sold.
Not all constructions that are typically pleonasms are so in all cases, nor are all constructions derived from pleonasms themselves pleonastic:
"Put that glass over there on the table." This could, depending on room layout, mean "Put that glass on the table across the room, not the table right in front of you"; if the room were laid out like that, most English speakers would intuitively understand that the distant, not immediate table was the one being referred to; however, if there were only one table in the room, the phrase would indeed be pleonastic. Also, it could mean, "Put that glass on the spot (on the table) which I am gesturing to"; thus, in this case, it is not pleonastic.
"I'm going way down South." This may imply "I'm going much farther south than you might think if I didn't stress the southerliness of my destination"; but such phrasing is also sometimes—and sometimes jokingly—used pleonastically when simply "south" would do; it depends upon the context, the intent of the speaker/writer, and ultimately even on the expectations of the listener/reader.
Morphemic pleonasm
Morphemes, not just words, can enter the realm of pleonasm: Some word-parts are simply optional in various languages and dialects. A familiar example to American English speakers would be the allegedly optional "-al-", probably most commonly seen in "" vs. "publicly"—both spellings are considered correct/acceptable in American English, and both pronounced the same, in this dialect, rendering the "" spelling pleonastic in US English; in other dialects it is "required", while it is quite conceivable that in another generation or so of American English it will be "forbidden". This treatment of words ending in "-ic", "-ac", etc., is quite inconsistent in US English—compare "maniacally" or "forensically" with "stoicly" or "heroicly"; "forensicly" doesn't look "right" in any dialect, but "heroically" looks internally redundant to many Americans. (Likewise, there are thousands of mostly American Google search results for "eroticly", some in reputable publications, but it does not even appear in the 23-volume, 23,000-page, 500,000-definition Oxford English Dictionary (OED), the largest in the world; and even American dictionaries give the correct spelling as "erotically".) In a more modern pair of words, Institute of Electrical and Electronics Engineers dictionaries say that "electric" and "electrical" mean the same thing. However, the usual adverb form is "electrically". (For example, "The glass rod is electrically charged by rubbing it with silk".)
Some (mostly US-based) prescriptive grammar pundits would say that the "-ly" not "-ally" form is "correct" in any case in which there is no "-ical" variant of the basic word, and vice versa; i.e. "maniacally", not "maniacly", is correct because "maniacal" is a word, while "publicly", not "", must be correct because "publical" is (arguably) not a real word (it does not appear in the OED). This logic is in doubt, since most if not all "-ical" constructions arguably are "real" words and most have certainly occurred more than once in "reputable" publications and are also immediately understood by any educated reader of English even if they "look funny" to some, or do not appear in popular dictionaries. Additionally, there are numerous examples of words that have very widely accepted extended forms that have skipped one or more intermediary forms, e.g., "disestablishmentarian" in the absence of "disestablishmentary" (which does not appear in the OED). At any rate, while some US editors might consider "-ally" vs. "-ly" to be pleonastic in some cases, the majority of other English speakers would not, and many "-ally" words are not pleonastic to anyone, even in American English.
The most common definitely pleonastic morphological usage in English is "irregardless", which is very widely criticized as being a non-word. The standard usage is "regardless", which is already negative; adding the additional negative ir- is interpreted by some as logically reversing the meaning to "with regard to/for", which is certainly not what the speaker intended to convey. (According to most dictionaries that include it, "irregardless" appears to derive from confusion between "regardless" and "irrespective", which have overlapping meanings.)
Morphemic pleonasm in Modern Standard Chinese
There are several instances in Chinese vocabulary where pleonasms and cognate objects are present. Their presence usually indicate the plural form of the noun or the noun in formal context.
('book(s)' – in general)
('paper, tissue, pieces of paper' – formal)
In some instances, the pleonasmic form of the verb is used with the intention as an emphasis to one meaning of the verb, isolating them from their idiomatic and figurative uses. But over time, the pseudo-object, which sometimes repeats the verb, is almost inherently coupled with the it.
For example, the word ('to sleep') is an intransitive verb, but may express different meaning when coupled with objects of prepositions as in "to sleep with". However, in Mandarin, is usually coupled with a pseudo-character , yet it is not entirely a cognate object, to express the act of resting.
('I want sleep'). Although such usage of is not found among native speakers of Mandarin and may sound awkward, this expression is grammatically correct and it is clear that means 'to sleep/to rest' in this context.
('I want to sleep') and ('I'm going to sleep'). In this context, ('to sleep') is a complete verb and native speakers often express themselves this way. Adding this particle clears any suspicion from using it with any direct object shown in the next example:
('I want to have sex with her') and ('I want to sleep with her'). When the verb follows an animate direct object the meaning changes dramatically. The first instance is mainly seen in colloquial speech. Note that the object of preposition of "to have sex with" is the equivalent of the direct object of in Mandarin.
One can also find a way around this verb, using another one which does not is used to express idiomatic expressions nor necessitate a pleonasm, because it only has one meaning:
('I want "to dorm)
Nevertheless, is a verb used in high-register diction, just like English verbs with Latin roots.
There is no relationship found between Chinese and English regarding verbs that can take pleonasms and cognate objects. Although the verb to sleep may take a cognate object as in "sleep a restful sleep", it is a pure coincidence, since verbs of this form are more common in Chinese than in English; and when the English verb is used without the cognate objects, its diction is natural and its meaning is clear in every level of diction, as in "I want to sleep" and "I want to have a rest".
Subtler redundancies
In some cases, the redundancy in meaning occurs at the syntactic level above the word, such as at the phrase level:
"It's déjà vu all over again."
"I never make predictions, especially about the future."
The redundancy of these two well-known statements is deliberate, for humorous effect. (See Yogi Berra#"Yogi-isms".) But one does hear educated people say "my predictions about the future of politics" for "my predictions about politics", which are equivalent in meaning. While predictions are necessarily about the future (at least in relation to the time the prediction was made), the nature of this future can be subtle (e.g., "I predict that he died a week ago"—the prediction is about future discovery or proof of the date of death, not about the death itself). Generally "the future" is assumed, making most constructions of this sort pleonastic. The latter humorous quote above about not making predictions—by Yogi Berra—is not really a pleonasm, but rather an ironic play on words.
Alternatively it could be an analogy between predict and guess.
However, "It's déjà vu all over again" could mean that there was earlier another déjà vu of the same event or idea, which has now arisen for a third time; or that the speaker had very recently experienced a déjà vu of a different idea.
Redundancy, and "useless" or "nonsensical" words (or phrases, or morphemes), can also be inherited by one language from the influence of another and are not pleonasms in the more critical sense but actual changes in grammatical construction considered to be required for "proper" usage in the language or dialect in question. Irish English, for example, is prone to a number of constructions that non-Irish speakers find strange and sometimes directly confusing or silly:
"I'm after putting it on the table."('I [have] put it on the table.') This example further shows that the effect, whether pleonastic or only pseudo-pleonastic, can apply to words and word-parts, and multi-word phrases, given that the fullest rendition would be "I am after putting it on the table".
"Have a look at your man there."('Have a look at that man there.') An example of word substitution, rather than addition, that seems illogical outside the dialect. This common possessive-seeming construction often confuses the non-Irish enough that they do not at first understand what is meant. Even "Have a look at that man there" is arguably further doubly redundant, in that a shorter "Look at that man" version would convey essentially the same meaning.
"She's my wife so she is."('She's my wife.') Duplicate subject and verb, post-complement, used to emphasize a simple factual statement or assertion.
All of these constructions originate from the application of Irish Gaelic grammatical rules to the English dialect spoken, in varying particular forms, throughout the island.
Seemingly "useless" additions and substitutions must be contrasted with similar constructions that are used for stress, humor, or other intentional purposes, such as:
"I abso-fuckin'-lutely agree!"(tmesis, for stress)
"Topless-shmopless—nudity doesn't distract me."(shm-reduplication, for humor)
The latter of these is a result of Yiddish influences on modern English, especially East Coast US English.
Sometimes editors and grammatical stylists will use "pleonasm" to describe simple wordiness. This phenomenon is also called prolixity or logorrhea. Compare:
"The sound of the loud music drowned out the sound of the burglary."
"The loud music drowned out the sound of the burglary."
or even:
"The music drowned out the burglary."
The reader or hearer does not have to be told that loud music has a sound, and in a newspaper headline or other abbreviated prose can even be counted upon to infer that "burglary" is a proxy for "sound of the burglary" and that the music necessarily must have been loud to drown it out, unless the burglary was relatively quiet (this is not a trivial issue, as it may affect the legal culpability of the person who played the music); the word "loud" may imply that the music should have been played quietly if at all. Many are critical of the excessively abbreviated constructions of "headline-itis" or "newsspeak", so "loud [music]" and "sound of the [burglary]" in the above example should probably not be properly regarded as pleonastic or otherwise genuinely redundant, but simply as informative and clarifying.
Prolixity is also used to obfuscate, confuse, or euphemize and is not necessarily redundant or pleonastic in such constructions, though it often is. "Post-traumatic stress disorder" (shell shock) and "pre-owned vehicle" (used car) are both tumid euphemisms but are not redundant. Redundant forms, however, are especially common in business, political, and academic language that is intended to sound impressive (or to be vague so as to make it hard to determine what is actually being promised, or otherwise misleading). For example: "This quarter, we are presently focusing with determination on an all-new, innovative integrated methodology and framework for rapid expansion of customer-oriented external programs designed and developed to bring the company's consumer-first paradigm into the marketplace as quickly as possible."
In contrast to redundancy, an oxymoron results when two seemingly contradictory words are adjoined.
Foreign words
Redundancies sometimes take the form of foreign words whose meaning is repeated in the context:
"We went to the El Restaurante restaurant."
"The La Brea tar pits are fascinating."
"Roast beef served with au jus sauce."
"Please R.S.V.P."
"The Schwarzwald Forest is deep and dark."
"The Drakensberg Mountains are in South Africa."
"We will vacation in Timor-Leste."
LibreOffice office suite.
The hoi polloi.
I'd like to have a chai tea.
"That delicious Queso cheese."
"Some salsa sauce on the side?."
These sentences use phrases which mean, respectively, "the restaurant restaurant", "the tar tar", "with juice sauce" and so on. However, many times these redundancies are necessary—especially when the foreign words make up a proper noun as opposed to a common one. For example, "We went to Il Ristorante" is acceptable provided the audience can infer that it is a restaurant. (If they understand Italian and English it might, if spoken, be misinterpreted as a generic reference and not a proper noun, leading the hearer to ask "Which ristorante do you mean?"—such confusions are common in richly bilingual areas like Montreal or the American Southwest when mixing phrases from two languages.) But avoiding the redundancy of the Spanish phrase in the second example would only leave an awkward alternative: "La Brea pits are fascinating".
Most find it best to not even drop articles when using proper nouns made from foreign languages:
"The movie is playing at the El Capitan theater."
However, there are some exceptions to this, for example:
"Jude Bellingham plays for Real Madrid in La Liga." ("La Liga" literally means "The League" in Spanish)
This is also similar to the treatment of definite and indefinite articles in titles of books, films, etc. where the article can—some would say must—be present where it would otherwise be "forbidden":
"Stephen King's The Shining is scary."(Normally, the article would be left off following a possessive.)
"I'm having an An American Werewolf in London movie night at my place."(Seemingly doubled article, which would be taken for a stutter or typographical error in other contexts.)
Some cross-linguistic redundancies, especially in placenames, occur because a word in one language became the title of a place in another (e.g., the Sahara Desert—"Sahara" is an English approximation of the word for "deserts" in Arabic). "The Los Angeles Angels" professional baseball team is literally "the The Angels Angels". A supposed extreme example is Torpenhow Hill in Cumbria, where some of the elements in the name likely mean "hill". See the List of tautological place names for many more examples.
The word tsetse means "fly" in the Tswana language, a Bantu language spoken in Botswana and South Africa. This word is the root of the English name for a biting fly found in Africa, the tsetse fly.
Acronyms and initialisms
Acronyms and initialisms can also form the basis for redundancies; this is known humorously as RAS syndrome (for Redundant Acronym Syndrome syndrome). In all the examples that follow, the word after the acronym repeats a word represented in the acronym. The full redundant phrase is stated in the parentheses that follow each example:
"I forgot my PIN number for the ATM machine." (Personal Identification Number number; Automated Teller Machine machine)
"I upgraded the RAM memory of my computer." (Random Access Memory memory)
"She is infected with the HIV virus." (Human Immunodeficiency Virus virus)
"I have installed a CMS system on my server." (Content Management System system)
"The SI system of units is the modern form of the metric system." (International System system)
(See RAS syndrome for many more examples.) The expansion of an acronym like PIN or HIV may be well known to English speakers, but the acronyms themselves have come to be treated as words, so little thought is given to what their expansion is (and "PIN" is also pronounced the same as the word "pin"; disambiguation is probably the source of "PIN number"; "SIN number" for "Social Insurance Number number" is a similar common phrase in Canada.) But redundant acronyms are more common with technical (e.g., computer) terms where well-informed speakers recognize the redundancy and consider it silly or ignorant, but mainstream users might not, since they may not be aware or certain of the full expansion of an acronym like "RAM".
Typographical
Some redundancies are simply typographical. For instance, when a short inflexional word like "the" occurs at the end of a line, it is very common to accidentally repeat it at the beginning of the following line, and a large number of readers would not even notice it.
Apparent redundancies that actually are not redundant
Carefully constructed expressions, especially in poetry and political language, but also some general usages in everyday speech, may appear to be redundant but are not. This is most common with cognate objects (a verb's object that is cognate with the verb):
"She slept a deep sleep."
Or, a classic example from Latin:
mutatis mutandis = "with change made to what needs to be changed" (an ablative absolute construction)
The words need not be etymologically related, but simply conceptually, to be considered an example of cognate object:
"We wept tears of joy."
Such constructions are not actually redundant (unlike "She slept a sleep" or "We wept tears") because the object's modifiers provide additional information. A rarer, more constructed form is polyptoton, the stylistic repetition of the same word or words derived from the same root:
"...[T]he only thing we have to fear is fear itself." — Franklin D. Roosevelt, "First Inaugural Address", March 1933.
"With eager feeding[,] food doth choke the feeder." — William Shakespeare, Richard II, II, i, 37.
As with cognate objects, these constructions are not redundant because the repeated words or derivatives cannot be removed without removing meaning or even destroying the sentence, though in most cases they could be replaced with non-related synonyms at the cost of style (e.g., compare "The only thing we have to fear is terror".)
Semantic pleonasm and context
In many cases of semantic pleonasm, the status of a word as pleonastic depends on context. The relevant context can be as local as a neighboring word, or as global as the extent of a speaker's knowledge. In fact, many examples of redundant expressions are not inherently redundant, but can be redundant if used one way, and are not redundant if used another way. The "up" in "climb up" is not always redundant, as in the example "He climbed up and then fell down the mountain." Many other examples of pleonasm are redundant only if the speaker's knowledge is taken into account. For example, most English speakers would agree that "tuna fish" is redundant because tuna is a kind of fish. However, given the knowledge that "tuna" can also refer to a kind of edible prickly pear, the "fish" in "tuna fish" can be seen as non-pleonastic, but rather a disambiguator between the fish and the prickly pear.
Conversely, to English speakers who do not know Spanish, there is nothing redundant about "the La Brea tar pits" because the name "La Brea" is opaque: the speaker does not know that it is Spanish for "the tar" and thus "the La Brea Tar Pits" translates to "the the tar tar pits". Similarly, even though scuba stands for "self-contained underwater breathing apparatus", a phrase like "the scuba gear" would probably not be considered pleonastic because "scuba" has been reanalyzed into English as a simple word, and not an acronym suggesting the pleonastic word sequence "apparatus gear". (Most do not even know that it is an acronym and do not spell it SCUBA or S.C.U.B.A. Similar examples are radar and laser.)
See also
Notes
References
Citations
Bibliography
External links
Figures of speech
Linguistics
Rhetoric
Semantics
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Pervasive developmental disorder | The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) (from 1980 to 2013), and the International Classification of Diseases (ICD) (until 2022).
The pervasive developmental disorders included autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), childhood disintegrative disorder (CDD), overactive disorder associated with mental retardation and stereotyped movements, and Rett syndrome. The first four of these disorders are commonly called the autism spectrum disorders; the last disorder is much rarer, and is sometimes placed in the autism spectrum and sometimes not.
There is a division among doctors on the use of the term PDD. Many use the term PDD as a short way of saying PDD-NOS. Others diagnose the general category label of PDD because they are hesitant to diagnose very young children with a specific type of PDD, such as autism. Both approaches contribute to confusion about the term, because the term PDD is intended by its coiners and major bodies to refer to a category of disorders and not be used as a diagnostic label.
The terminology PDD and ASD is often used interchangeably and varies depending on location.
The onset of pervasive developmental disorders occurs during infancy, but the condition is usually not identified until the child is around three years old. Parents may begin to question the health of their child when developmental milestones are not met, including age appropriate motor movement and speech production.
The fifth edition of the DSM removed PDD as a category of diagnoses, and largely replaced it with ASD and a measure of the relative severity of the condition. The eleventh edition of the ICD also removed the category.
Signs and symptoms
Symptoms of PDD may include behavioral and communication problems such as:
Difficulty using and understanding language
Difficulty relating to people, objects, and events; for example, lack of eye contact, pointing behavior, and lack of facial responses
Unusual play with toys and other objects.
Paranoia, a characteristic form of social anxiety, derealization, transient psychosis, and unconventional beliefs if environment or routine are changed without notice
Repetitive body movements or behavior patterns, such as hand flapping, hair twirling, foot tapping, or more complex movements
Difficulty regulating behaviors and emotions, which may result in temper tantrums, anxiety, and aggression
Emotional breakdowns
Delusional or unconventional perception of the world
Maladaptive daydreaming
Degrees
Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information—loud noises, lights—are common.
Diagnosis
Diagnosis is usually made during early childhood. Individuals who received diagnoses based on the DSM-IV maintain their diagnosis under the autism spectrum disorders. However, an editorial published in the October 2012 issue of American Journal of Psychiatry notes that, while some doctors argue that there is insufficient evidence to support the diagnostic distinction between ASD and PDD, multiple literature reviews found that studies showing significant differences between the two disorders significantly outnumbered those that found no difference.
The World Health Organization’s International Classification of Diseases, 10th edition (ICD-10) categorized PDD into five distinct subtypes, each with their own diagnostic criteria. The five subtypes, childhood autism, atypical autism, Rett syndrome, Asperger syndrome and childhood disintegrative disorder, are characterized by abnormalities in social interactions and communication.
The disorders were primarily diagnosed based on behavioral features, although the presence of any other medical conditions is important, it is not taken into account when making a diagnosis.
Before the release of the DSM-5, some clinicians used PDD-NOS as a "temporary" diagnosis for children under the age of five when, for whatever reason, they are reluctant to diagnose autism. There are several justifications for this. Very young children have limited social interaction and communication skills to begin with, so it can be difficult to correctly diagnose milder cases of autism in toddlers. The unspoken assumption is that by the age of five, unusual behaviors will either resolve or develop into diagnosable autism. However, some parents view the PDD label as no more than a euphemism for autism spectrum disorders, while the PDD label makes it more difficult to receive aid for early childhood intervention.
Classification
The pervasive developmental disorders were:
Pervasive developmental disorder not otherwise specified (PDD-NOS), which includes atypical autism, and is the most common (47% of autism diagnoses);
Typical autism, the best-known;
Asperger syndrome (9% of autism diagnoses);
Rett syndrome; and
Childhood disintegrative disorder (CDD).
The first three of these disorders are commonly called the autism spectrum disorders; the last two disorders are much rarer, and are sometimes placed in the autism spectrum and sometimes not.
In May 2013, the Diagnostic and Statistical Manual–5th Edition (DSM-5) was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger syndrome, Rett syndrome, and CDD, has been removed and replaced with the general term of autism spectrum disorders (ASDs). The American Psychiatric Association has concluded that using the general diagnosis of ASD supports more accurate diagnoses. The grouping of these disorders into ASD also reflects that autism is characterized by common symptoms and should therefore bear a single diagnostic term. In order to distinguish between the different disorders, the DSM-5 employs severity levels. The severity levels take into account required support, restricted interests and repetitive behaviors, and deficits in social communication.
PDD and PDD-NOS
There is a division among doctors on the use of the term PDD. Many use the term PDD as a short way of saying PDD-NOS. Others use the general category because the term PDD actually refers to a category of disorders and is not a diagnostic label.
PDD is not itself a diagnosis, while PDD-NOS is a diagnosis. To further complicate the issue, PDD-NOS can also be referred to as "atypical personality development", "atypical PDD", or "atypical autism".
Treatment
Medications are used to address certain behavioral problems; therapy for children with PDD should be specialized according to the child's specific needs.
Some children with PDD benefit from specialized classrooms in which the class size is small and instruction is given on a one-to-one basis. Others function well in standard special education classes or regular classes with support. Early intervention, including appropriate and specialized educational programs and support services, play a critical role in improving the outcome of individuals with PDD.
See also
Infantile neuroaxonal dystrophy
Multiple complex developmental disorder
Multisystem developmental disorder
Overactive disorder associated with mental retardation and stereotyped movements
References
External links
CDC's "Learn the Signs. Act Early." campaign - Information for parents on early childhood development and developmental disabilities
NINFS Pervasive Developmental Disorders Information Page
Special education
Neurological disorders in children
Learning disabilities
Autism spectrum disorders
he:הפרעה התפתחותית נרחבת
sv:Autismspektrumstörning | 0.763069 | 0.99567 | 0.759765 |
Pro-ana | Promotion of anorexia is the promotion of behaviors related to the eating disorder anorexia nervosa. It is often referred to simply as pro-ana or ana. The lesser-used term pro-mia refers likewise to bulimia nervosa and is sometimes used interchangeably with pro-ana. Pro-ana groups differ widely in their stances. Most claim that they exist mainly as a non-judgmental environment for anorexics; a place to turn to, to discuss their illness, and to support those who choose to enter recovery. Others deny anorexia nervosa is a mental illness and claim instead that it is a lifestyle choice that should be respected by doctors and family.
Pro-ana sites often feature thinspiration (or thinspo): images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. The scientific community recognises anorexia nervosa as a serious illness. Some research suggests anorexia nervosa has the highest rate of mortality of any psychological disorder.
Culture
Medical professionals treating eating disorders have long noted that patients in recovery programs often "symptom pool", banding closely together for emotional support and validation. In this context, people with anorexia may collectively normalize their condition, defending it not as an illness but as an accomplishment of self-control and an essential part of their identity, with some members of these online communities going as far as claiming that starving oneself is a lifestyle choice rather than an illness. These 'lifestyle' claims may be a symptom of anosognosia. Other community members band together for support in managing their illnesses, such as sharing harm reduction tips and having others to talk to about their experiences that are going through the same thing. Many individuals in pro-ana communities use the phrase "pro for myself, not anyone else" to indicate that they are only interested in furthering their own disorders, not encouraging anyone else to imitate their behavior.
Online presence
Such advocacy has flourished on the Internet, mainly through tight-knit support groups centred on web forums and social network services such as Tumblr, Xanga, LiveJournal, Facebook and Myspace. These groups are typically small, vulnerable, partly hidden and characterized by frequent migrations. They also have a high female readership and are frequently the only means of support available to socially isolated anorexics.
Members of such support groups may:
Endorse anorexia and/or bulimia as desirable (84% and 64% respectively in a 2010 survey).
Share crash dieting techniques and recipes (67% of sites in a 2006 survey, rising to 83% in a 2010 survey).
Coach each other on using socially acceptable pretexts for refusing food, such as veganism (which is notably more prevalent in the eating-disordered in general).
Compete with each other at losing weight, or fast together in displays of solidarity.
Commiserate with one another after breaking fast or binging.
Advise on how to best induce vomiting, and on using laxatives and emetics.
Give tips on hiding weight loss from parents and doctors.
Share information on reducing the side-effects of anorexia.
Post their weight, body measurements, details of their dietary regimen or pictures of themselves to solicit acceptance and affirmation.
Suggest ways to ignore or suppress hunger pangs.
Many have popular blogs and forums on which members seek companionship by posting about their daily lives or boasting about personal accomplishments of weight loss. The communities centred on such sites can be warmly welcoming (especially in recovery-friendly groups) or sometimes cliquish and openly suspicious of newcomers. In particular, hostility is often leveled at:
The non-eating disordered who express disapproval, including the spouses, relatives and friends of members who appear on-site to post threats and warnings.
Casual dieters who join, believing that inducing eating disorders will cause them to lose weight more effectively. Such people are often derisively referred to as "wannabes" or "wannarexics".
Thinspiration
Pro-ana sites often (84%, in a 2010 survey) feature thinspiration (or thinspo): images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. Pro-ana bloggers, forum members and social networking groups likewise post thinspiration to motivate one another toward further weight loss. Conversely, reverse thinspiration features images of fatty food or overweight people intended to induce disgust. There exists significant controversy between supporters and opponents of thinspiration; some assert that thinspiration only "glorifies" eating disorders while some thinspiration bloggers argue that the purpose of thinspiration is to support a healthy level of weight loss.
Thinspirational clips circulate widely on video sharing sites, pro-ana blogs often post thinspirational entries, and many pro-ana forums have threads dedicated to sharing thinspiration. Thinspiration can also take the form of inspirational mantras, quotes or selections of lyrics from poetry or popular music (94% of sites in a 2003 survey).
Thinspiration often has a spiritual-ascetic flavour, referring to fasting through metaphors of bodily purity, food through allusions to sin and corruption, and thinness through imagery of angels and angelic flight. Exhortations like "Ana's Creed" and "The Thin Commandments" are also common.
Appeal
Social researchers studying pro-ana have varied explanations for its popularity, with some characterizing it as a rejection of modern consumerism and others suggesting that pro-ana functions as a coping mechanism for those already emotionally stressed by eating disorders. However, most agree on two elements of pro-ana sites:
Initially, pro-ana sites attract both the non-eating disordered (who first visit seeking tips and techniques for losing weight) and the eating-disordered (who seek advice on hiding their disordered behaviors or minimizing the physical damage caused by over-exercising and severe calorie restriction).
Pro-ana sites give their members a strong sense of community and common identity.
Fashion
Red bracelets are popularly worn in pro-ana, both as a discreet way for anorexics to socially identify and as a tangible reminder to avoid eating. Pro-mia bracelets, likewise, are blue or purple. Most such bracelets are simple beaded items traded briskly on online auction sites.
Impact
Proliferation
Pro-ana has proliferated rapidly on the Internet, with some observers noting a first wave of pro-ana sites on free web hosting services in the late 1990s, and a second wave attributed to the recent rise of blogging and social networking services.
A survey by Internet security firm Optenet found a 470% increase in pro-ana and pro-mia sites from 2006 to 2007. A similar increase was also noted in a 2006 Maastricht University study investigating alternatives to censorship of pro-ana material. In the study, the Dutch blog host punt.nl began in October 2006 presenting visitors to pro-ana blogs on its service with a click-through warning containing a disparaging message and links to pro-recovery sites. Although the warnings were a deterrence (33.6% of the 530,000 unique visitors logged did not proceed past the warning), the number of such blogs actually increased tenfold, with their monthly traffic figures doubling on average by the end of the study.
Viewership
In a 2009 survey by the Katholieke Universiteit Leuven of 711 Flemish high school students aged 13–17, 12.6% of girls and 5.9% of boys reported having visited pro-ana websites at least once. In another 2009 survey, by parental control software vendor CyberSentinel of 1500 female Internet users aged 6–15, one in three reported having searched online for dieting tips, while one in five reported having corresponded with others on social networking sites or in chat rooms for tips on dieting.
Visitors to pro-ana web sites also include a significant number of those already diagnosed with eating disorders: a 2006 survey of eating disorder patients at Stanford Medical School found that 35.5% had visited pro-ana web sites; of those, 96.0% learned new weight loss or purging methods from such sites (while 46.4% of viewers of pro-recovery sites learned new techniques).
Effect
Pro-ana sites can negatively impact the eating behavior of people with and without eating disorders. One study of individuals without eating disorders demonstrated that 84% of participants decreased caloric intake by an average of 2,470 calories (301 min -7851 max) per week after viewing pro-ED (eating disorder) websites. Only 56% of participants actually perceived the reduction in their intake. Three weeks after the experiment, 24% of participants reported continuing weight control strategies from pro-ana websites, though they did not continue to visit those sites. Controls viewing health and travel websites did not decrease caloric intake at a significant level. Other studies have found that women with varying levels of eating disorder symptomatology were more likely to engage in image comparison and exercise after viewing pro-ana websites versus control websites.
Pro-ana sites can negatively impact cognition and affect. Women who viewed a pro-ana site, but not control sites focused on fashion or home décor, experienced an increase in negative affect and decreases in self-esteem, appearance self-efficacy, and perceived attractiveness. They also reported feeling heavier and being more likely to think about their weight. The effects of perfectionism, BMI, internalization of the thin ideal, and pre-existing ED symptomatology as moderators of negative affect were comparable to chance, suggesting that pro-ana websites can affect a broad spectrum of individuals, not simply those with ED characteristics.
A 2007 survey by the University of South Florida of 1575 girls and young women found that those who had a history of viewing pro-ana websites did not differ from those who viewed only pro-recovery websites on any of the survey's measures, including body mass index, negative body image, appearance dissatisfaction, level of disturbance, and dietary restriction. Those who had viewed pro-ana websites were, however, moderately more likely to have a negative body image than those who did not.
Similarly, girls in the 2009 Leuven survey who viewed pro-ana websites were more likely to have a negative body image and be dissatisfied with their body shape.
A 2012 report by Deloitte Access Economics, commissioned by Australian non-profit The Butterfly Foundation, estimated that eating disorders resulted in productivity losses totaling just over $AUD15 billion, with 1828 (515 males and 1313 females) dying that year from eating disorder-related complications.
Social support vs. exacerbation of illness
Unlike pro-ana sites, pro-recovery sites are designed to encourage development and maintenance of healthy behaviors and cognitions. A study of pro-ana and pro-recovery website use among adolescents with eating disorders found that adolescents used both types of websites to further eating disordered behaviors. Those who viewed pro-ana sites were comparable to those who viewed pro-recovery sites with respect to appearance dissatisfaction, restriction, and bulimic behaviors. Over half of parents were unaware of any ED website usage.
People who use pro-ana sites report lower social support than controls and seek to fill this deficit by use of pro-ana sites. While pro-ana site users in this study perceived greater support from online communities than offline relationships, they also reported being encouraged to continue eating disorder behaviors. Users of pro-ana sites (n=60) cited a sense of belonging (77%), social support (75%), and support for the choice to continue current eating disorder behaviors (54%) as reasons for joining a pro-ana site. Reasons for continuing to use a pro-ana site included general support for stress (84%), meeting others with eating disorders (50%), and finding triggers for eating disorder behaviors (37%). Finally, behaviors first learned after visiting a pro-ana site include using thinspiration (63%), hiding eating disorder behaviors (60%), fasting (57%), using diuretics and laxatives (45%), vomiting (23%), using alcohol or other drugs to inhibit appetite (22%), and self-harm (22%).
Some studies, however, claim that the link between pro-ana websites and increased incidence of eating disorders are not strongly linked; instead, these communities have just increased the visibility of those affected. It's possible that health professionals and academics are eager to place blame on these communities because of this increased visibility and being an "easy target" for understanding the complex problem of root causes of eating disorders.
Controversy and criticism
Many medical professionals and some anorexics view pro-ana as a glamorization of a serious illness. Pro-ana began to attract attention from the mainstream press when The Oprah Winfrey Show aired a special episode in October 2001 focusing on pro-ana. Pressure from the public and pro-recovery organizations led to Yahoo and GeoCities shutting down pro-ana sites. In response, many groups now take steps to conceal themselves, disclaim their intentions as neutral and recovery-supportive (58% of sites in a 2006 survey), or interview members to screen out the non-eating disordered.
Medical profession
Health care professionals and medical associations have generally negative views of pro-ana groups and the information they disseminate:
The National Association of Anorexia Nervosa and Associated Disorders (ANAD) states that Pro-Ana sites "can pose a serious threat to some individuals, not simply because they promote eating disorder behaviors, but because they build a sense of community that is unhealthy. They lure the impressionable and persuade them that the Pro-Ana community is providing caring and nurturing advice."
The Academy for Eating Disorders (AED) stated that "websites that glorify anorexia as a lifestyle choice play directly to the psychology of its victims", expressing concern that sites dedicated to the promotion of anorexia as a desirable "lifestyle choice" "provide support and encouragement to engage in health threatening behaviors, and neglect the serious consequences of starvation." However, one of its board members, Eric van Furth, has noted that pro-ana sites have relatively few visitors and advises against legal sanction of such sites, claiming instead that popular media play the more important role in establishing ideals of female thinness.
Bodywhys (the Eating Disorders Association of Ireland) notes that pro-ana sites "might initially help people to feel less isolated, but the community that they create is an unhealthy community that encourages obsessiveness and minimization of the seriousness of these potentially deadly disorders."
B-eat (the Eating Disorders Association of the UK) has remarked that those who seek out pro-ana sites do so "to find support, understanding and acceptance. We don't call for the sites to be banned, but rather for everyone else to consider how they can also provide that understanding and acceptance so that these sites don't become the only refuge for someone."
The UK Royal College of Psychiatrists has called for the Council of Child Internet Safety—a UK government advisory body—to expand its definition of harmful online content to include pro-ana sites, and to inform parents and teachers of the dangers of pro-ana, arguing that "the broader societal context in which pro-ana and pro-mia sites thrive is one where young women are constantly bombarded with toxic images of supposed female perfection that are impossible to achieve, make women feel bad about themselves and significantly increase their risk of eating disorders."
The National Eating Disorders Association (NEDA) "actively speaks out against pro-anorexia and pro-bulimia websites. These sites provide no useful information on treatment but instead encourage and falsely support those who, sadly, are ill but do not seek help." NEDA has also warned that journalists often glamorize anorexia by associating anorexia with personal self-control and that media coverage of pro-ana often triggers the already-anorexic by mentioning weights and calorie counts and by showing photographs of thin people.
Media
In October 2001, The Oprah Winfrey Show hosted a special on anorexia; the pro-ana movement was discussed briefly by the guest panel, who expressed alarm at the appearance of pro-ana websites and recommended the use of filtering software to bar access to them.
In July 2002, the Baltimore City Paper published an investigative report into pro-ana on the web.
"Growing up Online", a January 2008 episode of the PBS Frontline television program, also featured a brief discussion of pro-ana.
The 2009 novel Wintergirls features a protagonist with anorexia, who at one point in the novel seeks support from a pro-ana forum, referring to the people there as “her sisters” and “the only people that understand”.
In April 2009, The Truth about Online Anorexia, an investigative documentary about pro-ana on the Internet, aired on ITV1 in the UK presented by BBC Radio 1 DJ Fearne Cotton.
In April 2012 speech at Harvard University, Vogue Italia editor Franca Sozzani conceded that the fashion industry may be a cause of the recent rise in eating disorders, but that the industry was being unfairly singled out for blame: "How can all this be possibly caused by fashion? And how come that Twiggy, who would be surely considered an anorexic today, did not arise controversy in the Sixties and did not produce a string of anorexia followers?" According to Sozzani, pro-ana sites were more effective at promoting eating disorders, and obesity was the more pressing public health problem that food industry was not being likewise attacked for exacerbating.
The existence of pro-ana blogs and forums was featured in the 2014 Lifetime film Starving in Suburbia, which starred Polish actress Izabella Miko as "ButterflyAna", a beautiful model and moderator on the internet who promotes anorexia religiously to the followers of her blog. This entices teenager Hannah (Laura Wiggins) to become severely anorexic; this was also the first Lifetime film to address the subject matter of anorexia among men and boys, when Hannah's brother, Leo, is revealed to suffer from anorexia and later dies due to health complications from the disorder.
Arts
Thirty-two kilos, an exhibition by photographer Ivonne Thein, went on display at the Berlin Postfuhramt art exhibition center in May 2008 and the Washington Goethe-Institut in January 2009, featuring photographs of young women digitally manipulated to appear skeletally thin. Thein said that the photographs were intended as a mocking and satirical take on pro-ana. However, many images from the exhibition were nevertheless later shared online as thinspiration.
Social networking services
In July 2001, Yahoo—after receiving a letter of complaint from ANAD—began removing pro-ana sites from its Yahoo Clubs (now Yahoo Groups) service, stating that such sites endorsing self-harm were violations of its terms of service agreement.
LiveJournal has not made a position statement on pro-ana. In August 2007, however, a staff member declined to act on an abuse report filed against a pro-ana community hosted on its network, stating that:
Facebook staff seek out and regularly delete pro-ana related groups. A spokesperson for the online service has stated that such pages violate the site's terms of service agreement by promoting self-harm in others.
MySpace does not ban pro-ana material and has stated that
MySpace has chosen instead to cycle banner advertisements for pro-recovery organizations through pro-ana members' profiles.
In November 2007, Microsoft shut down four pro-ana sites on the Spanish-language version of its Spaces social networking service at the behest of IQUA, the Internet regulatory body for Catalonia. A Microsoft spokesperson stated that such sites "infringe all the rules on content created by users and visible on our sites".
In September 2008, San Sebastián-based Spanish-language web portal removed its pro-ana forums at the request of the provincial prosecutor for Guipúzcoa and the , who stated that "while not illegal, the harmful and false information in such forums being disseminated to minors will impair their proper development."
In February 2012, after consulting with NEDA, the blog-hosting service Tumblr announced that it would shut down blogs hosted on its microblogging service which "actively promote or glorify self harm," including eating disorders, and display warnings with names of organizations that can help facilitate recovery in people affected by eating disorders, on searches for common pro-eating disorder terms. Despite this, Tumblr remains a large hub for pro-ana microblogging. Pinterest, a social photo-sharing site, similarly amended its TOS in March 2012 to ban pro-ana content, but was similarly unsuccessful. Instagram followed suit and announced in April 2012 that it would summarily disable any accounts on its photo-sharing service with pro-ana specific hashtags on images.
TikTok's algorithm has been criticized for amplifying pro-ana content.
Politics
In the United Kingdom, 40 MPs signed an early day motion tabled in February 2008 by the then Liberal Democrats member for Cheadle, Mark Hunter, urging government action against pro-ana sites. The motion was timed to coincide with the UK National Eating Disorder Awareness Week.
In the United Kingdom, Jo Swinson, the Liberal Democrat member for East Dunbartonshire, called for advertisers to voluntarily adopt similar disclaimers in an adjournment debate in October 2009, and later in an early day motion tabled in February 2010. She has stated that such "photos can lead people to believe in realities that, very often, do not exist," and that "when teenagers and women look at these pictures in magazines, they end up feeling unhappy with themselves."
In April 2008, a bill outlawing material which "provokes a person to seek excessive thinness by encouraging prolonged restriction of nourishment" was tabled in the French National Assembly by UMP MP Valérie Boyer. It imposes a fine of €30,000 and two years imprisonment (rising to €45,000 and three years if there was a resulting death) on offenders. Health minister Roselyne Bachelot, arguing for the bill, stated that "giving young girls advice about how to lie to their doctors, telling them what kinds of food are easiest to vomit, encouraging them to torture themselves whenever they take any kind of food is not part of liberty of expression." The bill passed the National Assembly, but stalled in the Senate, where a June 2008 report by the Committee of Social Affairs emphatically recommended against such legislation and instead suggested early-screening programs by schools and physicians.
Boyer subsequently introduced another bill in September 2009 to mandate disclaimers on photographs in which body parts have been retouched, with the aim of reducing the impact of unrealism in photography on young girls and women. The bill was ostensibly targeted at advertising photography but could be broadly applicable to digitally manipulated photography in general, including thinspirational montages. It imposes a penalty of €37,500 per violation, with a possible rise to 50% of the cost of each advertisement. The bill did not pass its first reading and was relegated to the Committee of Social Affairs.
In April 2009, Dutch Minister for Youth and Family André Rouvoet called for click-through warnings to be added to all pro-ana sites on Dutch hosting services, citing a successful trial of such warnings by blog host punt.nl in 2006. The Dutch Hosting Provider Association, however, has stated that "the Internet is simply a reflection of a world with many undesirable things", and that its members cannot be held responsible for monitoring and disclaiming all hosted content.
In March 2012, the Israeli Knesset passed a bill sponsored by Kadima MK Rachel Adato and Likud MK Danny Danon requiring advertisements which have been retouched to alter the body shape of models to fully disclose the fact. The bill, which applies to both foreign-produced and locally produced advertising, also sets a lower BMI limit for models featured in advertisements of 18.5 (the threshold of underweight under World Health Organization guidelines).
Popular culture
In a November 2009 interview with Women's Wear Daily, model Kate Moss gave a popular thinspirational slogan as her motto: "Nothing tastes as good as skinny feels." Moss came under widespread criticism—particularly by eating disorder recovery organizations—for endorsing pro-ana. Her agency, Storm, stated: "This was part of a longer answer Kate gave during a wider ranging interview which has unfortunately been taken out of context and misrepresented." Still, Moss has been known in the fashion world to have helped popularize the "heroin chic" trend, which uses models with disheveled, ultra-skinny, and waif-like body types on the runway.
See also
Fat acceptance movement
Inedia
References
Anorexia nervosa
Culture-bound syndromes
Body shape
Self-harm | 0.764476 | 0.993823 | 0.759754 |
Andragogy | Andragogy refers to methods and principles used in adult education. The word comes from the Greek ἀνδρ- (andr-), meaning "adult male", and ἀγωγός (agogos), meaning "leader of". Therefore, andragogy literally means "leading men (adult males)", whereas "pedagogy" literally means "leading children".
Definitions
There are many different theories in the areas of learning, teaching and training. Andragogy commonly is defined as the art or science of teaching adults or helping adults learn. In contrast to pedagogy, or the teaching of children, andragogy is based on a humanistic conception of self-directed and autonomous learners where teachers are defined as facilitators of learning.
Although Malcolm Knowles proposed andragogy as a theory, others posit that there is no single theory of adult learning or andragogy. In the literature where adult learning theory is often identified as a principle or an assumption, there are a variety of different approaches and theories that are also evolving in view of evolving higher education instruction, workplace training, new technology and online learning (Omoregie, 2021).
Malcolm Knowles identified these adult learner characteristics related to the motivation of adult learning.
Need to know: Adults need to know the reason for learning something.
Foundation: Experience (including error) provides the basis for learning activities.
Self-concept: Adults need to be responsible for their decisions on education; involvement in the planning and evaluation of their instruction.
Readiness: Adults are most interested in learning subjects having immediate relevance to their work and/or personal lives.
Orientation: Adult learning is problem-centered rather than content-oriented.
Motivation: Adults respond better to internal versus external motivators.
Blaschke (2012) described Malcolm Knowles' 1973 theory as "self-directed" learning. The goals include helping learners develop the capacity for self-direction, supporting transformational learning and promoting "emancipatory learning and social action" (Blaschke, 2019, p. 76).
Although Knowles' andragogy is a well-known theory in the English-speaking world, his theory has an ancillary role internationally. This is especially true in European countries where andragogy is a term used to refer to a field of systematic reflection. The acceptance of andragogy in European countries, according to St. Clair and Käpplinger (2021) is to accept andragogy as the "scientific study of learning in adults and the concomitant teaching approaches" (p. 485). Further, the definition of andragogy and its application to adult learning is more variable currently due to both the impact of globalization and the rapid expansion of adult online learning.
History
The term was originally coined by German educator Alexander Kapp in 1833. Andragogy was developed into a theory of adult education by Eugen Rosenstock-Huessy. It later became very popular in the US by the American educator Malcolm Knowles. Knowles asserted that andragogy (Greek: "man-leading") should be distinguished from the more commonly used term pedagogy (Greek: "child-leading").
Knowles collected ideas about a theory of adult education from the end of World War II until he was introduced to the term "androgogy". In 1966, Knowles met Dušan Savićević in Boston. Savićević was the one who shared the term andragogy with Knowles and explained how it was used in the European context. In 1967, Knowles made use of the term "andragogy" to explain his theory of adult education. Then after consulting with Merriam-Webster, he corrected the spelling of the term to "andragogy" and continued to make use of the term to explain his multiple ideas about adult learning.
Knowles' theory can be stated with six assumptions related to the motivation of adult learning:
Need to know: Adults need to know the reason for learning something.
Foundation: Experience (including error) provides the basis for learning activities.
Self-concept: Adults need to be responsible for their decisions on education; involvement in the planning and evaluation of their instruction.
Readiness: Adults are most interested in learning subjects having immediate relevance to their work and/or personal lives.
Orientation: Adult learning is problem-centered rather than content-oriented.
Motivation: Adults respond better to internal versus external motivators.
In most European countries, the Knowles discussion played at best, a marginal role. "Andragogy" was, from 1970 on, connected with emerging academic and professional institutions, publications, or programs, triggered by a similar growth of adult education in practice and theory as in the United States. "Andragogy" functioned here as a header for (places of) systematic reflections, parallel to other academic headers like "biology", "medicine", and "physics".
Early examples of this use of andragogy are the Yugoslavian (scholarly) journal for adult education, named Andragogija in 1969, and the Yugoslavian Society for Andragogy; at Palacky University in Olomouc (Czech Republic) the Katedra sociologie a andragogiky (Sociology and Andragogy Department) was established in 1990. Also, Prague University has a Katedra Andragogiky (Andragogical Department); in 1993, Slovenia's Andragoski Center Republike Slovenije (Slovenian Republic Andragogy Center) was founded with the journal Andragoska Spoznanja; in 1995, Bamberg University (Germany) named a Lehrstuhl Andragogik (Androgogy Chair).
On this formal level "above practice" and specific approaches, the term "andragogy" could be used relating to all types of theories, for reflection, analysis, training, in person-oriented programs, or human resource development.
Principles
Adult learning is based upon comprehension, organization and synthesis of knowledge rather than rote memory. Some scholars have proposed seven principles of adult learning:
Adults must want to learn: They learn effectively only when they are free to direct their own learning and have a strong inner motivation to develop a new skill or acquire a particular type of knowledge, this sustains learning.
Adults will learn only what they feel they need to learn – Adults are practical in their approach to learning; they want to know, "How is this going to help me right now? Is it relevant (content, connection, and application) and does it meet my targeted goals?"
Adults learn by doing: Adolescents learn by doing, but adults learn through active practice and participation. This helps in integrating component skills into a coherent whole.
Adult learning focuses on problem solving: Adolescents tend to learn skills sequentially. Adults tend to start with a problem and then work to find a solution. A meaningful engagement, such as posing and answering realistic questions and problems is necessary for deeper learning. This leads to more elaborate, longer lasting, and stronger representations of the knowledge (Craik & Lockhart, 1972).
Experience affects adult learning: Adults have more experience than adolescents. This can be an asset and a liability, if prior knowledge is inaccurate, incomplete, or immature, it can interfere with or distort the integration of incoming information (Clement, 1982; National Research Council, 2000).
Adults learn best in an informal situation: Adolescents have to follow a curriculum. Often, adults learn by taking responsibility for the value and need of content they have to understand and the particular goals it will achieve. Being in an inviting, collaborative and networking environment as an active participant in the learning process makes it efficient.
Adults want guidance and consideration as equal partners in the process: Adults want information that will help them improve their situation. They do not want to be told what to do and they evaluate what helps and what doesn't. They want to choose options based on their individual needs and the meaningful impact a learning engagement could provide. Socialization is more important among adults.
Academic discipline
In the field of adult education during recent decades, a process of growth and differentiation emerged as a scholarly and scientific approach, andragogy. It refers to the academic discipline(s) within university programs that focus on the education of adults; andragogy exists today worldwide. The term refers to a new type of education which was not qualified by missions and visions, but by academic learning including: reflection, critique, and historical analyses.
Dušan Savićević, who provided Knowles with the term andragogy, explicitly claims andragogy as a discipline, the subject of which is the study of education and learning of adults in all its forms of expression' (Savicevic, 1999, p. 97, similarly Henschke, 2003,), Reischmann, 2003.
Recent research and the COVID 19 pandemic have expanded andragogy into the online world internationally, as evidenced by country and international organizations that foster the development of adult learning, research and collaboration in educating adults. New and expanding online instruction is fostered by national organizations, literacy organizations, academic journals and higher education institutions that are helping adults to achieve learning and skills that will contribute to individual economic improvement.
New learning resources and approaches are identified, such as finding that using collaborative tools like a wiki can encourage learners to become more self-directed, thereby enriching the classroom environment. Andragogy gives scope to self-directed learners and helps in designing and delivering the focused instructions. The methods used by andragogy can be used in different educational environments (e.g. adolescent education).
Internationally there are many academic journals, adult education organizations (including government agencies) and centers for adult learning housed in a plethora of international colleges and universities that are working to promote the field of adult learning, as well as adult learning opportunities in training, traditional classes and in online learning.
In academic fields, andrologists are those who practice and specialize in the field of andragogy. Andragologists have received a doctoral degree from an accredited university in Education (EdD) or a Philosophy (PhD) and focused their dissertation utilizing andragogy as a main component of their theoretical framework.
Differences in learning: The Pedagogy, andragogy and heutagogy continuum
In the 20th century, adult educators began to challenge the application of pedagogical theory and teacher-centered approaches to the teaching of adults. Unlike children, adult learners are not transmitted knowledge. Rather, the adult learner is an active participant in their learning. Adult students also are asked to actively plan their learning process to include identifying learning objectives and how they will be achieved. Knowles (1980) summarized the key characteristics of andragogy in this model: 1) independency or self-directedness 2) using past experiences to construct learning, 3) association with readiness to learn, and 4) changing education perspectives from subject-centered one to performance centered perspectives.
A new educational strategy has evolved in response to globalization that identifies learners as self-determined, especially in higher education and work-place settings: heutagogy, a process where students learn on their own with some guidance from the teacher. The motivation to learn comes from the students' interest in not only performing, but being recognized for their accomplishment (Akiyildiz, 2019). In addition, in heutagogy, learning is learner-centric - where the decisions relating to the learning process are managed by the student. Further, the student determines whether or not the learning objectives are met.
Differences between pedagogy, andragogy, and heutagogy include:
Critique
There is no consensus internationally on whether andragogy is a learning theory or a set of principles, characteristics or assumptions of adult learning. Knowles himself changed his position on whether andragogy applied only to adults and came to believe that "pedagogy-andragogy represents a continuum ranging from teacher-directed to student-directed learning and that both approaches are appropriate with children and adults, depending on the situation." Hanson (1996) argues that the difference in learning is not related to the age and stage of one's life, but instead related to individual characteristics and the differences in "context, culture and power" within different educational settings.
In another critique of Knowles' work, Knowles was not able to use one of his principles (Self-concept) with adult learners to the extent that he describes in his practices. In one course, Knowles appears to allow "near total freedom in learner determination of objectives" but still "intended" the students to choose from a list of 18 objectives on the syllabus. Self-concept can be critiqued not just from the instructor's point of view, but also from the student's point of view. Not all adult learners will know exactly what they want to learn in a course and may seek a more structured outline from an instructor. An instructor cannot assume that an adult will desire self-directed learning in every situation.
Kidd (1978) goes further by claiming that principles of learning have to be applied to lifelong development. He suggested that building a theory on adult learning would be meaningless, as there is no real basis for it. Jarvis even implies that andragogy would be more the result of an ideology than a scientific contribution to the comprehension of the learning processes. Knowles himself mentions that andragogy is a "model of assumptions about learning or a conceptual framework that serves as a basis for an emergent theory." There appears to be a lack of research on whether this framework of teaching and learning principles is more relevant to adult learners or if it is just a set of good practices that could be used for both children and adult learners.
The way adults learn is different from the pedagogical approach used to foster learning in K-12 settings. These learning differences are key and can be used to show that the six characteristics/principles of andragogy remain applicable when designing teaching and learning materials, in English as a Foreign Language (EFL), for example.
See also
References
Further reading
Loeng, S. (2012). Eugen Rosenstock-Huessy – an andragogical pioneer. Studies in Continuing Education,
Reischmann, Jost (2005): Andragogy. In: English, Leona (ed): International Encyclopedia of Adult Education. London: Palgrave Macmillan. S. 58–63. (.pdf-download)
Smith, M. K. (1996; 1999) 'Andragogy', in the Encyclopedia of Informal Education.
Andragogy and other Learning Theories
Philosophy of education | 0.764656 | 0.993581 | 0.759748 |
Tavistock and Portman NHS Foundation Trust | The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust based in north London. The Trust specialises in talking therapies. The education and training department caters for 2,000 students a year from the United Kingdom and abroad. The Trust is based at the Tavistock Centre in Swiss Cottage. The founding organisation was the Tavistock Institute of Medical Psychology founded in 1920 by Hugh Crichton-Miller.
The Tavistock and Portman NHS Trust was formed in 1994, when the Tavistock Clinic merged with the neighbouring Portman Clinic in Fitzjohns Avenue. The Portman specialises in areas of forensic psychiatry, including the treatment of addictive, sociopathic and criminal behaviours and tendencies.
It has developed as a centre for psychoanalysis within the NHS since being included at its founding in 1948.
The Trust and predecessor organisations have been influential beyond medicine, including in the British Army, management consultancy, prison and probation services.
Early history
It owes its name to the fact that its original location was in Tavistock Square in central London. When it moved later to larger premises, it took its name with it.
Although Hugh Crichton-Miller was a psychiatrist who developed psychological treatments for shell-shocked soldiers during and after the First World War, clinical services were always destined for both children and adults. The clinic's first patient was a child. From its foundation it was also clear that to offer free treatment to all who need it meant that the Tavistock Clinic needed to generate income by providing training to clinical professionals who could eventually help people across the UK and beyond. The clinical staff were also researchers. These principles remain influential to this day.
Following its foundation the Tavistock Clinic developed a focus on preventive psychiatry, expertise in group relations – including army officer selection – social psychiatry, and action research. There was an openness to different streams of research and thought as, for instance, the famous series of lectures given by the Swiss psychiatrist and one time collaborator of Sigmund Freud, Carl Jung, which were attended by doctors, churchmen and members of the public, including H. G. Wells and Samuel Beckett.
Its staff, who were still mainly unpaid honorary psychiatrists, psychologists and social workers, were interested in researching and consulting to leadership within the armed forces. The staff also offered treatment to members of the civilian population who might be traumatised by the prospect of a further world war, which could bring bombing of cities, evacuation of children and the shocks of loss and bereavement.
Post-war history
After the Second World War, the Tavistock Clinic benefited from the Northfield Hospital experience and from the arrival of talented professionals from Europe, many fleeing Nazi persecution. In 1948 it became a leading clinic within the newly created National Health Service. At this point its education and training services were managed separately by the Tavistock Institute for Medical Psychology, which was also the umbrella for the Tavistock Institute, involved in social action research and thinking about group relations and organisational dynamics, and for work with marital couples. The clinic was managed on a democratic model by a professional committee and developed further its distinct focus on multi-disciplinary and community-centred work. At the Clinic's centenary in 2020 many post-war Tavistock staff contributed personal chapters in "The Tavistock Century" (edited by Margot Waddell and Sebastian Kraemer, Phoenix Publishing House https://firingthemind.com/product/9781912691715/)
Children and young people
New developments in child and adolescent mental health were particularly fruitful in the immediate post-war period. In 1948 the creation of the children's department supported the development of training in child and adolescent psychotherapy. Dr John Bowlby supported this new training and naturalistic infant observation. He also developed Attachment Theory. Husband and wife clinicians James Robertson and Joyce Robertson showed in their film work the impact of separation in temporary substitute care on young children for example, when their parent was admitted to hospital. The Australian Hazel Harrison was teacher-in-charge from 1954 to 1956 where she worked with Bowlby. They looked in detail at English pre-school education.
The Tavistock Clinic opened its Adolescent Department in 1959, recognising the distinctive developmental needs and difficulties of younger and older adolescents. In 1967 it absorbed the London Child Guidance Clinic, founded in 1929.
In 1989 the Tavistock established the Gender Identity Development Service (GIDS), a highly specialised clinic for young people presenting with difficulties with their gender identity.
In July 2022, following a critical independent review from Hilary Cass, it was announced that this service would be discontinued and replaced with regional clinics providing a more "holistic" approach.
Training in education
By the 1960s The Tavistock Clinic was also providing both 1-year and 4-year professional training courses in educational psychology, the latter embracing a teacher training element through Leicester University School of Education. For a number of years the senior tutor and principal psychologist for these courses was Irene Caspari who did much to promote the concept and practice of Educational therapy. In the 1970s systemic psychotherapy became the Tavistock Clinic's newest professional training. Applications of the clinical ideas and skills of its multidisciplinary clinicians are at the heart of its education and training, with academically validated programmes developing from the early 1990s with the University of East London, and later with the University of Essex and Middlesex University.
Reflecting on the workplace
Work discussion, supervised clinical practice and experiential group relations work are central to many trainings all of which aim to equip mental health workers with the emotional, organisational, and relational capacities to operate confidently in front line settings. A BBC TV series 'Talking Cure: Jan' brought the work of the Clinic to a wider audience in 1999 and remains relevant today. Organisational consultancy by former CEO Anton Obholzer, featured in the TV series, and their edited collection, with Vega Roberts, 'The Unconscious at Work: Individual and Organizational Stress in the Human Services', remains one of the classic texts to emerge from the Tavistock Clinic.
Public sphere
The Tavistock's tradition of social and political engagement has been renewed in recent years through its programme of Policy Seminars which model a dialogic, exploratory approach to policy analysis and debate with the social epidemiologist, Richard G. Wilkinson, the psychologist, Oliver James and the columnist, Polly Toynbee, among recent contributors. The series of Thinking Space events follows a similar model of participatory engagement around themes of diversity, racism, and sexual orientation.
The Tavistock Institute, which had been part of the Tavistock family, moved to its own premises in 1994. The Tavistock Centre for Couples Relationships, TCCR, formerly the Tavistock Institute of Marital Studies, was always a separate, charitably-funded organisation which left the Tavistock Centre for new premises in 2009.
NHS Trust
In 1994, the Tavistock Clinic joined with the Portman Clinic to become the Tavistock and Portman NHS Trust. In 2006 the Trust acquired NHS Foundation Trust status and become the Tavistock and Portman NHS Foundation Trust. It is an active member of UCL Partners, the Academic Health Service Centre located in North London.
Paul Burstow, a former Minister of State for Care and Support in the Cameron-Clegg coalition government, became Chair of the Trust in November 2015.
Services
The Trust provides clinical services for children and families, young people and adults. It also provides multi-disciplinary training and education. These programmes include core professional training, for example in psychiatry, psychology, social work and advanced psychotherapy training, as well as applied programmes for anyone working in the mental health or social care workforce.
Since 2010, the clinical work of the Trust has diversified, with new services, such as the Family Drug and Alcohol Court in Milton Keynes, and the City and Hackney community psychotherapy service.
It is the largest provider of transgender services in England, but funding for the service has not kept pace with demand. In August 2019, 5,717 people were on the waiting list for a first appointment, and average waiting time was about two years. The Gender Identity Development Service (GIDS) at the Tavistock Centre has come under scrutiny due to reports that concerns over children's welfare were "shut down". The Tavistock and Portman NHS Trust have defended their practices. In July 2022, following criticism in the interim report by Hilary Cass, it was announced that this service would be discontinued, and replaced with regional clinics providing a more "holistic" approach. It was set to close at the end of March 2024.
In February 2023, BBC journalist Hannah Barnes' book, Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children was published. Barnes describes the premise of the book by saying, "I wanted to write a definitive record of what happened [at GIDS] because there needs to be one."
Performance
The Tavistock was named by the Health Service Journal as one of the top hundred NHS trusts to work for in 2015. At that time, it had 449 full-time equivalent staff, and a sickness absence rate of 0.92%. 84% of staff recommend it as a place for treatment and 73% recommended it as a place to work.
The Trust borrowed £58 million in 2016, which it intends to repay by selling its current sites.
Discrimination claim
The Tavistock has been accused of forcing racist ideology on students, with lectures such as "Whiteness - A Problem of Our Time", and in 2022 a claim against the Trust for discrimination on the basis of race and religion was commenced.
Notable contributors to the clinic
Over the years many hundreds of staff members, at all levels, have contributed to the work of this institution. This list is merely representative of some of the lasting contributors to the different fields encompassed by the Clinic.
Medical directors, chief executives and Chair of Trust
Hugh Crichton-Miller 1920–1933
John Rawlings Rees 1933–1947
J. D. Sutherland 1947–1968
Robert H. Gosling 1968–1985
Anton Obholzer 1985–2002
Nick Temple 2002–2015
Matthew Patrick
Paul Jenkins
The Scottish Institute of Human Relations
In line with Hugh Crichton-Miller's original vision for clinics to be set up in communities across the country, his dream was not realised in his 'native' Scotland for another 50 years. However, with Jock Sutherland's return to Edinburgh in 1968, he became the catalyst for the formation of an organisation modelled on the London centre, albeit on a smaller scale. The Scottish Institute of Human Relations (SIHR), now defunct, was constituted as a charitable educational institution in Edinburgh in the early 1970s. Eventually a branch was opened in Glasgow. The 'MacTavi', as it was sometimes fondly called, worked closely with the National Health Service in Scotland and provided psychoanalytic training and courses for professionals in the health and educational systems and beyond. It also guided adults and children into treatment for the forty years of its operation. SIHR was finally dissolved in 2013 and its centres closed down. Some of its functions were taken over by a number of other organisations, specifically psychoanalytic training has become the remit of the Scottish Association for Psychoanalytic Psychotherapy (SAPP).
See also
References
External links
Tavistock Anthology by Eric Trist and Hugh Murray
Tavistock Clinic – History
1920 establishments in England
Research institutes established in 1920
Research institutes in London
Health in London
Mental health organisations in the United Kingdom
Social science methodology
Psychological methodology
Qualitative research
NHS foundation trusts
Buildings and structures in the London Borough of Camden
History of the London Borough of Camden
Psychiatric research institutes
Medical research institutes in the United Kingdom | 0.774057 | 0.981456 | 0.759703 |
Case report | In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence. Some case reports also contain a literature review of other reported cases. Case reports are professional narratives that provide feedback on clinical practice guidelines and offer a framework for early signals of effectiveness, adverse events, and cost. They can be shared for medical, scientific, or educational purposes.
Types
Most case reports are on one of six topics:
An unexpected association between diseases or symptoms.
An unexpected event in the course of observing or treating a patient.
Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.
Unique or rare features of a disease.
Unique therapeutic approaches.
A positional or quantitative variation of the anatomical structures.
Roles in research and education
A case report is generally considered a type of anecdotal evidence. Given their intrinsic methodological limitations, including lack of statistical sampling, case reports are placed at the bottom of the hierarchy of clinical evidence, together with case series. Nevertheless, case reports do have genuinely useful roles in medical research and evidence-based medicine. In particular, they have facilitated recognition of new diseases and adverse effects of treatments (e.g., recognition of the link between administration of thalidomide to mothers and malformations in their babies was triggered by a case report). Case reports have a role in pharmacovigilance. They can also help understand the clinical spectrum of rare diseases as well as unusual presentations of common diseases. They can help generate study hypotheses, including plausible mechanisms of disease. Case reports may also have a role to play in guiding the personalization of treatments in clinical practice.
Proponents of case reports have outlined some particular advantages of the format. Case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical progress; they provide many new ideas in medicine. Whereas randomized clinical trials usually only inspect one variable or very few variables, rarely reflecting the full picture of a complicated medical situation, the case report can detail many different aspects of the patient's medical situation (e.g. patient history, physical examination, diagnosis, psychosocial aspects, follow up).
Because typical, unremarkable cases are less likely to be published, use of case reports as scientific evidence must take into account publication bias. Some case reports also contain an extensive review of the relevant literature on the topic at-hand (and sometimes a systematic review of available evidence). Reports adopting this sort of approach can be identified by terms such as a "case report and review of the literature". Reports containing broader active research such as this might be considered case studies in the true definition of the term.
Case reports can also play a relevant role in medical education, providing a structure for case-based learning.
A particular attraction of case reports is the possibility of quick publication (with respect to more extensive studies such as randomized control trials), allowing them to act as a kind of rapid short communication between busy clinicians who may not have the time or resources to conduct large scale research.
Reporting guidelines
The quality of the scientific reporting of case reports is variable, and sub-optimal reporting hinders the use of case reports to inform research design or help guide clinical practice. In response to these issues, reporting guidelines are under development to facilitate greater transparency and completeness in the provision of relevant information for individual cases. The CARE (i.e. CAse REport) guidelines include a reporting checklist that is listed on the EQUATOR Network, an international initiative aimed at promoting transparent and accurate reporting of health research studies to enhance the value and reliability of medical research literature. This 13-item checklist includes indications regarding the title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. An explanation and elaboration article (a manual for writing case reports following the CARE guidelines) was published in the Journal of Clinical Epidemiology in 2017.
Publishing
Many international journals publish case reports, but they restrict the number that appear in the print run because this has an adverse effect on the journal's impact factor. Case reports are often published online, and there is often still a requirement for a subscription to access them. However, an increasing number of journals are devoted to publishing case reports alone, most of which are open access. The first of these to start publishing, in 2001, was Grand Rounds.
There are a number of websites that allow patients to submit and share their own patient case reports with other people. PatientsLikeMe and Treatment Report are two such sites.
Use of terminology outside science
The term is also used to describe non-scientific reports usually prepared for educational reasons.
Famous scientific case reports
Sigmund Freud reported on numerous cases, including Anna O., Dora, Little Hans, Rat Man, and Wolf Man
Frederick Treves reported on "The Elephant Man"
Paul Broca reported on language impairment following left hemisphere lesions in the 1860s.
Joseph Jules Dejerine reported on a case of pure alexia.
William MacIntyre reported on a case of multiple myeloma (described in the 1840s).
Christiaan Barnard described the world's first heart transplant as a case report
W. G. McBride, Thalidomide Case Report (1961). The Lancet 2:1358.
See also
Case series
Case presentation
References
Further reading
External links
Case reports – The CARE guidelines
Medical terminology
Medical literature
Clinical research
Reports | 0.776366 | 0.978473 | 0.759653 |
Enthesopathy | An enthesopathy refers to a disorder involving the attachment of a tendon or ligament to a bone. This site of attachment is known as the enthesis (pl. entheses).
If the condition is known to be inflammatory, it can more precisely be called an enthesitis.
Forms
Enthesopathy can occur at the shoulder, elbow, wrist, carpus, hip, knee, ankle, tarsus, or heel bone, among other regions. Enthesopathies may take the form of spondyloarthropathies (joint diseases of the spine) such as ankylosing spondylitis, or psoriatic arthritis, plantar fasciitis, and Achilles tendinitis. Further examples include:
Adhesive capsulitis of shoulder
Rotator cuff syndrome of shoulder and allied disorders
Periarthritis of shoulder
Scapulohumeral fibrositis
Synovitis of hand or wrist
Periarthritis of wrist
Gluteal tendinitis
Iliac crest spur
Psoas tendinitis
Trochanteric tendinitis
Causes
Generalized involvement of the entheses with calcification of tendon and ligament insertions and of joint capsules has been found for example in people with X-linked hypophosphatemic rickets.
Diagnosis
Mainly by clinical examination and provocative tests by counteracting the muscle action.
Treatment
The natural history of the two most common enthesopathies (plantar fasciitis and lateral epicondylitis-both mislabeled as inflammatory) is resolution over a period of about one year without treatment.
There are no known disease-modifying treatments for these enthesopathies. In other words, there is no experimental evidence that any treatment can alter the pathophysiology (mucoid degeneration) or the duration of symptoms. There is no evidence that activity modification alters the natural history of the disease.
To date, all treatments are palliative. The evidence suggests that most treatments have non-specific effects (e.g. placebo effect, regression to the mean, self-limiting course of symptoms).
Injection of corticosteroid, platelet-rich plasma, stem cells, and extracorporeal shockwave therapy are examples of treatments that are not supported by experimental evidence and remain open to debate.
Palliative treatments consist of stretching, analgesics, and padding (e.g. cushioned foot wear for plantar fasciitis), splints (e.g. tennis elbow strap), and other treatments. The concept that a calcified attachment can be removed surgically is highly debatable as these calcifications are a regular part of an enthesopathy.
References
External links
Musculoskeletal disorders | 0.763677 | 0.994642 | 0.759586 |
Positive and Negative Syndrome Scale | The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia. It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is the "gold standard" for evaluating the effects of psychopharmacological treatments.
The name refers to the two types of symptoms in schizophrenia, as defined by the American Psychiatric Association: positive symptoms, which refer to an excess or distortion of normal functions (e.g., hallucinations and delusions), and negative symptoms, which represent a diminution or loss of normal functions. Some of these functions which may be lost include normal thoughts, actions, ability to tell fantasies from reality, and the ability to properly express emotions.
The PANSS is a relatively brief interview, requiring 45 to 50 minutes to administer. The interviewer must be trained to a standardized level of reliability.
Interview items
To assess a patient using PANSS, an approximately 45-minute clinical interview is conducted. The patient is rated from 1 to 7 on 30 different symptoms based on the interview as well as reports of family members or primary care hospital workers.
Positive scale
7 Items, (minimum score = 7, maximum score = 49)
Delusions
Conceptual disorganization
Hallucinations
Excitement
Grandiosity
Suspiciousness/persecution
Hostility
Negative scale
7 Items, (minimum score = 7, maximum score = 49)
Blunted affect
Emotional withdrawal
Poor rapport
Passive/apathetic social withdrawal
Difficulty in abstract thinking
Lack of spontaneity and flow of conversation
Stereotyped thinking
General Psychopathology scale
16 Items, (minimum score = 16, maximum score = 112)
Somatic concern
Anxiety
Guilt feelings
Tension
Mannerisms and posturing
Depression
Motor retardation
Uncooperativeness
Unusual thought content
Disorientation
Poor attention
Lack of judgment and insight
Disturbance of volition
Poor impulse control
Preoccupation
Active social avoidance
PANSS Total score minimum = 30, maximum = 210
Scoring
As 1 rather than 0 is given as the lowest score for each item, a patient can not score lower than 30 for the total PANSS score. Scores are often given separately for the positive items, negative items, and general psychopathology. In their original publication on the PANSS scale, Stanley Kay and colleagues tested the scale on 101 adult patients (20-68 years-old) with schizophrenia and the mean scores were,
Positive scale = 18.20
Negative scale = 21.01
General psychopathology = 37.74
Based on meta-analytic results, an alternative five-factor solution of the PANSS was proposed with positive symptoms, negative symptoms, disorganization, excitement, and emotional distress.
See also
Brief Psychiatric Rating Scale (BPRS)
Diagnostic classification and rating scales used in psychiatry
Scale for the Assessment of Negative Symptoms (SANS)
Scale for the Assessment of Positive Symptoms (SAPS)
References
External links
The positive and negative syndrome scale (PANSS) for schizophrenia.
The PANSS Institute
Works about schizophrenia
Psychosis screening and assessment tools | 0.769638 | 0.986937 | 0.759584 |
Child and adolescent psychiatry | Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.
Classification of disorders
There are many classifications of disorders. Developmental disorders include autism spectrum disorder and learning disorders, and some attention and behaviors disorders are attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Childhood schizophrenia is an example of a psychotic disorder. Major depressive disorder, bipolar disorder, persistent depressive disorder, and disruptive mood dysregulation disorder are under the classification of mood disorders.
A wide range of disorders that are classified as eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), and pica. Some anxiety disorders are panic disorder, phobias, and Generalized anxiety disorder. Lastly, substance use disorders can be specified to specific substances, such as alcohol use disorder or cannabis use disorder.
Disorders are often comorbid. For example, an adolescent can be diagnosed with both major depressive disorder and generalized anxiety disorder. The incidence of psychiatric comorbidities during adolescence may vary by race, ethnicity and socioeconomic status, among other variables.
Clinical practice
Assessment
The psychiatric assessment of a child or adolescent starts with obtaining a psychiatric history by interviewing the young person and his/her parents or caregivers. The assessment includes a detailed exploration of the current concerns about the child's emotional or behavioral problems, the child's physical health and development, history of parental care (including possible abuse and neglect), family relationships and history of parental mental illness. It is regarded as desirable to obtain information from multiple sources (for example both parents, or a parent and a grandparent) as informants may give widely differing accounts of the child's problems. Collateral information is usually obtained from the child's school with regards to academic performance, peer relationships, and behavior in the school environment.
Psychiatric assessment always includes a mental state examination of the child or adolescent which consists of a careful behavioral observation and a first-hand account of the young person's subjective experiences. This assessment also includes an observation of the interactions within the family, especially the interactions between the child and his/her parents.
The assessment may be supplemented by the use of behavior or symptom rating scales such as the Achenbach Child Behavior Checklist or CBCL, the Behavioral Assessment System for Children or BASC, Conners Comprehensive Behaviour Rating Scale (used for diagnosis of ADHD), Millon Adolescent Clinical Inventory or MACI, and the Strengths and Difficulties Questionnaire or SDQ. While these instruments bring a degree of objectivity and consistency to the clinical assessment, the diagnosis of ADHD requires confirmation by a clinician experienced in the evaluation of youth with and without ADHD who supplements the findings with input from parents, teachers, and the youth themselves.
More specialized psychometric testing may be carried out by a psychologist, for example using the Wechsler Intelligence Scale for Children, to detect intellectual impairment or other cognitive problems which may be contributing to the child's difficulties.
Diagnosis and formulation
The child and adolescent psychiatrist makes a diagnosis based on the pattern of behavior and emotional symptoms, using a standardized set of diagnostic criteria such as the Diagnostic and Statistical Manual (DSM-V) or the International Classification of Diseases (ICD-11). While the DSM system is widely used, it may not adequately take into account social, cultural and contextual factors and it has been suggested that an individualized clinical formulation may be more useful. A case formulation is standard practice for child and adolescent psychiatrists and can be defined as a process of integrating and summarizing all the relevant factors implicated in the development of the patient's problem, including biological, psychological, social and cultural perspectives (the "biopsychosocial model"). The applicability of DSM diagnoses have also been questioned with regard to the assessment of very young children: it is argued that very young children are developing too rapidly to be adequately described by a fixed diagnosis, and furthermore that a diagnosis unhelpfully locates the problem within the child when the parent-child relationship is a more appropriate focus of assessment.
The child and adolescent psychiatrist then designs a treatment plan which considers all the components and discusses these recommendations with the child or adolescent and family.
Treatment
Treatment will usually involve one or more of the following elements: behavior therapy, cognitive-behavior therapy, problem-solving therapies, psychodynamic therapy, parent training programs, family therapy, and/or the use of medication. The intervention can also include consultation with pediatricians, primary care physicians or professionals from schools, juvenile courts, social agencies or other community organizations.
In a review of existing meta-analyses and disorders on the four most frequent childhood and adolescent psychiatric disorders (anxiety disorder, depression, ADHD, conduct disorder), only for ADHD was the use of medication (stimulants) considered to be the most efficacious treatment option available. For the remaining three disorders, psychotherapy is recommended as the most effective treatment of choice. A combination of psychological and pharmacological treatments is an important option in ADHD and depressive disorders. Treatments for ADHD and anxiety disorders produce higher effect-sizes than do interventions for depressive and conduct disorders.
Training
In the United States, Child and adolescent psychiatric training requires 4 years of medical school, at least 4 years of approved residency training in medicine, neurology, and general psychiatry with adults, and 2 years of additional specialized training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry. Child and adolescent sub-speciality training is similar in other Western countries (such as the UK, New Zealand, and Australia), in that trainees must generally demonstrate competency in general adult psychiatry prior to commencing sub-speciality training.
Certification and continuing education
In the US, having completed the child and adolescent psychiatry residency, the child and adolescent psychiatrist is eligible to take the additional certification examination in the subspecialty of child and adolescent psychiatry from the American Board of Psychiatry and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP). Although the ABPN and AOBNP examinations are not required for practice, they are a further assurance that the child and adolescent psychiatrist with these certifications can be expected to diagnose and treat all psychiatric conditions in patients of any age competently. Training requirements are listed on the web site of The American Academy of Child & Adolescent Psychiatry.
Shortage of child and adolescent psychiatrists in the United States
The demand for child and adolescent psychiatrists continues to far outstrip the supply worldwide. There is also a severe maldistribution of child and adolescent psychiatrists, especially in rural and poor, urban areas where access is significantly reduced. As of 2016, there are 7991 child and adolescent psychiatrists in the United States. A report by the US Bureau of Health Professions (2000) projected a need by the year 2020 for 12,624 child and adolescent psychiatrists, but a supply of only 8,312. In its 1998 report, the Center for Mental Health Services estimated that 9-13% of 9- to 17-year-olds had serious emotional disturbances, and 5-9% had extreme functional impairments. In 1999, however, the Surgeon General reported that "there is a dearth of child psychiatrists." Only 20% of emotionally disturbed children and adolescents received any mental health treatment, a small percentage of which was performed by child and adolescent psychiatrists. Furthermore, the US Bureau of Health Professions projects that the demand for child and adolescent psychiatry services will increase by 100% between 1995 and 2020.
Cross-cultural considerations
Steady growth in migration of immigrants to higher-income regions and countries has contributed to the growth and interest in cross-cultural psychiatry. Families of immigrants whose child has a psychiatric illness must come to understand the disorder while navigating an unfamiliar health care system.
Criticisms
Subjective diagnoses
One criticism against psychiatry is that psychiatric diagnoses lack complete "objectivity," particularly when compared with diagnoses in other medical specialties. However, for several major psychiatric disorders interrater reliability, which shows the degree to which psychiatrists agree on the diagnosis, is generally similar to those in other medical specialties. In 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests."
Traditional deficit and disease models of child psychiatry have been criticized as rooted in the medical model which conceptualizes adjustment problems in terms of disease states. It is said by these critics that these normative models explicitly characterize problematic behavior as representing a disorder within the child or young person and these commentators assert that the role of environmental influences on behavior has become increasingly neglected, leading to a decrease in the popularity of, for example, family therapy. There are criticisms of the medical model approach from within and without the psychiatric profession (see references): it is said to neglect the role of environmental, family, and cultural influences, to discount the psychological meaning of behavior and symptoms, to promote a view of the "patient" as dependent and needing to be cured or cared for and therefore undermines a sense of personal responsibility for conduct and behavior, to promote a normative conception based on adaptation to the norms of society (the ill person must adapt to society), and to be based on the shaky foundations of reliance on a classificatory system that has been shown to have problems of validity and reliability (Boorse, 1976; Jensen, 2003; Sadler et al. 1994; Timimi, 2006).
Prescription of psychotropic medications
Since the late 1990s, use of psychiatric medication has become increasingly common for children and adolescents. In 2004 the U.S. Food and Drug Administration (FDA) issued the Black Box Warning on antidepressant prescriptions to alert patients of a research link between use of medication and apparent increased risk of suicidal thoughts, hostility, and agitation in pediatric patients. The most common diagnoses for which children receive psychiatric medication are ADHD, ODD, and conduct disorder.
Some research suggests that children and adolescents are sometimes given antipsychotic drugs as a first-line treatment for mental health problems or behavioral issues other than a psychotic disorder. In the United States, the usage of these drugs in young people has greatly increased since 2000, especially among children from low-income families. More research is needed to specifically assess the efficacy and tolerability of antipsychotic medications in pediatric populations. Because of the risk of metabolic syndrome and cardiovascular events with long-term antipsychotic use, use in pediatric populations is highly scrutinized and recommended in combination with psychotherapy and effective parent-training interventions.
Electroconvulsive therapy
In 1947, child neuropsychiatrist Lauretta Bender published a study on 98 children aged between four and eleven years old who had been treated in the previous five years with intensive courses of electroconvulsive therapy (ECT). These children received ECT daily for a typical course of approximately twenty treatments. This formed part of an experimental trend amongst a cadre of psychiatrists to explore the therapeutic impact of intensive regimes of ECT, which is also known as either regressive ECT or annihilation therapy. In the 1950s Bender abandoned ECT as a therapeutic practice for the treatment of children. In the same decade the results of her published work on the use of ECT in children was discredited after a study showing that the condition of the children so treated had either not improved or deteriorated. Commenting on his experience as part of Bender's therapeutic program, Ted Chabasinski said that, "It really made a mess of me ... I went from being a shy kid who read a lot to a terrified kid who cried all the time." Following his treatment, he spent ten years as an inmate of Rockland State Hospital, a psychiatric facility now known as the Rockland Psychiatric Center.
History
When psychiatrists and pediatricians first began to recognize and discuss childhood psychiatric disorders in the 19th century, they were largely influenced by literary works of the Victorian era. Authors like the Brontë sisters, George Eliot, and Charles Dickens, introduced new ways of thinking about the child mind and the potential influence early childhood experiences could have on child development and the subsequent adult mind. When the Journal of Psychological Medicine and Mental Pathology, the first psychiatric journal in English, was published in 1848, child psychiatry didn't exist as its own field yet. However, some of the earliest works on the possibility of nervous disorders and "insanity" in children were published in the Journal and several medical writers directly referenced works such as Jane Eyre (1847), Wuthering Heights (1847), Dombey and Son (1848), and David Copperfield (1850), to illustrate this new conceptualization of the child mind. Until that time, it was generally accepted that children were free from nervous disorders and the "passions" that affected the adult mind.
As early as 1899, the term "child psychiatry" (in French) was used as a subtitle in Manheimer's monograph Les Troubles Mentaux de l'Enfance. However, the Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define the parameters of child psychiatry in terms of diagnosis, treatment, and prognosis within the discipline of medicine, in 1933. In 1934, Tramer founded the Zeitschrift für Kinderpsychiatrie (Journal of Child Psychiatry), which later became Acta Paedopsychiatria. The first academic child psychiatry department in the world was founded in 1930 by Leo Kanner (1894–1981), an Austrian émigré and medical graduate of the University of Berlin, under the direction of Adolf Meyer at the Johns Hopkins Hospital in Baltimore. Kanner was the very first physician to be identified as a child psychiatrist in the US and his textbook, Child Psychiatry (1935), is credited with introducing both the specialty and the term to the anglophone academic community. In 1936, Kanner established the first formal elective course in child psychiatry at the Johns Hopkins Hospital. In 1944 he provided the first clinical description of early infantile autism, otherwise known as Kanner Syndrome.
Maria Montessori together with :It:Giuseppe Ferruccio Montesano and Clodomiro Bonfigli, two distinguished child psychiatrists, created in 1901 in Italy the "Lega Nazionale per la Protezione del Fanciullo" (National League for the Protection of Children). She gradually developed her own pedagogic method, initially based on the "intuition that the question of the 'mentally deficient' was more pedagogic than medical". In 1909, Jane Addams and her female colleagues established the Juvenile Psychopathic Institute (JPI) in Chicago, later renamed as the Institute for Juvenile Research (IJR), the world's first child guidance clinic. Neurologist William Healy, M.D., its first director, was charged with not only studying the delinquent's biological aspects of brain functioning and IQ, but also the delinquent's social factors, attitudes, and motivations, thus it was the birthplace of American child psychiatry.
From its establishment in February 1923, the Maudsley Hospital, a South London-based postgraduate teaching and research psychiatric hospital, contained a small children's department. Similar overall early developments took place in many other countries during the late 1920s and 1930s. In the United States, child and adolescent psychiatry was established as a recognized medical speciality in 1953 with the founding of the American Academy of Child Psychiatry, but was not established as a legitimate, board-certifiable medical speciality until 1959.
The use of medication in the treatment of children also began in the 1930s, when Charles Bradley opened a neuropsychiatric unit and was the first to use amphetamine for brain-damaged and hyperactive children. But it was not until the 1960s that the first NIH grant to study paediatric psychopharmacology was awarded. It went to one of Kanner's students, Leon Eisenberg, the second director of the division.
The discipline has relatively flourished since the 1980s, in large part, because of contributions made in the 1970s, even if the outcomes for patients have been disappointing at times. It was a decade during which child psychiatry witnessed a major evolution as a result of the work carried out by, Eva Frommer, Douglas Haldane, Michael Rutter, Robin Skynner and Sula Wolff, among others. The first comprehensive population survey of 9- to 11-year-olds, carried out in London and the Isle of Wight, which appeared in 1970, addressed questions that have continued to be of importance for child psychiatry; for example, rates of psychiatric disorders, the role of intellectual development and physical impairment, and specific concern for potential social influences on children's adjustment. This work was influential, especially since the investigators demonstrated specific continuities of psychopathology over time, and the influence of social and contextual factors in children's mental health, in their subsequent re-evaluation of the original cohort of children. These studies described the prevalence of ADHD (relatively low as compared to the US), identified the onset and prevalence of depression in mid-adolescence and the frequent co-morbidity with conduct disorder, and explored the relationship between various mental disorders and scholastic achievement.
It was paralleled similarly by work on the epidemiology of autism that was to enormously increase the number of children diagnosed with autism in future years. Although attention had been given in the 1960s and '70s to the classification of childhood psychiatric disorders, and some issues had then been delineated, such as the distinction between neurotic and conduct disorders, the nomenclature did not parallel the growing clinical knowledge. It was claimed that this situation was altered in the late 1970s with the development of the DSM-III system of classification, although research has shown that this system of classification has problems of validity and reliability. Since then, the DSM-IV and DSM-IVR have altered some of the parsing of psychiatric disorders into "childhood" and "adult" disorders, on the basis that while many psychiatric disorders are not diagnosed until adulthood, they may present in childhood or adolescence (DSM-IV).. The American Psychiatric Association's DSM is now on its fifth edition (DSM-5).
People in the field are sometimes referred to as "neurodevelopmentalists". As of 2005 there was debate in the field as to whether "neurodevelopmentalist" should be made a new speciality.
In terms of patient outcomes, there is evidence that, in the United Kingdom at least on the 70th anniversary of the NHS, mental health remains a medical "Cinderella" (low priority) and the more so Child and Adolescent Health services which have been through repeated reorganisations and underinvestment all of which leads to disruption and loss of adequate provision.
"Modern neuroscience, genetics, epigenetics, and public health research has presented
the tantalizing possibility that it can now be said with relative certainty that
much (certainly not all) is understood about why some children struggle and others
soar. Although it is an oversimplification, it can now be suggested that it is possible
to understand how environmental factors, both negative and positive, influence the
genome or epigenome, which in turn influence the structure and function of the brain
and thus human thoughts, actions, and behaviors."
See also
Biological psychiatry
Mental disorders diagnosed in childhood
Child Guidance
Child psychopathology
Consultation-liaison psychiatry
Developmental disorders
Medical model
Neuropsychiatry
Psychiatry
Anti-psychiatry
Biopsychiatry controversy
Controversy about ADHD
Child and Adolescent Mental Health Services - NHS service provision in the United Kingdom
Rennie v. Klein - right to refuse treatment
Notes
References
External links
American Academy of Child and Adolescent Psychiatry
IACAPAP website (International Association of Child and Adolescent Psychiatry and Allied Professions)
European Psychiatric Association: Child and Adolescent Psychiatry
NIMH Child Psychiatry Branch Homepage
Encyclopædia Britannica
Classification of psychiatric disorders in childhood and adolescence: building castles in the sand?
Cultural Diversity in the Development of Child Psychopathology
Resources For Outpatient Children's Mental Health Treatment | 0.775342 | 0.979614 | 0.759536 |
Developmental psychology | Developmental psychology is the scientific study of how and why humans grow, change, and adapt across the course of their lives. Originally concerned with infants and children, the field has expanded to include adolescence, adult development, aging, and the entire lifespan. Developmental psychologists aim to explain how thinking, feeling, and behaviors change throughout life. This field examines change across three major dimensions, which are physical development, cognitive development, and social emotional development. Within these three dimensions are a broad range of topics including motor skills, executive functions, moral understanding, language acquisition, social change, personality, emotional development, self-concept, and identity formation.
Developmental psychology examines the influences of nature and nurture on the process of human development, as well as processes of change in context across time. Many researchers are interested in the interactions among personal characteristics, the individual's behavior, and environmental factors. This includes the social context and the built environment. Ongoing debates in regards to developmental psychology include biological essentialism vs. neuroplasticity and stages of development vs. dynamic systems of development. Research in developmental psychology has some limitations but at the moment researchers are working to understand how transitioning through stages of life and biological factors may impact our behaviors and development.
Developmental psychology involves a range of fields, such as educational psychology, child psychopathology, forensic developmental psychology, child development, cognitive psychology, ecological psychology, and cultural psychology. Influential developmental psychologists from the 20th century include Urie Bronfenbrenner, Erik Erikson, Sigmund Freud, Anna Freud, Jean Piaget, Barbara Rogoff, Esther Thelen, and Lev Vygotsky.
Historical antecedents
Jean-Jacques Rousseau and John B. Watson are typically cited as providing the foundation for modern developmental psychology. In the mid-18th century, Jean Jacques Rousseau described three stages of development: infants (infancy), puer (childhood) and adolescence in Emile: Or, On Education. Rousseau's ideas were adopted and supported by educators at the time.
Developmental psychology generally focuses on how and why certain changes (cognitive, social, intellectual, personality) occur over time in the course of a human life. Many theorists have made a profound contribution to this area of psychology. One of them, Erik Erikson developed a model of eight stages of psychological development. He believed that humans developed in stages throughout their lifetimes and that this would affect their behaviors.
In the late 19th century, psychologists familiar with the evolutionary theory of Darwin began seeking an evolutionary description of psychological development; prominent here was the pioneering psychologist G. Stanley Hall, who attempted to correlate ages of childhood with previous ages of humanity. James Mark Baldwin, who wrote essays on topics that included Imitation: A Chapter in the Natural History of Consciousness and Mental Development in the Child and the Race: Methods and Processes, was significantly involved in the theory of developmental psychology. Sigmund Freud, whose concepts were developmental, significantly affected public perceptions.
Theories
Psychosexual development
Sigmund Freud developed a theory that suggested that humans behave as they do because they are constantly seeking pleasure. This process of seeking pleasure changes through stages because people evolve. Each period of seeking pleasure that a person experiences is represented by a stage of psychosexual development. These stages symbolize the process of arriving to become a maturing adult.
The first is the oral stage, which begins at birth and ends around a year and a half of age. During the oral stage, the child finds pleasure in behaviors like sucking or other behaviors with the mouth. The second is the anal stage, from about a year or a year and a half to three years of age. During the anal stage, the child defecates from the anus and is often fascinated with its defecation. This period of development often occurs during the time when the child is being toilet trained. The child becomes interested with feces and urine. Children begin to see themselves as independent from their parents. They begin to desire assertiveness and autonomy.
The third is the phallic stage, which occurs from three to five years of age (most of a person's personality forms by this age). During the phallic stage, the child becomes aware of its sexual organs. Pleasure comes from finding acceptance and love from the opposite sex. The fourth is the latency stage, which occurs from age five until puberty. During the latency stage, the child's sexual interests are repressed.
Stage five is the genital stage, which takes place from puberty until adulthood. During the genital stage, puberty begins to occur. Children have now matured, and begin to think about other people instead of just themselves. Pleasure comes from feelings of affection from other people.
Freud believed there is tension between the conscious and unconscious because the conscious tries to hold back what the unconscious tries to express. To explain this, he developed three personality structures: id, ego, and superego. The id, the most primitive of the three, functions according to the pleasure principle: seek pleasure and avoid pain. The superego plays the critical and moralizing role, while the ego is the organized, realistic part that mediates between the desires of the id and the superego.
Theories of cognitive development
Jean Piaget, a Swiss theorist, posited that children learn by actively constructing knowledge through their interactions with their physical and social environments. He suggested that the adult's role in helping the child learn was to provide appropriate materials. In his interview techniques with children that formed an empirical basis for his theories, he used something similar to Socratic questioning to get children to reveal their thinking. He argued that a principal source of development was through the child's inevitable generation of contradictions through their interactions with their physical and social worlds. The child's resolution of these contradictions led to more integrated and advanced forms of interaction, a developmental process that he called, "equilibration."
Piaget argued that intellectual development takes place through a series of stages generated through the equilibration process. Each stage consists of steps the child must master before moving to the next step. He believed that these stages are not separate from one another, but rather that each stage builds on the previous one in a continuous learning process. He proposed four stages: sensorimotor, pre-operational, concrete operational, and formal operational. Though he did not believe these stages occurred at any given age, many studies have determined when these cognitive abilities should take place.
Stages of moral development
Piaget claimed that logic and morality develop through constructive stages. Expanding on Piaget's work, Lawrence Kohlberg determined that the process of moral development was principally concerned with justice, and that it continued throughout the individual's lifetime.
He suggested three levels of moral reasoning; pre-conventional moral reasoning, conventional moral reasoning, and post-conventional moral reasoning. The pre-conventional moral reasoning is typical of children and is characterized by reasoning that is based on rewards and punishments associated with different courses of action. Conventional moral reason occurs during late childhood and early adolescence and is characterized by reasoning based on rules and conventions of society. Lastly, post-conventional moral reasoning is a stage during which the individual sees society's rules and conventions as relative and subjective, rather than as authoritative.
Kohlberg used the Heinz Dilemma to apply to his stages of moral development. The Heinz Dilemma involves Heinz's wife dying from cancer and Heinz having the dilemma to save his wife by stealing a drug. Preconventional morality, conventional morality, and post-conventional morality applies to Heinz's situation.
Stages of psychosocial development
German-American psychologist Erik Erikson and his collaborator and wife, Joan Erikson, posits eight stages of individual human development influenced by biological, psychological, and social factors throughout the lifespan. At each stage the person must resolve a challenge, or an existential dilemma. Successful resolution of the dilemma results in the person ingraining a positive virtue, but failure to resolve the fundamental challenge of that stage reinforces negative perceptions of the person or the world around them and the person's personal development is unable to progress.
The first stage, "Trust vs. Mistrust", takes place in infancy. The positive virtue for the first stage is hope, in the infant learning whom to trust and having hope for a supportive group of people to be there for him/her. The second stage is "Autonomy vs. Shame and Doubt" with the positive virtue being will. This takes place in early childhood when the child learns to become more independent by discovering what they are capable of whereas if the child is overly controlled, feelings of inadequacy are reinforced, which can lead to low self-esteem and doubt.
The third stage is "Initiative vs. Guilt". The virtue of being gained is a sense of purpose. This takes place primarily via play. This is the stage where the child will be curious and have many interactions with other kids. They will ask many questions as their curiosity grows. If too much guilt is present, the child may have a slower and harder time interacting with their world and other children in it.
The fourth stage is "Industry (competence) vs. Inferiority". The virtue for this stage is competency and is the result of the child's early experiences in school. This stage is when the child will try to win the approval of others and understand the value of their accomplishments.
The fifth stage is "Identity vs. Role Confusion". The virtue gained is fidelity and it takes place in adolescence. This is when the child ideally starts to identify their place in society, particularly in terms of their gender role.
The sixth stage is "Intimacy vs. Isolation", which happens in young adults and the virtue gained is love. This is when the person starts to share his/her life with someone else intimately and emotionally. Not doing so can reinforce feelings of isolation.
The seventh stage is "Generativity vs. Stagnation". This happens in adulthood and the virtue gained is care. A person becomes stable and starts to give back by raising a family and becoming involved in the community.
The eighth stage is "Ego Integrity vs. Despair". When one grows old, they look back on their life and contemplate their successes and failures. If they resolve this positively, the virtue of wisdom is gained. This is also the stage when one can gain a sense of closure and accept death without regret or fear.
Stages based on the model of hierarchical complexity
Michael Commons enhanced and simplified Bärbel Inhelder and Piaget's developmental theory and offers a standard method of examining the universal pattern of development. The Model of Hierarchical Complexity (MHC) is not based on the assessment of domain-specific information, It divides the Order of Hierarchical Complexity of tasks to be addressed from the Stage performance on those tasks. A stage is the order hierarchical complexity of the tasks the participant's successfully addresses. He expanded Piaget's original eight stage (counting the half stages) to seventeen stages. The stages are:
Calculatory
Automatic
Sensory & Motor
Circular sensory-motor
Sensory-motor
Nominal
Sentential
Preoperational
Primary
Concrete
Abstract
Formal
Systematic
Metasystematic
Paradigmatic
Cross-paradigmatic
Meta-Cross-paradigmatic
The order of hierarchical complexity of tasks predicts how difficult the performance is with an R ranging from 0.9 to 0.98.
In the MHC, there are three main axioms for an order to meet in order for the higher order task to coordinate the next lower order task. Axioms are rules that are followed to determine how the MHC orders actions to form a hierarchy. These axioms are: a) defined in terms of tasks at the next lower order of hierarchical complexity task action; b) defined as the higher order task action that organizes two or more less complex actions; that is, the more complex action specifies the way in which the less complex actions combine; c) defined as the lower order task actions have to be carried out non-arbitrarily.
Ecological systems theory
Ecological systems theory, originally formulated by Urie Bronfenbrenner, specifies four types of nested environmental systems, with bi-directional influences within and between the systems. The four systems are microsystem, mesosystem, exosystem, and macrosystem. Each system contains roles, norms and rules that can powerfully shape development. The microsystem is the direct environment in our lives such as our home and school. Mesosystem is how relationships connect to the microsystem. Exosystem is a larger social system where the child plays no role. Macrosystem refers to the cultural values, customs and laws of society.
The microsystem is the immediate environment surrounding and influencing the individual (example: school or the home setting). The mesosystem is the combination of two microsystems and how they influence each other (example: sibling relationships at home vs. peer relationships at school). The exosystem is the interaction among two or more settings that are indirectly linked (example: a father's job requiring more overtime ends up influencing his daughter's performance in school because he can no longer help with her homework). The macrosystem is broader taking into account social economic status, culture, beliefs, customs and morals (example: a child from a wealthier family sees a peer from a less wealthy family as inferior for that reason). Lastly, the chronosystem refers to the chronological nature of life events and how they interact and change the individual and their circumstances through transition (example: a mother losing her own mother to illness and no longer having that support in her life).
Since its publication in 1979, Bronfenbrenner's major statement of this theory, The Ecology of Human Development, has had widespread influence on the way psychologists and others approach the study of human beings and their environments. As a result of this conceptualization of development, these environments—from the family to economic and political structures—have come to be viewed as part of the life course from childhood through to adulthood.
Zone of proximal development
Lev Vygotsky was a Russian theorist from the Soviet era, who posited that children learn through hands-on experience and social interactions with members of their culture. Vygotsky believed that a child's development should be examined during problem-solving activities. Unlike Piaget, he claimed that timely and sensitive intervention by adults when a child is on the edge of learning a new task (called the "zone of proximal development") could help children learn new tasks. Zone of proximal development is a tool used to explain the learning of children and collaborating problem solving activities with an adult or peer. This adult role is often referred to as the skilled "master", whereas the child is considered the learning apprentice through an educational process often termed "cognitive apprenticeship" Martin Hill stated that "The world of reality does not apply to the mind of a child." This technique is called "scaffolding", because it builds upon knowledge children already have with new knowledge that adults can help the child learn. Vygotsky was strongly focused on the role of culture in determining the child's pattern of development, arguing that development moves from the social level to the individual level. In other words, Vygotsky claimed that psychology should focus on the progress of human consciousness through the relationship of an individual and their environment. He felt that if scholars continued to disregard this connection, then this disregard would inhibit the full comprehension of the human consciousness.
Constructivism
Constructivism is a paradigm in psychology that characterizes learning as a process of actively constructing knowledge. Individuals create meaning for themselves or make sense of new information by selecting, organizing, and integrating information with other knowledge, often in the context of social interactions. Constructivism can occur in two ways: individual and social. Individual constructivism is when a person constructs knowledge through cognitive processes of their own experiences rather than by memorizing facts provided by others. Social constructivism is when individuals construct knowledge through an interaction between the knowledge they bring to a situation and social or cultural exchanges within that content. A foundational concept of constructivism is that the purpose of cognition is to organize one's experiential world, instead of the ontological world around them.
Jean Piaget, a Swiss developmental psychologist, proposed that learning is an active process because children learn through experience and make mistakes and solve problems. Piaget proposed that learning should be whole by helping students understand that meaning is constructed.
Evolutionary developmental psychology
Evolutionary developmental psychology is a research paradigm that applies the basic principles of Darwinian evolution, particularly natural selection, to understand the development of human behavior and cognition. It involves the study of both the genetic and environmental mechanisms that underlie the development of social and cognitive competencies, as well as the epigenetic (gene-environment interactions) processes that adapt these competencies to local conditions.
EDP considers both the reliably developing, species-typical features of ontogeny (developmental adaptations), as well as individual differences in behavior, from an evolutionary perspective. While evolutionary views tend to regard most individual differences as the result of either random genetic noise (evolutionary byproducts) and/or idiosyncrasies (for example, peer groups, education, neighborhoods, and chance encounters) rather than products of natural selection, EDP asserts that natural selection can favor the emergence of individual differences via "adaptive developmental plasticity". From this perspective, human development follows alternative life-history strategies in response to environmental variability, rather than following one species-typical pattern of development.
EDP is closely linked to the theoretical framework of evolutionary psychology (EP), but is also distinct from EP in several domains, including research emphasis (EDP focuses on adaptations of ontogeny, as opposed to adaptations of adulthood) and consideration of proximate ontogenetic and environmental factors (i.e., how development happens) in addition to more ultimate factors (i.e., why development happens), which are the focus of mainstream evolutionary psychology.
Attachment theory
Attachment theory, originally developed by John Bowlby, focuses on the importance of open, intimate, emotionally meaningful relationships. Attachment is described as a biological system or powerful survival impulse that evolved to ensure the survival of the infant. A threatened or stressed child will move toward caregivers who create a sense of physical, emotional, and psychological safety for the individual. Attachment feeds on body contact and familiarity. Later Mary Ainsworth developed the Strange Situation protocol and the concept of the secure base. This tool has been found to help understand attachment, such as the Strange Situation Test and the Adult Attachment Interview. Both of which help determine factors to certain attachment styles. The Strange Situation Test helps find "disturbances in attachment" and whether certain attributes are found to contribute to a certain attachment issue. The Adult Attachment Interview is a tool that is similar to the Strange Situation Test but instead focuses attachment issues found in adults. Both tests have helped many researchers gain more information on the risks and how to identify them.
Theorists have proposed four types of attachment styles: secure, anxious-avoidant, anxious-resistant, and disorganized. Secure attachment is a healthy attachment between the infant and the caregiver. It is characterized by trust. Anxious-avoidant is an insecure attachment between an infant and a caregiver. This is characterized by the infant's indifference toward the caregiver. Anxious-resistant is an insecure attachment between the infant and the caregiver characterized by distress from the infant when separated and anger when reunited. Disorganized is an attachment style without a consistent pattern of responses upon return of the parent.
A child can be hindered in its natural tendency to form attachments. Some babies are raised without the stimulation and attention of a regular caregiver or locked away under conditions of abuse or extreme neglect. The possible short-term effects of this deprivation are anger, despair, detachment, and temporary delay in intellectual development. Long-term effects include increased aggression, clinging behavior, detachment, psychosomatic disorders, and an increased risk of depression as an adult.\
According to the theory, attachment is established in early childhood and attachment continues into adulthood. As such, proponents posit that the attachment style that individuals form in childhood impacts the way they manage stressors in intimate relationships as an adult.
Nature vs nurture
A significant debate in developmental psychology is the relationship between innateness and environmental influence in regard to any particular aspect of development. This is often referred to as "nature and nurture" or nativism versus empiricism. A nativist account of development would argue that the processes in question are innate, that is, they are specified by the organism's genes. What makes a person who they are? Is it their environment or their genetics? This is the debate of nature vs nurture.
An empiricist perspective would argue that those processes are acquired in interaction with the environment. Today developmental psychologists rarely take such polarized positions with regard to most aspects of development; rather they investigate, among many other things, the relationship between innate and environmental influences. One of the ways this relationship has been explored in recent years is through the emerging field of evolutionary developmental psychology.
One area where this innateness debate has been prominently portrayed is in research on language acquisition. A major question in this area is whether or not certain properties of human language are specified genetically or can be acquired through learning. The empiricist position on the issue of language acquisition suggests that the language input provides the necessary information required for learning the structure of language and that infants acquire language through a process of statistical learning. From this perspective, language can be acquired via general learning methods that also apply to other aspects of development, such as perceptual learning.
The nativist position argues that the input from language is too impoverished for infants and children to acquire the structure of language. Linguist Noam Chomsky asserts that, evidenced by the lack of sufficient information in the language input, there is a universal grammar that applies to all human languages and is pre-specified. This has led to the idea that there is a special cognitive module suited for learning language, often called the language acquisition device. Chomsky's critique of the behaviorist model of language acquisition is regarded by many as a key turning point in the decline in the prominence of the theory of behaviorism generally. But Skinner's conception of "Verbal Behavior" has not died, perhaps in part because it has generated successful practical applications.
Maybe there could be "strong interactions of both nature and nurture".
Continuity vs discontinuity
One of the major discussions in developmental psychology includes whether development is discontinuous or continuous.
Continuous development is quantifiable and quantitative, whereas discontinuous development is qualitative. Quantitative estimations of development can be measuring the stature of a child, and measuring their memory or consideration span. "Particularly dramatic examples of qualitative changes are metamorphoses, such as the emergence of a caterpillar into a butterfly."
Those psychologists who bolster the continuous view of improvement propose that improvement includes slow and progressing changes all through the life span, with behavior within the prior stages of advancement giving the premise of abilities and capacities required for the other stages. "To many, the concept of continuous, quantifiable measurement seems to be the essence of science".
Not all psychologists, be that as it may, concur that advancement could be a continuous process. A few see advancement as a discontinuous process. They accept advancement includes unmistakable and partitioned stages with diverse sorts of behavior happening in each organization. This proposes that the development of certain capacities in each arrange, such as particular feelings or ways of considering, have a definite beginning and finishing point. Be that as it may, there's no correct time at which a capacity abruptly shows up or disappears. Although some sorts of considering, feeling or carrying on could seem to seem abruptly, it is more than likely that this has been developing gradually for some time.
Stage theories of development rest on the suspicion that development may be a discontinuous process including particular stages which are characterized by subjective contrasts in behavior. They moreover assume that the structure of the stages is not variable concurring to each person, in any case, the time of each arrangement may shift separately. Stage theories can be differentiated with ceaseless hypotheses, which set that development is an incremental process.
Stability vs change
This issue involves the degree to which one becomes older renditions of their early experience or whether they develop into something different from who they were at an earlier point in development. It considers the extent to which early experiences (especially infancy) or later experiences are the key determinants of a person's development. Stability is defined as the consistent ordering of individual differences with respect to some attribute. Change is altering someone/something.
Most human development lifespan developmentalists recognize that extreme positions are unwise. Therefore, the key to a comprehensive understanding of development at any stage requires the interaction of different factors and not only one.
Theory of mind
Theory of mind is the ability to attribute mental states to ourselves and others. It is a complex but vital process in which children begin to understand the emotions, motives, and feelings of not only themselves but also others. Theory of mind allows people to understand that others have unique beliefs and desires that are different from our own. This enables people to engage in daily social interactions as we explain the mental state around us. If a child does not fully develop theory of mind within this crucial 5-year period, they can suffer from communication barriers that follow them into adolescence and adulthood. Exposure to more people and the availability of stimuli that encourages social-cognitive growth is a factor that relies heavily on family.
Mathematical models
Developmental psychology is concerned not only with describing the characteristics of psychological change over time but also seeks to explain the principles and internal workings underlying these changes. Psychologists have attempted to better understand these factors by using models. A model must simply account for the means by which a process takes place. This is sometimes done in reference to changes in the brain that may correspond to changes in behavior over the course of the development.
Mathematical modeling is useful in developmental psychology for implementing theory in a precise and easy-to-study manner, allowing generation, explanation, integration, and prediction of diverse phenomena. Several modeling techniques are applied to development: symbolic, connectionist (neural network), or dynamical systems models.
Dynamic systems models illustrate how many different features of a complex system may interact to yield emergent behaviors and abilities. Nonlinear dynamics has been applied to human systems specifically to address issues that require attention to temporality such as life transitions, human development, and behavioral or emotional change over time. Nonlinear dynamic systems is currently being explored as a way to explain discrete phenomena of human development such as affect, second language acquisition, and locomotion.
Research areas
Neural Development
One critical aspect of developmental psychology is the study of neural development, which investigates how the brain changes and develops during different stages of life. Neural development focuses on how the brain changes and develops during different stages of life. Studies have shown that the human brain undergoes rapid changes during prenatal and early postnatal periods. These changes include the formation of neurons, the development of neural networks, and the establishment of synaptic connections. The formation of neurons and the establishment of basic neural circuits in the developing brain are crucial for laying the foundation of the brain's structure and function, and disruptions during this period can have long-term effects on cognitive and emotional development.
Experiences and environmental factors play a crucial role in shaping neural development. Early sensory experiences, such as exposure to language and visual stimuli, can influence the development of neural pathways related to perception and language processing.
Genetic factors play a huge roll in neural development. Genetic factors can influence the timing and pattern of neural development, as well as the susceptibility to certain developmental disorders, such as autism spectrum disorder and attention-deficit/hyperactivity disorder.
Research finds that the adolescent brain undergoes significant changes in neural connectivity and plasticity. During this period, there is a pruning process where certain neural connections are strengthened while others are eliminated, resulting in more efficient neural networks and increased cognitive abilities, such as decision-making and impulse control.
The study of neural development provides crucial insights into the complex interplay between genetics, environment, and experiences in shaping the developing brain. By understanding the neural processes underlying developmental changes, researchers gain a better understanding of cognitive, emotional, and social development in humans.
Cognitive development
Cognitive development is primarily concerned with the ways that infants and children acquire, develop, and use internal mental capabilities such as: problem-solving, memory, and language. Major topics in cognitive development are the study of language acquisition and the development of perceptual and motor skills. Piaget was one of the influential early psychologists to study the development of cognitive abilities. His theory suggests that development proceeds through a set of stages from infancy to adulthood and that there is an end point or goal.
Other accounts, such as that of Lev Vygotsky, have suggested that development does not progress through stages, but rather that the developmental process that begins at birth and continues until death is too complex for such structure and finality. Rather, from this viewpoint, developmental processes proceed more continuously. Thus, development should be analyzed, instead of treated as a product to obtain.
K. Warner Schaie has expanded the study of cognitive development into adulthood. Rather than being stable from adolescence, Schaie sees adults as progressing in the application of their cognitive abilities.
Modern cognitive development has integrated the considerations of cognitive psychology and the psychology of individual differences into the interpretation and modeling of development. Specifically, the neo-Piagetian theories of cognitive development showed that the successive levels or stages of cognitive development are associated with increasing processing efficiency and working memory capacity. These increases explain differences between stages, progression to higher stages, and individual differences of children who are the same-age and of the same grade-level. However, other theories have moved away from Piagetian stage theories, and are influenced by accounts of domain-specific information processing, which posit that development is guided by innate evolutionarily-specified and content-specific information processing mechanisms.
Social and emotional development
Developmental psychologists who are interested in social development examine how individuals develop social and emotional competencies. For example, they study how children form friendships, how they understand and deal with emotions, and how identity develops. Research in this area may involve study of the relationship between cognition or cognitive development and social behavior.
Emotional regulation or ER refers to an individual's ability to modulate emotional responses across a variety of contexts. In young children, this modulation is in part controlled externally, by parents and other authority figures. As children develop, they take on more and more responsibility for their internal state. Studies have shown that the development of ER is affected by the emotional regulation children observe in parents and caretakers, the emotional climate in the home, and the reaction of parents and caretakers to the child's emotions.
Music also has an influence on stimulating and enhancing the senses of a child through self-expression.
A child's social and emotional development can be disrupted by motor coordination problems, evidenced by the environmental stress hypothesis. The environmental hypothesis explains how children with coordination problems and developmental coordination disorder are exposed to several psychosocial consequences which act as secondary stressors, leading to an increase in internalizing symptoms such as depression and anxiety. Motor coordination problems affect fine and gross motor movement as well as perceptual-motor skills. Secondary stressors commonly identified include the tendency for children with poor motor skills to be less likely to participate in organized play with other children and more likely to feel socially isolated.
Social and emotional development focuses on five keys areas: Self-Awareness, Self Management, Social Awareness, Relationship Skills and Responsible Decision Making.
Physical development
Physical development concerns the physical maturation of an individual's body until it reaches the adult stature. Although physical growth is a highly regular process, all children differ tremendously in the timing of their growth spurts. Studies are being done to analyze how the differences in these timings affect and are related to other variables of developmental psychology such as information processing speed. Traditional measures of physical maturity using x-rays are less in practice nowadays, compared to simple measurements of body parts such as height, weight, head circumference, and arm span.
A few other studies and practices with physical developmental psychology are the phonological abilities of mature 5- to 11-year-olds, and the controversial hypotheses of left-handers being maturationally delayed compared to right-handers. A study by Eaton, Chipperfield, Ritchot, and Kostiuk in 1996 found in three different samples that there was no difference between right- and left-handers.
Memory development
Researchers interested in memory development look at the way our memory develops from childhood and onward. According to fuzzy-trace theory, a theory of cognition originally proposed by Valerie F. Reyna and Charles Brainerd, people have two separate memory processes: verbatim and gist. These two traces begin to develop at different times as well as at a different pace. Children as young as four years old have verbatim memory, memory for surface information, which increases up to early adulthood, at which point it begins to decline. On the other hand, our capacity for gist memory, memory for semantic information, increases up to early adulthood, at which point it is consistent through old age. Furthermore, one's reliance on gist memory traces increases as one ages.
Research methods and designs
Main research methods
Developmental psychology employs many of the research methods used in other areas of psychology. However, infants and children cannot be tested in the same ways as adults, so different methods are often used to study their development.
Developmental psychologists have a number of methods to study changes in individuals over time. Common research methods include systematic observation, including naturalistic observation or structured observation; self-reports, which could be clinical interviews or structured interviews; clinical or case study method; and ethnography or participant observation. These methods differ in the extent of control researchers impose on study conditions, and how they construct ideas about which variables to study. Every developmental investigation can be characterized in terms of whether its underlying strategy involves the experimental, correlational, or case study approach. The experimental method involves "actual manipulation of various treatments, circumstances, or events to which the participant or subject is exposed; the experimental design points to cause-and-effect relationships. This method allows for strong inferences to be made of causal relationships between the manipulation of one or more independent variables and subsequent behavior, as measured by the dependent variable. The advantage of using this research method is that it permits determination of cause-and-effect relationships among variables. On the other hand, the limitation is that data obtained in an artificial environment may lack generalizability. The correlational method explores the relationship between two or more events by gathering information about these variables without researcher intervention. The advantage of using a correlational design is that it estimates the strength and direction of relationships among variables in the natural environment; however, the limitation is that it does not permit determination of cause-and-effect relationships among variables. The case study approach allows investigations to obtain an in-depth understanding of an individual participant by collecting data based on interviews, structured questionnaires, observations, and test scores. Each of these methods have its strengths and weaknesses but the experimental method when appropriate is the preferred method of developmental scientists because it provides a controlled situation and conclusions to be drawn about cause-and-effect relationships.
Research designs
Most developmental studies, regardless of whether they employ the experimental, correlational, or case study method, can also be constructed using research designs. Research designs are logical frameworks used to make key comparisons within research studies such as:
cross-sectional design
longitudinal design
sequential design
microgenetic design
In a longitudinal study, a researcher observes many individuals born at or around the same time (a cohort) and carries out new observations as members of the cohort age. This method can be used to draw conclusions about which types of development are universal (or normative) and occur in most members of a cohort. As an example a longitudinal study of early literacy development examined in detail the early literacy experiences of one child in each of 30 families.
Researchers may also observe ways that development varies between individuals, and hypothesize about the causes of variation in their data. Longitudinal studies often require large amounts of time and funding, making them unfeasible in some situations. Also, because members of a cohort all experience historical events unique to their generation, apparently normative developmental trends may, in fact, be universal only to their cohort.
In a cross-sectional study, a researcher observes differences between individuals of different ages at the same time. This generally requires fewer resources than the longitudinal method, and because the individuals come from different cohorts, shared historical events are not so much of a confounding factor. By the same token, however, cross-sectional research may not be the most effective way to study differences between participants, as these differences may result not from their different ages but from their exposure to different historical events.
A third study design, the sequential design, combines both methodologies. Here, a researcher observes members of different birth cohorts at the same time, and then tracks all participants over time, charting changes in the groups. While much more resource-intensive, the format aids in a clearer distinction between what changes can be attributed to an individual or historical environment from those that are truly universal.
Because every method has some weaknesses, developmental psychologists rarely rely on one study or even one method to reach conclusions by finding consistent evidence from as many converging sources as possible.
Life stages of psychological development
Prenatal development
Prenatal development is of interest to psychologists investigating the context of early psychological development. The whole prenatal development involves three main stages: germinal stage, embryonic stage and fetal stage. Germinal stage begins at conception until 2 weeks; embryonic stage means the development from 2 weeks to 8 weeks; fetal stage represents 9 weeks until birth of the baby. The senses develop in the womb itself: a fetus can both see and hear by the second trimester (13 to 24 weeks of age). The sense of touch develops in the embryonic stage (5 to 8 weeks). Most of the brain's billions of neurons also are developed by the second trimester. Babies are hence born with some odor, taste and sound preferences, largely related to the mother's environment.
Some primitive reflexes too arise before birth and are still present in newborns. One hypothesis is that these reflexes are vestigial and have limited use in early human life. Piaget's theory of cognitive development suggested that some early reflexes are building blocks for infant sensorimotor development. For example, the tonic neck reflex may help development by bringing objects into the infant's field of view.
Other reflexes, such as the walking reflex, appear to be replaced by more sophisticated voluntary control later in infancy. This may be because the infant gains too much weight after birth to be strong enough to use the reflex, or because the reflex and subsequent development are functionally different. It has also been suggested that some reflexes (for example the moro and walking reflexes) are predominantly adaptations to life in the womb with little connection to early infant development. Primitive reflexes reappear in adults under certain conditions, such as neurological conditions like dementia or traumatic lesions.
Ultrasounds have shown that infants are capable of a range of movements in the womb, many of which appear to be more than simple reflexes. By the time they are born, infants can recognize and have a preference for their mother's voice suggesting some prenatal development of auditory perception. Prenatal development and birth complications may also be connected to neurodevelopmental disorders, for example in schizophrenia. With the advent of cognitive neuroscience, embryology and the neuroscience of prenatal development is of increasing interest to developmental psychology research.
Several environmental agents—teratogens—can cause damage during the prenatal period. These include prescription and nonprescription drugs, illegal drugs, tobacco, alcohol, environmental pollutants, infectious disease agents such as the rubella virus and the toxoplasmosis parasite, maternal malnutrition, maternal emotional stress, and Rh factor blood incompatibility between mother and child. There are many statistics which prove the effects of the aforementioned substances. A leading example of this would be that at least 100,000 "cocaine babies" were born in the United States annually in the late 1980s. "Cocaine babies" are proven to have quite severe and lasting difficulties which persist throughout infancy and right throughout childhood. The drug also encourages behavioural problems in the affected children and defects of various vital organs.
Infancy
From birth until the first year, children are referred to as infants. As they grow, children respond to their environment in unique ways. Developmental psychologists vary widely in their assessment of infant psychology, and the influence the outside world has upon it.
The majority of a newborn infant's time is spent sleeping. At first, their sleep cycles are evenly spread throughout the day and night, but after a couple of months, infants generally become diurnal. In human or rodent infants, there is always the observation of a diurnal cortisol rhythm, which is sometimes entrained with a maternal substance. Nevertheless, the circadian rhythm starts to take shape, and a 24-hour rhythm is observed in just some few months after birth.
Infants can be seen to have six states, grouped into pairs:
quiet sleep and active sleep (dreaming, when REM sleep occurs). Generally, there are various reasons as to why infants dream. Some argue that it is just a psychotherapy, which usually occurs normally in the brain. Dreaming is a form of processing and consolidating information that has been obtained during the day. Freud argues that dreams are a way of representing unconscious desires.
quiet waking, and active waking
fussing and crying. In a normal set up, infants have different reasons as to why they cry. Mostly, infants cry due to physical discomfort, hunger, or to receive attention or stimulation from their caregiver.
Infant perception
Infant perception is what a newborn can see, hear, smell, taste, and touch. These five features are considered as the "five senses". Because of these different senses, infants respond to stimuli differently.
Vision is significantly worse in infants than in older children. Infant sight tends to be blurry in early stages but improves over time. Color perception, similar to that seen in adults, has been demonstrated in infants as young as four months using habituation methods. Infants attain adult-like vision at about six months.
Hearing is well-developed prior to birth. Newborns prefer complex sounds to pure tones, human speech to other sounds, mother's voice to other voices, and the native language to other languages. Scientist believe these features are probably learned in the womb. Infants are fairly good at detecting the direction a sound comes from, and by 18 months their hearing ability is approximately equal to an adult's.
Smell and taste are present, with infants showing different expressions of disgust or pleasure when presented with pleasant odors (honey, milk, etc.) or unpleasant odors (rotten egg) and tastes (e.g. sour taste). Newborns are born with odor and taste preferences acquired in the womb from the smell and taste of amniotic fluid, in turn influenced by what the mother eats. Both breast- and bottle-fed babies around three days old prefer the smell of human milk to that of formula, indicating an innate preference. Older infants also prefer the smell of their mother to that of others.
Touch and feel is one of the better-developed senses at birth as it is one of the first senses to develop inside the womb. This is evidenced by the primitive reflexes described above, and the relatively advanced development of the somatosensory cortex.
Pain: Infants feel pain similarly, if not more strongly than older children, but pain relief in infants has not received so much attention as an area of research. Glucose is known to relieve pain in newborns.
Language
Babies are born with the ability to discriminate virtually all sounds of all human languages. Infants of around six months can differentiate between phonemes in their own language, but not between similar phonemes in another language. Notably, infants are able to differentiate between various durations and sound levels and can easily differentiate all the languages they have encountered, hence easy for infants to understand a certain language compared to an adult.
At this stage infants also start to babble, whereby they start making vowel consonant sound as they try to understand the true meaning of language and copy whatever they are hearing in their surrounding producing their own phonemes.
In various cultures, a distinct form of speech called "babytalk" is used when communicating with newborns and young children. This register consists of simplified terms for common topics such as family members, food, hygiene, and familiar animals. It also exhibits specific phonological patterns, such as substituting alveolar sounds with initial velar sounds, especially in languages like English. Furthermore, babytalk often involves morphological simplifications, such as regularizing verb conjugations (for instance, saying "corned" instead of "cornered" or "goed" instead of "went"). This language is typically taught to children and is perceived as their natural way of communication. Interestingly, in mythology and popular culture, certain characters, such as the "Hausa trickster" or the Warner Bros cartoon character "Tweety Pie", are portrayed as speaking in a babytalk-like manner.
Infant cognition: the Piagetian era
Piaget suggested that an infant's perception and understanding of the world depended on their motor development, which was required for the infant to link visual, tactile and motor representations of objects. According to this theory, infants develop object permanence through touching and handling objects. Infants start to understanding that objects continue to exist when out of sight.
Piaget's sensorimotor stage comprised six sub-stages (see sensorimotor stages for more detail). In the early stages, development arises out of movements caused by primitive reflexes. Discovery of new behaviors results from classical and operant conditioning, and the formation of habits. From eight months the infant is able to uncover a hidden object but will persevere when the object is moved.
Piaget concluded that infants lacked object permanence before 18 months when infants' before this age failed to look for an object where it had last been seen. Instead, infants continued to look for an object where it was first seen, committing the "A-not-B error". Some researchers have suggested that before the age of 8–9 months, infants' inability to understand object permanence extends to people, which explains why infants at this age do not cry when their mothers are gone ("Out of sight, out of mind").
Recent findings in infant cognition
In the 1980s and 1990s, researchers developed new methods of assessing infants' understanding of the world with far more precision and subtlety than Piaget was able to do in his time. Since then, many studies based on these methods suggest that young infants understand far more about the world than first thought.
Based on recent findings, some researchers (such as Elizabeth Spelke and Renee Baillargeon) have proposed that an understanding of object permanence is not learned at all, but rather comprises part of the innate cognitive capacities of our species.
According to Jean Piaget's developmental psychology, object permanence, or the awareness that objects exist even when they are no longer visible, was thought to emerge gradually between the ages of 8 and 12 months. However, experts such as Elizabeth Spelke and Renee Baillargeon have questioned this notion. They studied infants' comprehension of object permanence at a young age using novel experimental approaches such as violation-of-expectation paradigms. These findings imply that children as young as 3 to 4 months old may have an innate awareness of object permanence. Baillargeon's "drawbridge" experiment, for example, showed that infants were surprised when they saw occurrences that contradicted object permanence expectations. This proposition has important consequences for our understanding of infant cognition, implying that infants may be born with core cognitive abilities rather than developing them via experience and learning.
Other research has suggested that young infants in their first six months of life may possess an understanding of numerous aspects of the world around them, including:
an early numerical cognition, that is, an ability to represent number and even compute the outcomes of addition and subtraction operations;
an ability to infer the goals of people in their environment;
an ability to engage in simple causal reasoning.
Critical periods of development
There are critical periods in infancy and childhood during which development of certain perceptual, sensorimotor, social and language systems depends crucially on environmental stimulation. Feral children such as Genie, deprived of adequate stimulation, fail to acquire important skills and are unable to learn in later childhood. In this case, Genie is used to represent the case of a feral child because she was socially neglected and abused while she was just a young girl. She underwent abnormal child psychology which involved problems with her linguistics. This happened because she was neglected while she was very young with no one to care about her and had less human contact. The concept of critical periods is also well-established in neurophysiology, from the work of Hubel and Wiesel among others. Neurophysiology in infants generally provides correlating details that exists between neurophysiological details and clinical features and also focuses on vital information on rare and common neurological disorders that affect infants.
Developmental delays
Studies have been done to look at the differences in children who have developmental delays versus typical development. Normally when being compared to one another, mental age (MA) is not taken into consideration. There still may be differences in developmentally delayed (DD) children vs. typical development (TD) behavioral, emotional and other mental disorders. When compared to MA children there is a bigger difference between normal developmental behaviors overall. DDs can cause lower MA, so comparing DDs with TDs may not be as accurate. Pairing DDs specifically with TD children at similar MA can be more accurate. There are levels of behavioral differences that are considered as normal at certain ages. When evaluating DDs and MA in children, consider whether those with DDs have a larger amount of behavior that is not typical for their MA group. Developmental delays tend to contribute to other disorders or difficulties than their TD counterparts.
Toddlerhood
Infants shift between ages of one and two to a developmental stage known as toddlerhood. In this stage, an infant's transition into toddlerhood is highlighted through self-awareness, developing maturity in language use, and presence of memory and imagination.
During toddlerhood, babies begin learning how to walk, talk, and make decisions for themselves. An important characteristic of this age period is the development of language, where children are learning how to communicate and express their emotions and desires through the use of vocal sounds, babbling, and eventually words. Self-control also begins to develop. At this age, children take initiative to explore, experiment and learn from making mistakes. Caretakers who encourage toddlers to try new things and test their limits, help the child become autonomous, self-reliant, and confident. If the caretaker is overprotective or disapproving of independent actions, the toddler may begin to doubt their abilities and feel ashamed of the desire for independence. The child's autonomic development is inhibited, leaving them less prepared to deal with the world in the future. Toddlers also begin to identify themselves in gender roles, acting according to their perception of what a man or woman should do.
Socially, the period of toddler-hood is commonly called the "terrible twos". Toddlers often use their new-found language abilities to voice their desires, but are often misunderstood by parents due to their language skills just beginning to develop. A person at this stage testing their independence is another reason behind the stage's infamous label. Tantrums in a fit of frustration are also common.
Childhood
Erik Erikson divides childhood into four stages, each with its distinct social crisis:
Stage 1: Infancy (0 to 1½) in which the psychosocial crisis is Trust vs. Mistrust
Stage 2: Early childhood (2½ to 3) in which the psychosocial crisis is Autonomy vs. Shame and doubt
Stage 3: Play age (3 to 5) in which the psychosocial crisis is Initiative vs. Guilt. (This stage is also called the "pre-school age", "exploratory age" and "toy age".)
Stage 4: School age (5 to 12) in which the psychosocial crisis is Industry vs. Inferiority
Infancy
As stated, the psychosocial crisis for Erikson is Trust versus Mistrust. Needs are the foundation for gaining or losing trust in the infant. If the needs are met, trust in the guardian and the world forms. If the needs are not met, or the infant is neglected, mistrust forms alongside feelings of anxiety and fear.
Early Childhood
Autonomy versus shame follows trust in infancy. The child begins to explore their world in this stage and discovers preferences in what they like. If autonomy is allowed, the child grows in independence and their abilities. If freedom of exploration is hindered, it leads to feelings of shame and low self-esteem.
Play (or preschool) ages 3–5.
In the earliest years, children are "completely dependent on the care of others". Therefore, they develop a "social relationship" with their care givers and, later, with family members. During their preschool years (3–5), they "enlarge their social horizons" to include people outside the family.
Preoperational and then operational thinking develops, which means actions are reversible, and egocentric thought diminishes.
The motor skills of preschoolers increase so they can do more things for themselves. They become more independent. No longer completely dependent on the care of others, the world of this age group expands. More people have a role in shaping their individual personalities. Preschoolers explore and question their world. For Jean Piaget, the child is "a little scientist exploring and reflecting on these explorations to increase competence" and this is done in "a very independent way".
Play is a major activity for ages 3–5. For Piaget, through play "a child reaches higher levels of cognitive development."
In their expanded world, children in the 3–5 age group attempt to find their own way. If this is done in a socially acceptable way, the child develops the initiative. If not, the child develops guilt. Children who develop "guilt" rather than "initiative" have failed Erikson's psychosocial crisis for the 3–5 age group.
Middle and Late childhood ages 6–12.
For Erik Erikson, the psychosocial crisis during middle childhood is Industry vs. Inferiority which, if successfully met, instills a sense of Competency in the child.
In all cultures, middle childhood is a time for developing "skills that will be needed in their society." School offers an arena in which children can gain a view of themselves as "industrious (and worthy)". They are "graded for their school work and often for their industry". They can also develop industry outside of school in sports, games, and doing volunteer work. Children who achieve "success in school or games might develop a feeling of competence."
The "peril during this period is that feelings of inadequacy and inferiority will develop. Parents and teachers can "undermine" a child's development by failing to recognize accomplishments or being overly critical of a child's efforts.
Children who are "encouraged and praised" develop a belief in their competence. Lack of encouragement or ability to excel lead to "feelings of inadequacy and inferiority".
The Centers for Disease Control (CDC) divides Middle Childhood into two stages, 6–8 years and 9–11 years, and gives "developmental milestones for each stage".
Middle Childhood (6–8).
Entering elementary school, children in this age group begin to thinks about the future and their "place in the world". Working with other students and wanting their friendship and acceptance become more important. This leads to "more independence from parents and family". As students, they develop the mental and verbal skills "to describe experiences and talk about thoughts and feelings". They become less self-centered and show "more concern for others".
Late Childhood (9–12).
For children ages 9–11 "friendships and peer relationships" increase in strength, complexity, and importance. This results in greater "peer pressure". They grow even less dependent on their families and they are challenged academically. To meet this challenge, they increase their attention span and learn to see other points of view.
Adolescence
Adolescence is the period of life between the onset of puberty and the full commitment to an adult social role, such as worker, parent, and/or citizen. It is the period known for the formation of personal and social identity (see Erik Erikson) and the discovery of moral purpose (see William Damon). Intelligence is demonstrated through the logical use of symbols related to abstract concepts and formal reasoning. A return to egocentric thought often occurs early in the period. Only 35% develop the capacity to reason formally during adolescence or adulthood. (Huitt, W. and Hummel, J. January 1998)
Erik Erikson labels this stage identity versus role confusion. Erikson emphasizes the importance of developing a sense of identity in adolescence because it affects the individual throughout their life. Identity is a lifelong process and is related with curiosity and active engagement. Role confusion is often considered the current state of identity of the individual. Identity exploration is the process of changing from role confusion to resolution.
During Erik Erikson's identity versus role uncertainty stage, which occurs in adolescence, people struggle to form a cohesive sense of self while exploring many social roles and prospective life routes. This time is characterized by deep introspection, self-examination, and the pursuit of self-understanding. Adolescents are confronted with questions regarding their identity, beliefs, and future goals. The major problem is building a strong sense of identity in the face of society standards, peer pressure, and personal preferences. Adolescents participate in identity exploration, commitment, and synthesis, actively seeking out new experiences, embracing ideals and aspirations, and merging their changing sense of self into a coherent identity. Successfully navigating this stage builds the groundwork for good psychological development in adulthood, allowing people to pursue meaningful relationships, make positive contributions to society, and handle life's adversities with perseverance and purpose.
It is divided into three parts, namely:
Early Adolescence: 9 to 13 years
Mid Adolescence: 13 to 15 years and
Late Adolescence: 15 to 18 years
The adolescent unconsciously explores questions such as "Who am I? Who do I want to be?" Like toddlers, adolescents must explore, test limits, become autonomous, and commit to an identity, or sense of self. Different roles, behaviors and ideologies must be tried out to select an identity. Role confusion and inability to choose vocation can result from a failure to achieve a sense of identity through, for example, friends.
Early adulthood
Early adulthood generally refers to the period between ages 18 to 39, and according to theorists such as Erik Erikson, is a stage where development is mainly focused on maintaining relationships. Erikson shows the importance of relationships by labeling this stage intimacy vs isolation. Intimacy suggests a process of becoming part of something larger than oneself by sacrificing in romantic relationships and working for both life and career goals. Other examples include creating bonds of intimacy, sustaining friendships, and starting a family. Some theorists state that development of intimacy skills rely on the resolution of previous developmental stages. A sense of identity gained in the previous stages is also necessary for intimacy to develop. If this skill is not learned the alternative is alienation, isolation, a fear of commitment, and the inability to depend on others.
Isolation, on the other hand, suggests something different than most might expect. Erikson defined it as a delay of commitment in order to maintain freedom. Yet, this decision does not come without consequences. Erikson explained that choosing isolation may affect one's chances of getting married, progressing in a career, and overall development.
A related framework for studying this part of the lifespan is that of emerging adulthood. Scholars of emerging adulthood, such as Jeffrey Arnett, are not necessarily interested in relationship development. Instead, this concept suggests that people transition after their teenage years into a period, not characterized as relationship building and an overall sense of constancy with life, but with years of living with parents, phases of self-discovery, and experimentation.
Middle adulthood
Middle adulthood generally refers to the period between ages 40 to 64. During this period, middle-aged adults experience a conflict between generativity and stagnation. Generativity is the sense of contributing to society, the next generation, or their immediate community. On the other hand, stagnation results in a lack of purpose. The adult's identity continues to develop in middle-adulthood. Middle-aged adults often adopt opposite gender characeristics. The adult realizes they are half-way through their life and often reevaluate vocational and social roles. Life circumstances can also cause a reexamination of identity.
Physically, the middle-aged experience a decline in muscular strength, reaction time, sensory keenness, and cardiac output. Also, women experience menopause at an average age of 48.8 and a sharp drop in the hormone estrogen. Men experience an equivalent endocrine system event to menopause. Andropause in males is a hormone fluctuation with physical and psychological effects that can be similar to those seen in menopausal females. As men age lowered testosterone levels can contribute to mood swings and a decline in sperm count. Sexual responsiveness can also be affected, including delays in erection and longer periods of penile stimulation required to achieve ejaculation.
The important influence of biological and social changes experienced by women and men in middle adulthood is reflected in the fact that depression is highest at age 48.5 around the world.
Old age
The World Health Organization finds "no general agreement on the age at which a person becomes old." Most "developed countries" set the age as 65 or 70. However, in developing countries inability to make "active contribution" to society, not chronological age, marks the beginning of old age. According to Erikson's stages of psychosocial development, old age is the stage in which individuals assess the quality of their lives.
Erikson labels this stage as integrity versus despair. For integrated persons, there is a sense of fulfillment in life. They have become self-aware and optimistic due to life's commitments and connection to others. While reflecting on life, people in this stage develop feelings of contentment with their experiences. If a person falls into despair, they are often disappointed about failures or missed chances in life. They may feel that the time left in life is an insufficient amount to turn things around.
Physically, older people experience a decline in muscular strength, reaction time, stamina, hearing, distance perception, and the sense of smell. They also are more susceptible to diseases such as cancer and pneumonia due to a weakened immune system. Programs aimed at balance, muscle strength, and mobility have been shown to reduce disability among mildly (but not more severely) disabled elderly.
Sexual expression depends in large part upon the emotional and physical health of the individual. Many older adults continue to be sexually active and satisfied with their sexual activity.
Mental disintegration may also occur, leading to dementia or ailments such as Alzheimer's disease. The average age of onset for dementia in males is 78.8 and 81.9 for women. It is generally believed that crystallized intelligence increases up to old age, while fluid intelligence decreases with age. Whether or not normal intelligence increases or decreases with age depends on the measure and study. Longitudinal studies show that perceptual speed, inductive reasoning, and spatial orientation decline. An article on adult cognitive development reports that cross-sectional studies show that "some abilities remained stable into early old age".
Parenting
Parenting variables alone have typically accounted for 20 to 50 percent of the variance in child outcomes.
All parents have their own parenting styles. Parenting styles, according to Kimberly Kopko, are "based upon two aspects of parenting behavior; control and warmth. Parental control refers to the degree to which parents manage their children's behavior. Parental warmth refers to the degree to which parents are accepting and responsive to their children's behavior."
Parenting styles
The following parenting styles have been described in the child development literature:
Authoritative parenting is characterized as parents who have high parental warmth, responsiveness, and demandingness, but rate low in negativity and conflict. These parents are assertive but not intrusive or overly restrictive. This method of parenting is associated with more positive social and academic outcomes. The beneficial outcomes of authoritative parenting are not necessarily universal. Among African American adolescents, authoritative parenting is not associated with academic achievement without peer support for achievement. Children who are raised by authoritative parents are "more likely to become independent, self-reliant, socially accepted, academically successful, and well-behaved. They are less likely to report depression and anxiety, and less likely to engage in antisocial behavior like delinquency and drug use."
Authoritarian parenting is characterized by low levels of warmth and responsiveness with high levels of demandingness and firm control. These parents focus on obedience and they monitor their children regularly. In general, this style of parenting is associated with maladaptive outcomes. The outcomes are more harmful for middle-class boys than girls, preschool white girls than preschool black girls, and for white boys than Hispanic boys.
Permissive parenting is characterized by high levels of responsiveness combined with low levels of demandingness. These parents are lenient and do not necessarily require mature behavior. They allow for a high degree of self-regulation and typically avoid confrontation. Compared to children raised using the authoritative style, preschool girls raised in permissive families are less assertive. Additionally, preschool children of both sexes are less cognitively competent than those children raised under authoritative parenting styles.
Rejecting or neglectful parenting is the final category. This is characterized by low levels of demandingness and responsiveness. These parents are typically disengaged in their child's lives, lacking structure in their parenting styles and are unsupportive. Children in this category are typically the least competent of all the categories.
Mother and father factors
Parenting roles in child development have typically focused on the role of the mother. Recent literature, however, has looked toward the father as having an important role in child development. Affirming a role for fathers, studies have shown that children as young as 15 months benefit significantly from substantial engagement with their father. In particular, a study in the U.S. and New Zealand found the presence of the natural father was the most significant factor in reducing rates of early sexual activity and rates of teenage pregnancy in girls. Furthermore, another argument is that neither a mother nor a father is actually essential in successful parenting, and that single parents as well as homosexual couples can support positive child outcomes. According to this set of research, children need at least one consistently responsible adult with whom the child can have a positive emotional connection. Having more than one of these figures contributes to a higher likelihood of positive child outcomes.
Divorce
Another parental factor often debated in terms of its effects on child development is divorce. Divorce in itself is not a determining factor of negative child outcomes. In fact, the majority of children from divorcing families fall into the normal range on measures of psychological and cognitive functioning. A number of mediating factors play a role in determining the effects divorce has on a child, for example, divorcing families with young children often face harsher consequences in terms of demographic, social, and economic changes than do families with older children. Positive coparenting after divorce is part of a pattern associated with positive child coping, while hostile parenting behaviors lead to a destructive pattern leaving children at risk. Additionally, direct parental relationship with the child also affects the development of a child after a divorce. Overall, protective factors facilitating positive child development after a divorce are maternal warmth, positive father-child relationship, and cooperation between parents.
Cross-cultural
A way to improve developmental psychology is a representation of cross-cultural studies. The psychology field in general assumes that "basic" human developments are represented in any population, specifically the Western-Educated-Industrialized-Rich and Democratic (W.E.I.R.D.) subjects that are relied on for a majority of their studies. Previous research generalizes the findings done with W.E.I.R.D. samples because many in the Psychological field assume certain aspects of development are exempted from or are not affected by life experiences. However, many of the assumptions have been proven incorrect or are not supported by empirical research. For example, according to Kohlberg, moral reasoning is dependent on cognitive abilities. While both analytical and holistic cognitive systems do have the potential to develop in any adult, the West is still on the extreme end of analytical thinking, and the non-West tend to use holistic processes. Furthermore, moral reasoning in the West only considers aspects that support autonomy and the individual, whereas non-Western adults emphasize moral behaviors supporting the community and maintaining an image of holiness or divinity. Not all aspects of human development are universal and we can learn a lot from observing different regions and subjects.
Indian model of human development
An example of a non-Western model for development stages is the Indian model, focusing a large amount of its psychological research on morality and interpersonal progress. The developmental stages in Indian models are founded by Hinduism, which primarily teaches stages of life in the process of someone discovering their fate or Dharma. This cross-cultural model can add another perspective to psychological development in which the West behavioral sciences have not emphasized kinship, ethnicity, or religion.
Indian psychologists study the relevance of attentive families during the early stages of life. The early life stages conceptualize a different parenting style from the West because it does not try to rush children out of dependency. The family is meant to help the child grow into the next developmental stage at a particular age. This way, when children finally integrate into society, they are interconnected with those around them and reach renunciation when they are older. Children are raised in joint families so that in early childhood (ages 6 months to 2 years) the other family members help gradually wean the child from its mother. During ages 2 to 5, the parents do not rush toilet training. Instead of training the child to perform this behavior, the child learns to do it as they mature at their own pace.
This model of early human development encourages dependency, unlike Western models that value autonomy and independence. By being attentive and not forcing the child to become independent, they are confident and have a sense of belonging by late childhood and adolescence. This stage in life (5–15 years) is also when children start education and increase their knowledge of Dharma. It is within early and middle adulthood that we see moral development progress. Early, middle, and late adulthood are all concerned with caring for others and fulfilling Dharma. The main distinction between early adulthood to middle or late adulthood is how far their influence reaches. Early adulthood emphasizes the importance of fulfilling the immediate family needs, until later adulthood when they broaden their responsibilities to the general public. The old-age life stage development reaches renunciation or a complete understanding of Dharma.
The current mainstream views in the psychological field are against the Indian model for human development. The criticism against such models is that the parenting style is overly protective and encourages too much dependency. It focuses on interpersonal instead of individual goals. Also, there are some overlaps and similarities between Erikson's stages of human development and the Indian model but both of them still have major differences. The West prefers Erickson's ideas over the Indian model because they are supported by scientific studies. The life cycles based on Hinduism are not as favored, because it is not supported with research and it focuses on the ideal human development.
See also
Journals
Autism Research
Child Development
Development and Psychopathology
Developmental Neuropsychology
Developmental Psychology
Developmental Review
Developmental Science
Human Development (journal)
Journal of Abnormal Child Psychology
Journal of Adolescent Health
Journal of Autism and Developmental Disorders
Journal of Child Psychology and Psychiatry
Journal of Clinical Child and Adolescent Psychology
Journal of Pediatric Psychology
Journal of Research on Adolescence
Journal of Youth and Adolescence
Journal of the American Academy of Child and Adolescent Psychiatry
Psychology and Aging
Research in Autism Spectrum Disorders
References
Further reading
External links
The Society for Research in Child Development
The British Psychological Society, Developmental Psychology Section
Developmental Psychology: lessons for teaching and learning developmental psychology
GMU's On-Line Resources for Developmental Psychology: a web directory of developmental psychology organizations
Home Economics Archive: Research, Tradition, History (HEARTH)An e-book collection of over 1,000 books spanning 1850 to 1950, created by Cornell University's Mann Library. Includes several hundred works on human development, child raising, and family studies itemized in a specific bibliography.
Developmental psychology Subject Area page at PLOS
Behavioural sciences | 0.761139 | 0.997884 | 0.759529 |
Amisulpride | Amisulpride is an antiemetic and antipsychotic medication used at lower doses intravenously to prevent and treat postoperative nausea and vomiting; and at higher doses by mouth to treat schizophrenia and acute psychotic episodes. It is sold under the brand names Barhemsys (as an antiemetic) and Solian, Socian, Deniban and others (as an antipsychotic). At very low doses it is also used to treat dysthymia.
It is usually classed with the atypical antipsychotics. Chemically it is a benzamide and like other benzamide antipsychotics, such as sulpiride, it is associated with a high risk of elevating blood levels of the lactation hormone, prolactin (thereby potentially causing the absence of the menstrual cycle, breast enlargement, even in males, breast milk secretion not related to breastfeeding, impaired fertility, impotence, breast pain, etc.), and a low risk, relative to the typical antipsychotics, of causing movement disorders.
Amisulpride is indicated for use in the United States in adults for the prevention of postoperative nausea and vomiting (PONV), either alone or in combination with an antiemetic of a different class; and to treat PONV in those who have received antiemetic prophylaxis with an agent of a different class or have not received prophylaxis.
Amisulpride is believed to work by blocking, or antagonizing, the dopamine D2 receptor, reducing its signalling. The effectiveness of amisulpride in treating dysthymia and the negative symptoms of schizophrenia is believed to stem from its blockade of the presynaptic dopamine D2 receptors. These presynaptic receptors regulate the release of dopamine into the synapse, so by blocking them amisulpride increases dopamine concentrations in the synapse. This increased dopamine concentration is theorized to act on dopamine D1 receptors to relieve depressive symptoms (in dysthymia) and the negative symptoms of schizophrenia.
It was introduced by Sanofi-Aventis in the 1990s. Its patent expired by 2008, and generic formulations became available. It is marketed in all English-speaking countries except for Canada.
Medical uses
Schizophrenia
Although according to other studies it appears to have comparable efficacy to olanzapine in the treatment of schizophrenia, amisulpride augmentation, similarly to sulpiride augmentation, has been considered a viable treatment option (although this is based on low-quality evidence) in clozapine-resistant cases of schizophrenia. Another recent study concluded that amisulpride is an appropriate first-line treatment for the management of acute psychosis.
Postoperative nausea and vomiting
Amisulpride is indicated for use in the United States in adults for the prevention of postoperative nausea and vomiting (PONV), either alone or in combination with an antiemetic of a different class; and to treat PONV in those who have received antiemetic prophylaxis with an agent of a different class or have not received prophylaxis.
Contraindications
Amisulpride's use is contraindicated in the following disease states and populations
Pheochromocytoma
Concomitant prolactin-dependent tumours e.g. prolactinoma, breast cancer
Movement disorders (e.g. Parkinson's disease and dementia with Lewy bodies)
Lactation
Children before the onset of puberty
Neither is it recommended to use amisulpride in patients with hypersensitivities to amisulpride or the excipients found in its dosage form.
Adverse effects
Very Common (≥10% incidence)
Extrapyramidal side effects (EPS; including dystonia, tremor, akathisia, parkinsonism).
Common (≥1%, <10% incidence)
Insomnia
Somnolence
Hypersalivation
Nausea
Headache
Hyperactivity
Vomiting
Hyperprolactinaemia (which can lead to galactorrhoea, breast enlargement and tenderness, sexual dysfunction, etc.)
Weight gain (produces less weight gain than chlorpromazine, clozapine, iloperidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, zotepine and more (although not statistically significantly) weight gain than haloperidol, lurasidone, ziprasidone and approximately as much weight gain as aripiprazole and asenapine)
Anticholinergic side effects (although it does not bind to the muscarinic acetylcholine receptors and hence these side effects are usually quite mild) such as
- constipation
- dry mouth
- disorder of accommodation
- Blurred vision
Rare (<1% incidence)
Hyponatraemia
Bradycardia
Hypotension
Palpitations
Urticaria
Seizures
Mania
Oculogyric crisis
Tardive dyskinesia
Blood dyscrasias such as leucopenia, neutropenia and agranulocytosis
QT interval prolongation (in a recent meta-analysis of the safety and efficacy of 15 antipsychotic drugs amisulpride was found to have the 2nd highest effect size for causing QT interval prolongation)
Hyperprolactinaemia results from antagonism of the D2 receptors located on the lactotrophic cells found in the anterior pituitary gland. Amisulpride has a high propensity for elevating plasma prolactin levels as a result of its poor blood–brain barrier penetrability and hence the resulting greater ratio of peripheral D2 occupancy to central D2 occupancy. This means that to achieve the sufficient occupancy (~60–80%) of the central D2 receptors in order to elicit its therapeutic effects a dose must be given that is enough to saturate peripheral D2 receptors including those in the anterior pituitary.
Discontinuation
The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a feeling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time.
There is tentative evidence that discontinuation of antipsychotics can result in psychosis. It may also result in reoccurrence of the condition that is being treated. Rarely tardive dyskinesia can occur when the medication is stopped.
Overdose
Torsades de pointes is common in overdose. Amisulpride is moderately dangerous in overdose (with the TCAs being very dangerous and the SSRIs being modestly dangerous).
Interactions
Amisulpride should not be used in conjunction with drugs that prolong the QT interval (such as citalopram, bupropion, clozapine, tricyclic antidepressants, sertindole, ziprasidone, etc.), reduce heart rate and those that can induce hypokalaemia. Likewise it is imprudent to combine antipsychotics due to the additive risk for tardive dyskinesia and neuroleptic malignant syndrome.
Pharmacology
Pharmacodynamics
Amisulpride functions primarily as a dopamine D2 and D3 receptor antagonist. It has high affinity for these receptors with dissociation constants of 3.0 and 3.5 nM, respectively. Although standard doses used to treat psychosis inhibit dopaminergic neurotransmission, low doses preferentially block inhibitory presynaptic autoreceptors. This results in a facilitation of dopamine activity, and for this reason, low-dose amisulpride has also been used to treat dysthymia.
Amisulpride and its relatives sulpiride, levosulpiride, and sultopride have been shown to bind to the high-affinity GHB receptor at concentrations that are therapeutically relevant ( = 50 nM for amisulpride).
Amisulpride, sultopride and sulpiride respectively present decreasing in vitro affinities for the D2 receptor (IC50 = 27, 120 and 181 nM) and the D3 receptor (IC50 = 3.6, 4.8 and 17.5 nM).
Though it was long widely assumed that dopaminergic modulation is solely responsible for the respective antidepressant and antipsychotic properties of amisulpride, it was subsequently found that the drug also acts as a potent antagonist of the serotonin 5-HT7 receptor (Ki = 11.5 nM). Several of the other atypical antipsychotics such as risperidone and ziprasidone are potent antagonists at the 5-HT7 receptor as well, and selective antagonists of the receptor show antidepressant properties themselves. To characterize the role of the 5-HT7 receptor in the antidepressant effects of amisulpride, a study prepared 5-HT7 receptor knockout mice. The study found that in two widely used rodent models of depression, the tail suspension test, and the forced swim test, those mice did not exhibit an antidepressant response upon treatment with amisulpride. These results suggest that 5-HT7 receptor antagonism mediates the antidepressant effects of amisulpride.
Amisulpride also appears to bind with high affinity to the serotonin 5-HT2B receptor (Ki = 13 nM), where it acts as an antagonist. The clinical implications of this, if any, are unclear. In any case, there is no evidence that this action mediates any of the therapeutic effects of amisulpride.
Amisulpride shows stereoselectivity in its actions. Aramisulpride ((R)-amisulpride) has higher affinity for the 5-HT7 receptor (Ki = 47 nM vs. 1,900 nM) while esamisulpride ((S)-amisulpride) has higher affinity for the D2 receptor (4.0 nM vs. 140 nM). An 85:15 ratio of aramisulpride to esamisulpride (SEP-4199) which provides more balanced 5-HT7 and D2 receptor antagonism than racemic amisulpride (50:50 ratio of enantiomers) is under development for the treatment of bipolar depression.
Through a high direct unmetabolized excretion, it has, despite its high usual dose, also high affinity for dopamine-D2-D3-receptors. Also the available literature gives us hints about also relatively high receptor dissociation kinetics (through a delayed but high occupancy at dopamine receptors after 6 hours from a 100 mg exposure). Moreover, this dopamine exposure could be slightly more "balanced" providing some little advantages over haloperidol in using it for drug exposure. Due to its lack of compensatory serotonin effects and also not having an anticholinergic profile, it may not considered as an effective alternative if akathasia is a problem.
Society and culture
Brand names
Brand names include: Amazeo, Amipride (AU), Amival, Solian (AU, IE, RU, UK, ZA), Soltus, Sulpitac (IN), Sulprix (AU), Midora (RO) and Socian (BR).
Availability
Amisulpride is not approved by the Food and Drug Administration for use in the United States in psychiatric indications, but it is approved and in use throughout Europe, Asia, Mexico, New Zealand and Australia to treat psychosis and schizophrenia.
An IV formulation of Amisulpride was approved for the treatment of postoperative nausea and vomiting ("PONV") in the United States in February 2020.
History of US clinical development
The U.S. Food and Drug Administration (FDA) approved a 10 mg/4mL amisulpride IV formulation for use in post-operative nausea based on evidence from four clinical trials of 2323 subjects undergoing surgery or experiencing nausea and vomiting after the surgery. The trials were conducted at 80 sites in the United States, Canada and Europe.
Two trials (Trials 1 and 2) enrolled subjects scheduled to have surgery. Subjects were randomly assigned to receive either amisulpride or a placebo drug at the beginning of general anesthesia. In Trial 1, subjects received amisulpride or placebo alone, and in Trial 2, they received amisulpride or placebo in combination with one medication approved for prevention of nausea and vomiting. Neither the subjects nor the health care providers knew which treatment was being given until after the trial was complete.
The trials counted the number of subjects who had no vomiting and did not use additional medications for nausea or vomiting in the first day (24 hours) after the surgery. The results then compared amisulpride to placebo.
The other two trials (Trials 3 and 4) enrolled subjects who were experiencing nausea and vomiting after surgery. In Trial 3, subjects did not receive any medication to prevent nausea and vomiting before surgery and in Trial 4 they received the medication, but the treatment did not work. In both trials, subjects were randomly assigned to receive either amisulpride or placebo. Neither the subjects nor the health care providers knew which treatment was being given until after the trial was complete.
The trials counted the number of subjects who had no vomiting and did not use additional medications for nausea or vomiting in the first day (24 hours) after the treatment. The trial compared amisulpride to placebo.
The FDA has not approved amisulpride for use in any psychiatric indication. LB Pharmaceuticals is developing N-methyl amisulpride for the use in the treatment of schizophrenia; a Phase 2 first-in-patient study is planned for 2023.
See also
SEP-4199, a non-racemic form of amisulpride
References
External links
5-HT2B antagonists
5-HT7 antagonists
Anilines
Antidepressants
Antiemetics
Atypical antipsychotics
Benzosulfones
D2 antagonists
D3 antagonists
GHB receptor ligands
Pyrrolidines
Salicylamide ethers | 0.762589 | 0.995984 | 0.759527 |
Health psychology | Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. The discipline is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person's health. For example, certain behaviors can, over time, harm (smoking or consuming excessive amounts of alcohol) or enhance (engaging in exercise) health. Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes (e.g., a virus, tumor, etc.) but also of psychological (e.g., thoughts and beliefs), behavioral (e.g., habits), and social processes (e.g., socioeconomic status and ethnicity).
By understanding psychological factors that influence health, and constructively applying that knowledge, health psychologists can improve health by working directly with individual patients or indirectly in large-scale public health programs. In addition, health psychologists can help train other healthcare professionals (e.g., physicians and nurses) to apply the knowledge the discipline has generated, when treating patients. Health psychologists work in a variety of settings: alongside other medical professionals in hospitals and clinics, in public health departments working on large-scale behavior change and health promotion programs, and in universities and medical schools where they teach and conduct research.
Although its early beginnings can be traced to the field of clinical psychology, four different divisions within health psychology and one related field, occupational health psychology (OHP), have developed over time. The four divisions include clinical health psychology, public health psychology, community health psychology, and critical health psychology. Professional organizations for the field of health psychology include Division 38 of the American Psychological Association (APA), the Division of Health Psychology of the British Psychological Society (BPS), the European Health Psychology Society (EHPS), and the College of Health Psychologists of the Australian Psychological Society (APS). Advanced credentialing in the US as a clinical health psychologist is provided through the American Board of Professional Psychology.
Overview
Recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This conceptualization, which has been labeled the biopsychosocial model, views health and illness as the product of a combination of factors including biological characteristics (e.g., genetic predisposition), behavioral factors (e.g., lifestyle, stress, health beliefs), and social conditions (e.g., cultural influences, family relationships, social support).
Psychologists who strive to understand how biological, behavioral, and social factors influence health and illness are called health psychologists. Health psychologists use their knowledge of psychology and health to promote general well-being and understand physical illness. They are specially trained to help people deal with the psychological and emotional aspects of health and illness. Health psychologists work with many different health care professionals (e.g., physicians, dentists, nurses, physician's assistants, dietitians, social workers, pharmacists, physical and occupational therapists, and chaplains) to conduct research and provide clinical assessments and treatment services. Many health psychologists focus on prevention research and interventions designed to promote healthier lifestyles and try to find ways to encourage people to improve their health. For example, they may help people to lose weight or stop smoking. Health psychologists also use their skills to try to improve the healthcare system. For example, they may advise doctors about better ways to communicate with their patients.
Health psychologists work in many different settings including the UK's National Health Service (NHS), private practice, universities, communities, schools and organizations. While many health psychologists provide clinical services as part of their duties, others function in non-clinical roles, primarily involving teaching and research. Leading journals include Health Psychology, the Journal of Health Psychology, the British Journal of Health Psychology, and Applied Psychology: Health and Well-Being. Health psychologists can work with people on a one-to-one basis, in groups, as a family, or at a larger population level.
Health psychology, like other areas of applied psychology, is both a theoretical and applied field. Health psychologists employ diverse research methods. These methods include controlled randomized experiments, quasi-experiments, longitudinal studies, time-series designs, cross-sectional studies, case-control studies, qualitative research as well as action research. Health psychologists study a broad range of health phenomena including cardiovascular disease (cardiac psychology), smoking habits, the relation of religious beliefs to health, alcohol use, social support, living conditions, emotional state, social class, and more. Some health psychologists treat individuals with sleep problems, headaches, alcohol problems, etc. Other health psychologists work to empower community members by helping community members gain control over their health and improve quality of life of entire communities.
Clinical health psychology (ClHP)
ClHP is the application of scientific knowledge, derived from the field of health psychology, to clinical questions that may arise across the spectrum of health care. ClHP is one of the specialty practice areas for clinical and health psychologists. It is also a major contributor to the prevention-focused field of behavioral health and the treatment-oriented field of behavioral medicine. Clinical practice includes education, the techniques of behavior change, and psychotherapy. In some countries, a clinical health psychologist, with additional training, can become a medical psychologist and, thereby, obtain prescription privileges.
Public health psychology (PHP)
PHP is population-oriented. A major aim of PHP is to investigate potential causal links between psychosocial factors and health at the population level. Public health psychologists present research results to educators, policy makers, and health care providers in order to promote better public health. PHP is allied to other public health disciplines including epidemiology, nutrition, genetics and biostatistics. Some PHP interventions are targeted toward at-risk population groups (e.g., undereducated, single pregnant women who smoke) and not the population as a whole (e.g., all pregnant women).
Community health psychology (CoHP)
CoHP investigates community factors that contribute to the health and well-being of individuals who live in communities. CoHP also develops community-level interventions that are designed to combat disease and promote physical and mental health. The community often serves as the level of analysis, and is frequently sought as a partner in health-related interventions.
Critical health psychology (CrHP)
CrHP is concerned with the distribution of power and the impact of power differentials on health experience and behavior, health care systems, and health policy. CrHP prioritizes social justice and the universal right to health for people of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The critical health psychologist is an agent of change, not simply an analyst or cataloger. A leading organization in this area is the International Society of Critical Health Psychology.
Occupational health psychology
Pickren and Degni and Sanderson observed that in Europe and North America, occupational health psychology (OHP) emerged as a specialty with its own organizations. The authors noted that OHP owes some of that emergence to health psychology as well as other disciplines (e.g., i/o psychology, occupational medicine). Sanderson underlined examples in which OHP aligns with health psychology, including Adkins's research. Adkins documented the application of behavioral principles to improve working conditions, mitigate job stress, and improve worker health in a complex organization.
Origins and development
Health psychology developed in different forms in different societies. Psychological factors in health had been studied since the early 20th century by disciplines such as psychosomatic medicine and later behavioral medicine, but these were primarily branches of medicine, not psychology.
United States
In 1969, William Schofield prepared a report for the APA entitled The Role of Psychology in the Delivery of Health Services. While there were exceptions, he found that the psychological research of the time frequently regarded mental health and physical health as separate, and devoted very little attention to psychology's impact upon physical health. One of the few psychologists working in this area at the time, Schofield proposed new forms of education and training for future psychologists. The APA, responding to his proposal, in 1973 established a task force to consider how psychologists could (a) help people to manage their health-related behaviors, (b) help patients manage their physical health problems, and (c) train healthcare staff to work more effectively with patients.
Health psychology began to emerge as a distinct discipline of psychology in the United States in the 1970s. In the mid-20th century there was a growing understanding in medicine of the effect of behavior on health. For example, the Alameda County Study, which began in the 1960s, showed that people who ate regular meals (e.g., breakfast), maintained a healthy weight, received adequate sleep, did not smoke, drank little alcohol, and exercised regularly were in better health and lived longer. In addition, psychologists and other scientists were discovering relationships between psychological processes and physiological ones. These discoveries include a better understanding of the impact of psychosocial stress on the cardiovascular and immune systems, and the early finding that the functioning of the immune system could be altered by learning.
Led by Joseph Matarazzo, in 1977, APA added a division devoted to health psychology. At the first divisional conference, Matarazzo delivered a speech that played an important role in defining health psychology. He defined the new field in this way, "Health psychology is the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of diagnostic and etiologic correlates of health, illness and related dysfunction, and the analysis and improvement of the healthcare system and health policy formation." Similar organizations were established in other countries, including Australia and Japan.
Europe
In the 1980s there was increasing interest in many European countries in researching psychological aspects of health and illness. In 1986, Stan Maes (1947–2018) of Tilburg University convened a meeting of researchers from Finland, Switzerland, Poland, Czechoslovakia, Italy, Germany, Belgium, Spain, the UK and the Netherlands. Out of this meeting emerged the European Health Psychology Society which began to organise regular conferences (e.g. Trier, 1988; Utrecht, 1989; Oxford, 1990; Lausanne, 1991; and Leipzig, 1992) and published proceedings from these meetings. This society also began to develop its own publications.
United Kingdom
Psychologists have been working in medical settings for many years (in the UK sometimes the field was termed medical psychology). Medical psychology, however, was a relatively small field, primarily aimed at helping patients adjust to illness. The BPS's reconsideration of the role of the Medical Section prompted the emergence of health psychology as a distinct field. Marie Johnston and John Weinman argued in a letter to the BPS Bulletin that there was a great need for a Health Psychology Section. In December 1986 the section was established at the BPS London Conference, with Marie Johnston as chair. Annual conferences began to be held and began to map out the areas of interest. At the Annual BPS Conference in 1993 a review of "Current Trends in Health Psychology" was organized, and a definition of health psychology as "the study of psychological and behavioural processes in health, illness and healthcare" was proposed.
The Health Psychology Section became a Special Group in 1993 and was awarded divisional status within the UK in 1997. The awarding of divisional status meant that the individual training needs and professional practice of health psychologists were recognized, and members were able to obtain chartered status with the BPS. The BPS went on to regulate training and practice in health psychology until the regulation of professional standards and qualifications was taken over by statutory registration with the Health Professions Council in 2010.
Development
A number of relevant trends coincided with the emergence of health psychology, including:
Epidemiological evidence linking behavior and health.
The addition of behavioral science to medical school curricula, with courses often taught by psychologists.
The training of health professionals in communication skills, with the aim of improving patient satisfaction and adherence to medical treatment.
Increasing numbers of interventions based on psychological theory (e.g., behavior modification).
An increased understanding of the interaction between psychological and physiological factors leading to the emergence of psychophysiology and psychoneuroimmunology (PNI).
The health domain having become a target of research by social psychologists interested in testing theoretical models linking beliefs, attitudes, and behavior.
The emergence of AIDS/HIV, and the increase in funding for behavioral research the epidemic provoked.
The emergence of academic /professional bodies to promote research and practice in health psychology was followed by the publication of a series of textbooks which began to lay out the interests of the discipline.
Objectives
Understanding behavioral and contextual factors
Health psychologists conduct research to identify behaviors and experiences that promote health, give rise to illness, and influence the effectiveness of health care. They also recommend ways to improve health care policy. Health psychologists have worked on developing ways to reduce smoking in order to promote health and prevent illness. They have also studied the association between illness and individual characteristics. For example, health psychology has found a relation between the personality characteristics of thrill seeking, impulsiveness, hostility/anger, emotional instability, and depression, on one hand, and high-risk driving, on the other.
Health psychology is also concerned with contextual factors, including economic, cultural, community, social, and lifestyle factors that influence health. Physical addiction impedes smoking cessation. Some research suggests that seductive advertising also contributes to psychological dependency on tobacco, although other research has found no relationship between media exposure and smoking in youth. OHP research indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease. Other research reveals a relation between unemployment and elevations in blood pressure. Epidemiologic research documents a relation between social class and cardiovascular disease.
Health psychologists also aim to change health behaviors for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens (also see health action process approach). Health psychologists employ cognitive behavioral therapy and applied behavior analysis (also see behavior modification) for that purpose.
Preventing illness
Health psychologists promote health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Health psychologists try to help people to lead a healthy life by developing and running programmes which can help people to make changes in their lives such as stopping smoking, reducing the amount of alcohol they consume, eating more healthily, and exercising regularly. Campaigns informed by health psychology have targeted tobacco use. Those least able to afford tobacco products consume them most. Tobacco provides individuals with a way of controlling aversive emotional states accompanying daily experiences of stress that characterize the lives of deprived and vulnerable individuals. Practitioners emphasize education and effective communication as a part of illness prevention because many people do not recognize, or minimize, the risk of illness present in their lives. Moreover, many individuals are often unable to apply their knowledge of health practices owing to everyday pressures and stresses. A common example of population-based attempts to motivate the smoking public to reduce its dependence on cigarettes is anti-smoking campaigns.
Health psychologists help to promote health and well-being by preventing illness. Some illnesses can be more effectively treated if caught early. Health psychologists have worked to understand why some people do not seek early screenings or immunizations, and have used that knowledge to develop ways to encourage people to have early health checks for illnesses such as cancer and heart disease. Health psychologists are also finding ways to help people to avoid risky behaviors (e.g., engaging in unprotected sex) and encourage health-enhancing behaviors (e.g., regular tooth brushing or hand washing).
Health psychologists also aim at educating health professionals, including physicians and nurses, in communicating effectively with patients in ways that overcome barriers to understanding, remembering, and implementing effective strategies for reducing exposures to risk factors and making health-enhancing behavior changes.
There is also evidence from OHP that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies.
Illness, disabilities and long-term conditions
Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. These stressors include problems meeting medical and other bills, problems obtaining proper care when home from the hospital, obstacles to caring for dependents, the experience of having one's sense of self-reliance compromised, gaining a new, unwanted identity as that of a sick person, and so on. These stressors can lead to depression, reduced self-esteem, etc.
The use of medications can alter the microbiome and potentially impact overall health and the development of diseases. It has been discovered that the metabolites produced by intestinal microorganisms can influence one's health. For instance, antidepressants can modify the composition of the intestinal microbiota, which can then affect the course of the disease through changes in specific metabolites produced by certain intestinal microorganisms. This has significant implications, particularly in the context of depression, as it offers new insights into how to approach and treat the condition at hand.
Health psychologists can support people living with long-term conditions to improve or maintain quality of life, self-manage their conditions, and adjust to life with an illness, disability or long-term condition.
Health psychology also concerns itself with bettering the lives of individuals with terminal illness. When there is little hope of recovery, health psychologist therapists can work within a multi-disciplinary palliative care team to improve the quality of life of the patient by helping the patient recover at least some of his or her psychological well-being.
A form of therapy shown in recent studies is psychotherapy. It is used as a mode of intervention due to the inconsistency and issues that may arise from pharmacological interventions. It ensures the use of evidence-based practices and helps in facilitating adherence to medication regimens that may be impacted by psychiatric symptoms, such as low motivation or depressive symptoms. When using psychotherapeutic strategies, clinicians can choose from three modes: individual, family/couples, and group psychotherapy.
Critical analysis of health policy
Critical health psychologists explore how health policy can influence inequities, inequalities and social injustice. These avenues of research expand the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists using qualitative methods that zero in on the health experience.
Conducting research
Like psychologists in the other main psychology disciplines, health psychologists have advanced knowledge of research methods. Health psychologists apply this knowledge to conduct research on a variety of questions. For example, health psychologists carry out research to answer questions such as:
What influences healthy eating?
How is stress linked to heart disease?
What are the emotional effects of genetic testing?
How can we change people's health behavior to improve their health?
Teaching and communication
Health psychologists can also be responsible for training other health professionals on how to deliver interventions to help promote healthy eating, stopping smoking, weight loss, etc. Health psychologists also train other health professionals in communication skills such as how to break bad news or support behavior change for the purpose of improving adherence to treatment.
Applications
Improving doctor–patient communication
Health psychologists aid the process of communication between physicians and patients during medical consultations. There are many problems in this process, with patients showing a considerable lack of understanding of many medical terms, particularly anatomical terms (e.g., intestines). One area of research on this topic involves "doctor-centered" or "patient-centered" consultations. Doctor-centered consultations are generally directive, with the patient answering questions and playing less of a role in decision-making. Although this style is preferred by elderly people and others, many people dislike the sense of hierarchy or ignorance that it inspires. They prefer patient-centered consultations, which focus on the patient's needs, involve the doctor listening to the patient completely before making a decision, and involving the patient in the process of choosing treatment and finding a diagnosis.
Improving adherence to medical advice
Health psychologists engage in research and practice aimed at getting people to follow medical advice and adhere to their treatment regimens. Patients often forget to take their pills or consciously opt not to take their prescribed medications because of side effects. Failing to take prescribed medication is costly and wastes millions of usable medicines that could otherwise help other people. Estimated adherence rates are difficult to measure (see below); there is, however, evidence that adherence could be improved by tailoring treatment programs to individuals' daily lives. Additionally, traditional cognitive-behavioural therapies have been adapted for people with chronic illnesses and comorbid psychological distress to include modules that encourage, support and reinforce adherence to medical advice as part of the larger treatment approach.
Ways of measuring adherence
Health psychologists have identified a number of ways of measuring patients' adherence to medical regimens:
Counting the number of pills in the medicine bottle
Using self-reports
Using "Trackcap" bottles, which track the number of times the bottle is opened.
Managing pain
Health psychology attempts to find treatments to reduce or eliminate pain, as well as understand pain anomalies such as episodic analgesia, causalgia, neuralgia, and phantom limb pain. Although the task of measuring and describing pain has been problematic, the development of the McGill Pain Questionnaire has helped make progress in this area. Treatments for pain involve patient-administered analgesia, acupuncture (found to be effective in reducing pain for osteoarthritis of the knee), biofeedback, and cognitive behavior therapy.
Health psychologist roles
Below are some examples of the types of positions held by health psychologists within applied settings such as the UK's NHS and private practice.
Healthcare professionals who treat individuals with mental health conditions prefer medications that provide energy and have fewer side effects. When prescribing psychiatric drugs, it is essential to consider individual needs, safety, and anti-doping policies. Psychologists patients prefer specific medications like escitalopram for anxiety, melatonin for insomnia, lamotrigine for bipolar disorders, and aripiprazole for psychotic disorders. This emphasizes the importance of personalized prescribing individuals.
Consultant health psychologist: A consultant health psychologist will take a lead for health psychology within public health, including managing tobacco control and smoking cessation services and providing professional leadership in the management of health trainers.
Principal health psychologist: A principal health psychologist could, for example lead the health psychology service within one of the leading heart and lung hospitals, providing a clinical service to patients and advising all members of the multidisciplinary team.
Health psychologist: An example of a health psychologist's role would be to provide health psychology input to a center for weight management. Psychological assessment of treatment, development and delivery of a tailored weight management program, and advising on approaches to improve adherence to health advice and medical treatment.
Research psychologist: Research health psychologists carry out health psychology research, for example, exploring the psychological impact of receiving a diagnosis of dementia, or evaluating ways of providing psychological support for people with burn injuries. Research can also be in the area of health promotion, for example investigating the determinants of healthy eating or physical activity or understanding why people misuse substances.
Health psychologist in training/assistant health psychologist: As an assistant/in training, a health psychologist will gain experience assessing patients, delivering psychological interventions to change health behaviors, and conducting research, whilst being supervised by a qualified health psychologist.
Training
United States
Universities began to develop doctoral-level training programs in health psychology. In the US, post-doctoral level health psychology training programs were established for individuals who completed a doctoral degree in clinical psychology.
United Kingdom
The term "health psychologist" is a protected title, with health psychologists required to register with the Health Professions Council (HPC) and have trained to a level to be eligible for full membership of the Division of Health Psychology within the BPS. Registered health psychologists who are chartered with the BPS will have undertaken a minimum of six years of training, with three of those years dedicated to health psychology training. Following the completion of a BPS-accredited undergraduate degree in Psychology, aspiring health psychologists must first complete a BPS-accredited masters in health psychology (Stage 1 training). Once the trainee has completed Stage 1 training, they can either choose to complete the BPS' independent Stage 2 training route or sign up to an accredited health psychology doctorate program at a UK university (DHealthPsy). Both training routes require trainees to demonstrate they meet the core competencies of:
professional skills (including implementing ethical and legal standards, communication, and teamwork),
research skills (including designing, conducting, and analyzing psychological research in numerous areas),
consultancy skills (including planning and evaluation),
teaching and training skills (including knowledge of designing, delivering, and evaluating large and small scale training program),
intervention skills (including delivery and evaluation of behavior change interventions).
At present, there are limited opportunities for trainees to receive fully funded training. The NHS Education Scotland (NES) Stage 2 program funds several trainee health psychologists each year, providing trainees with fixed-term posts within NHS Boards across Scotland. In 2022, a pilot scheme was launched by Health Education England (HEE) to provide similar opportunities to aspiring health psychologists across England.
Once qualified, health psychologists can work in a range of settings, for example the NHS, universities, schools, private healthcare, and research and charitable organizations. A health psychologist in training might be working within applied settings while working towards registration and chartered status. All qualified health psychologists must also engage in and record their continuing professional development (CPD) for psychology each year throughout their career.
Australia
Health psychologists are registered by the Psychology Board of Australia. The standard pathway to becoming an endorsed health psychologists involves a minimum of six years training and a two-year registrar program. Health psychologists must also undertake continuing professional development (CPD) each year.
New Zealand
Health psychologists are registered by the New Zealand Psychologists Board within the psychologist scope of practice. The training pathway to becoming a registered health psychologist requires a Masters in Health Psychology and a two-year registration Postgraduate Diploma in Health Psychology at the University of Auckland. Outside of clinical work in primary, secondary and tertiary healthcare settings, graduates may choose careers in research and health promotion in universities and private settings. Health psychologists are able to join the Institute of Health Psychology (IHP), an institute of the New Zealand Psychological Society, as a practitioner, academic or student affiliate.
See also
Applied psychology
Behavioral medicine
Bodymind
Cardiac psychology
Chronic stress
Cognitive epidemiology
European Academy of Occupational Health Psychology
Healing environments
Impact of health on intelligence
Nutrition psychology
Occupational health psychology
Occupational safety and health
Outline of psychology
Pediatric psychology
Perseverative cognition
Self-concealment
Society for Occupational Health Psychology
Workplace stress
Pain Psychology
References
External links
North America
Europe
Applied psychology
Behavioural sciences
Determinants of health | 0.764903 | 0.992865 | 0.759446 |
Narrative therapy | Narrative therapy (or narrative practice) is a form of psychotherapy that seeks to help patients identify their values and the skills associated with them. It provides the patient with knowledge of their ability to live these values so they can effectively confront current and future problems. The therapist seeks to help the patient co-author a new narrative about themselves by investigating the history of those values. Narrative therapy is a social justice approach to therapeutic conversations, seeking to challenge dominant discourses that shape people's lives in destructive ways. While narrative work is typically located within the field of family therapy, many authors and practitioners report using these ideas and practices in community work, schools and higher education. Narrative therapy has come to be associated with collaborative as well as person-centered therapy.
History
Narrative therapy was developed during the 1970s and 1980s, largely by Australian social worker Michael White and David Epston of New Zealand, and it was influenced by different philosophers, psychologists, and sociologists such as Michel Foucault, Jerome Bruner, Lev Semyonovich Vygotsky etc.
Conversation maps
Re-authoring identity
The narrative therapist focuses upon assisting people to create stories about themselves, about their identities, that are helpful to them. This work of "re-authoring identity" helps people identify their values and identify the skills and knowledge to live out these values by way of the therapist's skilled use of listening and questioning. Through the process of identifying the history of values in people's lives, the therapist and client are able to co-author a new story about the person.
The story people tell about themselves and that is told about them is important in this approach, which asserts that the story of a person's identity may determine what they think is possible for themselves. The narrative process allows people to identify what values are important to them and how they might use their own skills and knowledge to live these values.
This includes a focus on "unique outcomes" (a term of Erving Goffman) or exceptions to the problem that wouldn't be predicted by the problem's narrative or story itself.
Externalizing conversations
The concept of identity is important in narrative therapy. The approach aims not to conflate people's identities with the problems they may face or the mistakes they have made. Rather, the approach seeks to avoid modernist, essentialist notions of the self that lead people to believe there is a biologically determined "true self" or "true nature". Instead, identity, seen as primarily social, can be changed according to the choices people make.
To separate people's identities from the problems they face, narrative therapy employs conversations. The process of externalization allows people to consider their relationships with problems. A person's strengths or positive attributes can also be externalized, allowing people to recognise the stories of how such strength and positive attributes come into the person's life, and engage in the construction and performance of preferred identities.
An emphasis involves naming a problem so that a person can assess the problem's effects in their life, can analyze how the problem operates or works in their life, and in the end can choose their relationship to the problem.
"Statement of Position Map"
In a narrative approach, the therapist aims to adopt a collaborative therapeutic posture rather than imposing ideas on people by giving them advice. Michael White developed a conversation map called a "Statement of Position Map" designed to elicit the client's own evaluation of the problems and developments in their lives. Both the therapist and the client are seen as having valuable information relevant to the process and the content of the therapeutic conversation. By adopting a posture of curiosity and collaboration, the therapist aims to give the implicit message to people that they already have knowledge and skills to solve the problems they face. When people develop solutions to their own problems on the basis of their own values, they may become much more committed to implementing these solutions.
Re-membering practice
Narrative therapy identifies that identities are social achievements and the practice of re-membering draws closer those who support a person's preferred story about themselves and dis-engages those that do not support the person.
Absent but implicit
Inspired by the work of Jacques Derrida, Michael White became curious about the values implicit in people's pain, their sense of failure, and actions. Often, people only feel pain or failure in when their values are abridged, or when their relationships and lives are not as they should be. Furthermore, there are often stalled initiatives that people take in life that are also guided by implicit values.
Outsider witnesses map
In this particular narrative practice or conversation, outsider witnesses are invited listeners to a consultation. Often they are friends of the consulting person or past clients of the therapist who have their own knowledge and experience of the problem at hand. During the first interview, between therapist and consulting person, the outsider listens without comment.
Then the therapist interviews them with the instructions not to critique or evaluate or make a proclamation about what they have just heard, but instead to simply say what phrase or image stood out for them, followed by any resonances between their life struggles and those just witnessed. Lastly, the outsider is asked in what ways they may feel a shift in how they experience themselves from when they first entered the room.
Next, in similar fashion, the therapist turns to the consulting person, who has been listening all the while, and interviews them about what images or phrases stood out in the conversation just heard and what resonances have struck a chord within them.
In the end, an outsider witness conversation is often rewarding for witnesses. But for the consulting person the outcomes are remarkable: they learn they are not the only one with this problem, and they acquire new images and knowledge about it and their chosen alternate direction in life. The main aim of the narrative therapy is to engage in people's problems by providing the alternative best solution.
Therapeutic documents
Narrative therapy embodies a strong appreciation for the creation and use of documents, as when a person and a counsellor co-author "A Graduation from the Blues Certificate", for example. In some instances, case notes are created collaboratively with clients to provide documentation as well as markers of progress.
Social-political therapeutic approach
A strong awareness of the impact of power relations in therapeutic conversations, with a commitment to checking back with the client about the effects of therapeutic styles in order to mitigate the possible negative effect of invisible assumptions or preferences held by the therapist. There is also an awareness of how social narratives such as femininity and masculinity can be corrupted and negatively influence peoples identities.
Eating disorders
Narrative therapy has made numerous contributions to the field of eating disorders. David Epston, Stephen Madigan and Catrina Brown have made the most significant contribution to bringing a depathologizing approach to this issue.
Men and domestic violence
Narrative therapy has also been applied to work with men who abuse their female partners. Alan Jenkins and Tod Augusta-Scott have been the most prolific in this field. They integrated a social-political analysis of the violence, while at the same time engaging men in a respectful, collaborative manner.
Community work
Narrative therapy has also been used in a variety of community settings. In particular, an exercise called "Tree of Life" has been used to mobilize communities to act according to their own values.
Criticisms
There have been several formal criticisms of narrative therapy over what are viewed as its theoretical and methodological inconsistencies, among various other concerns.
Narrative therapy has been criticised as holding to a social constructionist belief that there are no absolute truths, but only socially sanctioned points of view, and that Narrative therapists simply privilege their client's concerns over and above "dominating" cultural narratives.
Several critics have posed concerns that narrative therapy has made gurus of its leaders, particularly in the light that its leading proponents tend to be overly harsh about most other kinds of therapy.
Narrative therapy is also criticized for the lack of clinical and empirical studies to validate its many claims. Etchison & Kleist (2000) stated that narrative therapy's focus on outcomes is not congruent with larger research and findings which the majority of respected empirical studies employ today. This has led to a lack of research material which can support its claims of efficacy.
See also
Theoretical foundations
Constructivist epistemology
Feminism
Hermeneutics
Postmodernism
Poststructuralism
Related types of therapy
Brief therapy
Family therapy
Logotherapy
Response based therapy
Script analysis
Solution focused brief therapy
Other related concepts
Dialogical self
Lucid dream
Narrative
References
External links
Constructivism (psychological school)
Psychotherapy by type | 0.76722 | 0.989832 | 0.759419 |
Colonial mentality | A colonial mentality is an internalized ethnic, linguistic, or cultural inferiority complex imposed on peoples as a result of colonization, i.e. being invaded and conquered by another nation state and gaslit, often through the educational system, into linguistic imperialism and cultural assimilation through an instilled belief that the language and culture of the colonizer are superior to their own heritage languages and cultures. The term has been used by postcolonial scholars to discuss the transgenerational effects of colonialism present in former colonies following decolonization. It is commonly used as an operational concept for framing ideological domination in historical colonial experiences. In psychology, colonial mentality has been used to explain instances of collective depression, anxiety, and other widespread mental health issues in populations that have experienced colonization.
Notable Marxist influences on the postcolonial concept of colonial mentality include Frantz Fanon's works on the fracturing of the colonial psyche through Western cultural domination, as well as the concept of cultural hegemony developed by Italian Communist Party Founder Antonio Gramsci.
Criticism of the colonial mentality, however, is not solely a Marxist concept. Anti-Marxist nationalist intellectuals, such as Douglas Hyde, Saunders Lewis, Patrick Pearse, Máirtín Ó Direáin, and John Lorne Campbell, who have also favored political, cultural, literary, and linguistic decolonisation, have also denounced the colonial mentality as a serious problem among their own people. As a solution, they recommended heritage language learning and cultural nationalism; meaning a combination of reviving the best elements of the pre-colonial past and turning away from only emulating the colonizer in favor of looking at the culture and literature of the whole world, especially by those engaged in literature and the arts.
Influences from Marxism
Frantz Fanon
Frantz Fanon's Marxist writings on imperialism, racism, and decolonizing struggles have influenced post-colonial discussions about the internalization of colonial prejudice. Fanon first tackled the problem of, what he called, the "colonial alienation of the person" as a mental health issue through psychiatric analysis.
In The Wretched of the Earth (French: Les Damnés de la Terre), published in 1961, Fanon used psychiatry to analyze how French colonization and the carnage of the Algerian War had mentally affected Algerians' self-identity and mental health. The book argues that during the period of colonization there was a subtle and constant mental pathology that developed within the colonial psyche. Fanon argued that the colonial psyche is fractured by the lack of mental and material homogeneity as a result of the colonial power's Western culture being pressured onto the colonized population despite the existing material differences between them.
Here Fanon expands traditional Marxist understandings of historical materialism to explore how the dissonance between material existence and culture functions to transform the colonized people through the mold of the Western bourgeoisie. This meant that the native Algerian came to view their own traditional culture and identity through the lens of colonial prejudice. Fanon observed that average Algerians internalized and then openly repeated remarks that were in line with the institutionalized racist culture of the French colonizers; dismissing their own culture as backward due to the internalization of Western colonial ideologies.
According to Fanon this results in a destabilizing existential conflict within the colonized culture:"In the West, the family circle, the effects of education, and the relatively high standard of living of the working class provide a more or less efficient protection against the harmful action of these pastimes. But in an African country, where mental development is uneven, where the violent collision of two worlds has considerably shaken old traditions and thrown the universe of the perceptions out of focus, the impressionability and sensibility of the Young African are at the mercy of the various assaults made upon them by the very Nature of Western Culture."
British Empire
Wales
A person who suffers from excessive Anglophilia, enthusiasm for the British Empire, and embarrassment about Welsh identity is traditionally known in Welsh culture as a Dic Siôn Dafydd.
Anti-Marxist and Welsh nationalist Saunders Lewis fought a decades-long battle against the Far Left leadership of Plaid Cymru, the political party he co-founded, because of his belief that cultural nationalism was a preferable cause than Socialism. Unlike the Plaid Cymru leadership, Lewis believed that linguistic and cultural decolonisation needed to precede Welsh devolution or political independence. Lewis called, most of all, for the revival of the Welsh people's increasingly threatened heritage language and moving Welsh-language literature and theatre towards the whole Western canon and away from only emulating English literature. Otherwise, Lewis predicted as early as 1918, "the Welsh Parliament would [only] be an enlarged County Council."
Ireland
In British-ruled Ireland, Irish people who displayed snobbery, extreme Anglophilia, or mimicked the English nobility and felt a cultural cringe regarding Irish culture, Irish nationalism, Gaelic games, and the Gaelic revival, were termed Jackeens if they were Dubliners, West Brits if they were Anglo-Irish or Ulster Scots people, and, if they were Irish Catholics and Gaels, to be suffering from Shoneenism. The most widely accepted etymology of shoneen is (, def. "Little John"), referring to John Bull, the national personification of the British Empire in general and of England in particular.
According to Marcus Tanner, however, the Irish people, like many other invaded, conquered, and colonized peoples before and since, overwhelmingly chose to abandon their heritage language out of a misunderstanding of the benefits of being multilingual and a deep longing for their children to succeed and move up in the world. The commonly quoted proverb in many rural areas during the Victorian era language shift was, "Irish doesn't sell the cow." Ironically, the complete opposite was taking place during the same decades among speakers of minority languages in the Austro-Hungarian Empire.
At the same time, the modern history of the Irish language revival is dated from Protestant Celticist Douglas Hyde's 1892 manifesto The necessity for de-anglicising the Irish nation.
Yet another of the most influential critics of Shoneenism was Easter Rising leader Patrick Pearse, whose ideas on the decolonisation of Ireland's educational system are contained within his essay The Murder Machine.
Also according to Louis de Paor, Pearse's reading of the radically experimental poetry of Walt Whitman and of the French Symbolists led him to introduce Modernist poetry into the Irish language. As a literary critic, Pearse also left behind a very detailed blueprint for the decolonization of Irish literature, particularly in the Irish language.
Louis de Paor writes that Patrick Pearse was "the most perceptive critic and most accomplished poet," of the early Gaelic revival providing "a sophisticated model for a new literature in Irish that would reestablish a living connection with the pre-colonial Gaelic past while resuming its relationship with contemporary Europe, bypassing the monolithic influence of English." For this reason, de Paor has termed the youthful Pearse's execution by a British Army firing squad a catastrophe for Irish language literature.
Following the Irish War of Independence and Irish Civil War, Ernest Augustus Boyd's 1924 collection Portraits: real and imaginary included "A West Briton", which gave a table of West-Briton responses to certain words:
{|
|-
! Word !! Response
|-
| Sinn Féin || Pro-German
|-
| Irish || Vulgar
|-
| England || Mother-country
|-
| Green || Red
|-
| Nationality || Disloyalty
|-
| Patriotism || O.B.E.
|-
| Self-determination || Czecho-Slovakia
|}
According to Boyd, "The West Briton is the near Englishman ... an unfriendly caricature, the reductio ad absurdum of the least attractive English characteristics. ... The best that can be said ... is that the species is slowly becoming extinct. ... nationalism has become respectable". The opposite of the "West Briton" Boyd called the "synthetic Gael" and is called, more recently, a Plastic Paddy.
Even long after the 1940s Pearse-inspired revival of Modern literature in Irish, however, a colonial mentality in Ireland has repeatedly been accused of continuing to exist and is still being criticized.
For example, Máirtín Ó Direáin's poetry in Connaught Irish, which was written both during and after the Emergency in Dublin, repeatedly displays the horror he felt as he witnessed the escalating collapse of Christian morality, the growing number of, "emasculated men" and the similar loss of feminity in women. Ó Direáin considered all three trends to be rooted in the, or "Uprootedness", of Irish culture and the Irish people, most particularly in long English-speaking parts of the country.
In contrast, Far Left nationalist Máirtín Ó Cadhain's politics were Irish republicanism mixed with Marxism and radical politics, and then tempered with a rhetorical anti-clericalism. In his writings, however, concerning the revival of the Irish language, ÓCadhain was very practical about the Catholic Church in Ireland but demanded greater commitment to the language revival from Roman Catholic priests. It was his view that, as the Church was there anyway, it would be better if the clergy were more willing to address their faithful in the Irish language. He further promoted what he termed the ("Re-Conquest of Ireland"), (meaning both decolonization and re-Gaelicisation) and in response to what he saw as the Irish Government's bureaucratic foot-dragging on both Irish language broadcasting and Irish-medium education, Ó Cadhain was a key figure in the 1969 civil rights movement, . This group has used civil disobedience tactics influenced by Saunders Lewis, the Welsh language activist and co-founder of Plaid Cymru.
More recently, in 2017 Irish Court of Appeals judge Gerard Hogan denounced the growing preference among Irish lawyers to allege that the European Convention of Human Rights has completely superseded the Constitution of Ireland, as a "sort of legal shoneenism".
Scotland
Under to the 1872 Education Act, school attendance was compulsory and only English was taught or tolerated in the schools of both the Lowlands and the Highlands and Islands. As a result, any student who spoke Scots or Scottish Gaelic in the school or on its grounds could expect what Ronald Black calls the, "familiar Scottish experience of being thrashed for speaking [their] native language."
In 1891, An Comunn Gàidhealach was founded in Oban to help preserve the Scottish Gaelic language and its literature and to establish the Royal National Mòd (Am Mòd Nàiseanta Rìoghail), as a festival of Gaelic music, literature, arts, and culture deliberately modelled upon the National Eisteddfod of Wales.
Before serving in the Seaforth Highlanders in British India and during the Fall of France in 1940, however, Gaelic language war poet Aonghas Caimbeul attended the 300-pupil Cross School on the Isle of Lewis after the 1872 Education Act. He later recalled, "A Lowlander, who had not a word of Gaelic, was the schoolmaster. I never had a Gaelic lesson in school, and the impression you got was that your language, people, and tradition had come from unruly, wild, and ignorant tribes and that if you wanted to make your way in the world you would be best to forget them completely. Short of the stories of the German Baron Münchhausen, I have never come across anything as dishonest, untruthful, and inaccurate as the history of Scotland as taught in those days."
Even so, large numbers of the Scottish people, both Highlander and Lowlander, continued to enlist in the British armed forces and the Scottish regiments, through the role in spreading British Colonial rule to other countries, became renowned worldwide as shock troops.
For this reason, literary critic Wilson MacLeod has written that, in post-Culloden Scottish Gaelic literature, anti-colonialist poets such as Duncan Livingstone "must be considered isolated voices. The great majority of Gaelic verse, from the eighteenth century onwards, was steadfastly Pro-British and Pro-Empire, with several poets, including Aonghas Moireasdan and Dòmhnall MacAoidh, enthusiastically asserting the conventual justificatory rationale for imperial expansion, that it was a civilising mission rather than a process of conquest and expropriation. Conversely, there is no evidence that Gaelic poets saw a connection between their own difficult history and the experience of colonised people in other parts of the world."
For this reason, during the final phase of the Second Boer War, Afrikaner residents of Winburg in the former Orange Free State, routinely taunted the Scottish Regiments in the local British Army garrison with a parody of the Jacobite rebel song Bonnie Dundee, which was typically sung in English. The parody celebrated the guerrilla warfare of Boer commando leader Christiaan De Wet.
De Wet he is mounted, he rides up the street
The English skedaddle an A1 retreat!
And the commander swore: They've got through the net
That's been spread with such care for Christiaan De Wet.
There are hills beyond Winburg and Boers on each hill
Sufficient to thwart ten generals' skill
There are stout-hearted burghers 10,000 men set
On following the Mausers of Christian De Wet.
Then away to the hills, to the veld, to the rocks
Ere we own a usurper we'll crouch with the fox
And tremble false Jingoes amidst all your glee
Ye have not seen the last of my Mausers and me!
Colonial India
During the period of European colonial rule in India, Europeans in India typically regarded many aspects Indian culture with disdain and supported colonial rule as a beneficial "civilizing mission". Colonial rule in India was framed as an act which was beneficial to the people of India, rather than a process of political and economic dominance by a small minority of foreigners.
Under colonial rule, many practices were outlawed, such as the practice of forcing widows to immolate themselves (known as sati) with acts being deemed idolatrous being discouraged by Evangelical missionaries, the latter of which has been claimed by some scholars to have played a large role in the developments of the modern definition of Hinduism. These claims base their assumptions on the lack of a unified Hindu identity prior to the period of colonial rule, and modern Hinduism's unprecedented outward focus on a monotheistic Vedanta worldview. These developments have been read as the result of colonial views which discouraged aspects of Indian religions which differed significantly from Christianity. It has been noted that the prominence of the Bhagavad Gita as a primary religious text in Hindu discourse was a historical response to European criticisms of Indian culture. Europeans found that the Gita had more in common with their own Christian Bible, leading to the denouncement of Hindu practices more distantly related to monotheistic world views; with some historians claiming that Indians began to characterize their faith as the equivalent of Christianity in belief (especially in terms of monotheism) and structure (in terms of providing an equivalent primary sacred text).
Hindu nationalism developed in the 19th century as an opposition to European ideological prominence; however, local Indian elites often aimed to make themselves and Indian society modern by "emulating the West". This led to the emergence of what some have termed 'neo-Hinduism': consisting of reformist rhetoric transforming Hindu tradition from above, disguised as a revivalist call to return to the traditional practises of the faith. Reflecting the same arguments made by Christian missionaries, who argued that the more superstitious elements of Hindu practice were responsible for corrupting the potential rational philosophy of the faith (i.e. the more Christian-like sentiments). Moving the definitions of Hindu practice away from more overt idol worshiping, reemphasizing the concept of Brahman as a monotheistic divinity, and focusing more on the figure of Krishna in Vaishnavism due to his role as a messianic type figure (more inline with European beliefs) which makes him a suitable alternative to the Christian figure of Jesus Christ.
The Bharatiya Janata Party (BJP), India's current ruling party, follows this tradition of nationalistic Hinduism (Hindutva), and promotes an Indian national identity infused with neo-Vedantic which has been claimed by some to have been influenced by a "colonial mentality".
Legacy
Some critics have claimed that writer Rudyard Kipling's portrayals of Indian characters in his works supported the view that colonized people were incapable of living without being ruled by White British people, describing these portrayals as racist. In his famous poem "The White Man's Burden", Kipling directly argues for this point by romanticizing the "civilising mission" in non-Western countries. Jaway Syed has claimed that Kipling's poems idolizes Western culture as entirely rational and civilized, while treating non-white cultures as 'childlike' and 'demonic'. Similar sentiments have been interpreted in Kipling's other works, such as his characterization of the Second Boer War, despite rampant British war crimes and post-war colonialism aimed at using the educational system to destroy the Afrikaans language, as a "white man's war"; along with his presentation of 'whiteness' as a morally and culturally superior trait of the West. His portrayal of both Indians and monkeys in his Jungle Book stories have also been criticized by Jane Hotchkiss as examples of the chauvinistic infantilization of all colonized peoples in Victorian era British culture. Some historians claim that Kipling's works have contributed towards the development of a colonial mentality in the ways that the colonized people in these fictional narratives are made submissive to and dependent on their white rulers.
Spanish Empire
Latin America
In the overseas territories administered by the Spanish Empire, racial mixing between Spanish settlers and the indigenous peoples resulted in a prosperous union later called Mestizo. There were limitations in the racial classes only to people from African descent, this mainly for being descendants of slaves under a current state of slavery. Unlike Mestizos, castizos or indigenous people who were protected by the Leyes de las Indias "to be treated like equals, as citizens of the Spanish Empire". It was completely forbidden to enslave the indígenas under the death penalty charge.
Mestizos and other mixed raced combinations were categorized into different castas by viceroyalty administrators. This system was applied to Spanish territories in the Americas and the Philippines, where large populations of mixed raced individuals made up the increasing majority of the viceroyalty population (until the present day).
These racial categories punished those with Black African or Afro-Latin heritage; those of European descent were given privilege over these other mixtures. As a result of this system, people of African descent struggled to downplay their indigenous heritage and cultural trappings, in order to appear superficially more Spanish or natives. With these internalized prejudices individuals' choices of clothes, occupations, and forms of religious expression. Those of mixed racial identities who wanted to receive the institutional benefits of being Spanish (such as higher educational institutions and career opportunities), could do so by suppressing their own cultures and acting with "Spanishness". This mentality lead to commonplace racial forgery in Latin America, often accompanied by legitimizing oral accounts of a Spanish ancestor and a Spanish surname. Most mixed-white and white people in Latin America have Spanish surnames inherited from Spanish ancestors, while most other Latin Americans who have Spanish names and surnames acquired them through the Christianization and Hispanicization of the indigenous and African slave populations by Spanish friars.
However, most initial attempts at this were only partially successful, as Amerindian groups simply blended Catholicism with their traditional beliefs. Syncretism between native beliefs and Christianity is still largely prevalent in Indian and Mestizo communities in Latin America.
Philippines
Prior to the arrival by the Spaniards (1565–1898), the Sulu Archipelago (located in southern Philippines) was a colony of the Majapahit Empire (1293–1527) based in Indonesia. The Americans were the last country to colonize the Philippines (1898–1946) and nationalists claim that it continues to act as a neo-colony of the US despite its formal independence in 1946. In the Philippines colonial mentality is most evident in the preference for Filipino mestizos (primarily those of mixed native Filipino and white ancestry, but also mixed indigenous Filipinos and Chinese, and other ethnic groups) in the entertainment industry and mass media, in which they have received extensive exposure despite constituting a small fraction of the population.
The Cádiz Constitution of 1812 automatically gave Spanish citizenship to all Filipinos regardless of race. The census of 1870 stated that at least one-third of the population of Luzon had partial Hispanic ancestry (from varying points of origin and ranging from Latin America to Spain).
The combined number of all types of white mestizos or Eurasians is 3.6%, according to a genetic study by Stanford University. This is contradicted by another genetic study done by California University which stated that Filipinos possess moderate amounts of European admixture.
A cultural preference for relatively light skinned people exists within the Philippines. According to Kevin Nadal and David Okazaki, light skin preference may have pre-colonial origins. However, they also suggest that this preference was strengthened by colonialism. In an undated Philippine epic, the hero covers his face with a shield so that the sun would not "lessen his handsome looks". Some regard this as proof that desire for light-colored skin predates overseas influences. Regardless of the origin of the preference, the use of skin bleaching remains prevalent among Filipino men and women, however there is also a growing embrace of darker skinned female aesthetic within the Philippines.
See also
References
Works cited
Ethnocentrism
Mentality
Cultural anthropology
Colonies in antiquity
Cultural studies
Linguistic rights
White supremacy
Cultural genocide
Race and society | 0.765834 | 0.991522 | 0.759341 |
Toxidrome | A toxidrome (a portmanteau of toxic and syndrome, coined in 1970 by Mofenson and Greensher) is a syndrome caused by a dangerous level of toxins in the body. It is often the consequence of a drug overdose. Common symptoms include dizziness, disorientation, nausea, vomiting and oscillopsia. It may indicate a medical emergency requiring treatment at a poison control center. Aside from poisoning, a systemic infection may also lead to one. Classic toxidromes are presented below, which are variable or obscured by co-ingestion of multiple drugs.
A common tool for assessing for the presence of toxidrome in the United Kingdom is the CRESS tool.
Anticholinergic
The symptoms of an anticholinergic toxidrome include blurred vision, coma, decreased bowel sounds, delirium, dry skin, fever, flushing, hallucinations, ileus, memory loss, mydriasis (dilated pupils), myoclonus, psychosis, seizures and urinary retention. Complications include hypertension, hyperthermia and tachycardia. Substances that may cause this toxidrome include antihistamines, antipsychotics, antidepressants, antiparkinsonian drugs, atropine, benztropine, datura, diphenhydramine and scopolamine.
Cholinergic
The symptoms of a cholinergic toxidrome include bronchorrhea, confusion, defecation, diaphoresis, diarrhea, emesis, lacrimation, miosis, muscle fasciculations, salivation, seizures, urination and weakness. Complications include bradycardia, hypothermia and tachypnea. Substances that may cause this toxidrome include carbamates, mushrooms and organophosphates.
Hallucinogenic
The symptoms of a hallucinogenic toxidrome include disorientation, hallucinations, hyperactive bowel sounds, panic and seizures. Complications include hypertension, tachycardia and tachypnea. Substances that may cause this toxidrome include substituted amphetamines, cocaine and phencyclidine.
Opiate
The symptoms of an opiate toxidrome include the classic triad of coma, pinpoint pupils and respiratory depression as well as altered mental states, shock, pulmonary edema and unresponsiveness. Complications include bradycardia, hypotension and hypothermia. Substances that may cause this toxidrome are opioids.
Sedative/hypnotic
The symptoms of sedative/hypnotic toxidrome include ataxia, blurred vision, coma, confusion, delirium, deterioration of central nervous system functions, diplopia, dysesthesias, hallucinations, nystagmus, paresthesias, sedation, slurred speech and stupor. Apnea is a potential complication. Substances that may cause it include anticonvulsants, barbiturates, benzodiazepines, gamma-Hydroxybutyric acid, Methaqualone and ethanol. While most sedative-hypnotics are anticonvulsant, some such as GHB and methaqualone instead lower the seizure threshold, so can cause paradoxical seizures in overdose.
Sympathomimetic
The symptoms of a sympathomimetic toxidrome include anxiety, delusions, diaphoresis, hyperreflexia, mydriasis, paranoia, piloerection and seizures. Complications include hypertension and tachycardia. Substances that may cause this toxidrome include cocaine, amphetamine and compounds based upon amphetamine's structure such as ephedrine (Ma Huang), methamphetamine, phenylpropanolamine and pseudoephedrine. The bronchodilator salbutamol may also cause this toxidrome. It may appear very similar to the anticholinergic toxidrome, but is distinguished by hyperactive bowel sounds and sweating.
References
Further reading
Medical emergencies
Medical terminology
Toxicology
Substance intoxication
Medical mnemonics | 0.766055 | 0.991202 | 0.759315 |
Androcentrism | Androcentrism (Ancient Greek, ἀνήρ, "man, male") is the practice, conscious or otherwise, of placing a masculine point of view at the center of one's world view, culture, and history, thereby culturally marginalizing femininity. The related adjective is androcentric, while the practice of placing the feminine point of view at the center is gynocentric.
Androcentrism has been described as a pervasive form of sexism. However, it has also been described as a movement centered on, emphasizing, or dominated by males or masculine interests.
Etymology
The term androcentrism was introduced as an analytic concept by Charlotte Perkins Gilman in a scientific debate. Perkins Gilman described androcentric practices in society and the resulting problems they created in her investigation on The Man-Made World; or, Our Androcentric Culture, published in 1911. Because of this, androcentrism can be understood as a societal fixation on masculinity whereby all things originate. Under androcentrism, masculinity is normative and all things outside of masculinity are defined as other. According to Perkins Gilman, masculine patterns of life and masculine mindsets claimed universality while female patterns were considered as deviance.
Science
Until the 19th century, women were effectively barred from higher education in Western countries. For over 300 years, Harvard admitted only white men from prominent families. Many universities, such as for example the University of Oxford, consciously practiced a numerus clausus and restricted the number of female undergraduates they accepted. Due to the later access of women to university and academic life, the participation of women in fundamental research is marginal. The basic principles in sciences, even human sciences, are hence predominantly formed by men.
Medicine
There is a gender health data gap and women are systematically discriminated against and misdiagnosed in medicine. Early medical research has been carried out nearly exclusively on male corpses. Women were considered "small men" and not investigated. To this day, clinical studies are frequently confirmed for both sexes even though only men have participated and the female body is often not considered in animal tests, even when "women diseases" are concerned. However, female and male bodies differ, all the way up to the cell level. The same diseases can have different symptoms in the sexes, calling for different treatment, and medicines can work completely differently, including different side effects. Since male symptoms are much more prominent, women are symptomatically under- and misdiagnosed, and have for example a 50% increased risk to die from a heart attack. Here, the male and known symptoms are chest-, and shoulder pain, the female symptoms are upper abdominal pain and nausea.
Literature
Research by Dr. David Anderson and Dr. Mykol Hamilton has documented the under-representation of female characters in a sample of 200 books that included top-selling children's books from 2001 and a seven-year sample of Caldecott award-winning books. There were nearly twice as many male main characters as female main characters, and male characters appeared in illustrations 53 percent more than female characters. Most of the plot-lines centered on the male characters and their experiences of life.
The arts
In 1985, a group of female artists from New York, the Guerrilla Girls, began to protest the under-representation of female artists. According to them, male artists and the male viewpoint continued to dominate the visual art world. In a 1989 poster (displayed on NYC buses) titled "Do women have to be naked to get into the Met. Museum?" they reported that less than 5% of the artists in the Modern Art sections of the Met Museum were women, but 85% of the nudes were female.
Over 20 years later, women were still under-represented in the art world. In 2007, Jerry Saltz (journalist from the New York Times) criticized the Museum of Modern Art for undervaluing work by female artists. Of the 400 works of art he counted in the Museum of Modern Art, only 14 were by women (3.5%). Saltz also found a significant under-representation of female artists in the six other art institutions he studied.
Generic male language
In literature, the use of masculine language to refer to men, women, intersex, and non-binary people may indicate a male or androcentric bias in society where men are seen as the 'norm', and women, intersex, and non-binary people are seen as the 'other'. Philosophy scholar Jennifer Saul argues that the use of male generic language marginalizes women, intersex, and non-binary people in society. In recent years, some writers have started to use more gender-inclusive language (for instance, using the pronouns they/them and using gender-inclusive words like humankind, person, partner, spouse, businessperson, firefighter, chairperson, and police officer).
Many studies have shown that male generic language is not interpreted as truly gender-inclusive. Psychological research has shown that, in comparison to unbiased terms such as "they" and "humankind", masculine terms lead to male-biased mental imagery in the mind of both the listener and the communicator.
Three studies by Mykol Hamilton show that there is not only a male → people bias but also a people → male bias. In other words, a masculine bias remains even when people are exposed to only gender neutral language (although the bias is lessened). In two of her studies, half of the participants (after exposure to gender neutral language) had male-biased imagery but the rest of the participants displayed no gender bias at all. In her third study, only males showed a masculine-bias (after exposure to gender neutral language) – females showed no gender bias. Hamilton asserted that this may be due to the fact that males have grown up being able to think more easily than females of "any person" as generic "he," since "he" applies to them. Further, of the two options for neutral language, neutral language that explicitly names women (e.g., "he or she") reduces androcentrism more effectively than neutral language that makes no mention of gender whatsoever (e.g., "human").
Feminist anthropologist Sally Slocum argues that there has been a longstanding male bias in anthropological thought as evidenced by terminology used when referring to society, culture, and humankind. According to Slocum, "All too often the word 'man' is used in such an ambiguous fashion that it is impossible to decide whether it refers to males or just the human species in general, including both males and females."
Men's language will be judged as the 'norm' and anything that women do linguistically will be judged negatively against this. The speech of a socially subordinate group will be interpreted as linguistically inadequate against that used by socially dominant groups. It has been found that women use more hedges and qualifiers than men. Feminine speech has been viewed as more tentative and has been deemed powerless speech. This is based on the view that masculine speech is the standard.
Generic male symbols
On the Internet, many avatars are gender-neutral (such as an image of a smiley face). However, when an avatar is human and discernibly gendered, it usually appears to be a man.
Depictions of skeletons typically have male anatomy rather than female, even when the character of the skeleton is meant to be female.
Impacts
Men are more severely impacted by androcentric thinking. However, the ideology has substantial effects on the way of thinking of everyone within it. In a 2022 study, in which 3815 people were shown a selection of 256 images containing illusory faces (objects, in which humans see faces), 90% of the objects were on average by the participants identified as male.
See also
Honorary male
Male as norm
Male supremacy
Manosphere
Patriarchy
Phallocentrism
Trophy wife
References
Literature
Ginzberg, Ruth (1989), "Uncovering gynocentric science", in
Social epistemology
Feminist philosophy
Feminist terminology
Patriarchy
Philosophy of science
Feminism and society | 0.766426 | 0.990701 | 0.759299 |
Hyperfocus | Hyperfocus is an intense form of mental concentration or visualization that focuses consciousness on a subject, topic, or task. In some individuals, various subjects or topics may also include daydreams, concepts, fiction, the imagination, and other objects of the mind. Hyperfocus on a certain subject can cause side-tracking away from assigned or important tasks.
Psychiatrically, it is considered to be a trait of ADHD together with inattention, and it has been proposed as a trait of other conditions, such as schizophrenia, and autism spectrum disorder (ASD).
One proposed factor in hyperfocus as a symptom involves the psychological theory of brain lateralization, wherein one hemisphere of the brain specializes in some neural functions and cognitive processes over others. Those who have a tendency to hyperfocus, such as those with ADHD, may experience a form of "pseudoneglect" where attention is dominant on one side of the brain, leading to preferential attention in some neural connections and processes over others overall. While this idea is under study, it is not yet empirically proven.
Hyperfocus may bear a relationship to the concept of flow. In some circumstances, both flow and hyperfocus can be an aid to achievement, but in other circumstances, the same focus and behavior could be a liability, distracting from the task at hand. However, unlike hyperfocus, "flow" is often described in more positive terms, suggesting they are not two sides of the same condition under contrasting circumstance or intellect.
Psychiatric symptom
Hyperfocus may in some cases also be symptomatic of a psychiatric condition. In some cases, it is referred to as perseveration—an inability or impairment in switching tasks or activities ("set-shifting"), or desisting from mental or physical response repetition (gestures, words, thoughts) despite absence or cessation of a stimulus. It is distinguished from stereotypy (a highly repetitive idiosyncratic behaviour).
Conditions associated with hyperfocus or perseveration include neurodevelopmental disorders, particularly those considered to be on the autism spectrum and attention deficit hyperactivity disorder (ADHD). In ADHD, it may be a coping mechanism or a symptom of emotional self-regulation. So called "twice exceptional" people, with high intellect and learning disabilities, may have either or both of hyperfocus and perseverative behaviours. They are often mimicked by similar conditions involving executive dysfunction or emotional dysregulation, and lack of diagnosis and treatment may lead to further co-morbidity.
ADHD
In ADHD, formulation and thinking can be slower than in neurotypical people (though this is not universal), and may be "long-winded or tangential". These inattentive symptoms occur dually with what has been termed "hyperfocus" by the 2019 Updated European Consensus Statement on Adult ADHD. The over-concentration or hyperfocus often occurs if the person finds something "very interesting and/or provide(s) instant gratification, such as computer games or online chatting. For such activities, concentration may last for hours on end, in a very focused manner."
ADHD is a difficulty in directing one's attention (an executive function of the frontal lobe), not a lack of attention.
Conditions likely to be confused with hyperfocus often involve repetition of thoughts or behaviors such as obsessive–compulsive disorder (OCD), trauma, and some cases of traumatic brain injury.
Autism
Two major symptoms of autism spectrum disorder (ASD) include repetitive sounds or movements and fixation on various things including topics and activities. Hyperfocus in the context of ASD has also been referred to as the inability to redirect thoughts or tasks as the situation changes (cognitive flexibility).
One suggested explanation for hyperfocus in those with ASD is that the activity they are hyperfocused on is predictable. Aversion to unpredictable situations is a characteristic of ASD, while focusing on something predictable, they will have trouble changing to a task that is unpredictable.
Schizophrenia
Schizophrenia is a mental condition characterized by a disconnect from reality, including grandiose delusions, disorganized thinking, and abnormal social behavior. Recently, hyperfocus has come into attention as a part of the cognitive symptoms associated with the disorder. In this use, hyperfocus is an intense focus on processing the information in front of them. This hypothesis suggests that hyperfocus is the reason those afflicted with schizophrenia experience difficulty spreading their attention across multiple things.
Psychopathy
Some research, such as that of Naomi Sadeh and Edelyn Verona, published in Neuropsychology in 2008, has suggested that psychopaths are hyperfocused on obtaining a reward and as a result their ability to use contextual cues, punishment or contextual information for adjusting their behaviour may be impaired. Moreover, they develop tunnel vision blocking out any peripheral stimulation (such as fear of achieving the goal).
See also
Absent-mindedness
Hunter vs. farmer hypothesis
Mind-wandering (antonym)
References
Further reading
Memory
Symptoms and signs of mental disorders
Attention
Interest (psychology)
Attention deficit hyperactivity disorder
Autism | 0.761244 | 0.997361 | 0.759235 |
Physical abuse | Physical abuse is any intentional act causing injury or trauma to another person or animal by way of bodily contact. In most cases, children are the victims of physical abuse, but adults can also be victims, as in cases of domestic violence or workplace aggression. Alternative terms sometimes used include physical assault or physical violence, and may also include sexual abuse. Physical abuse may involve more than one abuser, and more than one victim.
Forms
Physical abuse means any non-accidental act or behavior causing injury, trauma, or other physical suffering or bodily harm. Abusive acts toward children can often result from parents' attempts at child discipline through excessive corporal punishment.
Causes
A number of causes of physical abuse against children have been identified, the most common of which, according to Mash and Wolfe, being:
many abusive and neglectful parents have had little exposure to positive parental models and supports.
there is often a greater degree of stress in the family environment.
information-processing disturbances may cause maltreating parents to misperceive or mislabel their child's behavior, which leads to inappropriate responses.
there is often a lack of awareness or understanding the appropriate expected mental growth or development.
Effects
Physically abused children are at risk for later interpersonal problems involving aggressive behavior, and adolescents are at a much greater risk for substance use disorders. In addition, symptoms of depression, emotional distress, and suicidal ideation are also common features of people who have been physically abused. Studies have also shown that children with a history of physical abuse may meet DSM-IV-TR criteria for post traumatic stress disorder (PTSD). As many as one-third of children who experience physical abuse are also at risk to become abusive as adults.
Researchers have pointed to other potential psycho-biological effects of child physical abuse on parenting, when abused children become adults. These recent findings may, at least in part, be carried forward by epigenetic changes that impact the regulation of stress physiology.
Treatment
Evidence-based interventions for physical abuse include cognitive behavioral therapy (CBT) as well as video-feedback interventions and child-parent psychodynamic psychotherapy; all of which specifically target anger patterns and distorted beliefs, and offer training and/or reflection, support, and modelling that focuses on parenting skills and expectations, as well as increasing empathy for the child by supporting the parent's taking the child's perspective.
These forms of treatment may include training in social competence and management of daily demands in an effort to decrease parental stress, which is a known risk factor for physical abuse. Although these treatment and prevention strategies are to help children and parents of children who have been abused, some of these methods can also be applied to adults who have physically abused.
Other animals
Physical abuse has also been observed among Adélie penguins in Antarctica.
Forms
References
External links
Abuse
Effects of external causes
Violence
Acute pain
Domestic violence | 0.7618 | 0.99663 | 0.759233 |
Derailment (thought disorder) | In psychiatry, derailment (aka loosening of association, asyndesis, asyndetic thinking, knight's move thinking, entgleisen, disorganised thinking) categorises any speech that sequences of unrelated or barely related ideas compose; the topic often changes from one sentence to another.
In a mild manifestation, this thought disorder is characterized by slippage of ideas further and further from the point of a discussion. Derailment can often be manifestly caused by intense emotions such as euphoria or hysteria. Some of the synonyms given above (loosening of association, asyndetic thinking) are used by some authors to refer just to a loss of goal: discourse that sets off on a particular idea, wanders off and never returns to it. A related term is tangentiality—it refers to off-the-point, oblique or irrelevant answers given to questions. In some studies on creativity, knight's move thinking—while describing a similarly loose association of ideas—is not considered a mental disorder or the hallmark of one; it is sometimes used as a synonym for lateral thinking.
Examples
"The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California."—given by Nancy C. Andreasen
"I think someone's infiltrated my copies of the cases. We've got to case the joint. I don't believe in joints, but they do hold your body together."—given by Elyn Saks.
History
Entgleisen (derailment in German) was first used with this meaning by Carl Schneider in 1930. The term asyndesis was introduced by N. Cameron in 1938, while loosening of association was introduced by A. Bleuler in 1950. The phrase knight's move thinking was first used in the context of pathological thinking by the psychologist Peter McKellar in 1957, who hypothesized that individuals with schizophrenia fail to suppress divergent associations. Derailment was used with this meaning by Kurt Schneider in 1959.
See also
Nonsense
Non sequitur (logic) and non sequitur (literary device)
Red herring
Relevance logic
Schizophasia
SCIgen, a program that generates nonsense research papers by grammatically combining snippets; many of the sentences generated are individually plausible
Tip-of-the-tongue
Train of thought
References
Cognition
Medical signs
Thought disorders | 0.767911 | 0.988653 | 0.759198 |
Effects of human sexual promiscuity | Human sexual promiscuity is the practice of having many different sexual partners. In the case of men, this behavior of sexual nondiscrimination and hypersexuality is referred to as satyriasis, while in the case of women, this behavior is conventionally known as nymphomania. Both conditions are regarded as possibly compulsive and pathological qualities, closely related to hyper-sexuality. The results of, or costs associated with, these behaviors are the effects of human sexual promiscuity.
A high number of sexual partners in a person's life usually means they are at a higher risk of sexually transmitted infections and life-threatening cancers. These costs largely pertain to the dramatic consequences to physical and mental health. The physical health risks mainly consist of the sexually transmitted infection risks, such as HIV and AIDS, that increase as individuals have develop sexual partners over their lifetime. The mental health risks typically associated with promiscuous individuals are mood, and personality disorders, often resulting in substance use disorders and, or permanent illness. These effects typically translate into several other long-term issues in people's lives and in their relationships, especially in the case of adolescents or those with previous pathological illnesses, disorders, or factors such as family dysfunction and social stress.
Research has also shown that there might be some benefit regarding the health fitness of the offsprings of promiscuous females in some animals.
Promiscuity in adolescents
The prevalence of promiscuity, in the case of adolescents, is known to be a root cause for many physical, mental, and socio-economic risks. Research has found that adolescents, in particular, are at a higher risk of negative consequences as a result of promiscuity.
In sub-Saharan Africa, adolescents engaged in promiscuous activities face many health and economic risks related to teenage pregnancy, maternal mortality, labor complications, and loss of educational opportunities.
It is suggested that the increasing association of sexually transmitted infections among adolescents could be a result of barriers to prevention and management services, such as infrastructural barriers (improper medical treatment facilities), cost barriers, educational barriers, and social factors such as concerns of confidentiality and embarrassment.
Physical health effects
Incidence and prevalence estimates suggest that adolescents, in comparison to adults, are particularly at higher risk of developing sexually transmitted infections, such as chlamydia, gonorrhea, syphilis and herpes. It is accepted that adolescent females are especially at risk to develop sexually transmitted infections. This is claimed to be due to the increased cervical ectopy, which is more susceptible to infection. In addition to these risks, adolescent mothers, whose offspring are generally first-births, are at a higher risk of certain pregnancy and labor complications, which can affect the mother and the offspring, as well as the entire community and future generations.
Pregnancy and maternal labor complications
It has been found that pregnancy-related complications cause up to half of all deaths in women of reproductive age in developing countries. In some areas, for every one woman who dies a maternal death, there are 10-15 who suffer severe damage to health by labor, which often causes substantial mental health risks and distress. These figures, however, are estimations since official data is not recorded in registration systems. In the context of pregnancy, maternal complications, and maternal death, it has been studied that age itself may cause fewer health risks for the mother or the offspring due to the prevalence of first-births among the younger ages. First births are higher among teenagers and are usually more complicated than higher-order births. Included in these observations are other complications related to delivery such as cephalopelvic disproportion, which is a condition in which the mother's pelvis is too small relative to the child's head to allow the child to pass. Cephalopelvis disproportion is most common in younger women. Many of these risks are higher among younger females, and a more mature physique is considered to be ideal for a successful pregnancy and childbearing. A mother older than 35 years old, however, may at a higher risk of facing various other labor complications.
In a study of over 22,000 births in Zaria, Nigeria, it was found that maternal mortality was 2-3 times higher for women 15 years old and under than for women from 16–29 years old. It was also found that in Africa, those under the age of 15 are 5-7 times more likely to have maternal deaths than women just 5–9 years older.
Sexually transmitted infections
While rates of these sexually transmitted infections increased for 15-24 year-old individuals in the United States for both males and females in 2016–2017, the rates of chlamydia are found to be consistently highest among 15-24 year-old young women. Reported cases of primary and secondary syphilis have consistently been higher among adolescent men and women compared to adult men and women. In the United States in 2017, there were 1,069,111 reported cases of chlamydia among persons aged 15–25, which represented the majority, almost 63%, of all chlamydia cases in the United States. These figures increased by 7.5% from 2016 in the 15-25 age group. In the 20-24 age group, the rate was increased by 5.0% during the same time frame. Among men in the 15-24 age group, there was an increase of 8.9% in 2017 since 2016 and an increase of 29.1% since 2013.
Gonorrhea infection cases were also reported to have increased for the 15-19 year age group in 2017 since 2016. In the case of women aged 15–24, there was an increase of 14.3% in 2017 since 2016, and a 24.1% increase since 2013. Among men, the rate of reported gonorrhea infections rose 913.4% in 2017 since 2016 and 951.6% since 2013. 20-24-year-old women had the highest increase in reported cases of gonorrhea among women, and the 15-19 year old age group had the second highest rate of increase.
While cases of primary and secondary syphilis is much rarer than gonorrhea, chlamydia, and herpes, the reported cases had increased for both males and females. In 15-24-year-old women, the cases of syphilis had increased 107.8% in 2017 since 2016 and increased 583.3% since 2013. In the case of 15-24-year-old men, the rate increased 8.3% to 26.1 cases per 100,000 males in 2017 since 2016 and 50.9% since 2013. Primary and secondary syphilis reports increased 9.8% for the 15-19 year age group and 7.8% for the 20-24 year age group from 2016 to 2017.
In the United States, Human papillomavirus is the most common STI. Routine use of HPV vaccines have greatly reduced the prevalence of HPV in specimens of females aged 14–19 and 20–24, the age group most at risk of contracting HPV, in 2011-2014 since 2003–2006.
Mental health effects
Emotional and mental disruptions are also observed to be an effect of the promiscuity in adolescence. Studies have shown a correlation and direct relationship between adolescent sexual risk taking and mental health risks. Sexual risks include multiple sexual partners, lack of protection use, and sexual intercourse at a young age. The mental risks that are associated with these include cognitive disorders such as anxiety, depression, and a substance use disorder. It is also found that sexual promiscuity in teens can be a result of substance misuse and pre-existing mental health conditions such as clinical depression.
In relation to the contraction of sexually transmitted infections, there is shown to be a correlation to decreased mental health. The neurosyphilis disease is known to cause extreme depression, mania, psychosis, and even hallucinations in late stages of the diseases. The chlamydia infection is known to increase rates of depression even in asymptomatic individuals.
STIs can put women at a high risk for infertility, which generally leads to feelings of depression. This holds true for women who are still able to conceive because there is a high risk of transferring the disease to their child through pregnancy or child birth.
Women are of higher susceptibility to psychosocial mental health effects of STIs. They report to having feelings immense of shame, guilt, and self blame after diagnosis. This can lead to avoidant behaviors and fear of disclosure to not only sexual partners but family and friends. All of these behaviors are associated with a decline to mental health, whether it is depression, anxiety, or any other disorder.
Other factors contribute to how STIs effect mental health and these include history of trauma and stigma from the disease.
Socio and economic effects
Sexual risk-taking and promiscuous activities, in regards to the youth, can also lead to many social and economic risks. In sub-Saharan Africa, for example, research has found that teenage pregnancy poses significant social and economic risks, as it forces young women, particularly those from extremely low-income families, to leave school to pursue childbearing. These disruptions in basic education pose life-long and generational risks to those involved. Social condemnation also prevents these young mothers from seeking help, and as a result are at a higher risk for developing other physical and mental risks, which can later result in physical health risks and substance use.
Promiscuity in adults
Sexual promiscuity in adults, as with adolescents, presents substantial risks to physical, mental, and socioeconomic health. Having multiple sexual partners is linked with risks such as maternal deaths and complications, cancers, sexually transmitted infections, alcohol, and substance use, and social condemnation in some societies. A higher number of sexual partners poses a greater risk of contracting sexually transmitted infections, mental health issues, and alcohol/substance use. Adults, however, are generally found to be less at risk of certain pregnancy and labor complications, such as cephalopelvis disproportion, than adolescents, while being at higher risk for other labor complications.
Physical health effects
Promiscuity in adults has detrimental effects on physical health. As the number of sexual partners a person has in his or her lifetime increases, the higher the risk he or she contracts sexually transmitted infections. The length of a sexual relationship with a partner, the number of past and present partners, and pre-existing conditions are all variables that affect the development of risks in a person's life. Promiscuous individuals may also be at a higher risk of developing prostate cancer, cervical cancer, and oral cancer as a result of having multiple sexual partners, and combined with other risky acts such as smoking, and substance use, promiscuity can also lead to heart disease.
Despite the frequency of HIV/AIDS cases decreasing as medical treatment and education on the matter improve, HIV/AIDS has still been responsible for over 20 million lives in 20 years, greatly affecting the livelihoods of whole communities in developing nations. According to the World Health Organization, over 40 million people are currently infected with HIV/AIDS, and 95% of these cases are in the developing world.
Over 340 million treatable sexually transmitted infections affect people around the world each year, which presents a great risk to individuals as they become more susceptible to HIV and more likely to spread the virus.
Studies have also shown that individuals who engage in long-term relationships, as opposed to hypersexual and promiscuous behavior are less likely to fall victim to domestic violence.
Mental health effects
According to research conducted by Sandhya Ramrakha of the Dunedin School of Medicine, the probability of developing a substance use disorder increased linearly with an increase in the number of sexual partners. This was particularly greater for women, however, there was no correlation with other mental health risks. This contrasts other studies that find there indeed is a correlation between mental health risk and multiple sexual partners.
Social and economic effects
Having multiple sexual partners frequently adversely affects educational opportunities for young women, which can affect their careers and opportunities as adults; the frequency of multiple sexual partners have negative long-term economic effects for women as a result of a loss of schooling. There is little evidence, however, that the number of sexual partners adversely affects the educational and economic opportunities for males.
Reducing the effects
Human sexual promiscuity presents substantial physical, mental, and socio-economic risks to adolescents as well as adults in all parts of the world. Researchers and organizations have identified ways of reducing these risks over time. These include the prevention and treatment of sexually transmitted infections and other effects of human sexual promiscuity.
Prevention
According to the World Health Organization, the reduction in the harmful risks of human sexual promiscuity can be achieved first by prevention. These are sustained through HIV and STI prevention programs, defined in the Declaration of Commitment during the United Nations General Assembly on HIV/AIDS in June 2001. Safe sex, condom and contraceptive usage and effectual STI management are essential in preventing the spread of these sexually transmitted infections, and it can also improve the social and economic status of entire communities as young women can pursue education instead of childbearing. At a large enough scale with a target on STI concentrated locations with high rates of STIs, these programs can greatly reduce the effects of promiscuity.
Treatment
Many of these lower-income areas lack proper equipment or facilities to treat these risks. Expansion of antiretroviral treatment and the enabling of broader access to all medical services and support can be paramount in the treatment of sexually transmitted infections once they occur. For the mental health risks that human sexual promiscuity presents, effective counseling services, and facilities must be offered, enabling the reduction of these risks over time.
References
Human sexuality
Promiscuity
Societal effects of promiscuity may include crimes of passion as jealous partners may seek to drive-off competition.
Also, child support may be reduced as males
may be loth to contribute to support of children who may not be their own.
https://www.ojp.gov/ncjrs/virtual-library/abstracts/crime-passion-and-changing-cultural-construction-jealousy
https://www.texasattorneygeneral.gov/child-support/paternity/mistaken-paternity#:~:text=If%20the%20genetic%20testing%20results,child%20relationship%20and%20support%20obligation.
(Trying for first time here to cite references) | 0.766378 | 0.990611 | 0.759182 |
Ashworth Hospital | Ashworth Hospital is a high-security psychiatric hospital in Maghull, 10 miles (16 km) northeast of Liverpool. It is a part of Mersey Care NHS Foundation Trust, catering to patients with psychiatric health needs that require treatment in conditions of high security.
The hospital is one of four psychiatric hospitals in the United Kingdom providing psychiatric care within conditions of high security, and one of three in England (alongside Broadmoor Hospital in Crowthorne and Rampton Secure Hospital near Woodbeck). For Scotland and Northern Ireland, the facility meeting the same high security environment is the State Hospital in Carstairs.
Organisation
Ashworth is one of the three high-security psychiatric hospitals in England and Wales, alongside Rampton and Broadmoor, that exist to work with people who require treatment due to their "dangerous, violent or criminal propensities", with the majority experiencing psychotic conditions such as schizophrenia, comorbid or other personality disorders. Ashworth currently has 14 wards. Five locked wards constitute the personality disorder unit. A wide variety of pharmacological, rehabilitative and psychological treatments are available. Rehabilitative and creative activity is supported with patients frequently entering work for the Koestler awards winning 27 prizes in 2011. In collaboration with The Reader Organisation reading groups have been set up in which staff and patients read literature together, promoting confidence and developing communication and other skills.
History
Early history
The hospital has its origins in Moss Side House, a convalescent home for children from Liverpool's workhouses, which was established on the site in 1878. For the duration of the First World War, it became Moss Side Military Hospital, the first specialist hospital for the treatment of what is now known as Post-traumatic stress disorder. Moss Side became a special hospital in 1933. In 1974, overcrowding at Broadmoor led to the construction of Park Lane Special Hospital on land at the facility. In 1989, Moss Side and Park Lane hospitals merged to form Ashworth Hospital. The name "Ashworth Hospital" was chosen by a ballot among patients and staff.
Industrial action
In 1987, members of the Prison Officers Association, which then represented almost all the nurses were involved in a dispute during which more than 200 patients were locked in their rooms for 23 hours per day for 10 days.
Blom-Cooper Inquiry
Following a 1988 television documentary which alleged that a patient, Sean Walton, had died after being beaten by staff allegedly with a snooker cue and a series of other serious allegations, a Committee of Inquiry into Complaints about Ashworth Hospital, Merseyside, headed by Sir Louis Blom-Cooper, was set up; it published its findings in 1992. Blom-Cooper was highly critical of the regime, which was felt to be more custodial than therapeutic, describing the regime as a "brutalising, stagnant, closed institution." The inquiry uncovered evidence of physical and psychological abuse of patients. Nurses had used a pig's head to intimidate patients, had placed pictures of brains in the locker of a patient who had undergone brain surgery, and had submerged one patient under water to test his breaking point. Extreme right-wing propaganda had been on prominent display. The inquiry report suggested, only half-jokingly, that international torture monitors should visit the hospital. Seven staff and two managers were relieved of their duties. Prof. Robert Bluglass who was the medical member of the inquiry concluded that all the Special Hospitals should be closed.
In 1993, a patients' advocacy service was set up in the hospital. This was the first mental health advocacy service to be introduced in a high security hospital in the United Kingdom.
Fallon Inquiry
In 1997, a patient absconded from a day rehabilitation trip in protest against his treatment and the management of the Personality Disorder Unit. He made multiple allegations including that pornography, drugs and alcohol were freely available, that patients were running businesses and that a child had been put at risk of abuse at the hands of a number of paedophiles, that security had been compromised and that a number of staff were corrupt. The Fallon Inquiry was set up and reported in 1999. The inquiry found that Child A had visited the hospital on hundreds of occasions and had spent periods dressed only in her underwear with a patient with a history of violent sexual assaults against young girls. The patient had also visited the child at her home whilst escorted by a nurse. The nurse had taken pictures of the child for the patient. One of her on her bed and another of her on the lavatory. Child A's father also took the young son of a friend to visit a second patient found guilty of kidnapping, sexual torture, mutilation, and murder of a 13-year-old boy. The inquiry team reported that Dr John Reed, chairman of the Reed Committee on Mentally Disordered Offenders, described a conversation with Prof Pamela Taylor, then head of medical services of the special hospitals, in which the doctors at Ashworth were described as follows. "Doctor 1: moderately capable but with a serious alcohol problem. Doctor 2: moderately capable but feeble. Doctor 3: appalling. Doctor 4: never there. Doctor 5: weak. Doctor 6: made very poor provision for patients on the ward. Doctor 7: lazy. Doctor 8: unstable and not clinically good. There were three competent doctors." The Fallon inquiry recommended that the hospital should close. As a result of the Fallon Inquiry, a review into security was undertaken by Sir Richard Tilt, who recommended in May 2000, that security be upgraded to that of a Category B prison.
The Swann Report
Another inquiry, The Swann Report, was also conducted in the 1990s in relation to the overuse of drugs, but is unavailable.
European Committee for the Prevention of Torture inspection
As part of the 2016 review of the United Kingdom as a whole the European Committee for the Prevention of Torture and Inhuman or Degrading treatment or Punishment visited Ashworth Hospital. The conclusions included that living conditions were variable. The CPT expressed serious concerns relating to the necessity and application of the use of Long Term Segregation (LTS) finding that some patients were kept in LTS for years at a time. It found that some patients were unable to access outside areas on a daily basis. The CPT expressed misgiving about the use of overwhelming force deployed at Ashworth including the use of personal protective equipment, helmets and shields. The committee found that night-time confinement was being used. This is a policy in which all patients are locked in their rooms between the hours of 9.15p.m. and 7.15a.m, with the aim to save money. The committee considered that the systematic locking-in of patients, amounting to ten hours of de facto seclusion, was not acceptable in a care establishment provided there was sufficient staff. It also found that the original intention of increasing day-time activities had not been realised. At the time of the CPT inspection there were; 12 consultant psychiatrists, a general practitioner and 3.8 FTE other doctors. There were 10 clinical psychologists, seven approved social workers, two dieticians and a range of other staff including six modern matrons, five nurse managers, 24 charge nurses, 173 registered mental health nurses and 254 healthcare support workers and assistants.
CQC inspection 2013
The CQC inspection of 2013 found that the services were good for all domains; the services provided were caring, responsive and well-led.
Patients of note
Ian Brady, the principal perpetrator of the "Moors murders", who was at Ashworth for more than 30 years after being transferred from a mainstream prison in November 1985. Brady remained there until his death in May 2017; he had been in custody for more than 50 years.
Valdo Calocane, perpetrator of the 2023 Nottingham attacks, in which three people were killed and a further three people were injured. On 25 January 2024, he was sentenced to be detained indefinitely in hospital.
Dale Cregan, convicted of murdering four people (including two female police officers) in Greater Manchester during 2012, he was transferred from a mainstream prison shortly after his conviction in 2013.
Sandra Riley, serial killer who repeatedly murdered her own children
Charles Salvador, armed robber, born as Michael Peterson and formerly known as Charles Bronson.
Robert Sartin, responsible for the Monkseaton shootings in April 1989, where one man was killed and 14 other people were injured.
Barry Williams, also known as Harry Street, multiple murder and possession of explosives, spent 15 years there after a killing spree in West Bromwich in 1978. He was returned to the hospital in 2014 for firearms offences and making threats against a neighbour in Birmingham, and died from a heart attack shortly after returning to Ashworth.
See also
List of hospitals in England
References
Sources
Further reading
Hospitals in Liverpool
Psychiatric hospitals in England
NHS hospitals in England
Metropolitan Borough of Sefton
Buildings and structures in the Metropolitan Borough of Sefton | 0.765659 | 0.99153 | 0.759173 |
Problem solving | Problem solving is the process of achieving a goal by overcoming obstacles, a frequent part of most activities. Problems in need of solutions range from simple personal tasks (e.g. how to turn on an appliance) to complex issues in business and technical fields. The former is an example of simple problem solving (SPS) addressing one issue, whereas the latter is complex problem solving (CPS) with multiple interrelated obstacles. Another classification of problem-solving tasks is into well-defined problems with specific obstacles and goals, and ill-defined problems in which the current situation is troublesome but it is not clear what kind of resolution to aim for. Similarly, one may distinguish formal or fact-based problems requiring psychometric intelligence, versus socio-emotional problems which depend on the changeable emotions of individuals or groups, such as tactful behavior, fashion, or gift choices.
Solutions require sufficient resources and knowledge to attain the goal. Professionals such as lawyers, doctors, programmers, and consultants are largely problem solvers for issues that require technical skills and knowledge beyond general competence. Many businesses have found profitable markets by recognizing a problem and creating a solution: the more widespread and inconvenient the problem, the greater the opportunity to develop a scalable solution.
There are many specialized problem-solving techniques and methods in fields such as engineering, business, medicine, mathematics, computer science, philosophy, and social organization. The mental techniques to identify, analyze, and solve problems are studied in psychology and cognitive sciences. Also widely researched are the mental obstacles that prevent people from finding solutions; problem-solving impediments include confirmation bias, mental set, and functional fixedness.
Definition
The term problem solving has a slightly different meaning depending on the discipline. For instance, it is a mental process in psychology and a computerized process in computer science. There are two different types of problems: ill-defined and well-defined; different approaches are used for each. Well-defined problems have specific end goals and clearly expected solutions, while ill-defined problems do not. Well-defined problems allow for more initial planning than ill-defined problems. Solving problems sometimes involves dealing with pragmatics (the way that context contributes to meaning) and semantics (the interpretation of the problem). The ability to understand what the end goal of the problem is, and what rules could be applied, represents the key to solving the problem. Sometimes a problem requires abstract thinking or coming up with a creative solution.
Problem solving has two major domains: mathematical problem solving and personal problem solving. Each concerns some difficulty or barrier that is encountered.
Psychology
Problem solving in psychology refers to the process of finding solutions to problems encountered in life. Solutions to these problems are usually situation- or context-specific. The process starts with problem finding and problem shaping, in which the problem is discovered and simplified. The next step is to generate possible solutions and evaluate them. Finally a solution is selected to be implemented and verified. Problems have an end goal to be reached; how you get there depends upon problem orientation (problem-solving coping style and skills) and systematic analysis.
Mental health professionals study the human problem-solving processes using methods such as introspection, behaviorism, simulation, computer modeling, and experiment. Social psychologists look into the person-environment relationship aspect of the problem and independent and interdependent problem-solving methods. Problem solving has been defined as a higher-order cognitive process and intellectual function that requires the modulation and control of more routine or fundamental skills.
Empirical research shows many different strategies and factors influence everyday problem solving. Rehabilitation psychologists studying people with frontal lobe injuries have found that deficits in emotional control and reasoning can be re-mediated with effective rehabilitation and could improve the capacity of injured persons to resolve everyday problems. Interpersonal everyday problem solving is dependent upon personal motivational and contextual components. One such component is the emotional valence of "real-world" problems, which can either impede or aid problem-solving performance. Researchers have focused on the role of emotions in problem solving, demonstrating that poor emotional control can disrupt focus on the target task, impede problem resolution, and lead to negative outcomes such as fatigue, depression, and inertia. human problem solving consists of two related processes: problem orientation, and the motivational/attitudinal/affective approach to problematic situations and problem-solving skills. People's strategies cohere with their goals and stem from the process of comparing oneself with others.
Cognitive sciences
Among the first experimental psychologists to study problem solving were the Gestaltists in Germany, such as Karl Duncker in The Psychology of Productive Thinking (1935). Perhaps best known is the work of Allen Newell and Herbert A. Simon.
Experiments in the 1960s and early 1970s asked participants to solve relatively simple, well-defined, but not previously seen laboratory tasks. These simple problems, such as the Tower of Hanoi, admitted optimal solutions that could be found quickly, allowing researchers to observe the full problem-solving process. Researchers assumed that these model problems would elicit the characteristic cognitive processes by which more complex "real world" problems are solved.
An outstanding problem-solving technique found by this research is the principle of decomposition.
Computer science
Much of computer science and artificial intelligence involves designing automated systems to solve a specified type of problem: to accept input data and calculate a correct or adequate response, reasonably quickly. Algorithms are recipes or instructions that direct such systems, written into computer programs.
Steps for designing such systems include problem determination, heuristics, root cause analysis, de-duplication, analysis, diagnosis, and repair. Analytic techniques include linear and nonlinear programming, queuing systems, and simulation. A large, perennial obstacle is to find and fix errors in computer programs: debugging.
Logic
Formal logic concerns issues like validity, truth, inference, argumentation, and proof. In a problem-solving context, it can be used to formally represent a problem as a theorem to be proved, and to represent the knowledge needed to solve the problem as the premises to be used in a proof that the problem has a solution.
The use of computers to prove mathematical theorems using formal logic emerged as the field of automated theorem proving in the 1950s. It included the use of heuristic methods designed to simulate human problem solving, as in the Logic Theory Machine, developed by Allen Newell, Herbert A. Simon and J. C. Shaw, as well as algorithmic methods such as the resolution principle developed by John Alan Robinson.
In addition to its use for finding proofs of mathematical theorems, automated theorem-proving has also been used for program verification in computer science. In 1958, John McCarthy proposed the advice taker, to represent information in formal logic and to derive answers to questions using automated theorem-proving. An important step in this direction was made by Cordell Green in 1969, who used a resolution theorem prover for question-answering and for such other applications in artificial intelligence as robot planning.
The resolution theorem-prover used by Cordell Green bore little resemblance to human problem solving methods. In response to criticism of that approach from researchers at MIT, Robert Kowalski developed logic programming and SLD resolution, which solves problems by problem decomposition. He has advocated logic for both computer and human problem solving and computational logic to improve human thinking.
Engineering
When products or processes fail, problem solving techniques can be used to develop corrective actions that can be taken to prevent further failures. Such techniques can also be applied to a product or process prior to an actual failure event—to predict, analyze, and mitigate a potential problem in advance. Techniques such as failure mode and effects analysis can proactively reduce the likelihood of problems.
In either the reactive or the proactive case, it is necessary to build a causal explanation through a process of diagnosis. In deriving an explanation of effects in terms of causes, abduction generates new ideas or hypotheses (asking "how?"); deduction evaluates and refines hypotheses based on other plausible premises (asking "why?"); and induction justifies a hypothesis with empirical data (asking "how much?"). The objective of abduction is to determine which hypothesis or proposition to test, not which one to adopt or assert. In the Peircean logical system, the logic of abduction and deduction contribute to our conceptual understanding of a phenomenon, while the logic of induction adds quantitative details (empirical substantiation) to our conceptual knowledge.
Forensic engineering is an important technique of failure analysis that involves tracing product defects and flaws. Corrective action can then be taken to prevent further failures.
Reverse engineering attempts to discover the original problem-solving logic used in developing a product by disassembling the product and developing a plausible pathway to creating and assembling its parts.
Military science
In military science, problem solving is linked to the concept of "end-states", the conditions or situations which are the aims of the strategy. Ability to solve problems is important at any military rank, but is essential at the command and control level. It results from deep qualitative and quantitative understanding of possible scenarios. Effectiveness in this context is an evaluation of results: to what extent the end states were accomplished. Planning is the process of determining how to effect those end states.
Processes
Some models of problem solving involve identifying a goal and then a sequence of subgoals towards achieving this goal. Andersson, who introduced the ACT-R model of cognition, modelled this collection of goals and subgoals as a goal stack in which the mind contains a stack of goals and subgoals to be completed, and a single task being carried out at any time.
Knowledge of how to solve one problem can be applied to another problem, in a process known as transfer.
Problem-solving strategies
Problem-solving strategies are steps to overcoming the obstacles to achieving a goal. The iteration of such strategies over the course of solving a problem is the "problem-solving cycle".
Common steps in this cycle include recognizing the problem, defining it, developing a strategy to fix it, organizing knowledge and resources available, monitoring progress, and evaluating the effectiveness of the solution. Once a solution is achieved, another problem usually arises, and the cycle starts again.
Insight is the sudden aha! solution to a problem, the birth of a new idea to simplify a complex situation. Solutions found through insight are often more incisive than those from step-by-step analysis. A quick solution process requires insight to select productive moves at different stages of the problem-solving cycle. Unlike Newell and Simon's formal definition of a move problem, there is no consensus definition of an insight problem.
Some problem-solving strategies include:
Abstraction solving the problem in a tractable model system to gain insight into the real system
Analogy adapting the solution to a previous problem which has similar features or mechanisms
Brainstorming (especially among groups of people) suggesting a large number of solutions or ideas and combining and developing them until an optimum solution is found
Bypasses transform the problem into another problem that is easier to solve, bypassing the barrier, then transform that solution back to a solution to the original problem.
Critical thinking analysis of available evidence and arguments to form a judgement via rational, skeptical, and unbiased evaluation
Divide and conquer breaking down a large, complex problem into smaller, solvable problems
Help-seeking obtaining external assistance to deal with obstacles
Hypothesis testing assuming a possible explanation to the problem and trying to prove (or, in some contexts, disprove) the assumption
Lateral thinking approaching solutions indirectly and creatively
Means-ends analysis choosing an action at each step to move closer to the goal
Morphological analysis assessing the output and interactions of an entire system
Observation / Question in the natural sciences an observation is an act or instance of noticing or perceiving and the acquisition of information from a primary source. A question is an utterance which serves as a request for information.
Proof of impossibility try to prove that the problem cannot be solved. The point where the proof fails will be the starting point for solving it
Reduction transforming the problem into another problem for which solutions exist
Research employing existing ideas or adapting existing solutions to similar problems
Root cause analysis identifying the cause of a problem
Trial-and-error testing possible solutions until the right one is found
Problem-solving methods
Scientific method – is an empirical method for acquiring knowledge that has characterized the development of science.
Common barriers
Common barriers to problem solving include mental constructs that impede an efficient search for solutions. Five of the most common identified by researchers are: confirmation bias, mental set, functional fixedness, unnecessary constraints, and irrelevant information.
Confirmation bias
Confirmation bias is an unintentional tendency to collect and use data which favors preconceived notions. Such notions may be incidental rather than motivated by important personal beliefs: the desire to be right may be sufficient motivation.
Scientific and technical professionals also experience confirmation bias. One online experiment, for example, suggested that professionals within the field of psychological research are likely to view scientific studies that agree with their preconceived notions more favorably than clashing studies. According to Raymond Nickerson, one can see the consequences of confirmation bias in real-life situations, which range in severity from inefficient government policies to genocide. Nickerson argued that those who killed people accused of witchcraft demonstrated confirmation bias with motivation. Researcher Michael Allen found evidence for confirmation bias with motivation in school children who worked to manipulate their science experiments to produce favorable results.
However, confirmation bias does not necessarily require motivation. In 1960, Peter Cathcart Wason conducted an experiment in which participants first viewed three numbers and then created a hypothesis in the form of a rule that could have been used to create that triplet of numbers. When testing their hypotheses, participants tended to only create additional triplets of numbers that would confirm their hypotheses, and tended not to create triplets that would negate or disprove their hypotheses.
Mental set
Mental set is the inclination to re-use a previously successful solution, rather than search for new and better solutions. It is a reliance on habit.
It was first articulated by Abraham S. Luchins in the 1940s with his well-known water jug experiments. Participants were asked to fill one jug with a specific amount of water by using other jugs with different maximum capacities. After Luchins gave a set of jug problems that could all be solved by a single technique, he then introduced a problem that could be solved by the same technique, but also by a novel and simpler method. His participants tended to use the accustomed technique, oblivious of the simpler alternative. This was again demonstrated in Norman Maier's 1931 experiment, which challenged participants to solve a problem by using a familiar tool (pliers) in an unconventional manner. Participants were often unable to view the object in a way that strayed from its typical use, a type of mental set known as functional fixedness (see the following section).
Rigidly clinging to a mental set is called fixation, which can deepen to an obsession or preoccupation with attempted strategies that are repeatedly unsuccessful. In the late 1990s, researcher Jennifer Wiley found that professional expertise in a field can create a mental set, perhaps leading to fixation.
Groupthink, in which each individual takes on the mindset of the rest of the group, can produce and exacerbate mental set. Social pressure leads to everybody thinking the same thing and reaching the same conclusions.
Functional fixedness
Functional fixedness is the tendency to view an object as having only one function, and to be unable to conceive of any novel use, as in the Maier pliers experiment described above. Functional fixedness is a specific form of mental set, and is one of the most common forms of cognitive bias in daily life.
As an example, imagine a man wants to kill a bug in his house, but the only thing at hand is a can of air freshener. He may start searching for something to kill the bug instead of squashing it with the can, thinking only of its main function of deodorizing.
Tim German and Clark Barrett describe this barrier: "subjects become 'fixed' on the design function of the objects, and problem solving suffers relative to control conditions in which the object's function is not demonstrated." Their research found that young children's limited knowledge of an object's intended function reduces this barrier Research has also discovered functional fixedness in educational contexts, as an obstacle to understanding: "functional fixedness may be found in learning concepts as well as in solving chemistry problems."
There are several hypotheses in regards to how functional fixedness relates to problem solving. It may waste time, delaying or entirely preventing the correct use of a tool.
Unnecessary constraints
Unnecessary constraints are arbitrary boundaries imposed unconsciously on the task at hand, which foreclose a productive avenue of solution. The solver may become fixated on only one type of solution, as if it were an inevitable requirement of the problem. Typically, this combines with mental set—clinging to a previously successful method.
Visual problems can also produce mentally invented constraints. A famous example is the dot problem: nine dots arranged in a three-by-three grid pattern must be connected by drawing four straight line segments, without lifting pen from paper or backtracking along a line. The subject typically assumes the pen must stay within the outer square of dots, but the solution requires lines continuing beyond this frame, and researchers have found a 0% solution rate within a brief allotted time.
This problem has produced the expression "think outside the box". Such problems are typically solved via a sudden insight which leaps over the mental barriers, often after long toil against them. This can be difficult depending on how the subject has structured the problem in their mind, how they draw on past experiences, and how well they juggle this information in their working memory. In the example, envisioning the dots connected outside the framing square requires visualizing an unconventional arrangement, which is a strain on working memory.
Irrelevant information
Irrelevant information is a specification or data presented in a problem that is unrelated to the solution. If the solver assumes that all information presented needs to be used, this often derails the problem solving process, making relatively simple problems much harder.
For example: "Fifteen percent of the people in Topeka have unlisted telephone numbers. You select 200 names at random from the Topeka phone book. How many of these people have unlisted phone numbers?" The "obvious" answer is 15%, but in fact none of the unlisted people would be listed among the 200. This kind of "trick question" is often used in aptitude tests or cognitive evaluations. Though not inherently difficult, they require independent thinking that is not necessarily common. Mathematical word problems often include irrelevant qualitative or numerical information as an extra challenge.
Avoiding barriers by changing problem representation
The disruption caused by the above cognitive biases can depend on how the information is represented: visually, verbally, or mathematically. A classic example is the Buddhist monk problem:
The problem cannot be addressed in a verbal context, trying to describe the monk's progress on each day. It becomes much easier when the paragraph is represented mathematically by a function: one visualizes a graph whose horizontal axis is time of day, and whose vertical axis shows the monk's position (or altitude) on the path at each time. Superimposing the two journey curves, which traverse opposite diagonals of a rectangle, one sees they must cross each other somewhere. The visual representation by graphing has resolved the difficulty.
Similar strategies can often improve problem solving on tests.
Other barriers for individuals
People who are engaged in problem solving tend to overlook subtractive changes, even those that are critical elements of efficient solutions. This tendency to solve by first, only, or mostly creating or adding elements, rather than by subtracting elements or processes is shown to intensify with higher cognitive loads such as information overload.
Dreaming: problem solving without waking consciousness
People can also solve problems while they are asleep. There are many reports of scientists and engineers who solved problems in their dreams. For example, Elias Howe, inventor of the sewing machine, figured out the structure of the bobbin from a dream.
The chemist August Kekulé was considering how benzene arranged its six carbon and hydrogen atoms. Thinking about the problem, he dozed off, and dreamt of dancing atoms that fell into a snakelike pattern, which led him to discover the benzene ring. As Kekulé wrote in his diary,
There also are empirical studies of how people can think consciously about a problem before going to sleep, and then solve the problem with a dream image. Dream researcher William C. Dement told his undergraduate class of 500 students that he wanted them to think about an infinite series, whose first elements were OTTFF, to see if they could deduce the principle behind it and to say what the next elements of the series would be. He asked them to think about this problem every night for 15 minutes before going to sleep and to write down any dreams that they then had. They were instructed to think about the problem again for 15 minutes when they awakened in the morning.
The sequence OTTFF is the first letters of the numbers: one, two, three, four, five. The next five elements of the series are SSENT (six, seven, eight, nine, ten). Some of the students solved the puzzle by reflecting on their dreams. One example was a student who reported the following dream:
With more than 500 undergraduate students, 87 dreams were judged to be related to the problems students were assigned (53 directly related and 34 indirectly related). Yet of the people who had dreams that apparently solved the problem, only seven were actually able to consciously know the solution. The rest (46 out of 53) thought they did not know the solution.
Mark Blechner conducted this experiment and obtained results similar to Dement's. He found that while trying to solve the problem, people had dreams in which the solution appeared to be obvious from the dream, but it was rare for the dreamers to realize how their dreams had solved the puzzle. Coaxing or hints did not get them to realize it, although once they heard the solution, they recognized how their dream had solved it. For example, one person in that OTTFF experiment dreamed:
In the dream, the person counted out the next elements of the series—six, seven, eight, nine, ten, eleven, twelve—yet he did not realize that this was the solution of the problem. His sleeping mindbrain solved the problem, but his waking mindbrain was not aware how.
Albert Einstein believed that much problem solving goes on unconsciously, and the person must then figure out and formulate consciously what the mindbrain has already solved. He believed this was his process in formulating the theory of relativity: "The creator of the problem possesses the solution." Einstein said that he did his problem solving without words, mostly in images. "The words or the language, as they are written or spoken, do not seem to play any role in my mechanism of thought. The psychical entities which seem to serve as elements in thought are certain signs and more or less clear images which can be 'voluntarily' reproduced and combined."
Cognitive sciences: two schools
Problem-solving processes differ across knowledge domains and across levels of expertise. For this reason, cognitive sciences findings obtained in the laboratory cannot necessarily generalize to problem-solving situations outside the laboratory. This has led to a research emphasis on real-world problem solving, since the 1990s. This emphasis has been expressed quite differently in North America and Europe, however. Whereas North American research has typically concentrated on studying problem solving in separate, natural knowledge domains, much of the European research has focused on novel, complex problems, and has been performed with computerized scenarios.
Europe
In Europe, two main approaches have surfaced, one initiated by Donald Broadbent in the United Kingdom and the other one by Dietrich Dörner in Germany. The two approaches share an emphasis on relatively complex, semantically rich, computerized laboratory tasks, constructed to resemble real-life problems. The approaches differ somewhat in their theoretical goals and methodology. The tradition initiated by Broadbent emphasizes the distinction between cognitive problem-solving processes that operate under awareness versus outside of awareness, and typically employs mathematically well-defined computerized systems. The tradition initiated by Dörner, on the other hand, has an interest in the interplay of the cognitive, motivational, and social components of problem solving, and utilizes very complex computerized scenarios that contain up to 2,000 highly interconnected variables.
North America
In North America, initiated by the work of Herbert A. Simon on "learning by doing" in semantically rich domains, researchers began to investigate problem solving separately in different natural knowledge domains—such as physics, writing, or chess playing—rather than attempt to extract a global theory of problem solving. These researchers have focused on the development of problem solving within certain domains, that is on the development of expertise.
Areas that have attracted rather intensive attention in North America include:
calculation
computer skills
game playing
lawyers' reasoning
managerial problem solving
mathematical problem solving
mechanical problem solving
personal problem solving
political decision making
problem solving in electronics
problem solving for innovations and inventions: TRIZ
reading
social problem solving
writing
Characteristics of complex problems
Complex problem solving (CPS) is distinguishable from simple problem solving (SPS). In SPS there is a singular and simple obstacle. In CPS there may be multiple simultaneous obstacles. For example, a surgeon at work has far more complex problems than an individual deciding what shoes to wear. As elucidated by Dietrich Dörner, and later expanded upon by Joachim Funke, complex problems have some typical characteristics, which include:
complexity (large numbers of items, interrelations, and decisions)
enumerability
heterogeneity
connectivity (hierarchy relation, communication relation, allocation relation)
dynamics (time considerations)
temporal constraints
temporal sensitivity
phase effects
dynamic unpredictability
intransparency (lack of clarity of the situation)
commencement opacity
continuation opacity
polytely (multiple goals)
inexpressivenes
opposition
transience
Collective problem solving
People solve problems on many different levels—from the individual to the civilizational. Collective problem solving refers to problem solving performed collectively. Social issues and global issues can typically only be solved collectively.
The complexity of contemporary problems exceeds the cognitive capacity of any individual and requires different but complementary varieties of expertise and collective problem solving ability.
Collective intelligence is shared or group intelligence that emerges from the collaboration, collective efforts, and competition of many individuals.
In collaborative problem solving people work together to solve real-world problems. Members of problem-solving groups share a common concern, a similar passion, and/or a commitment to their work. Members can ask questions, wonder, and try to understand common issues. They share expertise, experiences, tools, and methods. Groups may be fluid based on need, may only occur temporarily to finish an assigned task, or may be more permanent depending on the nature of the problems.
For example, in the educational context, members of a group may all have input into the decision-making process and a role in the learning process. Members may be responsible for the thinking, teaching, and monitoring of all members in the group. Group work may be coordinated among members so that each member makes an equal contribution to the whole work. Members can identify and build on their individual strengths so that everyone can make a significant contribution to the task. Collaborative group work has the ability to promote critical thinking skills, problem solving skills, social skills, and self-esteem. By using collaboration and communication, members often learn from one another and construct meaningful knowledge that often leads to better learning outcomes than individual work.
Collaborative groups require joint intellectual efforts between the members and involve social interactions to solve problems together. The knowledge shared during these interactions is acquired during communication, negotiation, and production of materials. Members actively seek information from others by asking questions. The capacity to use questions to acquire new information increases understanding and the ability to solve problems.
In a 1962 research report, Douglas Engelbart linked collective intelligence to organizational effectiveness, and predicted that proactively "augmenting human intellect" would yield a multiplier effect in group problem solving: "Three people working together in this augmented mode [would] seem to be more than three times as effective in solving a complex problem as is one augmented person working alone".
Henry Jenkins, a theorist of new media and media convergence, draws on the theory that collective intelligence can be attributed to media convergence and participatory culture. He criticizes contemporary education for failing to incorporate online trends of collective problem solving into the classroom, stating "whereas a collective intelligence community encourages ownership of work as a group, schools grade individuals". Jenkins argues that interaction within a knowledge community builds vital skills for young people, and teamwork through collective intelligence communities contributes to the development of such skills.
Collective impact is the commitment of a group of actors from different sectors to a common agenda for solving a specific social problem, using a structured form of collaboration.
After World War II the UN, the Bretton Woods organization, and the WTO were created. Collective problem solving on the international level crystallized around these three types of organization from the 1980s onward. As these global institutions remain state-like or state-centric it is unsurprising that they perpetuate state-like or state-centric approaches to collective problem solving rather than alternative ones.
Crowdsourcing is a process of accumulating ideas, thoughts, or information from many independent participants, with aim of finding the best solution for a given challenge. Modern information technologies allow for many people to be involved and facilitate managing their suggestions in ways that provide good results. The Internet allows for a new capacity of collective (including planetary-scale) problem solving.
See also
Notes
Further reading
(Portions adapted from Michigan State Board of Education's Position Paper on Information Processing Skills, 1992.)
External links
Reasoning
Artificial intelligence
Educational psychology
Cognitive psychology
Neuropsychological assessment
Psychology articles needing expert attention | 0.760449 | 0.998307 | 0.759162 |
Psychosocial hazard | A psychosocial hazard or work stressor is any occupational hazard related to the way work is designed, organized and managed, as well as the economic and social contexts of work. Unlike the other three categories of occupational hazard (chemical, biological, and physical), they do not arise from a physical substance, object, or hazardous energy.
Psychosocial hazards affect the psychological and physical well-being of workers, including their ability to participate in a work environment among other people. They cause not only psychiatric and psychological outcomes such as occupational burnout, anxiety disorders, and depression, but they can also cause physical injury or illness such as cardiovascular disease or musculoskeletal injury. Psychosocial risks are linked to the organization of work as well as workplace violence and are recognized internationally as major challenges to occupational safety and health as well as productivity.
Types of hazard
In general, workplace stress can be defined as an imbalance between the demands of a job, and the physical and mental resources available to cope with them. Several models of workplace stress have been proposed, including imbalances between work demands and employee control, between effort and reward, and general focuses on wellness.
Psychosocial hazards may be divided into those that arise from the content or the context of work. Work content includes the amount and pace of work, including both too much and too little to do; the extent, flexibility, and predictability of work hours; and the extent of employee control and participation in decision-making. Work context includes impacts on career development and wages, organizational culture, interpersonal relationships, and work–life balance.
According to a survey by the European Agency for Safety and Health at Work, the most important psychosocial hazards—work stressors—are:
Job strain
Effort-reward imbalance
Lack of supervisor and co-worker support
Long working hours
Work intensification
Lean production and outsourcing
Emotional labor
Work–life balance
Job insecurity
Precarious work
Other psychosocial hazards are:
Having a toxic workplace or hostile work environment
Lack of perceived organizational support, including perceived psychological contract violation
Lack of work–life balance, including work–family conflict
Lack of person–environment fit
Behavioral issues such as workplace aggression, workplace bullying, workplace harassment including sexual harassment, workplace incivility, workplace revenge, and workplace violence
Personality issues such as narcissism in the workplace, Machiavellianism in the workplace, and psychopathy in the workplace
Micromanagement
Organizational conflict
Incident stress
Jury stress
Shift work
Information privacy issues regarding data derived from workers
In addition, levels of noise or air quality that are considered acceptable from a physical or chemical hazard standpoint may still provide psychosocial hazards from being annoying, irritating, or causing fear of other health impacts from the environment.
Assessment
Psychosocial hazards are usually identified or assessed through inspecting how workers carry out work and interact with each other, having conversations with workers individually or in focus groups, using surveys, and reviewing records such as incident reports, workers' compensation claims, and worker absenteeism and turnover data. A more formal occupational risk assessment may be warranted if there is uncertainty about the hazards' potential severity, interactions, or the effectiveness of controls.
There are several risk assessment survey tools for psychosocial hazards. These include the NIOSH Worker Well-Being Questionnaire (WellBQ) from the U.S. National Institute for Occupational Safety and Health's Total Worker Health program, the People at Work survey from Queensland Workplace Health and Safety, the Copenhagen Psychosocial Questionnaire from the Danish , and the Management Standards Indicator Tool from the UK Health and Safety Executive.
Control
According to the hierarchy of hazard controls, the most effective controls are eliminating hazards, or if that is impractical, minimizing them, through good work design practices. These include measures to reduce overwork; providing workers with support, personal control, and clearly defined roles; and providing effective change management.
In the context of psychosocial hazards, engineering controls are physical changes to the workplace that mitigate hazards or isolate workers from them. Engineering controls for psychosocial hazards include workplace design to affect the amount, type, and level of personal control of work, as well as access controls and alarms. The risk of workplace violence can be reduced through physical design of the workplace or by cameras. Proper manual handling equipment, measures to reduce noise exposure, and appropriate lighting levels have a positive effect on psychosocial hazards, in addition to their effects to control physical hazard.
Administrative controls include job rotation to reduce exposure time, clear policies on workplace bullying and sexual harassment, and proper consultation and training of employees. Personal protective equipment includes personal distress alarms, as well as equipment typically used for other types of hazards such as eye and face protection and hearing protection.
Health promotion activities can improve workers' general and mental health, but should not be used as an alternative or substitute for directly managing risk from psychosocial hazards. A recent Cochrane review – using moderate quality evidence – related that the addition of work-directed interventions for depressed workers receiving clinical interventions reduces the number of lost work days as compared to clinical interventions alone. This review also demonstrated that the addition of cognitive behavioral therapy to primary or occupational care and the addition of a "structured telephone outreach and care management program" to usual care are both effective at reducing sick leave days.
International Standards to manage psychosocial risk at work
ISO 45003:2021 is an international standard developed by the International Organization for Standardization (ISO) allowing organizations to manage psychosocial risk at work, in particular, to be considered within occupational health and safety (OH&S) management systems based on ISO 45001 on Occupational Health and Safety Management System Standards.
Impact
Exposure to psychosocial hazards in the workplace not only has the potential to produce psychological and physiological harm to individual employees, but can also produce further repercussions within society—reducing productivity in local/state economies, corroding familial/interpersonal relationships, and producing negative behavioral outcomes. Occupational burnout is a consequence of psychosocial hazards.
Psychological and behavioral
Occupational stress, anxiety, and depression can be directly correlated to psychosocial hazards in the workplace.
Exposure to workplace psychosocial hazards has been strongly correlated with a wide spectrum of unhealthy behaviors such as physical inactivity, excessive alcohol and drug consumption, nutritional imbalance and sleep disturbances. In 2003, a cross-sectional survey of 12,110 employees from 26 different workplace environments was established to examine the relationship between subjective workplace stress and healthy activity. The survey quantified the measurement of stress mainly through evaluation of an individual's perceived locus of control in the workplace (although other variables were also examined). The results concluded that self-reported high levels of stress were associated with, across both sexes: diets with a higher concentration of fat, less exercise, cigarette smoking (and increasing use), and less self-efficacy to control smoking habits.
Physiological
Supported by strong evidence from a plethora of meticulous cross-sectional and longitudinal studies, a link has been indicated between the psychosocial work environment and consequences on employees' physical health. Increasing evidence indicates that four main physiological systems are effected: hypertension and heart disease, wound-healing, musculoskeletal disorders, gastro-intestinal disorders, and impaired immuno-competence. Additional disorders generally recognized as stress-induced include: bronchitis, coronary heart disease, mental illness, thyroid disorders, skin diseases, certain types of rheumatoid arthritis, obesity, tuberculosis, headaches and migraine, peptic ulcers and ulcerative colitis, and diabetes.
Economic
Across the European Union, work-related stress alone affects over 40 million individuals, costing an estimated €20 billion a year in lost productivity.
See also
Industrial and organizational psychology
Occupational health psychology
Positive psychology in the workplace
References
External links
Psychosocial issues on OSH-Wiki
Occupational hazards
Social psychology | 0.773205 | 0.981827 | 0.759154 |
Treatment of mental disorders | Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.
History
Treatments, as well as societies attitudes towards mental illnesses have substantially changed throughout the years. Many earlier treatments for mental illness were later deemed as ineffective as well dangerous. Some of these earlier treatments included trephination and bloodletting. Trephination was when a small hole was drilled into a person's skull to let out demons, as that was an earlier belief for mental disorders. Bloodletting is when a certain amount of blood was drained out of a person, due to the belief that chemical imbalances resulted in mental disorders. A more scientific reason behind mental disorders but both treatments were dangerous and ineffective nevertheless. During the 17th century however, many people with mental disorders were just locked away in institutions due to lack of knowledgeable treatment. Mental institutions became the main treatment for a long period of time. But though years of research, studies, and medical developments, many current treatments are now effective and safe for patients. Early glimpses of treatment of mental illness included dunking in cold water by Samuel Willard (physician), who reportedly established the first American hospital for mental illness. The history of treatment of mental disorders consists in a development through years mainly in both psychotherapy (Cognitive therapy, Behavior therapy, Group Therapy, and ECT) and psychopharmacology (drugs used in mental disorders).
Different perspectives on the causes of psychological disorders arose. Some believed that stated that psychological disorders are caused by specific abnormalities of the brain and nervous system and that is, in principle, they should be approached for treatments in the same way as physical illness (arose from Hippocrates's ideas).
Psychotherapy is a relatively new method used in treatment of mental disorders. The practice of individual psychotherapy as a treatment of mental disorders is about 100 years old. Sigmund Freud (1856–1939) was the first one to introduce this concept in psychoanalysis. Cognitive behavioral therapy is a more recent therapy that was founded in the 1960s by Aaron T. Beck, an American psychiatrist. It is a more systematic and structured part of psychotherapy. It consist in helping the patient learn effective ways to overcome their problems and difficulties that causes them distress. Behavior therapy has its roots in experimental psychology. E.L. Thorndike and B.F. Skinner were among the first to work on behavior therapy.
Convulsive therapy was introduced by Ladislas Meduna in 1934. He induced seizures through a series of injections, as a means to attempt to treat schizophrenia. Meanwhile, in Italy, Ugo Cerletti substituted injections with electricity. Because of this substitution the new theory was called electroconvulsive therapy (ECT).
Beside psychotherapy, a wide range of medication is used in the treatment of mental disorders. The first drugs used for this purpose were extracted from plants with psychoactive properties. Louis Lewin, in 1924, was the first one to introduce a classification of drugs and plants that had properties of this kind. The history of the medications used in mental disorders has developed a lot through years. The discovery of modern drugs prevailed during the 20th century. Lithium, a mood stabilizer, was discovered as a treatment of mania, by John F. Cade in 1949, "and Hammond (1871) used lithium bromide for 'acute mania with depression'". In 1937, Daniel Bovet and Anne-Marie Staub discovered the first antihistamine. In 1951 Paul Charpentier synthesized chlorpromazine an antipsychotic.
Influences
There are numbers of practitioners who have influenced the treatment of modern mental disorders. During the 18th century in Philippe Pinel a French physician helped/advocated for better treatment of patients with mental disorders. Similar to Pinel Benjamin Rush, a Philadelphian physician believed patients just needed time away from the stresses of modern life. Which he believed was the cause of mental disorders to develop. Benjamin Rush(1746–1813) was considered the Father of American Psychiatry for his many works and studies in the mental health field. He tried to classify different types of mental disorders, he theorized about their causes, and tried to find possible cures for them. Rush believed that mental disorders were caused by poor blood circulation, though he was wrong. He also described Savant Syndrome and had an approach to addictions.
Other important early psychiatrists include George Parkman, Oliver Wendell Holmes Sr., George Zeller, Carl Jung, Leo Kanner, and Peter Breggin. George Parkman (1790–1849) got his medical degree at the University of Aberdeen in Scotland. He was influenced by Benjamin Rush, who inspired him to take interest in the state asylums. He trained at the Parisian Asylum. Parkman wrote several papers on treatment for the mentally ill. Oliver Wendell Holmes Sr.(1809–1894) was an American Physician who wrote many famous writings on medical treatments. George Zeller (1858–1938) was famous for his way of treating the mentally ill. He believed they should be treated like people and did so in a caring manner. He banned narcotics, mechanical restraints, and imprisonment while he was in charge at Peoria State Asylum. Peter Breggin (1939–present) disagrees with the practices of harsh psychiatry such as electroconvulsive therapy.
Classification
German Physician Emil Kraepelin was more interested in the causes of mental disorders and potential classifications rather than focusing on and attempting to treating symptoms of mental disorders. This led to the classification of manic depression and Schizophrenia, as well as the start of a framework for classifying other disorders. However this method of research/work was ignored until the need for a universal classification system. This need would later lead to the creation of the DSM. Which not only provided classification of mental disorders but helped to understand where to start in terms of treatment.
Psychotherapy
A form of treatment for many mental disorders is psychotherapy. Psychotherapy is an interpersonal intervention, usually provided by a mental health professional such as a clinical psychologist, that employs any of a range of specific psychological techniques. There are several main types. Cognitive behavioral therapy (CBT) is used for a wide variety of disorders, based on modifying the patterns of thought and behavior associated with a particular disorder. There are various kinds of CBT therapy, and offshoots such as dialectical behavior therapy. Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of relationships as well as individuals themselves. Some psychotherapies are based on a humanistic approach. Some therapies are for a specific disorder only, for example interpersonal and social rhythm therapy. Mental health professionals often pick and choose techniques, employing an eclectic or integrative approach tailored to a particular disorder and individual. Much may depend on the therapeutic relationship, and there may be issues of trust, confidentiality and engagement.
To regulate the potentially powerful influences of therapies, psychologists hold themselves to a set of ethical standers for the treatment of people with mental disorders, written by the American Psychological Association. These ethical standards include:
Striving to benefit clients and taking care to do no harm;
Establishing relationships of trust with clients;
Promoting accuracy, honesty, and truthfulness;
Seeking fairness in treatment and taking precautions to avoid biases;
Respecting the dignity and worth of all people.
Medication
Psychiatric medication is also widely used to treat mental disorders. These are licensed psychoactive drugs usually prescribed by a psychiatrist or family doctor. There are several main groups. Antidepressants are used for the treatment of clinical depression as well as often for anxiety and other disorders. Anxiolytics are used, generally short-term, for anxiety disorders and related problems such as physical symptoms and insomnia. Mood stabilizers are used primarily in bipolar disorder, mainly targeting mania rather than depression. Antipsychotics are used for psychotic disorders, notably in schizophrenia. However, they are also often used to treat bipolar disorder in smaller doses to treat anxiety. Stimulants are commonly used, notably for ADHD.
Despite the different conventional names of the drug groups, there can be considerable overlap in the kinds of disorders for which they are actually indicated. There may also be off-label use. There can be problems with adverse effects and adherence.
Antipsychotics
In addition of atypical antipsychotics in cases of inadequate response to antidepressant therapy is an increasingly popular strategy that is well supported in the literature, though these medications may result in greater discontinuation due to adverse events. Aripiprazole was the first drug approved by the US Food and Drug Administration for adjunctive treatment of MDD in adults with inadequate response to antidepressant therapy in the current episode. Recommended doses of aripiprazole range from 2 mg/d to 15 mg/d based on 2 large, multicenter randomized, double-blind, placebo-controlled studies, which were later supported by a third large trial. Most conventional antipsychotics, such as the phenothiazines, work by blocking the D2 Dopamine receptors. Atypical antipsychotics, such as clozapine block both the D2 Dopamine receptors as well as 5HT2A serotonin receptors. Atypical antipsychotics are favored over conventional antipsychotics because they reduce the prevalence of pseudoparkinsonism which causes tremors and muscular rigidity similar to Parkinson's disease. The most severe side effect of antipsychotics is agranulocytosis, a depression of white blood cell count with unknown cause, and some patients may also experience photosensitivity. Atypical and conventional antipsychotics also differ in the fact that atypical medications help with both positive and negative symptoms while conventional medications only help with the positive symptoms; negative symptoms being things that are taken away from the person such as a reduction in motivation, while positive symptoms are things being added such as seeing illusions.
Antidepressant
Early antidepressants were discovered through research on treating tuberculosis and yielded the class of antidepressants known as monoamine oxidase inhibitors (MAO). Only two MAO inhibitors remain on the market in the United States because they alter the metabolism of the dietary amino acid tyramine which can lead to a hypertensive crisis. Research on improving phenothiazine antipsychotics led to the development of tricyclic antidepressants which inhibit synaptic uptake of the neurotransmitters norepinephrine and serotonin. SSRIs or selective serotonin reuptake inhibitors are the most frequently used antidepressant. These drugs share many similarities with the tricyclic antidepressants but are more selective in their action. The greatest risk of the SSRIs is an increase in violent and suicidal behavior, particularly in children and adolescents. In 2006 antidepressant sales worldwide totaled US$15 billion and over 226 million prescriptions were given.
Research on the effects of physical activity on mental illness
Research completed
As increasing evidence of the benefits of physical activity has become apparent, research on the mental benefits of physical activity has been examined. While it was originally believed that physical activity only slightly benefits mood and mental state, overtime positive mental effects from physical activity became more pronounced. Scientists began completing studies, which were often highly problematic due to problems such as getting patients to complete their trials, controlling for all possible variables, and finding adequate ways to test progress. Data were often collected through case and population studies, allowing for less control, but still gathering observations. More recently studies have begun to have more established methods in an attempt to start to comprehend the benefits of different levels and amounts of fitness across multiple age groups, genders, and mental illnesses. Some psychologists are recommending fitness to patients, however the majority of doctors are not prescribing patients with a full program.
Results
Many early studies show that physical activity has positive effects on subjects with mental illness. Most studies have shown that higher levels of exercise correlate to improvement in mental state, especially for depression. On the other hand, some studies have found that exercise can have a beneficial short-term effect at lower intensities. Demonstrating that lower intensity sessions with longer rest periods produced significantly higher positive affect and reduced anxiety when measured shortly after. Physical activity was found to be beneficial regardless of age and gender. Some studies found exercise to be more effective at treating depression than medication over long periods of time, but the most effective treatment of depression was exercise in combination with antidepressants. Exercise appeared to have the greatest effect on mental health a short period of time after exercise. Different studies have found this time to be from twenty minutes to several hours. Patients who have added exercise to other treatments tend to have more consistent long lasting relief from symptoms than those who just take medication. No single regimented workout has been agreed upon as most effective for any mental illness at this time. The exercise programs prescribed are mostly intended to get patients doing some form of physical activity, as the benefits of doing any form of exercise have been proven to be better than doing nothing at all.
Other
Electroconvulsive therapy (known as ECT) is when electric currents are applied to someone with a mental disorder who is not responding well to other forms of therapy. Psychosurgery, including deep brain stimulation, is another available treatment for some disorders. This form of therapy is disputed in many cases on its ethicality and effectiveness.
Creative therapies are sometimes used, including music therapy, art therapy or drama therapy. Each form of these therapy involves performing, creating, listening to, observing, or being a part of the therapeutic act.
Lifestyle adjustments and supportive measures are often used, including peer support, self-help and supported housing or employment. Some advocate dietary supplements. A placebo effect may play a role.
Services
Mental health services may be based in hospitals, clinics or the community. Often an individual may engage in different treatment modalities and use various mental health services. These may be under case management (sometimes referred to as "service coordination"), use inpatient or day treatment. Patients can utilize a psychosocial rehabilitation program or take part in an assertive community treatment program. Providing optimal treatments earlier in the course of a mental health disorder may prevent further relapses and ongoing disability. This has led to a new early intervention in psychosis service approach for psychosis Some approaches are based on a recovery model of mental disorder, and may focus on challenging stigma and social exclusion and creating empowerment and hope.
In America, half of people with severe symptoms of a mental health condition were found to have received no treatment in the prior 12 months. Fear of disclosure, rejection by friends, and ultimately discrimination are a few reasons why people with mental health conditions often don't seek help.
The UK is moving towards paying mental health providers by the outcome results that their services achieve.
Stigmas and treatment
Stigma against mental disorders can lead people with mental health conditions not to seek help. Two types of mental health stigmas include social stigma and perceived stigma. Though separated into different categories, the two can interact with each other, where prejudicial attitudes in social stigma lead to the internalization of discriminatory perceptions in perceived stigma.
The stigmatization of mental illnesses can elicit stereotypes, some common ones including violence, incompetence, and blame. However, the manifestation of that stereotype into prejudice may not always occur. When it does, prejudice leads to discrimination, the behavioral reaction.
Public stigmas may also harm social opportunities. Prejudice frequently disallows people with mental illnesses from finding suitable housing or procuring good jobs. Studies have shown that stereotypes and prejudice about mental illness have harmful impacts on obtaining and keeping good jobs. This, along with other negative effects of stigmatization have led researchers to conduct studies on the relationship between public stigma and care seeking. Researchers have found that an inverse relationship exists between public stigma and care seeking, as well as between stigmatizing attitudes and treatment adherence. Furthermore, specific beliefs that may influence people not to seek treatment have been identified, one of which is concern over what others might think.
The internalization of stigmas may lead to self-prejudice which in turn can lead a person to experience negative emotional reactions, interfering with a person's quality of life. Research has shown a significant relationship between shame and avoiding treatment. A study measuring this relationship found that research participants who expressed shame from personal experiences with mental illnesses were less likely to participate in treatment. Additionally, family shame is also a predictor of avoiding treatment. Research showed that people with psychiatric diagnoses were more likely to avoid services if they believed family members would have a negative reaction to said services. Hence, public stigma can influence self-stigma, which has been shown to decrease treatment involvement. As such, the interaction between the two constructs impact care seeking.
Public discourse on mental health treatment often centers on the biomedical model, which primarily treats mental illness with medication. While widespread, this approach can reinforce stigma by oversimplifying the complexity of mental health conditions. Arthur Kleinman, in "Rethinking Psychiatry" (1988), critiques the biomedical model by emphasizing the importance of cultural and social factors in understanding mental illness. He argues that reducing mental health to purely biological factors overlooks the societal influences that shape these conditions, challenging the misconception that mental illness is merely a personal weakness.
Laurence J. Kirmayer, in "Cultural Variations in the Clinical Presentation of Depression and Anxiety" (2001), expands on Kleinman's critique by demonstrating that mental health conditions manifest differently across cultures. Kirmayer advocates for culturally sensitive treatment approaches that not only improve diagnosis but also reduce stigma by recognizing cultural differences. This work counters the misconception that mental illness is a universal experience, instead promoting a nuanced approach that considers cultural context.
Anthropologist Byron J. Good, in "Medicine, Rationality, and Experience"(1994), further supports these views by arguing that mental health treatment must consider cultural narratives that shape individuals' experiences. Together, these scholars advocate for a shift from the limitations of the biomedical model toward a more holistic and culturally informed approach, crucial for reducing stigma and improving care.
List of treatments
Somatotherapy (type of pharmacotherapy; biology-based treatments)
Psychiatric medications (psychoactive drugs used in psychiatry)
Antianxiety drugs (anxiolytics)
Antidepressant drugs
Antipsychotic drugs
Mood stabilizers
Shock therapy also known as convulsive therapies
Insulin shock therapy (no longer practiced)
Electroconvulsive therapy
Psychosurgery
Leukotomy (prefrontal lobotomy; no longer practiced)
Bilateral cingulotomy
Deep brain stimulation
Psychotherapy (psychology-based treatment)
Cognitive behavioral therapy
Psychoanalysis
Gestalt therapy
Interpersonal psychotherapy
EMDR
Behavior therapy
References
72.Kleinman, Arthur. (1988). Rethinking Psychiatry: From Cultural Category to Personal Experience. Free Press.
73.Kirmayer, Laurence J. (2001). "Cultural Variations in the Clinical Presentation of Depression and Anxiety: Implications for Diagnosis and Treatment." Journal of Clinical Psychiatry, 62(suppl 13), 22–28.
74.Scheper-Hughes, Nancy, & Lock, Margaret M. (1987). "The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology." Medical Anthropology Quarterly, 1(1), 6-41.
Further reading
Mind, Brain, and Personality Disorders Am. J. Psychiatry 1 April 2005: 648–655.
General Psychiatry JAMA 16 September 1998: 961–962
The practice of medicinal chemistry, Camille Georges Wermuth
Theories of Psychotherapy & Counseling: Concepts and Cases, Richard S. Sharf
Cognitive behavioural interventions in physiotherapy and occupational therapy, Marie Donaghy, Maggie Nicol, Kate M. Davidson
Key concepts in psychotherapy integration, Jerold R. Gold
Mental disorders | 0.785466 | 0.96648 | 0.759137 |
Integrative psychotherapy | Integrative psychotherapy is the integration of elements from different schools of psychotherapy in the treatment of a client. Integrative psychotherapy may also refer to the psychotherapeutic process of integrating the personality: uniting the "affective, cognitive, behavioral, and physiological systems within a person".
Background
Initially, Sigmund Freud developed a talking cure called psychoanalysis; then he wrote about his therapy and popularized psychoanalysis. After Freud, many different disciplines splintered off. Some of the more common therapies include: psychodynamic psychotherapy, transactional analysis, cognitive behavioral therapy, gestalt therapy, body psychotherapy, family systems therapy, person-centered psychotherapy, and existential therapy. Hundreds of different theories of psychotherapy are practiced.
A new therapy is born in several stages. After being trained in an existing school of psychotherapy, the therapist begins to practice. Then, after follow up training in other schools, the therapist may combine the different theories as a basis of a new practice. Then, some practitioners write about their new approach and label this approach with a new name.
A pragmatic or a theoretical approach can be taken when fusing schools of psychotherapy. Pragmatic practitioners blend a few strands of theory from a few schools as well as various techniques; such practitioners are sometimes called eclectic psychotherapists and are primarily concerned with what works. Alternatively, other therapists consider themselves to be more theoretically grounded as they blend their theories; they are called integrative psychotherapists and are not only concerned with what works, but also why it works.
For example, an eclectic therapist might experience a change in their client after administering a particular technique and be satisfied with a positive result. In contrast, an integrative therapist is curious about the "why and how" of the change as well. A theoretical emphasis is important: for example, the client may only have been trying to please the therapist and was adapting to the therapist rather than becoming more fully empowered in themselves.
Different routes to integration
The most recent edition of the Handbook of Psychotherapy Integration (Norcross & Goldfried, 2005) recognized four general routes to integration: common factors, technical eclecticism, theoretical integration, and assimilative integration.
Common factors
The first route to integration is called common factors and "seeks to determine the core ingredients that different therapies share in common". The advantage of a common factors approach is the emphasis on therapeutic actions that have been demonstrated to be effective. The disadvantage is that common factors may overlook specific techniques that have been developed within particular theories. Common factors have been described by Jerome Frank, Bruce Wampold, and Miller, Duncan and Hubble (2005). Common factors theory asserts it is precisely the factors common to the most psychotherapies that make any psychotherapy successful.
Some psychologists have converged on the conclusion that a wide variety of different psychotherapies can be integrated via their common ability to trigger the neurobiological mechanism of memory reconsolidation in such a way as to lead to deconsolidation.
Technical eclecticism
The second route to integration is technical eclecticism which is designed "to improve our ability to select the best treatment for the person and the problem…guided primarily by data on what has worked best for others in the past". The advantage of technical eclecticism is that it encourages the use of diverse strategies without being hindered by theoretical differences. A disadvantage is that there may not be a clear conceptual framework describing how techniques drawn from divergent theories might fit together. The most well known model of technical eclectic psychotherapy is Arnold Lazarus' (2005) multimodal therapy. Another model of technical eclecticism is Larry E. Beutler and colleagues' systematic treatment selection.
Theoretical integration
The third route to integration commonly recognized in the literature is theoretical integration in which "two or more therapies are integrated in the hope that the result will be better than the constituent therapies alone". Some models of theoretical integration focus on combining and synthesizing a small number of theories at a deep level, whereas others describe the relationship between several systems of psychotherapy. One prominent example of theoretical synthesis is Paul Wachtel's model of cyclical psychodynamics that integrates psychodynamic, behavioral, and family systems theories. Another example of synthesis is Anthony Ryle's model of cognitive analytic therapy, integrating ideas from psychoanalytic object relations theory and cognitive psychotherapy. Another model of theoretical integration is specifically called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010). The most notable model describing the relationship between several different theories is the transtheoretical model.
Assimilative integration
Assimilative integration is the fourth route and acknowledges that most psychotherapists select a theoretical orientation that serves as their foundation but, with experience, incorporate ideas and strategies from other sources into their practice. "This mode of integration favors a firm grounding in any one system of psychotherapy, but with a willingness to incorporate or assimilate, in a considered fashion, perspectives or practices from other schools". Some counselors may prefer the security of one foundational theory as they begin the process of integrative exploration. Formal models of assimilative integration have been described based on a psychodynamic foundation, and based on cognitive behavioral therapy.
Govrin (2015) pointed out a form of integration, which he called "integration by conversion", whereby theorists import into their own system of psychotherapy a foreign and quite alien concept, but they give the concept a new meaning that allows them to claim that the newly imported concept was really an integral part of their original system of psychotherapy, even if the imported concept significantly changes the original system. Govrin gave as two examples Heinz Kohut's novel emphasis on empathy in psychoanalysis in the 1970s and the novel emphasis on mindfulness and acceptance in "third-wave" cognitive behavioral therapy in the 1990s to 2000s.
Other models that combine routes
In addition to well-established approaches that fit into the five routes mentioned above, there are newer models that combine aspects of the traditional routes.
Clara E. Hill's (2014) three-stage model of helping skills encourages counselors to emphasize skills from different theories during different stages of helping. Hill's model might be considered a combination of theoretical integration and technical eclecticism. The first stage is the exploration stage. This is based on client-centered therapy. The second stage is entitled insight. Interventions used in this stage are based on psychoanalytic therapy. The last stage, the action stage, is based on behavioral therapy.
Good and Beitman (2006) described an integrative approach highlighting both core components of effective therapy and specific techniques designed to target clients' particular areas of concern. This approach can be described as an integration of common factors and technical eclecticism.
Multitheoretical psychotherapy is an integrative model that combines elements of technical eclecticism and theoretical integration. Therapists are encouraged to make intentional choices about combining theories and intervention strategies.
An approach called integral psychotherapy is grounded in the work of theoretical psychologist and philosopher Ken Wilber (2000), who integrates insights from contemplative and meditative traditions. Integral theory is a meta-theory that recognizes that reality can be organized from four major perspectives: subjective, intersubjective, objective, and interobjective. Various psychotherapies typically ground themselves in one of these four foundational perspectives, often minimizing the others. Integral psychotherapy includes all four. For example, psychotherapeutic integration using this model would include subjective approaches (cognitive, existential), intersubjective approaches (interpersonal, object relations, multicultural), objective approaches (behavioral, pharmacological), and interobjective approaches (systems science). By understanding that each of these four basic perspectives all simultaneously co-occur, each can be seen as essential to a comprehensive view of the life of the client. Integral theory also includes a stage model that suggests that various psychotherapies seek to address issues arising from different stages of psychological development.
The generic term, integrative psychotherapy, can be used to describe any multi-modal approach which combines therapies. For example, an effective form of treatment for some clients is psychodynamic psychotherapy combined with hypnotherapy. Kraft & Kraft (2007) gave a detailed account of this treatment with a 54-year-old female client with refractory IBS in a setting of a phobic anxiety state. The client made a full recovery and this was maintained at the follow-up a year later.
Comparison with eclecticism
In Integrative and Eclectic Counselling and Psychotherapy, the authors make clear the distinction between integrative and eclectic psychotherapy approaches: "Integration suggests that the elements are part of one combined approach to theory and practice, as opposed to eclecticism which draws ad hoc from several approaches in the approach to a particular case." Psychotherapy's eclectic practitioners are not bound by the theories, dogma, conventions or methodology of any one particular school. Instead, they may use what they believe or feel or experience tells them will work best, either in general or suiting the often immediate needs of individual clients; and working within their own preferences and capabilities as practitioners.
See also
Integrative body psychotherapy
Journal of Psychotherapy Integration
Notes
References
Beutler, L. E., Consoli, A. J. & Lane, G. (2005). Systematic treatment selection and prescriptive psychotherapy: an integrative eclectic approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 121–143). New York: Oxford.
Brooks-Harris, J. E. (2008). Integrative Multitheoretical Psychotherapy. Boston: Houghton-Mifflin.
Castonguay, L. G., Newman, M. G., Borkovec, T. D., Holtforth, M. G. & Maramba, G. G. (2005). Cognitive-behavioral assimilative integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 241–260). New York: Oxford.
Ecker, B., Ticic, R., Hulley, L. (2012). Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation. New York: Routledge.
Forman, M. D. (2010). A Guide to Integral Psychotherapy: Complexity, Integration, and Spirituality in Practice. Albany, NY: SUNY Press.
Frank, J. D. & Frank, J. B. (1991). Persuasion and Healing: A Comparative Study of Psychotherapy (3rd ed.). Baltimore, MD: Johns Hopkins University.
Frank, K. A. (1999). Psychoanalytic Participation: Action, Interaction, and Integration. Mahwah, NJ: Analytic Press.
Good, G. E. & Beitman, B. D. (2006). Counseling and Psychotherapy Essentials: Integrating Theories, Skills, and Practices. New York: W. W. Norton.
Govrin, A. (2015). Blurring the threat of 'otherness': integration by conversion in psychoanalysis and CBT. Journal of Psychotherapy Integration, 26(1): 78–90.
Hill, C. E. (2014). Helping Skills: Facilitating Exploration, Insight, and Action (4th ed.). Washington, DC: American Psychological Association.
Ingersoll, E. & Zeitler, D. (2010). Integral Psychotherapy: Inside Out/Outside In. Albany, NY: SUNY Press.
Kraft T. & Kraft D. (2007). Irritable bowel syndrome: symptomatic treatment approaches versus integrative psychotherapy. Contemporary Hypnosis, 24(4): 161–177.
Lane, R. D., Ryan, L., Nadel, L., Greenberg, L. S. (2015). Memory reconsolidation, emotional arousal and the process of change in psychotherapy: new insights from brain science. Behavioral and Brain Sciences, 38: e1.
Lazarus, A. A. (2005). Multimodal therapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 105–120). New York: Oxford.
Messer, S. B. (1992). A critical examination of belief structures in integrative and eclectic psychotherapy. In J. C. Norcross, & M. R. Goldfried, (Eds.), Handbook of Psychotherapy Integration (pp. 130–165). New York: Basic Books.
Miller, S. D., Duncan, B. L., & Hubble, M. A. (2005). Outcome-informed clinical work. In J. C. Norcross, & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 84–102). New York: Oxford.
Norcross, J. C. (2005). A primer on psychotherapy integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 3–23). New York: Oxford.
Norcross, J. C. & Goldfried, M. R. (Eds.) (2005). Handbook of Psychotherapy Integration (2nd ed.). New York: Oxford.
Prochaska, J. O. & DiClemente, C. C. (2005). The transtheoretical approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 147–171). New York: Oxford.
Ryle, A. (2005). Cognitive analytic therapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 196–217). New York: Oxford.
Stricker, G. & Gold, J. (2005). Assimilative psychodynamic psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 221–240). New York: Oxford.
Wachtel, P. L., Kruk, J. C., & McKinney, M. K. (2005). Cyclical psychodynamics and integrative relational psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 172–195). New York: Oxford.
Wampold, B. E. & Imel Z. E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work (2nd ed.). New York: Routledge.
Welling, H. (June 2012). Transformative emotional sequence: towards a common principle of change. Journal of Psychotherapy Integration, 22(2): 109–136.
Wilber, K. (2000). Integral Psychology: Consciousness, Spirit, Psychology, Therapy. Boston: Shambhala.
Woolfe, R. & Palmer, S. (2000). Integrative and Eclectic Counselling and Psychotherapy. London; Thousand Oaks, CA: Sage Publications.
Žvelc, G. & Žvelc, M. (2021). Integrative psychotherapy: A mindfulness- and compassion-oriented approach. Routledge.
Further reading
Fromme, D. K. (2011). Systems of Psychotherapy: Dialectical Tensions and Integration. New York: Springer.
Magnavita, J. J. & Anchin, J. C. (2014). Unifying Psychotherapy: Principles, Methods, and Evidence from Clinical Science. New York: Springer.
Prochaska, J. O. & Norcross, J. C. (2018). Systems of Psychotherapy: A Transtheoretical Analysis (9th ed.). New York: Oxford.
Scaturo, D. J. (2005). Clinical Dilemmas in Psychotherapy: a Transtheoretical Approach to Psychotherapy Integration. Washington, DC: American Psychological Association.
Schneider, K. J. (Ed.) (2008). Existential-Integrative Psychotherapy: Guideposts to the Core of Practice. New York: Routledge.
Schneider, K. J. & Krug, O.T. (2010). Existential-Humanistic Therapy. Washington, DC: American Psychological Association.
Stricker, G. & Gold, J. R. (2006). A Casebook of Psychotherapy Integration. Washington, DC: American Psychological Association.
Urban, W. J. (1978) Integrative Therapy: Foundations of Holistic and Self Healing. Los Angeles: Guild of Tutors Press.
External links
The Problem of Psychotherapy Integration by Tullio Carere
The Rise of Integrative Psychotherapy by John Söderlund
Society for the Exploration of Psychotherapy Integration
International Integrative Psychotherapy Association
Institute for Integrative Psychotherapy and Counselling, Ljubljana
International Journal of Integrative Psychotherapy | 0.771957 | 0.983362 | 0.759114 |
Salutogenesis | Salutogenesis is the study of the origins of health and focuses on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the "salutogenic model" was originally concerned with the relationship between health, stress, and coping through a study of Holocaust survivors. Despite going through the dramatic tragedy of the holocaust, some survivors were able to thrive later in life. The discovery that there must be powerful health causing factors led to the development of salutogenesis. The term was coined by Aaron Antonovsky (1923-1994), a professor of medical sociology. The salutogenic question posed by Aaron Antonovsky is, "How can this person be helped to move toward greater health?"
Antonovsky's theories reject the "traditional medical-model dichotomy separating health and illness". He described the relationship as a continuous variable, what he called the "health-ease versus dis-ease continuum". Salutogenesis now encompasses more than the origins of health and has evolved to be about multidimensional causes of higher levels of health. Models associated with salutogenesis generally include wholistic approaches related to at least the physical, social, emotional, spiritual, intellectual, vocational, and environmental dimensions.
Derivation
The word "salutogenesis" comes from the Latin salus (meaning health) and the Greek genesis (meaning origin). Antonovsky developed the term from his studies of "how people manage stress and stay well" (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.
Development
In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unraveling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: "this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the 'salutogenic model'."
In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalized resource deficits (GRDs). On the other hand, there are generalized resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.
Generalized resource deficits will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between generalized resource deficits and resources that determines whether a factor will be pathogenic, neutral, or salutary.
Antonovsky's formulation was that the generalized resistance resources enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was "in itself the essential tool for coping".
Sense of coherence
The "sense of coherence" is a theoretical formulation that provides a central explanation for the role of stress in human functioning. "Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence." Antonovsky defined Sense of Coherence as:
"a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement."
In his formulation, the sense of coherence has three components:
Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.
According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that "salutogenesis" depends on experiencing a strong "sense of coherence". His research demonstrated that the sense of coherence predicts positive health outcomes.
During the COVID-19 pandemic, one's sense of coherence was shown to be associated with the likelihood of their adherence to the pandemic safety guidelines.
Fields of application
Health and medicine
Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioral medicine, and the sociology of health. It has been adopted as a term to describe contemporary approaches to nursing, psychiatry, integrative medicine, and healthcare architecture. The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care and for healthcare architecture. Incorporating concepts from salutogenesis can support a transition from curative to preventive medicine.
Workplace
The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.
Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work. The meaningfulness component has also been linked with job control and task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves "the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement".
The manageability component is considered to be linked to job control as well as to access to resources. It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.
The comprehensibility component may be influenced by consistent feedback at work, for example concerning the performance appraisal.
Salutogenics perspectives are also considered in the design of offices.
See also
References
Further reading
Becker, C. M., Glascoff, M. A., & Felts, W. M. (2010). "Salutogenesis 30 Years Later: Where do we go from here?" International Electronic Journal of Health Education, 13, 25-32. Can access at:
Studying Health vs. Studying Disease - Aaron Antonovsky. Lecture at the Congress for Clinical Psychology and Psychotherapy, Berlin, 19 February 1990.
Coping with Existential Threats and the Inevitability of Asking for Meaningfulness - Peter Novak. A philosophical perspective
Start making sense - Start Making Sense; Applying a salutogenic model to architectural design for psychiatric care - Jan Golembiewski. A method of applying salutogenic theory.
Salutogenesis
Bengt Lindström, "Salutogenesis – an introduction"
Golembiewski, J. (2012). "Salutogenic design: The neural basis for health promoting environments." World Health Design Scientific Review 5(4): 62-68.https://www.academia.edu/2456916/Salutogenic_design_The_neural_basis_for_health_promoting_environments
Mayer, C.-H. & Krause, C. (Eds.)(2012): Exploring Mental Health: Theoretical and Empirical Discourses on Salutogenesis. Pabst Science Publishers.
Mayer, C.-H. & Hausner, s. (Eds.) (2015): Salutogene Aufstellungen. Beiträge zur Gesundheitsförderung in der systemischen Arbeit. - Vandenhoeck & Ruprecht
Mittelmark, M.B., Sagy, S., Eriksson, M., Bauer, G., Pelikan, J.M., Lindström, B., Espnes, G.A. (Eds.) (2016): The Handbook of Salutogenesis Comprehensive overview of salutogenesis and its contribution to health promotion theory.
Medical sociology
Positive psychology
Health psychology
Public health
Determinants of health | 0.768908 | 0.987211 | 0.759075 |
Confabulation | In psychology, confabulation is a memory error consisting of the production of fabricated, distorted, or misinterpreted memories about oneself or the world. It is generally associated with certain types of brain damage (especially aneurysm in the anterior communicating artery) or a specific subset of dementias. While still an area of ongoing research, the basal forebrain is implicated in the phenomenon of confabulation. People who confabulate present with incorrect memories ranging from subtle inaccuracies to surreal fabrications, and may include confusion or distortion in the temporal framing (timing, sequence or duration) of memories. In general, they are very confident about their recollections, even when challenged with contradictory evidence.
Confabulation occurs when individuals mistakenly recall false information, without intending to deceive. Brain damage, dementia, and anticholinergic toxidrome can cause this distortion. Two types of confabulation exist: provoked and spontaneous, with two distinctions: verbal and behavioral. Verbal statements, false information, and the patient's unawareness of the distortion are all associated with this phenomenon. Personality structure also plays a role in confabulation.
Numerous theories have been developed to explain confabulation. theories suggest that cognitive dysfunction causes the distortion. Self-identity theories posit that people confabulate to preserve themselves. The temporality theory believes that confabulation occurs when an individual cannot place events properly in time. The monitoring and strategic retrieval account theories argue that confabulation arises when individuals cannot recall memories correctly or monitor them after retrieval. The executive control and fuzzy-trace theories also attempt to explain why confabulation happens.
Confabulation can occur with nervous system injuries or illnesses, including Korsakoff's syndrome, Alzheimer's disease, schizophrenia, and traumatic brain injury. It is believed that the right frontal lobe of the brain is damaged, causing false memories. Children are especially susceptible to forced confabulation as they are highly impressionable. Feedback can increase confidence in false memories. In rare cases, confabulation occurs in ordinary individuals.
Different memory tests, including recognition tasks and free recall tasks, can be used to study confabulation. Treatment depends on the underlying cause of the distortion. Ongoing research aims to develop a standard test battery to discern between different types of confabulations, distinguish delusions from confabulations, understand the role of unconscious processes, and identify pathological and nonpathological confabulations.
Description
Confabulation is distinguished from lying as there is no intent to deceive and the person is unaware the information is false. Although individuals can present blatantly false information, confabulation can also seem to be coherent, internally consistent, and relatively normal.
Most known cases of confabulation are symptomatic of brain damage or dementias, such as aneurysm, Alzheimer's disease, or Wernicke–Korsakoff syndrome (a common manifestation of thiamine deficiency caused by alcohol use disorder). Additionally confabulation often occurs in people with anticholinergic toxidrome when interrogated about bizarre or irrational behaviour.
Confabulated memories of all types most often occur in autobiographical memory and are indicative of a complicated and intricate process that can be led astray at any point during encoding, storage, or recall of a memory. This type of confabulation is commonly seen in Korsakoff's syndrome.
Distinctions
Two types of confabulation are often distinguished:
Provoked (momentary, or secondary) confabulations represent a normal response to a faulty memory, are common in both amnesia and dementia, and can become apparent during memory tests.
Spontaneous (or primary) confabulations do not occur in response to a cue and seem to be involuntary. They are relatively rare, more common in cases of dementia, and may result from the interaction between frontal lobe pathology and organic amnesia.
Another distinction is that between:
Verbal confabulations- spoken false memories, most common type
Behavioral confabulations- occur when an individual acts on their false memories
Signs and symptoms
Confabulation is associated with several characteristics:
Typically verbal statements but can also be non-verbal gestures or actions.
Can include autobiographical and non-personal information, such as historical facts, fairy-tales, or other aspects of semantic memory.
The account can be fantastic or coherent.
Both the premise and the details of the account can be false.
The account is usually drawn from the patient's memory of actual experiences, including past and current thoughts.
The patient is unaware of the accounts' distortions or inappropriateness, and is not concerned when errors are pointed out.
There is no hidden motivation behind the account.
The patient's personality structure may play a role in their readiness to confabulate.
Theories
Theories of confabulation range in emphasis. Some theories propose that confabulations represent a way for memory disabled people to maintain their self-identity. Other theories use neurocognitive links to explain the process of confabulation. Still other theories frame confabulation around the more familiar concept of delusion. Other researchers frame confabulation within the fuzzy-trace theory. Finally, some researchers call for theories that rely less on neurocognitive explanations and more on epistemic accounts.
Neuropsychological theories
The most popular theories of confabulation come from the field of neuropsychology or cognitive neuroscience. Research suggests that confabulation is associated with dysfunction of cognitive processes that control the retrieval from long-term memory. Frontal lobe damage often disrupts this process, preventing the retrieval of information and the evaluation of its output. Furthermore, researchers argue that confabulation is a disorder resulting from failed "reality monitoring/source monitoring" (i.e. deciding whether a memory is based on an actual event or whether it is imagined). Some neuropsychologists suggest that errors in retrieval of information from long-term memory that are made by normal subjects involve different components of control processes than errors made by confabulators. Kraepelin distinguished two subtypes of confabulation, one of which he called simple confabulation, caused partly by errors in the temporal ordering of real events. The other variety he called fantastic confabulation, which was bizarre and patently impossible statements not rooted in true memory.
Simple confabulation may result from damage to memory systems in the medial temporal lobe. Fantastic confabulations reveal a dysfunction of the Supervisory System, which is believed to be a function of the frontal cortex.
Temporality theory
Support for the temporality account suggests that confabulations occur when an individual is unable to place events properly in time. Thus, an individual might correctly state an action they performed, but say they did it yesterday, when they did it weeks ago. In the Memory, Consciousness, and Temporality Theory, confabulation occurs because of a deficit in temporal consciousness or awareness.
Monitoring theory
Along a similar notion are the theories of reality and source monitoring theories. In these theories, confabulation occurs when individuals incorrectly attribute memories as reality, or incorrectly attribute memories to a certain source. Thus, an individual might claim an imagined event happened in reality, or that a friend told him/her about an event he/she actually heard about on television.
Strategic retrieval account theory
Supporters of the strategic retrieval account suggest that confabulations occur when an individual cannot actively monitor a memory for truthfulness after its retrieval. An individual recalls a memory, but there is some deficit after recall that interferes with the person establishing its falseness.
Executive control theory
Still others propose that all types of false memories, including confabulation, fit into a general memory and executive function model. In 2007, a framework for confabulation was proposed that stated confabulation is the result of two things: Problems with executive control and problems with evaluation. In the executive control deficit, the incorrect memory is retrieved from the brain. In the evaluative deficit, the memory will be accepted as a truth due to an inability to distinguish a belief from an actual memory.
In the context of delusion theories
Recent models of confabulation have attempted to build upon the link between delusion and confabulation. More recently, a monitoring account for delusion, applied to confabulation, proposed both the inclusion of conscious and unconscious processing. The claim was that by encompassing the notion of both processes, spontaneous versus provoked confabulations could be better explained. In other words, there are two ways to confabulate. One is the unconscious, spontaneous way in which a memory goes through no logical, explanatory processing. The other is the conscious, provoked way in which a memory is recalled intentionally by the individual to explain something confusing or unusual.
Fuzzy-trace theory
Fuzzy-trace theory, or FTT, is a concept more commonly applied to the explanation of judgement decisions. According to this theory, memories are encoded generally (gist), as well as specifically (verbatim). Thus, a confabulation could result from recalling the incorrect verbatim memory or from being able to recall the gist portion, but not the verbatim portion, of a memory.
FTT uses a set of five principles to explain false-memory phenomena. Principle 1 suggests that subjects store verbatim information and gist information parallel to one another. Both forms of storage involve the surface content of an experience. Principle 2 shares factors of retrieval of gist and verbatim traces. Principle 3 is based on dual-opponent processes in false memory. Generally, gist retrieval supports false memory, while verbatim retrieval suppresses it. Developmental variability is the topic of Principle 4. As a child develops into an adult, there is obvious improvement in the acquisition, retention, and retrieval of both verbatim and gist memory. However, during late adulthood, there will be a decline in these abilities. Finally, Principle 5 explains that verbatim and gist processing cause vivid remembering. Fuzzy-trace Theory, governed by these 5 principles, has proved useful in explaining false memory and generating new predictions about it.
Epistemic theory
However, not all accounts are so embedded in the neurocognitive aspects of confabulation. Some attribute confabulation to epistemic accounts. In 2009, theories underlying the causation and mechanisms for confabulation were criticized for their focus on neural processes, which are somewhat unclear, as well as their emphasis on the negativity of false remembering. Researchers proposed that an epistemic account of confabulation would be more encompassing of both the advantages and disadvantages of the process.
Presentation
Associated neurological and psychological conditions
Confabulations are often symptoms of various syndromes and psychopathologies in the adult population, including Korsakoff's syndrome, Alzheimer's disease, schizophrenia, and traumatic brain injury.
Wernicke–Korsakoff syndrome is a neurological disorder typically characterized by years of alcohol use disorder characterized by excessive alcohol consumption and a nutritional thiamine deficiency. Confabulation is one salient symptom of this syndrome. A study on confabulation in Korsakoff's patients found that they are subject to provoked confabulation when prompted with questions pertaining to episodic memory, not semantic memory, and when prompted with questions where the appropriate response would be "I don't know." This suggests that in these patients is "domain-specific." Korsakoff's patients who confabulate are more likely than healthy adults to falsely recognize distractor words, suggesting that false recognition is a "confabulatory behavior."
Alzheimer's disease is a condition with both neurological and psychological components. It is a form of dementia associated with severe frontal lobe . Confabulation in individuals with Alzheimer's is often more spontaneous than it is in other conditions, especially in the advanced stages of the disease. Alzheimer's patients demonstrate comparable abilities to encode information as healthy elderly adults, suggesting that impairments in encoding are not associated with confabulation. However, as seen in Korsakoff's patients, confabulation in Alzheimer's patients is higher when prompted with questions investigating episodic memory. Researchers suggest this is due to damage in the posterior cortical regions of the brain, which is a symptom characteristic of Alzheimer's disease.
Schizophrenia is a psychological disorder in which confabulation is sometimes observed. Although confabulation is usually coherent in its presentation, of schizophrenic patients are often delusional. Researchers have noted that these patients tend to make up delusions on the spot which are often fantastic and become increasingly elaborate with questioning. Unlike patients with Korsakoff's and Alzheimer's, patients with schizophrenia are more likely to confabulate when prompted with questions regarding their semantic memories, as opposed to episodic memory prompting. In addition, confabulation does not appear to be related to any memory deficit in patients. This is contrary to most forms of confabulation. Also, confabulations made by schizophrenic patients often do not involve the creation of new information, but instead involve an attempt by the patient to reconstruct actual details of a past event.
Traumatic brain injury (TBI) can also result in confabulation. Research has shown that patients with damage to the inferior medial frontal lobe confabulate significantly more than patients with damage to the posterior area and healthy controls. This suggests that this region is key in producing confabulatory responses, and that memory deficit is important but not necessary in . Additionally, research suggests that confabulation can be seen in patients with frontal lobe syndrome, which involves an insult to the frontal lobe as a result of disease or traumatic brain injury (TBI). Finally, rupture of the anterior or posterior communicating artery, subarachnoid hemorrhage, and encephalitis are also possible causes of confabulation.
Location of brain lesions
Confabulation is believed to be a result of damage to the right frontal lobe of the brain. In particular, damage can be localized to the ventromedial frontal lobes and other structures fed by the anterior communicating artery (ACoA), including the basal forebrain, septum, fornix, cingulate gyrus, cingulum, anterior hypothalamus, and head of the caudate nucleus.
Developmental differences
While some recent literature has suggested that older adults may be more susceptible than their younger counterparts to have false memories, the majority of research on forced confabulation centers around children. Children are particularly susceptible to forced confabulations based on their high suggestibility. When forced to recall confabulated events, children are less likely to remember that they had previously confabulated these situations, and they are more likely than their adult counterparts to come to remember these confabulations as real events that transpired. Research suggests that this inability to distinguish between past confabulatory and real events is centered on developmental differences in source monitoring. Due to underdeveloped encoding and critical reasoning skills, children's ability to distinguish real memories from false memories may be impaired. It may also be that younger children lack the meta-memory processes required to remember confabulated versus non-confabulated events. Children's meta-memory processes may also be influenced by expectancies or biases, in that they believe that highly plausible false scenarios are not confabulated. However, when knowingly being tested for accuracy, children are more likely to respond, "I don't know" at a rate comparable to adults for unanswerable questions than they are to confabulate. Ultimately, misinformation effects can be minimized by tailoring individual interviews to the specific developmental stage, often based on age, of the participant.
Provoked versus spontaneous confabulations
There is evidence to support different cognitive mechanisms for provoked and spontaneous confabulation. One study suggested that spontaneous confabulation may be a result of an amnesic patient's inability to distinguish the chronological order of events in their memory. In contrast, provoked confabulation may be a compensatory mechanism, in which the patient tries to make up for their memory deficiency by attempting to demonstrate competency in recollection.
Confidence in false memories
Confabulation of events or situations may lead to an eventual acceptance of the confabulated information as true. For instance, people who knowingly lie about a situation may eventually come to believe that their lies are truthful with time. In an interview setting, people are more likely to confabulate in situations in which they are presented false information by another person, as opposed to when they self-generate these falsehoods. Further, people are more likely to accept false information as true when they are interviewed at a later time (after the event in question) than those who are interviewed immediately or soon after the event. Affirmative feedback for confabulated responses is also shown to increase the confabulator's confidence in their response. For instance, in culprit identification, if a witness falsely identifies a member of a line-up, he will be more confident in his identification if the interviewer provides affirmative feedback. This effect of confirmatory feedback appears to last over time, as witnesses will even remember the confabulated information months later.
Among normal subjects
On rare occasions, confabulation can also be seen in normal subjects. It is currently unclear how completely healthy individuals produce confabulations. It is possible that these individuals are in the process of developing some type of organic condition that is causing their confabulation symptoms. It is not uncommon, however, for the general population to display some very mild symptoms of provoked confabulations. Subtle distortions and intrusions in memory are commonly produced by normal subjects when they remember something poorly.
Diagnosis and treatment
Spontaneous confabulations, due to their involuntary nature, cannot be manipulated in a laboratory setting. However, provoked confabulations can be researched in various theoretical contexts. The mechanisms found to underlie provoked confabulations can be applied to spontaneous confabulation mechanisms. The basic premise of researching confabulation comprises finding errors and distortions in memory tests of an individual.
Deese–Roediger–McDermott lists
Confabulations can be detected in the context of the Deese–Roediger–McDermott paradigm by using the Deese–Roediger–McDermott lists. Participants listen to audio recordings of several lists of words centered around a theme, known as the critical word. The participants are later asked to recall the words on their list. If the participant recalls the critical word, which was never explicitly stated in the list, it is considered a confabulation. Participants often have a false memory for the critical word.
Recognition tasks
Confabulations can also be researched by using continuous recognition tasks. These tasks are often used in conjunction with confidence ratings. Generally, in a recognition task, participants are rapidly presented with pictures. Some of these pictures are shown once; others are shown multiple times. Participants press a key if they have seen the picture previously. Following a period of time, participants repeat the task. More errors on the second task, versus the first, are indicative of confusion, representing false memories.
Free recall tasks
Confabulations can also be detected using a free recall task, such as a self-narrative task. Participants are asked to recall stories (semantic or autobiographical) that are highly familiar to them. The stories recalled are encoded for errors that could be classified as distortions in memory. Distortions could include falsifying true story elements or including details from a completely different story. Errors such as these would be indicative of confabulations.
Treatment
Treatment for confabulation is somewhat dependent on the cause or source, if identifiable. For example, treatment of Wernicke–Korsakoff syndrome involves large doses of vitamin B in order to reverse the thiamine deficiency. If there is no known physiological cause, more general cognitive techniques may be used to treat confabulation. A case study published in 2000 showed that Self-Monitoring Training (SMT) reduced delusional confabulations. Furthermore, improvements were maintained at a three-month follow-up and were found to generalize to everyday settings. Although this treatment seems promising, more rigorous research is necessary to determine the efficacy of SMT in the general confabulation population.
Research
Although significant gains have been made in the understanding of confabulation in recent years, there is still much to be learned. One group of researchers in particular has laid out several important questions for future study. They suggest more information is needed regarding the neural systems that support the different cognitive processes necessary for normal source monitoring. They also proposed the idea of developing a standard neuropsychological test battery able to discriminate between the different types of confabulations. And there is a considerable amount of debate regarding the best approach to organizing and combining neuro-imaging, pharmacological, and cognitive/behavioral approaches to understand confabulation.
In a recent review article, another group of researchers contemplate issues concerning the distinctions between delusions and confabulation. They question whether delusions and confabulation should be considered distinct or overlapping disorders and, if overlapping, to what degree? They also discuss the role of unconscious processes in confabulation. Some researchers suggest that unconscious emotional and motivational processes are potentially just as important as cognitive and memory problems. Finally, they raise the question of where to draw the line between the pathological and the nonpathological. Delusion-like beliefs and confabulation-like fabrications are commonly seen in healthy individuals. What are the important differences between patients with similar etiology who do and do not confabulate? Since the line between pathological and nonpathological is likely blurry, should we take a more dimensional approach to confabulation? Research suggests that confabulation occurs along a continuum of implausibility, bizarreness, content, conviction, preoccupation, and distress, and impact on daily life.
See also
Compare with:
Anosognosia
Confabulation (neural networks)
Cryptomnesia
False memory
Hallucination
Hallucination (artificial intelligence)
Hindsight bias
Misinformation effect
Revelation
Rosy retrospection
Not to be confused with:
Scams (swindles):
Confidence tricks
Fraud
Hoaxes
Gaslighting
Phishing
References
Further reading
External links
Memory
Health effects of alcohol
Error
Ignorance
Memory biases
Barriers to critical thinking
Symptoms and signs of mental disorders | 0.760986 | 0.997478 | 0.759067 |
SNOMED CT | SNOMED CT or SNOMED Clinical Terms is a systematically organized computer-processable collection of medical terms providing codes, terms, synonyms and definitions used in clinical documentation and reporting. SNOMED CT is considered to be the most comprehensive, multilingual clinical healthcare terminology in the world. The primary purpose of SNOMED CT is to encode the meanings that are used in health information and to support the effective clinical recording of data with the aim of improving patient care. SNOMED CT provides the core general terminology for electronic health records. SNOMED CT comprehensive coverage includes: clinical findings, symptoms, diagnoses, procedures, body structures, organisms and other etiologies, substances, pharmaceuticals, devices and specimens.
SNOMED CT is maintained and distributed by SNOMED International, an international non-profit standards development organization, located in London, UK. SNOMED International is the trading name of the International Health Terminology Standards Development Organisation (IHTSDO), established in 2007.
SNOMED CT provides for consistent information interchange and is fundamental to an interoperable electronic health record. It provides a consistent means to index, store, retrieve, and aggregate clinical data across specialties and sites of care. It also helps in organizing the content of electronic health records systems by reducing the variability in the way data are captured, encoded and used for clinical care of patients and research. SNOMED CT can be used to directly record clinical details of individuals in electronic patient records. It also provides the user with a number of linkages to clinical care pathways, shared care plans and other knowledge resources, in order to facilitate informed decision-making, and to support long-term patient care. The availability of free automatic coding tools and services, which can return a ranked list of SNOMED CT descriptors to encode any clinical report, could help healthcare professionals to navigate the terminology.
SNOMED CT is a terminology that can cross-map to other international standards and classifications. Specific language editions are available which augment the international edition and can contain language translations, as well as additional national terms. For example, SNOMED CT-AU, released in December 2009 in Australia, is based on the international version of SNOMED CT, but encompasses words and ideas that are clinically and technically unique to Australia.
History
SNOMED started in 1965 as a Systematized Nomenclature of Pathology (SNOP) and was further developed into a logic-based health care terminology.
SNOMED CT was created in 1999 by the merger, expansion and restructuring of two large-scale terminologies: SNOMED Reference Terminology (SNOMED RT), developed by the College of American Pathologists (CAP); and the Clinical Terms Version 3 (CTV3) (formerly known as the Read codes), developed by the National Health Service of the United Kingdom (NHS). The final product was released in January 2002. The International Health Terminology Standards Development Organisation now considers SNOMED CT to be a brand name rather than an acronym. Previously SNOMED was an acronym of Systematized Nomenclature Of Medicine, but it lost that meaning when SNOMED was combined with CTV3 (Clinical Terms Version 3) into the merged product called SNOMED Clinical Terms, which was shortened to SNOMED CT.
The historical strength of SNOMED was its coverage of medical specialties. SNOMED RT, with over 120,000 concepts, was designed to serve as a common reference terminology for the aggregation and retrieval of pathology health care data recorded by multiple organizations and individuals. The strength of CTV3 was its terminologies for general practice. CTV3, with 200,000 interrelated concepts, was used for storing structured information about primary care encounters in individual, patient-based records. The January 2020 release of the SNOMED CT International Edition included more than 350,000 concepts.
In July 2003, the National Library of Medicine (NLM), on behalf of the United States Department of Health and Human Services, entered into an agreement with the College of American Pathologists to make SNOMED CT available to U.S. users at no cost through the National Library of Medicine's Unified Medical Language System UMLS Metathesaurus. The NLM negotiation team was led by Betsy Humphreys, and the contract provided NLM with a perpetual license for the core SNOMED CT (in Spanish and English) and its ongoing updates.
In April 2007, SNOMED CT intellectual property rights were transferred from the CAP to the International Health Terminology Standards Development Organisation (IHTSDO) in order to promote international adoption and use of SNOMED CT. Now trading as SNOMED International, the organization is responsible for "ongoing maintenance, development, quality assurance, and distribution of SNOMED CT" internationally
and its Membership consists of a number of the world's leading e-health countries and territories, including: Argentina, Australia, Belgium, Brunei, Canada, Czech Republic, Chile, Denmark, Estonia, Hong Kong, Iceland, India, Ireland, Israel, Lithuania, Malaysia, Malta, Netherlands, New Zealand, Norway, Poland, Portugal, Singapore, Slovak Republic, Republic of Slovenia, Spain, Sweden, Switzerland, United Kingdom, United States and Uruguay.
SNOMED CT is a multinational and multilingual terminology, which can manage different languages and dialects. SNOMED CT is currently available in American English, British English, Spanish, Danish and Swedish, with other translations underway or nearly completed in French and Dutch. SNOMED CT cross maps to other terminologies, such as: ICD-9-CM, ICD-10, ICD-O-3, ICD-10-AM, Laboratory LOINC and OPCS-4. It supports ANSI, DICOM, HL7, and ISO standards.
Structure
SNOMED CT consists of four primary core components:
Concept Codes – numerical codes that identify clinical terms, primitive or defined, organized in hierarchies
Descriptions – textual descriptions of Concept Codes
Relationships – relationships between Concept Codes that have a related meaning
Reference Sets – used to group Concepts or Descriptions into sets, including reference sets and cross-maps to other classifications and standards.
SNOMED CT "Concepts" are representational units that categorize all the things that characterize healthcare processes and need to be recorded therein. In 2011, SNOMED CT included more than 311,000 concepts, which are uniquely identified by a concept ID, e.g. the concept 22298006 refers to Myocardial infarction. All SNOMED CT concepts are organized into acyclic taxonomic (is-a) hierarchies; for example, Viral pneumonia IS-A Infectious pneumonia IS-A Pneumonia IS-A Lung disease. Concepts may have multiple parents, for example Infectious pneumonia is also a child of Infectious disease. The taxonomic structure allows data to be recorded and later accessed at different levels of aggregation.
SNOMED CT concepts are linked by approximately 1,360,000 links, called relationships.
Concepts are further described by various clinical terms or phrases, called Descriptions, which are divided into Fully Specified Names (FSNs), Preferred Terms (PTs), and Synonyms. Each Concept has exactly one FSN, which is unique across all of SNOMED CT. It has, in addition, exactly one PT, which has been decided by a group of clinicians to be the most common way of expressing the meaning of the concept. It may have zero to many Synonyms. Synonyms are additional terms and phrases used to refer to this concept. They do not have to be unique or unambiguous.
Semantic tag
SNOMED CT assigns each concept a semantic tag. It is present in parentheses in Fully Specified Name of each concept. There can be multiple semantic tags used within each SNOMED CT top level hierarchy. For example, top level hierarchy of Pharmaceutical/biologic Product uses semantic tags of: product, medicinal product, medicinal product form and clinical drug. Only one semantic tag can be used for each concept.
The formal model underlying SNOMED CT
SNOMED CT can be characterized as a multilingual thesaurus with an ontological foundation. Thesaurus-like features are concept–term relations such as the synonymous descriptions "Acute coryza", "Acute nasal catarrh", "Acute rhinitis", "Common cold" (as well as Spanish "resfrío común" and "rinitis infecciosa") for the concept 82272006.
Under ontological scrutiny, SNOMED-CT is a class hierarchy (with extensive overlap of classes in contrast to typical statistical classifications like ICD).
This means that the SNOMED CT concept 82272006 defines the class of all the individual disease instances that match the criteria for "common cold" (e.g., one patient may have "head cold" noted in their record, and another may have "Acute coryza"; both can be found as instances of "common cold").
The superclass (Is-A) Relation relates classes in terms of inclusion of their members. That is, all individual "cold-processes" are also included in all superclasses of the class Common Cold, such as Viral upper respiratory tract infection (Figure).
SNOMED CT's relational statements are basically triplets of the form Concept1 – Relationx – Concept2, with Relationx being from a small number of relation types (called linkage concepts), e.g. finding site, due to, etc. The interpretation of these triplets is (implicitly) based on the semantics of a simple Description logic (DL). E.g., the triplet Common Cold – causative agent – Virus, corresponds to the first-order expression
forall x: instance-of (x, Common cold) -> exists y: instance-of (y, Virus) and causative-agent (y, x)
or the more intuitive DL expression
Common cold subClassOf causative-agent some Virus
In the Common cold example the concept description is "primitive", which means that necessary criteria are given that must be met for each instance, without being sufficient for classifying a disorder as an instance of Common Cold . In contrast, the example Viral upper respiratory tract infection depicts a fully described concept, which is represented in description logic as follows:
Viral upper respiratory tract infection equivalentTo
Upper respiratory infection and Viral respiratory infection and
Causative-agent some Virus and
Finding-site some Upper respiratory tract structure and
Pathological-process some Infectious process
This means that each and every individual disorder for which all definitional criteria are met can be classified as an instance of Viral upper respiratory tract infection.
Description logics
As of 2021, SNOMED CT content limits itself to a subset of the EL++ formalism, restricting itself to the following operators:
Top, bottom
Primitive roles and concepts with asserted parent(s) for each
Concept definition and conjunction but NOT disjunction or negation
Role hierarchy but not role composition
Domain and range constraints
Existential but not universal restriction
A restricted form of role inclusion axiom (xRy ^ ySz => xRz)
General Concept Inclusion axioms (A ⊆ B).
For understanding the modelling, it is also important to look at the stated view of a concept versus the inferred view of the concept. In further considering the state view, SNOMED CT used in the past a modelling approach referred to as 'proximal parent' approach. After 2015, a superior approach called "proximal primitive parent" has been adopted.
Precoordination and postcoordination
SNOMED CT provides a compositional syntax that can be used to create expressions that represent clinical ideas which are not explicitly represented by SNOMED CT concepts. This mechanism exists because it is challenging to create and maintain all possible concepts upfront (as precoordinated concepts).
For example, there is no explicit concept for a "third degree burn of left index finger caused by hot water". However, using the compositional syntax it can be represented as
284196006 | burn of skin | :
116676008 | associated morphology | = 80247002 | third degree burn injury |
, 272741003 | laterality | = 7771000 | left |
, 246075003 | causative agent | = 47448006 | hot water |
, 363698007 | finding site | = 83738005 | index finger structure
Such expressions are said to have been 'postcoordinated'. Post-coordination avoids the need to create large numbers of defined Concepts within SNOMED CT. However, many systems only allow for precoordinated representations. Reliable analysis and comparison of post-coordinated expressions is possible using appropriate algorithms machinery to efficiently process the expression taking account of the underlying description logic.
Major Electronic Health Record Systems (EHRS) have repeatedly complained to IHTSDO and other standards organizations about the "complexity" of post-coordinated expressions.
For example, the postcoordinated expression above can be transformed using a set of standard rules to the following "normal form expression" which enables comparison with similar concepts.
64572001 | disease | :
246075003 | causative agent | = 47448006 | hot water |
, 363698007 | finding site | = ( 83738005 | index finger structure | :
272741003 | laterality | = 7771000 | left | )
, { 116676008 | associated morphology | = 80247002 | third degree burn injury |
, 363698007 | finding site | = 39937001 | skin structure | }
Postcoordination is an important desirable feature of a terminology. Prior 2020, International Classification of Diseases (ICD) did not allow post-coordination and SNOMED CT was the only terminology that supported postcoordination. Since 2020, a new version of ICD-11 now also supports postcoordination.
Veterinary content
The International Edition of SNOMED CT only includes human terms. In 2014, clearly veterinary concepts were moved into a SNOMED CT veterinary extension. This extension is managed by the Veterinary Terminology Services Lab at the Va-Md College of Veterinary Medicine at Virginia Tech.
Known deficiencies and mitigation strategies
Earlier SNOMED versions had faceted structure ordered by semantic axes, requiring that more complex situations required to be coded by a coordination of different codes. This had two major shortcomings. On the one hand, the necessity of post-coordination was perceived as a user-unfriendly obstacle, which has certainly contributed to the rather low adoption of early SNOMED versions. On the other hand, uniform coding was difficult to obtain. E.g.,Acute appendicitis could be post-coordinated in three different ways with no means to compute semantic equivalences.
SNOMED RT had addressed this problem by introducing description logic formula. With the addition of CTV3 a large number of concepts were redefined using formal expressions. However, the fusion with CTV3, as a historically grown terminology with many close-to user descriptions, introduced some problems which still affect SNOMED CT. In addition to a confusing taxonomic web of many hierarchical levels with massive multiple inheritance (e.g. there are 36 taxonomic ancestors for Acute appendicitis), many ambiguous, context-dependent concepts have found their way into SNOMED CT. Pre-coordination was sometimes pushed to extremes, so there are, for example, 350 different concepts for burns found on the head.
A further phenomenon which characterizes parts of SNOMED CT is the so-called epistemic intrusion.
In principle, the task of terminology (and even an ontology) should be limited to providing context-free term or class meanings. The contextualization of these representational units should be ideally the task of an information model.
Human language is misleading here, as we use syntactically similar expression to represent categorically distinct entities, e.g. Ectopic pregnancy vs. Suspected pregnancy. The first one refers to a real pregnancy, the second one to a piece of (uncertain) information. In SNOMED CT most (but not all) of these context-dependent concepts are concentrated in the subhierachy Situation with explicit context. A major reason for why such concepts cannot be dispensed with is that SNOMED CT takes on, in many cases, the functionality of information models, as the latter do not exist in a given implementation.
With the establishment of IHTSDO, SNOMED CT became more accessible to a wider audience. Criticism of the state of the terminology was sparked by numerous substantive weaknesses as well as on the lack of quality assurance measures. From the beginning IHTSDO was open regarding such (also academic) criticism. In the last few years considerable progress has been made regarding quality assurance and tooling.
The need for a more principled ontological foundation was gradually accepted, as well as a better understanding of description logic semantics. Redesign priorities were formulated regarding observables, disorders, findings, substances, organisms etc. Translation guidelines were elaborated as well as guidelines for content submission requests and a strategy for the inclusion of pre-coordinated content. There are still known deficiencies regarding the "ontological commitment" of SNOMED CT, e.g., the clarification of which kind of entity is an instance of a given SNOMED CT concept. The same term can be interpreted as a disorder or a patient with a disorder, for example Tumour might denote a process or a piece of tissue; Allergy may denote an allergic reaction or just an allergic disposition. A more recent strategy is the use of rigorously typed upper-level ontologies to disambiguate SNOMED CT content.
The increased take-up of SNOMED CT for research into applications in daily use across the world to support patient care is leading to a larger engaged community. This has led to an increase in the resource allocated to authoring SNOMED CT terms as well as to an increase in collaboration to take SNOMED CT into a robust industry used standard. This is leading to an increase in the number of software tools and development of materials that contribute to knowledge base to support implementation. A number of on-line communities that focus on particular aspects of SNOMED CT and its implementation are also developing.
In theory, description logic reasoning can be applied to any new candidate post-coordinated expressions in order to assess whether it is a parent or ancestor of, a child or other descendant of, or semantically equivalent to any existing concept from the existing pre-coordinated concepts. However, partly as the continuing fall-out from the merger with CTV3, SNOMED still contains undiscovered semantically duplicate primitive and defined concepts. Additionally, many concepts remain primitive whilst their semantics can also be legitimately defined in terms of other primitives and roles concurrently in the system. Because of these omissions and actual or possible redundancies of semantic content, real-world performance of algorithms to infer subsumption or semantic equivalence will be unpredictably imperfect.
SNOMED CT validation
Using consistent rules is important for the quality of SNOMED CT. To that end, in 2009, a prototype Machine Readable Concept Model (MRCM) was created by the SNOMED CT team. In a follow-up work, this model is being revised to utilize SNOMED CT expression constraints.
SNOMED CT and other terminologies
SNOMED CT and ICD
SNOMED CT is a clinical terminology designed to capture and represent patient data for clinical purposes. The International Statistical Classification of Diseases and Related Health Problems (ICD) is an internationally used medical classification system; which is used to assign diagnostic and, in some national modifications, procedural codes in order to produce coded data for statistical analysis, epidemiology, reimbursement and resource allocation. Both systems use standardized definitions and form a common medical language used within electronic health record (EHR) systems. SNOMED CT enables information input into an EHR system during the course of patient care, while ICD facilitates information retrieval, or output, for secondary data purposes. In 2010s, the advantage of SNOMED CT over ICD was the multiple parent hierarchy of SNOMED CT. Since 2020 release of ICD 11, this advantage is less important because ICD-11 foundational level allows an ICD 11 concept to have multiple parents.
SNOMED CT and LOINC
LOINC is a terminology that contains laboratory tests. Since 2017, SNOMED International started creating terms for LOINC components and created a set of SNOMED CT expressions that capture the meaning of many LOINC terms.
SNOMED CT and MedDRA
There is overlap between MedDRA and SNOMED CT that is not beneficial for pharmaceutical industry. In 2021, two maps map between SNOMED CT and MedDRA were jointly published by both organizations (from SNOMED CT to MedDRA and from MedDRA to SNOMED CT).
Use
SNOMED CT is used in a number of different ways, some of which are:
It captures clinical information at the level of detail needed for the provision of healthcare
Through sharing data it can reduce the need to repeat health history at each new encounter with a healthcare professional
Information can be recorded by different people in different locations and combined into simple information views within the patient record
Use of a common terminology decreases the potential for differing interpretation of information
Structured Data Capture medical forms and questionnaires based on the FHIR standard
Electronic recording in a common way reduces errors and can help to ensure completeness in recording all relevant data
Standardised information makes analysis easier, supporting quality, cost effective practice, research and future clinical guideline development
A clinical terminology allows a health care provider to identify patients based on specified coded information, and more effectively manage screening, treatment and follow up
Use cases
More specifically, the following sample computer applications use SNOMED CT:
Electronic Health Record Systems
Computerized Provider Order Entry CPOE such as E-Prescribing or Laboratory Order Entry
Catalogues of clinical services; e.g., for Diagnostic Imaging procedures
Knowledge databases used in clinical decision support systems (CDSS)
Remote Intensive Care Unit Monitoring
Laboratory Reporting
Emergency Room Charting
Cancer Reporting
Genetic Databases
Access
SNOMED CT is maintained and distributed by SNOMED International, an international non-profit standards development organization, located in London, UK.
The use of SNOMED CT in production systems requires a license. There are two types of license:
Country/territory membership in SNOMED International (charged according to gross national product).
Affiliate license (dependent on the number of end users). LDCs (least developed countries) can use SNOMED CT without charges.
For scientific research in medical informatics, for demonstrations or evaluation purposes SNOMED CT sources can be freely downloaded and used. The original SNOMED CT sources in tabular form are accessible by registered users of the Unified Medical Language System (UMLS) who have signed an agreement. Numerous online and offline browsers are available.
Those wishing to obtain a license for its use and to download SNOMED CT should contact their National Release Centre, links to which are provided on the IHTSDO website.
License free subsets
To facilitate adoption of SNOMED CT and use of SNOMED CT in other standards, there are license free subsets. For example, a set of 7 314 codes and descriptions is free for use by users of DICOM-compliant software (without restriction to IHTSDO member countries).
Global Patient Set (GPS) subset
GPS was released in Sep 2019 and contains 21 782 concepts.
Top level concepts
SNOMED CT concepts typically belong to a single hierarchy (with the exception of drug-device combined concepts). Some hierarchies, have a concept model defined (e.g., clinical findings). For other domains (e.g., Organism, Substance, Qualifier value), there is no concept model yet defined.
Procedure
Concept in this hierarchy represent procedures performed on a patient. There is a well established defined concept model for procedures. Procedure site (direct or indirect) specifies on what part of body the procedure is performed. A separate set of rules exist for evaluation procedures. Evaluation procedures are procedures where evidence is evaluated to support the determination of a value, inference or conclusion. Evaluation procedures have additional attributes, such as 'Has specimen','Property' or 'Measurement method'.
Event
As of 2016, the Event hierarchy does not have a concept model defined. In 2006, some concepts from the 'Clinical Finding' hierarchy were moved to the Event hierarchy. Those concepts retained some of their attributes. (e.g., causative agent)
Observable entities
SNOMED International is working on creating a concept model for observable entities.
Body Structure
Body parts represent one of the largest hierarchies within SNOMED CT. The modeling is based on Foundational Model of Anatomy but it differs from the model in some aspects (e.g., region is taken as 3D region and not a 2D region). Important attributes include: 'Laterality', several types of 'Part of' relationships, and 'Is a'.
Pharmaceutical / biologic product
Pharmaceutical and biologic products are modeled using constructs of active ingredient, presentation strength, and basis of strength. Since 2018, harmonization of SNOMED CT drug content with IDMP standard is an editorial goal. The following types of entities are present:
Medicinal product
A higher level term grouping drugs. For example, 398731002 | Product containing sulfamethoxazole and
trimethoprim (medicinal product) |
Clinical Drug
Concept that represents a concrete drug product as used in clinical practice. For example, 317335000 | Product containing precisely esomeprazole 20milligram/1 each conventional release oral tablet (clinical drug)|
Dose Form
Concept representing how the product is delivered. For example, 385219001 | Conventional release solution for injection (dose form) |.
Authoring conventions
A goal for SNOMED CT is consistency. Several mechanisms are employed to ensure this. Machine readable concept model is used to check for compliance with a set of rules. Rules for creating fully specified name for a concept define allowed and not allowed patterns. When defining a concept, a proximal primitive parent rule is used (in stated definition) to employ best description logic derived classification of concepts.
Separate conventions govern grouping of relationships. Ability to group related relationships is an important strength of SNOMED CT. Rules in Machine Readable Concept Model (MRCM) specify by domain which relationships are never grouped (e.g., 'Is a' or 'Laterality' attributes) and which relationships are always grouped (e.g., 'Finding site'). For correct subsumption inference, some relationships may be in a group but consist of a single relationship.
Another convention for SNOMED CT international edition is to avoid creating intermediate primitive concepts (unless medically necessary and impossible to define with existing concept model). An intermediate primitive (=not defined) concept is a non-defined concept that has children concepts and parent concepts. This convention is related to the use of description logic to facilitate terminology maintenance. Because primitive concepts can not be processed by the description logic classifier, the maintenance of such concepts relies solely on human editors. Adding new intermediate primitive concepts requires changes to all affected concepts and is demanding in terms of terminology maintenance.
See also
CDISC
Clinical Care Classification System
DOCLE
EN 13606
MEDCIN
MedDRA
Omaha System
ICD11
Foundational Model of Anatomy
References
External links
SNOMED International website
SNOMED International's online browsers for SNOMED CT
US National Library of Medicine SNOMED CT resources
NHS Digital SNOMED CT resources
Veterinary Extension of SNOMED CT
Medical classification
Diagnosis codes
Nursing classification
Standards for electronic health records
Anatomical terminology | 0.766884 | 0.989713 | 0.758995 |
Schizophreniform disorder | Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time (at least a month), but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.
The symptoms of both disorders can include delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and social withdrawal. While impairment in social, occupational, or academic functioning is required for the diagnosis of schizophrenia, in schizophreniform disorder an individual's level of functioning may or may not be affected. While the onset of schizophrenia is often gradual over a number of months or years, the onset of schizophreniform disorder can be relatively rapid.
Like schizophrenia, schizophreniform disorder is often treated with antipsychotic medications, especially the atypicals, along with a variety of social supports (such as individual psychotherapy, family therapy, occupational therapy, etc.) designed to reduce the social and emotional impact of the illness. The prognosis varies depending upon the nature, severity, and duration of the symptoms, but about two-thirds of individuals diagnosed with schizophreniform disorder go on to develop schizophrenia.
Signs and symptoms
Schizophreniform disorder is a type of mental illness that is characterized by psychosis and closely related to schizophrenia. Both schizophrenia and schizophreniform disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), have the same symptoms and essential features except for two differences: the level of functional impairment and the duration of symptoms. Impairment in social, occupational, or academic functioning is usually present in schizophrenia, particularly near the time of first diagnosis, but such impairment may or may not be present in schizophreniform disorder. In schizophreniform disorder, the symptoms (including prodromal, active, and residual phases) must last at least one month but not more than six months, while in schizophrenia the symptoms must be present for a minimum of six months.
Cause
The exact cause of the disorder remains unknown, and relatively few studies have focused exclusively on the etiology of schizophreniform disorder. Like other psychotic disorders, a diathesis–stress model has been proposed, suggesting that some individuals have an underlying multifactorial genetic vulnerability to the disorder that can be triggered by certain environmental factors. Schizophreniform disorder is more likely to occur in people with family members who have schizophrenia or bipolar disorder.
Diagnosis
If the symptoms have persisted for at least one month, a provisional diagnosis of schizophreniform disorder can be made while waiting to see if recovery occurs. If the symptoms resolve within six months of onset, the provisional qualifier is removed from the diagnosis. However, if the symptoms persist for six months or more, the diagnosis of schizophreniform disorder must be revised. The diagnosis of brief psychotic disorder may be considered when the duration of symptoms is less than one month.
The main symptoms of both schizophreniform disorder and schizophrenia may include:
delusions,
hallucinations,
disorganized speech resulting from formal thought disorder,
disorganized or catatonic behavior, and negative symptoms, such as
an inability to feel a range of emotions (flat affect),
an inability to experience pleasure (anhedonia),
impaired or decreased speech (aphasia),
a lack of desire to form relationships (asociality), and
a lack of motivation (avolition).
Treatment
Various modalities of treatment, including pharmacotherapy, psychotherapy, and various other psychosocial and educational interventions, are used in the treatment of schizophreniform disorder. Pharmacotherapy is the most commonly used treatment modality as psychiatric medications can act quickly to both reduce the severity of symptoms and shorten their duration. The medications used are largely the same as those used to treat schizophrenia, with an atypical antipsychotic as the usual drug of choice. Patients who do not respond to the initial atypical antipsychotic may benefit from being switched to another atypical antipsychotic, the addition of a mood stabilizer such as lithium or an anticonvulsant, or being switched to a typical antipsychotic.
Treatment of schizophreniform disorder can occur in inpatient, outpatient, and partial hospitalization settings. In selecting the treatment setting, the primary aims are to minimize the psychosocial consequences for the patient and maintain the safety of the patient and others. While the need to quickly stabilize the patient's symptoms almost always exists, consideration of the patient's severity of symptoms, family support, and perceived likelihood of compliance with outpatient treatment can help determine if stabilization can occur in the outpatient setting. Patients who receive inpatient treatment may benefit from a structured intermediate environment, such as a sub-acute unit, step-down unit, partial hospital, or day hospital, during the initial phases of returning to the community.
As improvement progresses during treatment, help with coping skills, problem-solving techniques, psychoeducational approaches, and eventually occupational therapy and vocational assessments are often very helpful for patients and their families. Virtually all types of individual psychotherapy are used in the treatment of schizophreniform disorder, except for insight-oriented therapies as patients often have limited insight as a symptom of their illness.
Since schizophreniform disorder has such rapid onset of severe symptoms, patients are sometimes in denial about their illness, which also would limit the efficacy of insight-oriented therapies. Supportive forms of psychotherapy such as interpersonal psychotherapy, supportive psychotherapy, and cognitive behavioral therapy are particularly well suited for the treatment of the disorder. Group psychotherapy is usually not indicated for patients with schizophreniform disorder because they may be distressed by the symptoms of patients with more advanced psychotic disorders.
Prognosis
The following specifiers for schizophreniform disorder may be used to indicate the presence or absence of features that may be associated with a better prognosis:
With good prognostic features, used if at least two of the following features are present:
Onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning
Confusion or perplexity at the height of the psychotic episode
Good premorbid social and occupational functioning
Absence of blunted or flat affect
Without good prognostic features, used if two or more of the above features have not been present.
The presence of negative symptoms and poor eye contact both appear to be prognostic of a poor outcome. Many of the anatomic and functional changes seen in the brains of patients with schizophrenia also occur in patients with schizophreniform disorder. However, at present there is no consensus among scientists regarding whether or not ventricular enlargement, which is a poor prognostic factor in schizophrenia, has any prognostic value in patients with schizophreniform disorder. According to the American Psychiatric Association, approximately two-thirds of patients diagnosed with "provisional" schizophreniform disorder are subsequently diagnosed with schizophrenia; the remaining keep a diagnosis of schizophreniform disorder.
Epidemiology
Schizophreniform disorder is equally prevalent among men and women. The most common ages of onset are 18–24 for men and 18–35 for women. While the symptoms of schizophrenia often develop gradually over a period of years, the diagnostic criteria for schizophreniform disorder require a much more rapid onset.
Available evidence suggests variations in incidence across sociocultural settings. In the United States and other developed countries, the incidence is low, possibly fivefold less than that of schizophrenia. In developing countries, the incidence is substantially higher, especially for the subtype with good prognostic features. In some of these settings schizophreniform disorder may be as common as schizophrenia.
References
External links
Schizophrenia | 0.763451 | 0.994126 | 0.758966 |
Interpersonal psychotherapy | Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice for depression.
History
Originally named "high contact" therapy, IPT was first developed in 1969 at Yale University as part of a study designed by Gerald Klerman, Myrna Weissman and colleagues to test the efficacy of an antidepressant with and without psychotherapy as maintenance treatment of depression. IPT has been studied in many research protocols since its development. NIMH-TDCRP demonstrated the efficacy of IPT as a maintenance treatment and delineated some contributing factors.
Foundations
IPT was influenced by CBT as well as psychodynamic approaches. It takes its structure from CBT in that it is time-limited, employs structured interviews and assessment tools. In general, however, IPT focuses directly on affects, or feelings, whereas CBT focuses on cognitions with strong associated affects. Unlike CBT, IPT makes no attempt to uncover distorted thoughts systematically by giving homework or other assignments, nor does it help the patient develop alternative thought patterns through prescribed practice. Rather, as evidence arises during the course of therapy, the therapist calls attention to distorted thinking in relation to significant others. The goal is to change the relationship pattern rather than associated depressive cognitions, which are acknowledged as depressive symptoms.
The content of IPT's therapy was inspired by Attachment theory and Harry Stack Sullivan's Interpersonal psychoanalysis. Social theory is also influenced in a lesser role to emphasis on qualitative impact of social support networks for recovery. Unlike psychodynamic approaches, IPT does not include a personality theory or attempt to conceptualize or treat personality but focuses on humanistic applications of interpersonal sensitivity.
Attachment Theory, forms the basis for understanding patients' relationship difficulties, attachment schema and optimal functioning when attachment needs are met.
Interpersonal Theory, describes the ways in which patients' maladaptive metacommunication patterns (Low to high Affiliation & Inclusion and dominant to submissive Status) lead to or evoke difficulty in their here-and-now interpersonal relationships.
The aim of IPT is to help the patient to improve interpersonal and intrapersonal communication skills within relationships and to develop social support network with realistic expectations to deal with the crises precipitated in distress and to weather 'interpersonal storms'.
Clinical applications
It has been demonstrated to be an effective treatment for depression and has been modified to treat other psychiatric disorders such as substance use disorders and eating disorders. It is incumbent upon the therapist in the treatment to quickly establish a therapeutic alliance with positive countertransference of warmth, empathy, affective attunement and positive regard for encouraging a positive transferential relationship, from which the patient is able to seek help from the therapist despite resistance. It is primarily used as a short-term therapy completed in 12–16 weeks, but it has also been used as a maintenance therapy for patients with recurrent depression. A shorter, 6-week therapy suited to primary care settings called Interpersonal counselling (IPC) has been derived from IPT.
Interpersonal psychotherapy has been found to be an effective treatment for the following:
Bipolar disorder
Bulimia nervosa
Major depressive disorder
Post-partum depression
Adolescents
Although originally developed as an individual therapy for adults, IPT has been modified for use with adolescents and older adults.
IPT for children is based on the premise that depression occurs in the context of an individual's relationships regardless of its origins in biology or genetics. More specifically, depression affects people's relationships and these relationships further affect our mood. The IPT model identifies four general areas in which a person may be having relationship difficulties:
grief after the loss of a loved one;
conflict in significant relationships, including a client's relationship with his or her own self;
difficulties adapting to changes in relationships or life circumstances; and
difficulties stemming from social isolation.
The IPT therapist helps identify areas in need of skill-building to improve the client's relationships and decrease the depressive symptoms. Over time, the client learns to link changes in mood to events occurring in his/her relationships, communicate feelings and expectations for the relationships, and problem-solve solutions to difficulties in the relationships.
IPT has been adapted for the treatment of depressed adolescents (IPT-A) to address developmental issues most common to teenagers such as separation from parents, development of romantic relationships, and initial experience with death of a relative or friend. IPT-A helps the adolescent identify and develop more adaptive methods for dealing with the interpersonal issues associated with the onset or maintenance of their depression. IPT-A is typically a 12- to 16-week treatment. Although the treatment involves primarily individual sessions with the teenager, parents are asked to participate in a few sessions to receive education about depression, to address any relationship difficulties that may be occurring between the adolescent and his/her parents, and to help support the adolescent's treatment.
Elderly
IPT has been used as a psychotherapy for depressed elderly, with its emphasis on addressing interpersonally relevant problems. IPT appears especially well suited to the life changes that many people experience in their later years.
References
Sources
Psychotherapy by type | 0.766004 | 0.990798 | 0.758955 |
Mental health nurse | A mental health nurse (MHN) refers to a nurse in the UK, who specializes in the care of patients with mental health issues. The practice of MHNs is called mental health nursing.
Background
MHNs comprise approximately 12% of the total NHS Nursing workforce. In order to qualify as a MHN in the UK, a Nursing & Midwifery Council (NMC) accredited nursing degree or diploma is required. Registration must be renewed every three years, for which 450 hours of registered practice and 35 hours of study must have been completed in the past three years. The total number of registered mental health nurses in the UK was 48,130 in 2010, however, since then there has been a slight decrease, as some nurses have transferred over to voluntary and independent providers. MHNs typically work within community or hospital settings, as part of Crisis Assessment and Treatment, inpatient environments and/or community mental health teams.
Roles
MHNs act to bridge the gap between mental health services and general practice for patients with acute to chronic mental illnesses. The role of an MHN has gradually transitioned over the years, to encompass a greater level of involvement in patient care e.g. nurses now have authority to prescribe medication. The main responsibilities of a MHN can be subdivided into six broad categories with a certain degree of overlap:
Case management: This consists of tailoring care to the specific needs of an individual. It involves providing interventions in the form of psychotherapy or familial support; arranging other services when required; establishing networks with community agencies; overseeing changes in medication; community integration and actively seeking out people who drop out of services.
Psychosocial interventions: A holistic approach to patient care is required, by which the MHN should build rapport with patients to encourage trust, while listening to and interpreting their needs and concerns. If a patient is having social/financial problems, the MHN may offer advice and interventions e.g. by arranging social events in the community, in order to develop patients' socials skills and combat feelings of isolation. They may also work with patients' families and carers, helping to educate them about the burden of mental illness.
Physical health: Individuals with long-term mental illness may have substantial cardiometabolic/ respiratory illnesses. Furthermore, this population is at considerable risk of contracting infections, such as HIV and AIDS. The MHN will prepare and maintain comprehensive patient records, whilst also producing care plans and risk assessments. They must also monitor weight, blood pressure and provide health education and interventions in areas such as diet, smoking and sexual behaviour.
Medication management: MHN must ensure correct administration of medication, including injections, and monitoring the results of treatment.
Working with dual diagnosis patients, and promoting a 'recovery' based approach to care.
Behavioural therapy: Providing evidence- based individual therapy e.g. cognitive behavioural therapy for depression and anxiety. Empathising with distressed patients and applying de-escalation techniques to help patients manage their emotions and behaviour better. Encourage patients to take part in therapeutic hobbies such as art or drama.
See also
Community psychiatric nurse
Psychiatric-mental health nurse practitioner
Registered psychiatric nurse
References
Mental health occupations
Psychiatric nursing | 0.787729 | 0.963465 | 0.758949 |
Structural equation modeling | Structural equation modeling (SEM) is a diverse set of methods used by scientists doing both observational and experimental research. SEM is used mostly in the social and behavioral sciences but it is also used in epidemiology, business, and other fields. A definition of SEM is difficult without reference to technical language, but a good starting place is the name itself.
SEM involves a model representing how various aspects of some phenomenon are thought to causally connect to one another. Structural equation models often contain postulated causal connections among some latent variables (variables thought to exist but which can't be directly observed). Additional causal connections link those latent variables to observed variables whose values appear in a data set. The causal connections are represented using equations but the postulated structuring can also be presented using diagrams containing arrows as in Figures 1 and 2. The causal structures imply that specific patterns should appear among the values of the observed variables. This makes it possible to use the connections between the observed variables' values to estimate the magnitudes of the postulated effects, and to test whether or not the observed data are consistent with the requirements of the hypothesized causal structures.
The boundary between what is and is not a structural equation model is not always clear but SE models often contain postulated causal connections among a set of latent variables (variables thought to exist but which can't be directly observed, like an attitude, intelligence or mental illness) and causal connections linking the postulated latent variables to variables that can be observed and whose values are available in some data set. Variations among the styles of latent causal connections, variations among the observed variables measuring the latent variables, and variations in the statistical estimation strategies result in the SEM toolkit including confirmatory factor analysis, confirmatory composite analysis, path analysis, multi-group modeling, longitudinal modeling, partial least squares path modeling, latent growth modeling and hierarchical or multilevel modeling.
SEM researchers use computer programs to estimate the strength and sign of the coefficients corresponding to the modeled structural connections, for example the numbers connected to the arrows in Figure 1. Because a postulated model such as Figure 1 may not correspond to the worldly forces controlling the observed data measurements, the programs also provide model tests and diagnostic clues suggesting which indicators, or which model components, might introduce inconsistency between the model and observed data. Criticisms of SEM methods hint at: disregard of available model tests, problems in the model's specification, a tendency to accept models without considering external validity, and potential philosophical biases.
A great advantage of SEM is that all of these measurements and tests occur simultaneously in one statistical estimation procedure, where all the model coefficients are calculated using all information from the observed variables. This means the estimates are more accurate than if a researcher were to calculate each part of the model separately.
History
Structural equation modeling (SEM) began differentiating itself from correlation and regression when Sewall Wright provided explicit causal interpretations for a set of regression-style equations based on a solid understanding of the physical and physiological mechanisms producing direct and indirect effects among his observed variables. The equations were estimated like ordinary regression equations but the substantive context for the measured variables permitted clear causal, not merely predictive, understandings. O. D. Duncan introduced SEM to the social sciences in his 1975 book and SEM blossomed in the late 1970's and 1980's when increasing computing power permitted practical model estimation. In 1987 Hayduk provided the first book-length introduction to structural equation modeling with latent variables, and this was soon followed by Bollen's popular text (1989).
Different yet mathematically related modeling approaches developed in psychology, sociology, and economics. Early Cowles Commission work on simultaneous equations estimation centered on Koopman and Hood's (1953) algorithms from transport economics and optimal routing, with maximum likelihood estimation, and closed form algebraic calculations, as iterative solution search techniques were limited in the days before computers. The convergence of two of these developmental streams (factor analysis from psychology, and path analysis from sociology via Duncan) produced the current core of SEM. One of several programs Karl Jöreskog developed at Educational Testing Services, LISREL embedded latent variables (which psychologists knew as the latent factors from factor analysis) within path-analysis-style equations (which sociologists inherited from Wright and Duncan). The factor-structured portion of the model incorporated measurement errors which permitted measurement-error-adjustment, though not necessarily error-free estimation, of effects connecting different postulated latent variables.
Traces of the historical convergence of the factor analytic and path analytic traditions persist as the distinction between the measurement and structural portions of models; and as continuing disagreements over model testing, and whether measurement should precede or accompany structural estimates. Viewing factor analysis as a data-reduction technique deemphasizes testing, which contrasts with path analytic appreciation for testing postulated causal connections – where the test result might signal model misspecification. The friction between factor analytic and path analytic traditions continue to surface in the literature.
Wright's path analysis influenced Hermann Wold, Wold's student Karl Jöreskog, and Jöreskog's student Claes Fornell, but SEM never gained a large following among U.S. econometricians, possibly due to fundamental differences in modeling objectives and typical data structures. The prolonged separation of SEM's economic branch led to procedural and terminological differences, though deep mathematical and statistical connections remain. The economic version of SEM can be seen in SEMNET discussions of endogeneity, and in the heat produced as Judea Pearl's approach to causality via directed acyclic graphs (DAG's) rubs against economic approaches to modeling. Discussions comparing and contrasting various SEM approaches are available but disciplinary differences in data structures and the concerns motivating economic models make reunion unlikely. Pearl extended SEM from linear to nonparametric models, and proposed causal and counterfactual interpretations of the equations. Nonparametric SEMs permit estimating total, direct and indirect effects without making any commitment to linearity of effects or assumptions about the distributions of the error terms.
SEM analyses are popular in the social sciences because computer programs make it possible to estimate complicated causal structures, but the complexity of the models introduces substantial variability in the quality of the results. Some, but not all, results are obtained without the "inconvenience" of understanding experimental design, statistical control, the consequences of sample size, and other features contributing to good research design.
General steps and considerations
The following considerations apply to the construction and assessment of many structural equation models.
Model specification
Building or specifying a model requires attending to:
the set of variables to be employed,
what is known about the variables,
what is presumed or hypothesized about the variables' causal connections and disconnections,
what the researcher seeks to learn from the modeling,
and the cases for which values of the variables will be available (kids? workers? companies? countries? cells? accidents? cults?).
Structural equation models attempt to mirror the worldly forces operative for causally homogeneous cases – namely cases enmeshed in the same worldly causal structures but whose values on the causes differ and who therefore possess different values on the outcome variables. Causal homogeneity can be facilitated by case selection, or by segregating cases in a multi-group model. A model's specification is not complete until the researcher specifies:
which effects and/or correlations/covariances are to be included and estimated,
which effects and other coefficients are forbidden or presumed unnecessary,
and which coefficients will be given fixed/unchanging values (e.g. to provide measurement scales for latent variables as in Figure 2).
The latent level of a model is composed of endogenous and exogenous variables. The endogenous latent variables are the true-score variables postulated as receiving effects from at least one other modeled variable. Each endogenous variable is modeled as the dependent variable in a regression-style equation. The exogenous latent variables are background variables postulated as causing one or more of the endogenous variables and are modeled like the predictor variables in regression-style equations. Causal connections among the exogenous variables are not explicitly modeled but are usually acknowledged by modeling the exogenous variables as freely correlating with one another. The model may include intervening variables – variables receiving effects from some variables but also sending effects to other variables. As in regression, each endogenous variable is assigned a residual or error variable encapsulating the effects of unavailable and usually unknown causes. Each latent variable, whether exogenous or endogenous, is thought of as containing the cases' true-scores on that variable, and these true-scores causally contribute valid/genuine variations into one or more of the observed/reported indicator variables.
The LISREL program assigned Greek names to the elements in a set of matrices to keep track of the various model components. These names became relatively standard notation, though the notation has been extended and altered to accommodate a variety of statistical considerations. Texts and programs "simplifying" model specification via diagrams or by using equations permitting user-selected variable names, re-convert the user's model into some standard matrix-algebra form in the background. The "simplifications" are achieved by implicitly introducing default program "assumptions" about model features with which users supposedly need not concern themselves. Unfortunately, these default assumptions easily obscure model components that leave unrecognized issues lurking within the model's structure, and underlying matrices.
Two main components of models are distinguished in SEM: the structural model showing potential causal dependencies between endogenous and exogenous latent variables, and the measurement model showing the causal connections between the latent variables and the indicators. Exploratory and confirmatory factor analysis models, for example, focus on the causal measurement connections, while path models more closely correspond to SEMs latent structural connections.
Modelers specify each coefficient in a model as being free to be estimated, or fixed at some value. The free coefficients may be postulated effects the researcher wishes to test, background correlations among the exogenous variables, or the variances of the residual or error variables providing additional variations in the endogenous latent variables. The fixed coefficients may be values like the 1.0 values in Figure 2 that provide a scales for the latent variables, or values of 0.0 which assert causal disconnections such as the assertion of no-direct-effects (no arrows) pointing from Academic Achievement to any of the four scales in Figure 1. SEM programs provide estimates and tests of the free coefficients, while the fixed coefficients contribute importantly to testing the overall model structure. Various kinds of constraints between coefficients can also be used. The model specification depends on what is known from the literature, the researcher's experience with the modeled indicator variables, and the features being investigated by using the specific model structure.
There is a limit to how many coefficients can be estimated in a model. If there are fewer data points than the number of estimated coefficients, the resulting model is said to be "unidentified" and no coefficient estimates can be obtained. Reciprocal effect, and other causal loops, may also interfere with estimation.
Estimation of free model coefficients
Model coefficients fixed at zero, 1.0, or other values, do not require estimation because they already have specified values. Estimated values for free model coefficients are obtained by maximizing fit to, or minimizing difference from, the data relative to what the data's features would be if the free model coefficients took on the estimated values. The model's implications for what the data should look like for a specific set of coefficient values depends on:
a) the coefficients' locations in the model (e.g. which variables are connected/disconnected),
b) the nature of the connections between the variables (covariances or effects; with effects often assumed to be linear),
c) the nature of the error or residual variables (often assumed to be independent of, or causally-disconnected from, many variables),
and d) the measurement scales appropriate for the variables (interval level measurement is often assumed).
A stronger effect connecting two latent variables implies the indicators of those latents should be more strongly correlated. Hence, a reasonable estimate of a latent's effect will be whatever value best matches the correlations between the indicators of the corresponding latent variables – namely the estimate-value maximizing the match with the data, or minimizing the differences from the data. With maximum likelihood estimation, the numerical values of all the free model coefficients are individually adjusted (progressively increased or decreased from initial start values) until they maximize the likelihood of observing the sample data – whether the data are the variables' covariances/correlations, or the cases' actual values on the indicator variables. Ordinary least squares estimates are the coefficient values that minimize the squared differences between the data and what the data would look like if the model was correctly specified, namely if all the model's estimated features correspond to real worldly features.
The appropriate statistical feature to maximize or minimize to obtain estimates depends on the variables' levels of measurement (estimation is generally easier with interval level measurements than with nominal or ordinal measures), and where a specific variable appears in the model (e.g. endogenous dichotomous variables create more estimation difficulties than exogenous dichotomous variables). Most SEM programs provide several options for what is to be maximized or minimized to obtain estimates the model's coefficients. The choices often include maximum likelihood estimation (MLE), full information maximum likelihood (FIML), ordinary least squares (OLS), weighted least squares (WLS), diagonally weighted least squares (DWLS), and two stage least squares.
One common problem is that a coefficient's estimated value may be underidentified because it is insufficiently constrained by the model and data. No unique best-estimate exists unless the model and data together sufficiently constrain or restrict a coefficient's value. For example, the magnitude of a single data correlation between two variables is insufficient to provide estimates of a reciprocal pair of modeled effects between those variables. The correlation might be accounted for by one of the reciprocal effects being stronger than the other effect, or the other effect being stronger than the one, or by effects of equal magnitude. Underidentified effect estimates can be rendered identified by introducing additional model and/or data constraints. For example, reciprocal effects can be rendered identified by constraining one effect estimate to be double, triple, or equivalent to, the other effect estimate, but the resultant estimates will only be trustworthy if the additional model constraint corresponds to the world's structure. Data on a third variable that directly causes only one of a pair of reciprocally causally connected variables can also assist identification. Constraining a third variable to not directly cause one of the reciprocally-causal variables breaks the symmetry otherwise plaguing the reciprocal effect estimates because that third variable must be more strongly correlated with the variable it causes directly than with the variable at the "other" end of the reciprocal which it impacts only indirectly. Notice that this again presumes the properness of the model's causal specification – namely that there really is a direct effect leading from the third variable to the variable at this end of the reciprocal effects and no direct effect on the variable at the "other end" of the reciprocally connected pair of variables. Theoretical demands for null/zero effects provide helpful constraints assisting estimation, though theories often fail to clearly report which effects are allegedly nonexistent.
Model assessment
Model assessment depends on the theory, the data, the model, and the estimation strategy. Hence model assessments consider:
whether the data contain reasonable measurements of appropriate variables,
whether the modeled case are causally homogeneous, (It makes no sense to estimate one model if the data cases reflect two or more different causal networks.)
whether the model appropriately represents the theory or features of interest, (Models are unpersuasive if they omit features required by a theory, or contain coefficients inconsistent with that theory.)
whether the estimates are statistically justifiable, (Substantive assessments may be devastated: by violating assumptions, by using an inappropriate estimator, and/or by encountering non-convergence of iterative estimators.)
the substantive reasonableness of the estimates, (Negative variances, and correlations exceeding 1.0 or -1.0, are impossible. Statistically possible estimates that are inconsistent with theory may also challenge theory, and our understanding.)
the remaining consistency, or inconsistency, between the model and data. (The estimation process minimizes the differences between the model and data but important and informative differences may remain.)
Research claiming to test or "investigate" a theory requires attending to beyond-chance model-data inconsistency. Estimation adjusts the model's free coefficients to provide the best possible fit to the data. The output from SEM programs includes a matrix reporting the relationships among the observed variables that would be observed if the estimated model effects actually controlled the observed variables' values. The "fit" of a model reports match or mismatch between the model-implied relationships (often covariances) and the corresponding observed relationships among the variables. Large and significant differences between the data and the model's implications signal problems. The probability accompanying a (chi-squared) test is the probability that the data could arise by random sampling variations if the estimated model constituted the real underlying population forces. A small probability reports it would be unlikely for the current data to have arisen if the modeled structure constituted the real population causal forces – with the remaining differences attributed to random sampling variations.
If a model remains inconsistent with the data despite selecting optimal coefficient estimates, an honest research response reports and attends to this evidence (often a significant model test). Beyond-chance model-data inconsistency challenges both the coefficient estimates and the model's capacity for adjudicating the model's structure, irrespective of whether the inconsistency originates in problematic data, inappropriate statistical estimation, or incorrect model specification.
Coefficient estimates in data-inconsistent ("failing") models are interpretable, as reports of how the world would appear to someone believing a model that conflicts with the available data. The estimates in data-inconsistent models do not necessarily become "obviously wrong" by becoming statistically strange, or wrongly signed according to theory. The estimates may even closely match a theory's requirements but the remaining data inconsistency renders the match between the estimates and theory unable to provide succor. Failing models remain interpretable, but only as interpretations that conflict with available evidence.
Replication is unlikely to detect misspecified models which inappropriately-fit the data. If the replicate data is within random variations of the original data, the same incorrect coefficient placements that provided inappropriate-fit to the original data will likely also inappropriately-fit the replicate data. Replication helps detect issues such as data mistakes (made by different research groups), but is especially weak at detecting misspecifications after exploratory model modification – as when confirmatory factor analysis (CFA) is applied to a random second-half of data following exploratory factor analysis (EFA) of first-half data.
A modification index is an estimate of how much a model's fit to the data would "improve" (but not necessarily how much the model's structure would improve) if a specific currently-fixed model coefficient were freed for estimation. Researchers confronting data-inconsistent models can easily free coefficients the modification indices report as likely to produce substantial improvements in fit. This simultaneously introduces a substantial risk of moving from a causally-wrong-and-failing model to a causally-wrong-but-fitting model because improved data-fit does not provide assurance that the freed coefficients are substantively reasonable or world matching. The original model may contain causal misspecifications such as incorrectly directed effects, or incorrect assumptions about unavailable variables, and such problems cannot be corrected by adding coefficients to the current model. Consequently, such models remain misspecified despite the closer fit provided by additional coefficients. Fitting yet worldly-inconsistent models are especially likely to arise if a researcher committed to a particular model (for example a factor model having a desired number of factors) gets an initially-failing model to fit by inserting measurement error covariances "suggested" by modification indices. MacCallum (1986) demonstrated that "even under favorable conditions, models arising from specification serchers must be viewed with caution." Model misspecification may sometimes be corrected by insertion of coefficients suggested by the modification indices, but many more corrective possibilities are raised by employing a few indicators of similar-yet-importantly-different latent variables.
"Accepting" failing models as "close enough" is also not a reasonable alternative. A cautionary instance was provided by Browne, MacCallum, Kim, Anderson, and Glaser who addressed the mathematics behind why the test can have (though it does not always have) considerable power to detect model misspecification. The probability accompanying a test is the probability that the data could arise by random sampling variations if the current model, with its optimal estimates, constituted the real underlying population forces. A small probability reports it would be unlikely for the current data to have arisen if the current model structure constituted the real population causal forces – with the remaining differences attributed to random sampling variations. Browne, McCallum, Kim, Andersen, and Glaser presented a factor model they viewed as acceptable despite the model being significantly inconsistent with their data according to . The fallaciousness of their claim that close-fit should be treated as good enough was demonstrated by Hayduk, Pazkerka-Robinson, Cummings, Levers and Beres who demonstrated a fitting model for Browne, et al.'s own data by incorporating an experimental feature Browne, et al. overlooked. The fault was not in the math of the indices or in the over-sensitivity of testing. The fault was in Browne, MacCallum, and the other authors forgetting, neglecting, or overlooking, that the amount of ill fit cannot be trusted to correspond to the nature, location, or seriousness of problems in a model's specification.
Many researchers tried to justify switching to fit-indices, rather than testing their models, by claiming that increases (and hence probability decreases) with increasing sample size (N). There are two mistakes in discounting on this basis. First, for proper models, does not increase with increasing N, so if increases with N that itself is a sign that something is detectably problematic. And second, for models that are detectably misspecified, increase with N provides the good-news of increasing statistical power to detect model misspecification (namely power to detect Type II error). Some kinds of important misspecifications cannot be detected by , so any amount of ill fit beyond what might be reasonably produced by random variations warrants report and consideration. The model test, possibly adjusted, is the strongest available structural equation model test.
Numerous fit indices quantify how closely a model fits the data but all fit indices suffer from the logical difficulty that the size or amount of ill fit is not trustably coordinated with the severity or nature of the issues producing the data inconsistency. Models with different causal structures which fit the data identically well, have been called equivalent models. Such models are data-fit-equivalent though not causally equivalent, so at least one of the so-called equivalent models must be inconsistent with the world's structure. If there is a perfect 1.0 correlation between X and Y and we model this as X causes Y, there will be perfect fit and zero residual error. But the model may not match the world because Y may actually cause X, or both X and Y may be responding to a common cause Z, or the world may contain a mixture of these effects (e.g. like a common cause plus an effect of Y on X), or other causal structures. The perfect fit does not tell us the model's structure corresponds to the world's structure, and this in turn implies that getting closer to perfect fit does not necessarily correspond to getting closer to the world's structure – maybe it does, maybe it doesn't. This makes it incorrect for a researcher to claim that even perfect model fit implies the model is correctly causally specified. For even moderately complex models, precisely equivalently-fitting models are rare. Models almost-fitting the data, according to any index, unavoidably introduce additional potentially-important yet unknown model misspecifications. These models constitute a greater research impediment.
This logical weakness renders all fit indices "unhelpful" whenever a structural equation model is significantly inconsistent with the data, but several forces continue to propagate fit-index use. For example, Dag Sorbom reported that when someone asked Karl Joreskog, the developer of the first structural equation modeling program, "Why have you then added GFI?" to your LISREL program, Joreskog replied "Well, users threaten us saying they would stop using LISREL if it always produces such large chi-squares. So we had to invent something to make people happy. GFI serves that purpose." The evidence of model-data inconsistency was too statistically solid to be dislodged or discarded, but people could at least be provided a way to distract from the "disturbing" evidence. Career-profits can still be accrued by developing additional indices, reporting investigations of index behavior, and publishing models intentionally burying evidence of model-data inconsistency under an MDI (a mound of distracting indices). There seems no general justification for why a researcher should "accept" a causally wrong model, rather than attempting to correct detected misspecifications. And some portions of the literature seems not to have noticed that "accepting a model" (on the basis of "satisfying" an index value) suffers from an intensified version of the criticism applied to "acceptance" of a null-hypothesis. Introductory statistics texts usually recommend replacing the term "accept" with "failed to reject the null hypothesis" to acknowledge the possibility of Type II error. A Type III error arises from "accepting" a model hypothesis when the current data are sufficient to reject the model.
Whether or not researchers are committed to seeking the world’s structure is a fundamental concern. Displacing test evidence of model-data inconsistency by hiding it behind index claims of acceptable-fit, introduces the discipline-wide cost of diverting attention away from whatever the discipline might have done to attain a structurally-improved understanding of the discipline’s substance. The discipline ends up paying a real costs for index-based displacement of evidence of model misspecification. The frictions created by disagreements over the necessity of correcting model misspecifications will likely increase with increasing use of non-factor-structured models, and with use of fewer, more-precise, indicators of similar yet importantly-different latent variables.
The considerations relevant to using fit indices include checking:
whether data concerns have been addressed (to ensure data mistakes are not driving model-data inconsistency);
whether criterion values for the index have been investigated for models structured like the researcher's model (e.g. index criterion based on factor structured models are only appropriate if the researcher's model actually is factor structured);
whether the kinds of potential misspecifications in the current model correspond to the kinds of misspecifications on which the index criterion are based (e.g. criteria based on simulation of omitted factor loadings may not be appropriate for misspecification resulting from failure to include appropriate control variables);
whether the researcher knowingly agrees to disregard evidence pointing to the kinds of misspecifications on which the index criteria were based. (If the index criterion is based on simulating a missing factor loading or two, using that criterion acknowledges the researcher's willingness to accept a model missing a factor loading or two.);
whether the latest, not outdated, index criteria are being used (because the criteria for some indices tightened over time);
whether satisfying criterion values on pairs of indices are required (e.g. Hu and Bentler report that some common indices function inappropriately unless they are assessed together.);
whether a model test is, or is not, available. (A value, degrees of freedom, and probability will be available for models reporting indices based on .)
and whether the researcher has considered both alpha (Type I) and beta (Type II) errors in making their index-based decisions (E.g. if the model is significantly data-inconsistent, the "tolerable" amount of inconsistency is likely to differ in the context of medical, business, social and psychological contexts.).
Some of the more commonly used fit statistics include
Chi-square
A fundamental test of fit used in the calculation of many other fit measures. It is a function of the discrepancy between the observed covariance matrix and the model-implied covariance matrix. Chi-square increases with sample size only if the model is detectably misspecified.
Akaike information criterion (AIC)
An index of relative model fit: The preferred model is the one with the lowest AIC value.
where k is the number of parameters in the statistical model, and L is the maximized value of the likelihood of the model.
Root Mean Square Error of Approximation (RMSEA)
Fit index where a value of zero indicates the best fit. Guidelines for determining a "close fit" using RMSEA are highly contested.
Standardized Root Mean Squared Residual (SRMR)
The SRMR is a popular absolute fit indicator. Hu and Bentler (1999) suggested .08 or smaller as a guideline for good fit.
Comparative Fit Index (CFI)
In examining baseline comparisons, the CFI depends in large part on the average size of the correlations in the data. If the average correlation between variables is not high, then the CFI will not be very high. A CFI value of .95 or higher is desirable.
The following table provides references documenting these, and other, features for some common indices: the RMSEA (Root Mean Square Error of Approximation), SRMR (Standardized Root Mean Squared Residual), CFI (Confirmatory Fit Index), and the TLI (the Tucker-Lewis Index). Additional indices such as the AIC (Akaike Information Criterion) can be found in most SEM introductions. For each measure of fit, a decision as to what represents a good-enough fit between the model and the data reflects the researcher's modeling objective (perhaps challenging someone else's model, or improving measurement); whether or not the model is to be claimed as having been "tested"; and whether the researcher is comfortable "disregarding" evidence of the index-documented degree of ill fit.
Sample size, power, and estimation
Researchers agree samples should be large enough to provide stable coefficient estimates and reasonable testing power but there is no general consensus regarding specific required sample sizes, or even how to determine appropriate sample sizes. Recommendations have been based on the number of coefficients to be estimated, the number of modeled variables, and Monte Carlo simulations addressing specific model coefficients. Sample size recommendations based on the ratio of the number of indicators to latents are factor oriented and do not apply to models employing single indicators having fixed nonzero measurement error variances. Overall, for moderate sized models without statistically difficult-to-estimate coefficients, the required sample sizes (N’s) seem roughly comparable to the N’s required for a regression employing all the indicators.
The larger the sample size, the greater the likelihood of including cases that are not causally homogeneous. Consequently, increasing N to improve the likelihood of being able to report a desired coefficient as statistically significant, simultaneously increases the risk of model misspecification, and the power to detect the misspecification. Researchers seeking to learn from their modeling (including potentially learning their model requires adjustment or replacement) will strive for as large a sample size as permitted by funding and by their assessment of likely population-based causal heterogeneity/homogeneity. If the available N is huge, modeling sub-sets of cases can control for variables that might otherwise disrupt causal homogeneity. Researchers fearing they might have to report their model’s deficiencies are torn between wanting a larger N to provide sufficient power to detect structural coefficients of interest, while avoiding the power capable of signaling model-data inconsistency. The huge variation in model structures and data characteristics suggests adequate sample sizes might be usefully located by considering other researchers’ experiences (both good and bad) with models of comparable size and complexity that have been estimated with similar data.
Interpretation
Causal interpretations of SE models are the clearest and most understandable but those interpretations will be fallacious/wrong if the model’s structure does not correspond to the world’s causal structure. Consequently, interpretation should address the overall status and structure of the model, not merely the model’s estimated coefficients. Whether a model fits the data, and/or how a model came to fit the data, are paramount for interpretation. Data fit obtained by exploring, or by following successive modification indices, does not guarantee the model is wrong but raises serious doubts because these approaches are prone to incorrectly modeling data features. For example, exploring to see how many factors are required preempts finding the data are not factor structured, especially if the factor model has been “persuaded” to fit via inclusion of measurement error covariances. Data’s ability to speak against a postulated model is progressively eroded with each unwarranted inclusion of a “modification index suggested” effect or error covariance. It becomes exceedingly difficult to recover a proper model if the initial/base model contains several misspecifications.
Direct-effect estimates are interpreted in parallel to the interpretation of coefficients in regression equations but with causal commitment. Each unit increase in a causal variable’s value is viewed as producing a change of the estimated magnitude in the dependent variable’s value given control or adjustment for all the other operative/modeled causal mechanisms. Indirect effects are interpreted similarly, with the magnitude of a specific indirect effect equaling the product of the series of direct effects comprising that indirect effect. The units involved are the real scales of observed variables’ values, and the assigned scale values for latent variables. A specified/fixed 1.0 effect of a latent on a specific indicator coordinates that indicator’s scale with the latent variable’s scale. The presumption that the remainder of the model remains constant or unchanging may require discounting indirect effects that might, in the real world, be simultaneously prompted by a real unit increase. And the unit increase itself might be inconsistent with what is possible in the real world because there may be no known way to change the causal variable’s value. If a model adjusts for measurement errors, the adjustment permits interpreting latent-level effects as referring to variations in true scores.
SEM interpretations depart most radically from regression interpretations when a network of causal coefficients connects the latent variables because regressions do not contain estimates of indirect effects. SEM interpretations should convey the consequences of the patterns of indirect effects that carry effects from background variables through intervening variables to the downstream dependent variables. SEM interpretations encourage understanding how multiple worldly causal pathways can work in coordination, or independently, or even counteract one another. Direct effects may be counteracted (or reinforced) by indirect effects, or have their correlational implications counteracted (or reinforced) by the effects of common causes. The meaning and interpretation of specific estimates should be contextualized in the full model.
SE model interpretation should connect specific model causal segments to their variance and covariance implications. A single direct effect reports that the variance in the independent variable produces a specific amount of variation in the dependent variable’s values, but the causal details of precisely what makes this happens remains unspecified because a single effect coefficient does not contain sub-components available for integration into a structured story of how that effect arises. A more fine-grained SE model incorporating variables intervening between the cause and effect would be required to provide features constituting a story about how any one effect functions. Until such a model arrives each estimated direct effect retains a tinge of the unknown, thereby invoking the essence of a theory. A parallel essential unknownness would accompany each estimated coefficient in even the more fine-grained model, so the sense of fundamental mystery is never fully eradicated from SE models.
Even if each modeled effect is unknown beyond the identity of the variables involved and the estimated magnitude of the effect, the structures linking multiple modeled effects provide opportunities to express how things function to coordinate the observed variables – thereby providing useful interpretation possibilities. For example, a common cause contributes to the covariance or correlation between two effected variables, because if the value of the cause goes up, the values of both effects should also go up (assuming positive effects) even if we do not know the full story underlying each cause. (A correlation is the covariance between two variables that have both been standardized to have variance 1.0). Another interpretive contribution might be made by expressing how two causal variables can both explain variance in a dependent variable, as well as how covariance between two such causes can increase or decrease explained variance in the dependent variable. That is, interpretation may involve explaining how a pattern of effects and covariances can contribute to decreasing a dependent variable’s variance. Understanding causal implications implicitly connects to understanding “controlling”, and potentially explaining why some variables, but not others, should be controlled. As models become more complex these fundamental components can combine in non-intuitive ways, such as explaining how there can be no correlation (zero covariance) between two variables despite the variables being connected by a direct non-zero causal effect.
The statistical insignificance of an effect estimate indicates the estimate could rather easily arise as a random sampling variation around a null/zero effect, so interpreting the estimate as a real effect becomes equivocal. As in regression, the proportion of each dependent variable’s variance explained by variations in the modeled causes are provided by R2, though the Blocked-Error R2 should be used if the dependent variable is involved in reciprocal or looped effects, or if it has an error variable correlated with any predictor’s error variable.
The caution appearing in the Model Assessment section warrants repeat. Interpretation should be possible whether a model is or is not consistent with the data. The estimates report how the world would appear to someone believing the model – even if that belief is unfounded because the model happens to be wrong. Interpretation should acknowledge that the model coefficients may or may not correspond to “parameters” – because the model’s coefficients may not have corresponding worldly structural features.
Adding new latent variables entering or exiting the original model at a few clear causal locations/variables contributes to detecting model misspecifications which could otherwise ruin coefficient interpretations. The correlations between the new latent’s indicators and all the original indicators contribute to testing the original model’s structure because the few new and focused effect coefficients must work in coordination with the model’s original direct and indirect effects to coordinate the new indicators with the original indicators. If the original model’s structure was problematic, the sparse new causal connections will be insufficient to coordinate the new indicators with the original indicators, thereby signaling the inappropriateness of the original model’s coefficients through model-data inconsistency. The correlational constraints grounded in null/zero effect coefficients, and coefficients assigned fixed nonzero values, contribute to both model testing and coefficient estimation, and hence deserve acknowledgment as the scaffolding supporting the estimates and their interpretation.
Interpretations become progressively more complex for models containing interactions, nonlinearities, multiple groups, multiple levels, and categorical variables. Effects touching causal loops, reciprocal effects, or correlated residuals also require slightly revised interpretations.
Careful interpretation of both failing and fitting models can provide research advancement. To be dependable, the model should investigate academically informative causal structures, fit applicable data with understandable estimates, and not include vacuous coefficients. Dependable fitting models are rarer than failing models or models inappropriately bludgeoned into fitting, but appropriately-fitting models are possible.
The multiple ways of conceptualizing PLS models complicate interpretation of PLS models. Many of the above comments are applicable if a PLS modeler adopts a realist perspective by striving to ensure their modeled indicators combine in a way that matches some existing but unavailable latent variable. Non-causal PLS models, such as those focusing primarily on R2 or out-of-sample predictive power, change the interpretation criteria by diminishing concern for whether or not the model’s coefficients have worldly counterparts. The fundamental features differentiating the five PLS modeling perspectives discussed by Rigdon, Sarstedt and Ringle point to differences in PLS modelers’ objectives, and corresponding differences in model features warranting interpretation.
Caution should be taken when making claims of causality even when experiments or time-ordered investigations have been undertaken. The term causal model must be understood to mean "a model that conveys causal assumptions", not necessarily a model that produces validated causal conclusions—maybe it does maybe it does not. Collecting data at multiple time points and using an experimental or quasi-experimental design can help rule out certain rival hypotheses but even a randomized experiments cannot fully rule out threats to causal claims. No research design can fully guarantee causal structures.
Controversies and movements
Structural equation modeling is fraught with controversies. Researchers from the factor analytic tradition commonly attempt to reduce sets of multiple indicators to fewer, more manageable, scales or factor-scores for later use in path-structured models. This constitutes a stepwise process with the initial measurement step providing scales or factor-scores which are to be used later in a path-structured model. This stepwise approach seems obvious but actually confronts severe underlying deficiencies. The segmentation into steps interferes with thorough checking of whether the scales or factor-scores validly represent the indicators, and/or validly report on latent level effects. A structural equation model simultaneously incorporating both the measurement and latent-level structures not only checks whether the latent factors appropriately coordinates the indicators, it also checks whether that same latent simultaneously appropriately coordinates each latent’s indictors with the indicators of theorized causes and/or consequences of that latent. If a latent is unable to do both these styles of coordination, the validity of that latent is questioned, and a scale or factor-scores purporting to measure that latent is questioned. The disagreements swirled around respect for, or disrespect of, evidence challenging the validity of postulated latent factors. The simmering, sometimes boiling, discussions resulted in a special issue of the journal Structural Equation Modeling focused on a target article by Hayduk and Glaser followed by several comments and a rejoinder, all made freely available, thanks to the efforts of George Marcoulides.
These discussions fueled disagreement over whether or not structural equation models should be tested for consistency with the data, and model testing became the next focus of discussions. Scholars having path-modeling histories tended to defend careful model testing while those with factor-histories tended to defend fit-indexing rather than fit-testing. These discussions led to a target article in Personality and Individual Differences by Paul Barrett who said: “In fact, I would now recommend banning ALL such indices from ever appearing in any paper as indicative of model “acceptability” or “degree of misfit”.” (page 821). Barrett’s article was also accompanied by commentary from both perspectives.
The controversy over model testing declined as clear reporting of significant model-data inconsistency becomes mandatory. Scientists do not get to ignore, or fail to report, evidence just because they do not like what the evidence reports. The requirement of attending to evidence pointing toward model mis-specification underpins more recent concern for addressing “endogeneity” – a style of model mis-specification that interferes with estimation due to lack of independence of error/residual variables. In general, the controversy over the causal nature of structural equation models, including factor-models, has also been declining. Stan Mulaik, a factor-analysis stalwart, has acknowledged the causal basis of factor models. The comments by Bollen and Pearl regarding myths about causality in the context of SEM reinforced the centrality of causal thinking in the context of SEM.
A briefer controversy focused on competing models. Comparing competing models can be very helpful but there are fundamental issues that cannot be resolved by creating two models and retaining the better fitting model. The statistical sophistication of presentations like Levy and Hancock (2007), for example, makes it easy to overlook that a researcher might begin with one terrible model and one atrocious model, and end by retaining the structurally terrible model because some index reports it as better fitting than the atrocious model. It is unfortunate that even otherwise strong SEM texts like Kline (2016) remain disturbingly weak in their presentation of model testing. Overall, the contributions that can be made by structural equation modeling depend on careful and detailed model assessment, even if a failing model happens to be the best available.
An additional controversy that touched the fringes of the previous controversies awaits ignition. Factor models and theory-embedded factor structures having multiple indicators tend to fail, and dropping weak indicators tends to reduce the model-data inconsistency. Reducing the number of indicators leads to concern for, and controversy over, the minimum number of indicators required to support a latent variable in a structural equation model. Researchers tied to factor tradition can be persuaded to reduce the number of indicators to three per latent variable, but three or even two indicators may still be inconsistent with a proposed underlying factor common cause. Hayduk and Littvay (2012) discussed how to think about, defend, and adjust for measurement error, when using only a single indicator for each modeled latent variable. Single indicators have been used effectively in SE models for a long time, but controversy remains only as far away as a reviewer who has considered measurement from only the factor analytic perspective.
Though declining, traces of these controversies are scattered throughout the SEM literature, and you can easily incite disagreement by asking: What should be done with models that are significantly inconsistent with the data? Or by asking: Does model simplicity override respect for evidence of data inconsistency? Or, what weight should be given to indexes which show close or not-so-close data fit for some models? Or, should we be especially lenient toward, and “reward”, parsimonious models that are inconsistent with the data? Or, given that the RMSEA condones disregarding some real ill fit for each model degree of freedom, doesn’t that mean that people testing models with null-hypotheses of non-zero RMSEA are doing deficient model testing? Considerable variation in statistical sophistication is required to cogently address such questions, though responses will likely center on the non-technical matter of whether or not researchers are required to report and respect evidence.
Extensions, modeling alternatives, and statistical kin
Categorical dependent variables
Categorical intervening variables
Copulas
Deep Path Modelling
Exploratory Structural Equation Modeling
Fusion validity models
Item response theory models
Latent class models
Latent growth modeling
Link functions
Longitudinal models
Measurement invariance models
Mixture model
Multilevel models, hierarchical models (e.g. people nested in groups)
Multiple group modelling with or without constraints between groups (genders, cultures, test forms, languages, etc.)
Multi-method multi-trait models
Random intercepts models
Structural Equation Model Trees
Structural Equation Multidimensional scaling
Software
Structural equation modeling programs differ widely in their capabilities and user requirements.
See also
References
Bibliography
Further reading
Bartholomew, D. J., and Knott, M. (1999) Latent Variable Models and Factor Analysis Kendall's Library of Statistics, vol. 7, Edward Arnold Publishers,
Bentler, P.M. & Bonett, D.G. (1980), "Significance tests and goodness of fit in the analysis of covariance structures", Psychological Bulletin, 88, 588–606.
Bollen, K. A. (1989). Structural Equations with Latent Variables. Wiley,
Byrne, B. M. (2001) Structural Equation Modeling with AMOS - Basic Concepts, Applications, and Programming.LEA,
Goldberger, A. S. (1972). Structural equation models in the social sciences. Econometrica 40, 979- 1001.
Hoyle, R H (ed) (1995) Structural Equation Modeling: Concepts, Issues, and Applications. SAGE,
.
External links
Structural equation modeling page under David Garson's StatNotes, NCSU
Issues and Opinion on Structural Equation Modeling, SEM in IS Research
The causal interpretation of structural equations (or SEM survival kit) by Judea Pearl 2000.
Structural Equation Modeling Reference List by Jason Newsom: journal articles and book chapters on structural equation models
Handbook of Management Scales, a collection of previously used multi-item scales to measure constructs for SEM
Graphical models
Latent variable models
Regression models
Structural equation models | 0.761822 | 0.996226 | 0.758947 |
Existential therapy | Existential therapy is a form of psychotherapy based on the model of human nature and experience developed by the existential tradition of European philosophy. It focuses on the psychological experience revolving around universal human truths of existence such as death, freedom, isolation and the search for the meaning of life. Existential therapists largely reject the medical model of mental illness that views mental health symptoms as the result of biological causes. Rather, symptoms such as anxiety, alienation and depression arise because of attempts to deny or avoid the givens of existence, often resulting in an existential crisis. For example, existential therapists highlight the fact that since we have the freedom to choose, there will always be uncertainty - and therefore, there will always be a level of existential anxiety present in our lives.
Existential therapists also draw heavily from the methods of phenomenology, a philosophical approach developed by Edmund Husserl and later expanded on by Martin Heidegger that concentrates on the study of consciousness and the objects of direct experience. When working with clients, existential therapists focus on the client's lived experience of their subjective reality. While other types of therapies like Freudian psychoanalysis are aimed at analyzing and interpreting the client's experience, existential therapists are encouraged to "bracket", or set aside, their preconceived notions and biases in order to identify the core aspects of the client's experience. In existential therapy, clients gain self-awareness into their own existence, confront existential concerns, and are encouraged to use their freedom to choose a path towards a more authentic and meaningful life.
Background
The philosophers who are especially pertinent to the development of existential psychotherapy are those whose works were directly aimed at making sense of human existence. For example, the fields of phenomenology and existential philosophy are especially and directly responsible for the generation of existential therapy.
The starting point of existential philosophy (see Warnock 1970; Macquarrie 1972; Mace 1999; van Deurzen and Kenward 2005) can be traced back to the nineteenth century and the works of Søren Kierkegaard and Friedrich Nietzsche. Their works conflicted with the predominant ideologies of their time and committed to the exploration of reality as it can be experienced in a passionate and personal manner.
Søren Kierkegaard (1813–1855)
Soren Kierkegaard (1813–1855) protested vehemently against popular misunderstanding and abuse of Christian dogma and the so-called 'objectivity' of science (Kierkegaard, 1841, 1844). He thought that both were ways of avoiding the anxiety inherent in human existence. He had great contempt for the way life was lived by those around him and believed truth could only be discovered subjectively by the individual in action. He felt people lacked the courage to take a leap of faith and live with passion and commitment from the inward depth of existence. This involved a constant struggle between the finite and infinite aspects of our nature as part of the difficult task of creating a self and finding meaning. As Kierkegaard lived by his word, he was lonely and much ridiculed during his lifetime.
Friedrich Nietzsche (1844–1900)
Friedrich Nietzsche (1844–1900) took this philosophy of life a step further. His starting point was the notion that God is dead, that is, the idea of God was outmoded and limiting (Nietzsche, 1861, 1874, 1886). Furthermore, the Enlightenment—with the newfound faith in reason and rationality—had killed or replaced God with a new Truth that was perhaps more pernicious than the one it replaced. Science and rationality were the new "God," but instead took the form of a deity that was colder and less comforting than before. Nietzsche exerted a significant impact upon the development of psychology in general, but he specifically influenced an approach which emphasized an understanding of life from a personal perspective. In exploring the various needs of the individual about the ontological conditions of being, Nietzsche asserted that all things are in a state of "ontological privation," in which they long to become more than they are. This state of deprivation has major implications for the physiological and psychological needs of the individual.
Edmund Husserl (1859–1938)
While Kierkegaard and Nietzsche drew attention to the human issues that needed to be addressed, Edmund Husserl's phenomenology (Husserl, 1960, 1962; Moran, 2000) provided the method to address them rigorously. He contended that natural sciences assume the separateness of subject and object and that this kind of dualism can only lead to error. He proposed a whole new mode of investigation and understanding of the world and our experience of it. He said that prejudice has to be put aside or 'bracketed,' for us to meet the world afresh and discover what is absolutely fundamental, and only directly available to us through intuition. If people want to grasp the essence of things, instead of explaining and analyzing them, they have to learn to describe and understand them.
Max Scheler (1874-1928)
Max Scheler (1874-1928) developed philosophical anthropology from a material ethic of values ("Materielle Wertethik") that opposed Immanuel Kant's ethics of duty ("Pflichtethik"). He described a hierarchical system of values that further developed phenomenological philosophy. Scheler described the human psyche as being composed of four layers analogous to the layers of organic nature. However, in his description, the human psyche is opposed by the principle of the human spirit. Scheler's philosophy forms the basis of Viktor Frankl's logotherapy and existential analysis.
Martin Heidegger (1889–1976)
Martin Heidegger (1889–1976) applied the phenomenological method to understanding the meaning of being (Heidegger, 1962, 1968). He argued that poetry and deep philosophical thinking could bring greater insight into what it means to be in the world than what can be achieved through scientific knowledge. He explored human beings in the world in a manner that revolutionized classical ideas about the self and psychology. He recognized the importance of time, space, death, and human relatedness. He also favored hermeneutics, an old philosophical method of investigation, which is the art of interpretation.
Unlike interpretation as practiced in psychoanalysis (which consists of referring a person's experience to a pre-established theoretical framework), this kind of interpretation seeks to understand how the person himself/herself subjectively experiences something.
Jean-Paul Sartre (1905–1980)
Jean-Paul Sartre (1905–1980) contributed many other strands of existential exploration, particularly regarding emotions, imagination, and the person's insertion into a social and political world.
The philosophy of existence, on the contrary, is carried by a wide-ranging literature, which includes many authors, such as Karl Jaspers (1951, 1963), Paul Tillich, Martin Buber, and Hans-Georg Gadamer within the Germanic tradition and Albert Camus, Gabriel Marcel, Paul Ricoeur, Maurice Merleau-Ponty, Simone de Beauvoir and Emmanuel Lévinas within the French tradition (see for instance Spiegelberg, 1972, Kearney, 1986 or van Deurzen-Smith, 1997).
Existentialism and Therapy
Throughout the 20th century, psychotherapists began incorporating both the themes of existentialism as well as the phenomenological methods of describing experience into their theraputic practice:
Otto Rank (1884–1939) was an Austrian psychoanalyst who broke with Freud in the mid-1920s. He did not consider himself an existential therapist, but his ideas revolving the concept of "will" as a factor in human motivation, as well as the fear of death and the fear of living authentically would pave the foundation for later writers.
Throughout the 1930's and 40's, the Swiss psychiatrists Ludwig Binswanger and Medard Boss each developed a form of psychotherapy known as Daseinsanalysis. Daseinsanalysis merges Freudian psychoanalysis with the existential phenomenology of Martin Heidegger, particularly his concept of Dasein ("being"). It focuses on understanding the client's experience of Being-in-the-world, rather than diagnosing symptoms. Much of Binswanger's work was translated into English during the 1940s and 1950s and, together with the immigration to the USA of Paul Tillich (1886–1965) (Tillich, 1952) and others, this had a considerable effect on the popularization of existential ideas as a basis for therapy (Valle and King, 1978; Cooper, 2003).
Rollo May (1909–1994) played an important role in this, and is considered by many to be the "father" of existential therapy. His writings in the 1950's and 60's (1969, 1983; May et al., 1958) became the foundation of existential-humanistic therapy that would flourish in America (Bugental, 1981; May and Yalom, 1985; Yalom, 1980). May also worked closely with Carl Rogers and Abraham Maslow, founders of the humanistic psychology movement. As such, existential therapy in America became closely associated with humanistic psychology and the principles of Rogers' person-centered therapy, particularly regarding how the therapist and client should interact.
Viktor Frankl (1905–1997) was possibly the individual most responsible for spreading existential psychology throughout the world. His 1959 book Man's Search for Meaning created a unique branch of existential therapy known as Logotherapy. Logotherapy is premised on the idea that the primary motivation of individuals is to find meaning in life. He was invited by over 200 universities worldwide and accomplished over 80 journeys to North America alone, first invited by Gordon Allport at Harvard University.
In 1980, Irvin D. Yalom published 'Existential Psychotherapy'. This book was the first to provide a comprehensive overview of existential therapy. In it, Yalom identifies four existential concerns, or "givens", of life that underlie human experience - death, freedom, isolation, and meaninglessness. Yalom argues that the role of the therapist in existential therapy is not to provide solutions or answers, but to guide the client in exploring and confronting these challenges. Unlike other forms of therapy, Yalom does not prescribe specific techniques, rather, Yalom suggests existential therapy should be a personalized collaboration between therapist and client, tailored to each clients’ unique existential concerns.
Development
Development in Europe
The European School of existential analysis is dominated by two forms of therapy: Logotherapy, and Daseinsanalysis. Logotherapy was developed by psychiatrist Viktor E. Frankl. Frankl was heavily influenced by existential philosophy, as well as his own experience in the Nazi concentration camps of World War II. The three main components to Logotherapy are Freedom of Will, which is the ability to change one's life to the degree that such change is possible, Will to Meaning, which places meaning at the center of well-being, and Meaning in Life, which asserts the objectivity of meaning. The primary techniques of Logotherapy involve helping the clients to identify and remove any barriers to the pursuit of meaning in their own lives, to determine what is personally meaningful, and to then help patients effectively pursue related goals.
Daseinsanalysis is a psychotherapeutic system developed upon the ideas of Martin Heidegger, as well as the psychoanalytic theories of Sigmund Freud, that seeks to help the individual find autonomy and meaning in their "being in the world" (a rough translation of "Dasein").
Development in Britain
Britain became a fertile ground for further development of the existential approach when R. D. Laing and David Cooper, often associated with the anti-psychiatry movement, took Sartre's existential ideas as the basis for their work (Laing, 1960, 1961; Cooper, 1967; Laing and Cooper, 1964). Without developing a concrete method of therapy, they critically reconsidered the notion of mental illness and its treatment. In the late 1960s, they established an experimental therapeutic community at Kingsley Hall in the East End of London, where people could come to live through their 'madness' without the usual medical treatment. They also founded the Philadelphia Association, an organization providing an alternative living, therapy, and therapeutic training from this perspective. The Philadelphia Association is still in existence today and is now committed to the exploration of the works of philosophers such as Ludwig Wittgenstein, Jacques Derrida, Levinas, and Michel Foucault as well as the work of the French psychoanalyst Jacques Lacan. It also runs some small therapeutic households along these lines. The Arbours Association is another group that grew out of the Kingsley Hall experiment. Founded by Joseph Berke and Schatzman in the 1970s, it now runs a training program in psychotherapy, a crisis center, and several therapeutic communities. The existential input in the Arbours has gradually been replaced with a more neo-Kleinian emphasis.
The impetus for further development of the existential approach in Britain has primarily come from the development of some existentially based courses in academic institutions. This started with the programs created by Emmy van Deurzen, initially at Antioch University in London and subsequently at Regent's College, London and since then at the New School of Psychotherapy and Counseling, also located in London. The latter is a purely existentially based training institute, which offers postgraduate degrees validated by the University of Sheffield and Middlesex University. In the past few decades, the existential approach has spread rapidly and has become a welcome alternative to established methods. There are now many other, mostly academic, centers in Britain that provide training in existential counseling and psychotherapy and a rapidly growing interest in the approach in the voluntary sector and the National Health Service.
British publications dealing with existential therapy include contributions by these authors: Jenner (de Koning and Jenner, 1982), Heaton (1988, 1994), Cohn (1994, 1997), Spinelli (1997), Cooper (1989, 2002), Eleftheriadou (1994), Lemma-Wright (1994), Du Plock (1997), Strasser and Strasser (1997), van Deurzen (1997, 1998, 2002), van Deurzen and Arnold-Baker (2005), and van Deurzen and Kenward (2005). Other writers such as Lomas (1981) and Smail (1978, 1987, 1993) have published work relevant to the approach, although not explicitly 'existential' in orientation. The journal of the British Society for Phenomenology regularly publishes work on existential and phenomenological psychotherapy. The Society for Existential Analysis was founded in 1988, initiated by van Deurzen. This society brings together psychotherapists, psychologists, psychiatrists, counselors, and philosophers working from an existential perspective. It offers regular fora for discussion and debate as well as significant annual conferences. It publishes the Journal of the Society for Existential Analysis twice a year. It is also a member of the International Federation of Daseinsanalysis, which stimulates international exchange between representatives of the approach from around the world. An International Society for Existential Therapists also exists. It was founded in 2006 by Emmy van Deurzen and Digby Tantam and is called the International Community of Existential Counsellors and Therapists (ICECAP).
Development in Canada
New developments in existential therapy in the last 20 years include existential positive psychology and meaning therapy. Different from the traditional approach to existential therapy, these new developments incorporate research findings from contemporary positive psychology.
Existential positive psychology can reframe the traditional issues of existential concerns into positive psychology questions that can be subjected to empirical research. It also focuses on personal growth and transformation as much as on existential anxiety. Later, existential positive psychology was incorporated into the second wave of positive psychology.
Meaning therapy (MT) is an extension of Frankl's logotherapy and America's humanistic-existential tradition; it is also pluralistic because it incorporates elements of cognitive-behavioral therapy, narrative therapy, and positive psychotherapy, with meaning as its central organizing construct. MT not only appeals to people's natural desires for happiness and significance but also makes skillful use of their innate capacity for meaning-seeking and meaning-making. MT strikes a balance between a person-centered approach and a psycho-educational approach. At the outset of therapy, clients are informed of the use of meaning-centered interventions appropriate for their predicaments because of the empirical evidence for the vital role of meaning in healing and thriving. MT is a comprehensive and pluralistic way to address all aspects of clients' existential concerns. Clients can benefit from MT in two ways: (1) a custom-tailored treatment to solve their presenting problems, and (2) a collaborative journey to create a preferred better future.
View of the human mind
Existential therapy (of the American, existential-humanistic tradition) starts with the belief that although humans are essentially alone in the world, they long to be connected to others. People want to have meaning in one another's lives, but ultimately they must come to realize that they cannot depend on others for validation, and with that realization, they finally acknowledge and understand that they are fundamentally alone. The result of this revelation is anxiety in the knowledge that our validation must come from within and not from others.
Existential therapy is based on a theory of mind, and of psychology. In existentialism, personality is based on choosing to be, authentically, the real you, given an understanding based on a philosophical idea of what a person is. Therefore, practical therapeutic applications can be derived given a theory of personality, emotion, and “the good life.”
This leads to practical therapeutic applications like dealing with personal choices in life that lead to personal happiness. Personal happiness based on a concept of yourself as having the freedom of directing your life and making necessary changes (so to speak, a radical freedom). So, a full philosophical understanding of existentialism is basic to methods implemented for emotional and life changes. That is, a background in philosophy is basic to existential therapy.
Philosophical issues of the self, personality, philosophy of mind, meaning of life, personal development are all fundamentally relevant to any practical therapeutic expectations.
Psychological dysfunction
Because there is no single existential view, opinions about psychological dysfunction vary.
For theorists aligned with Yalom, psychological dysfunction results from the individual's refusal or inability to deal with the normal existential anxiety that comes from confronting life's "givens": death, freedom, isolation,
and meaninglessness.
For other theorists, there is no such thing as psychological dysfunction or mental illness. Every way of being is merely an expression of how one chooses to live one's life. However, one may feel unable to come to terms with the anxiety of being alone in the world. If so, an existential psychotherapist can assist one in accepting these feelings rather than trying to change them as if there is something wrong. Everyone has the freedom to choose how they are going to exist in life; however, this freedom may go unpracticed. It may appear easier and safer not to make decisions that one will be responsible for. Many people will remain unaware of alternative choices in life for various societal reasons.
The good life
Existentialism suggests that it is possible for individuals to face the anxieties of life head on, embrace the human condition of aloneness and to revel in the freedom to choose and take full responsibility for their choices. They can aim to take control of their lives and steer themselves in any direction they choose. There is no need to halt feelings of meaninglessness but instead to choose and focus on new meanings for the living. By building, loving and creating, life can be lived as one's own adventure. One can accept one's own mortality and overcome the fear of death. Although the French author Albert Camus denied the specific label of existentialist in his novel, L'Etranger, the novel's main character, Meursault, ends the novel by doing just this. He accepts his mortality and rejects the constrictions of society he previously placed on himself, leaving him unencumbered and free to live his life with an unclouded mind. Also, Gerd B. Achenbach has refreshed the Socratic tradition with his own blend of philosophical counseling, as has Michel Weber with his Chromatiques Center in Belgium.
The strictly Sartrean perspective of existential psychotherapy is generally unconcerned with the client's past, but instead, the emphasis is on the choices to be made in the present and future. The counselor and the client may reflect upon how the client has answered life's questions in the past, but attention ultimately shifts to searching for a new and increased awareness in the present and enabling a new freedom and responsibility to act. The patient can then accept that they are not special and that their existence is simply coincidental, or without destiny or fate. By accepting this, they can overcome their anxieties and instead view life as moments in which they are fundamentally free.
Four worlds
Existential thinkers seek to avoid restrictive models that categorize or label people. Instead, they look for the universals that can be observed cross-culturally. There is no existential personality theory which divides humanity into types or reduces people to part components. Instead, there is a description of the different levels of experience and existence with which people are inevitably confronted. The way in which a person is in the world at a particular stage can be charted on this general map of human existence (Binswanger, 1963; Yalom, 1980; van Deurzen, 1984).
In line with the view taken by van Deurzen, one can distinguish four basic dimensions of human existence: the physical, the social, the psychological, and the spiritual.
On each of these dimensions, people encounter the world and shape their attitude out of their particular take on their experience. Their orientation towards the world defines their reality. The four dimensions are interwoven and provide a complex four-dimensional force field for their existence. Individuals are stretched between a positive pole of what they aspire to on each dimension and a negative pole of what they fear. Binswanger proposed the first three of these dimensions from Heidegger's description of Umwelt and Mitwelt and his further notion of Eigenwelt. The fourth dimension was added by van Deurzen from Heidegger's description of a spiritual world (Überwelt) in Heidegger's later work.
Physical dimension
On the physical dimension (Umwelt), individuals relate to their environment and the givens of the natural world around them. This includes their attitude to the body they have, to the concrete surroundings they find themselves in, to the climate and the weather, to objects and material possessions, to the bodies of other people, their own bodily needs, to health and illness and their mortality. The struggle on this dimension is, in general terms, between the search for domination over the elements and natural law (as in technology, or in sports) and the need to accept the limitations of natural boundaries (as in ecology or old age). While people generally aim for security on this dimension (through health and wealth), much of life brings a gradual disillusionment and realization that such security can only be temporary. Recognizing limitations can deliver a significant release of tension.
Social dimension
On the social dimension (Mitwelt), individuals relate to others as they interact with the public world around them. This dimension includes their response to the culture they live in, as well as to the class and race they belong to (and also those they do not belong to). Attitudes here range from love to hate and from cooperation to competition. The dynamic contradictions can be understood concerning acceptance versus rejection or belonging versus isolation. Some people prefer to withdraw from the world of others as much as possible. Others blindly chase public acceptance by going along with the rules and fashions of the moment. Otherwise, they try to rise above these by becoming trendsetters themselves. By acquiring fame or other forms of power, individuals can attain dominance over others temporarily. Sooner or later, however, everyone is confronted with both failure and aloneness.
Psychological dimension
On the psychological dimension (Eigenwelt), individuals relate to themselves and in this way create a personal world. This dimension includes views about their character, their past experience and their future possibilities. Contradictions here are often experienced regarding personal strengths and weaknesses. People search for a sense of identity, a feeling of being substantial and having a self.
But inevitably many events will confront them with evidence to the contrary and plunge them into a state of confusion or disintegration. Activity and passivity are an important polarity here. Self-affirmation and resolution go with the former and surrender and yielding with the latter. Facing the final dissolution of self that comes with personal loss and the facing of death might bring anxiety and confusion to many who have not yet given up their sense of self-importance.
Spiritual dimension
On the spiritual dimension (Überwelt) (van Deurzen, 1984), individuals relate to the unknown and thus create a sense of an ideal world, an ideology, and a philosophical outlook. It is there that they find meaning by putting all the pieces of the puzzle together for themselves. For some people, this is done by adhering to a religion or other prescriptive worldview; for others, it is about discovering or attributing meaning in a more secular or personal way. The contradictions that must be faced on this dimension are often related to the tension between purpose and absurdity, hope and despair. People create their values in search of something that matters enough to live or die for, something that may even have ultimate and universal validity. Usually, the aim is the conquest of a soul or something that will substantially surpass mortality (as in having contributed something valuable to humankind). Facing the void and the possibility of nothingness are the indispensable counterparts of this quest for the eternal.
Research support
There has not been a tremendous amount of research on existential therapy. Much of the research focuses on people receiving therapy who also have medical concerns such as cancer. Despite this, some studies have indicated positive efficacy for existential therapies with certain populations. Overall, however, more research is needed before definitive scientific claims can be made.
See also
Ludwig Binswanger
Medard Boss
Gestalt Therapy
Existentialism
Viktor Frankl
Paul T. P. Wong
Martin Heidegger
Thomas Hora
Søren Kierkegaard
R. D. Laing
Rollo May
Clark Moustakas
Karlfried Graf Dürckheim
Friedrich Nietzsche
Otto Rank
Jean-Paul Sartre
Irvin D. Yalom
Karl Jaspers
Martin Buber
Contextual therapy
Emmy van Deurzen
William Glasser
Metapsychiatry
Philosophical Consultancy
Jan Hendrik van den Berg
Martti Olavi Siirala
Kirk J. Schneider
References
Further reading
Kierkegaard, Søren; The Concept of Dread and The Sickness Unto Death, Princeton University Press
Längle, Alfried (1990); Existential Analysis Psychotherapy, The Internat. Forum Logotherapy, Berkeley, 13, 1, 17-19.
Längle, Alfried (2003a); Special edition on Existential Analysis, European Psychotherapy 4, 1
Längle, Alfried (2003b); The Search for Meaning in Life and the Fundamental Existential Motivations, Psychotherapy in Australia, 10, 1, 22-27
Längle Silvia, Wurm CSE (2015); Living Your Own Life: Existential Analysis in Action, London: Karnac
ibid (1997) Everyday Mysteries: Existential Dimensions of Psychotherapy, London: Routledge. (2nd edition 2006)
van Deurzen, E. and Arnold-Baker, C., eds. (2005) Existential Perspectives on Human Issues: a Handbook for Practice, London: Palgrave, Macmillan.
van Deurzen, E. and M. Adams (2016). Skills in Existential Counselling and Psychotherapy, 2nd Edition (2016). London: Sage.
Willburg, Peter, "The Therapist as Listener: Martin Heidegger and the Missing Dimension of Counseling and Psychotherapy Training"
Wilkes, R and Milton, M, (2006) Being an Existential Therapist: An IPA study of existential therapists' experiences, Existential Analysis. Jan 2006
Milton, M., Charles, L., Judd, D., O'Brien, Tipney, A. and Turner, A . (2003) The Existential-Phenomenological Paradigm: The Importance for Integration, Existential Analysis
Judd, D. and Milton, M. (2001) Psychotherapy with Lesbian and Gay Clients: Existential-Phenomenological Contributions to Training, Lesbian and Gay Psychology Review, 2(1): 16-23
Corrie, S. and Milton, M . (2000) "The Relationship Between Existential-Phenomenological and Cognitive-Behavioural Therapies", European Journal of Psychotherapy, Counseling and Health.
Milton, M (2000) "Is Existential Psychotherapy A Lesbian and Gay Affirmative Psychotherapy?" Journal of the Society for Existential Analysis,
Milton, M. and Judd, D. (1999) "The Dilemma that is Assessment", Journal of the Society for Existential Analysis, 102-114.
Milton, M. (1999) "Depression and the Uncertainty of Identity: An existential-phenomenological exploration in just twelve sessions", Changes: An International Journal of Psychology and Psychotherapy,
Milton, M (1997) "An Existential Approach to HIV Related Psychotherapy", Journal of the Society for Existential Analysis, V8.1, 115-129
Milton, M (1994). "The Case for Existential Therapy in HIV Related Psychotherapy", Counselling Psychology Quarterly, V7 (4). 367-374
Milton, M. (1994). "HIV Related Psychotherapy and Its Existential Concerns", Counselling Psychology Review, V9 (4). 13-24
Milton, M (1993) "Existential Thought and Client Centred Therapy", Counselling Psychology Quarterly, V6 (3). 239-248
Sanders, Marc, Existential Depression. How to recognize and cure life-related sadness in gifted people, Self-Help Manual, 2013.
Schneider, K.J. (2009). "Awakening to Awe: Personal Stories of Profound Transformation." Lanham, MD: Jason Aronson.
Schneider, K.J. and Krug, O.T. (2010). "Existential-Humanistic Therapy." Washington, DC: American Psychological Association Press.
Schneider, K.J. (2011). "Existential-Humanistic Therapies". In S.B. Messer and Alan Gurman (eds.), Essential Psychotherapies. (Third ed.). New York: Guilford.
Seidner, Stanley S. (June 10, 2009) "A Trojan Horse: Logotherapeutic Transcendence and its Secular Implications for Theology". Mater Dei Institute. pp 10–12.
Sørensen, A. D. and K. D. Keller (eds.) (2015): Psykoterapi og eksistentiel fænomenologi." Aalborg: Aalborg Universitetsforlag
Tillich, Paul (1952). The Courage to Be. Yale University Press.
Wilberg, P. (2004) The Therapist as Listener - Martin Heidegger and the Missing Dimension of Counselling and Psychotherapy Training
External links
Existential positive psychology
Searching for meaning
Psychotherapy
Psychotherapy by type | 0.763519 | 0.993994 | 0.758933 |
Delphi method | The Delphi method or Delphi technique ( ; also known as Estimate-Talk-Estimate or ETE) is a structured communication technique or method, originally developed as a systematic, interactive forecasting method that relies on a panel of experts. Delphi has been widely used for business forecasting and has certain advantages over another structured forecasting approach, prediction markets.
Delphi can also be used to help reach expert consensus and develop professional guidelines. It is used for such purposes in many health-related fields, including clinical medicine, public health, and research.
Delphi is based on the principle that forecasts (or decisions) from a structured group of individuals are more accurate than those from unstructured groups. The experts answer questionnaires in two or more rounds. After each round, a facilitator or change agent provides an anonymised summary of the experts' forecasts from the previous round as well as the reasons they provided for their judgments. Thus, experts are encouraged to revise their earlier answers in light of the replies of other members of their panel. It is believed that during this process the range of the answers will decrease and the group will converge towards the "correct" answer. Finally, the process is stopped after a predefined stopping criterion (e.g., number of rounds, achievement of consensus, stability of results), and the mean or median scores of the final rounds determine the results.
Special attention has to be paid to the formulation of the Delphi theses and the definition and selection of the experts in order to avoid methodological weaknesses that severely threaten the validity and reliability of the results.
History
The name Delphi derives from the Oracle of Delphi, although the authors of the method were unhappy with the oracular connotation of the name, "smacking a little of the occult". The Delphi method assumes that group judgments are more valid than individual judgments.
The Delphi method was developed at the beginning of the Cold War to forecast the impact of technology on warfare. In 1944, General Henry H. Arnold ordered the creation of the report for the U.S. Army Air Corps on the future technological capabilities that might be used by the military.
Different approaches were tried, but the shortcomings of traditional forecasting methods, such as theoretical approach, quantitative models or trend extrapolation, quickly became apparent in areas where precise scientific laws have not been established yet. To combat these shortcomings, the Delphi method was developed by Project RAND during the 1950-1960s (1959) by Olaf Helmer, Norman Dalkey, and Nicholas Rescher. It has been used ever since, together with various modifications and reformulations, such as the Imen-Delphi procedure.
Experts were asked to give their opinion on the probability, frequency, and intensity of possible enemy attacks. Other experts could anonymously give feedback. This process was repeated several times until a consensus emerged.
In 2021, a cross-disciplinary study by Beiderbeck et al. focused on new directions and advancements of the Delphi method, including Real-time Delphi formats. The authors provide a methodological toolbox for designing Delphi surveys including among others sentiment analyses of the field of psychology.
Key characteristics
The following key characteristics of the Delphi method help the participants to focus on the issues at hand and separate Delphi from other methodologies: in this technique a panel of experts is drawn from both inside and outside the organisation. The panel consists of experts having knowledge of the area requiring decision making. Each expert is asked to make anonymous predictions.
Anonymity of the participants
Usually all participants remain anonymous. Their identity is not revealed, even after the completion of the final report. This prevents the authority, personality, or reputation of some participants from dominating others in the process. Arguably, it also frees participants (to some extent) from their personal biases, minimizes the "bandwagon effect" or "halo effect", allows free expression of opinions, encourages open critique, and facilitates admission of errors when revising earlier judgments.
Structuring of information flow
The initial contributions from the experts are collected in the form of answers to questionnaires and their comments to these answers. The panel director controls the interactions among the participants by processing the information and filtering out irrelevant content. This avoids the negative effects of face-to-face panel discussions and solves the usual problems of group dynamics.
Regular feedback
The Delphi method allows participants to comment on the responses of others, the progress of the panel as a whole, and to revise their own forecasts and opinions in real time.
Role of the facilitator
The person coordinating the Delphi method is usually known as a facilitator or Leader, and facilitates the responses of their panel of experts, who are selected for a reason, usually that they hold knowledge on an opinion or view. The facilitator sends out questionnaires, surveys etc. and if the panel of experts accept, they follow instructions and present their views. Responses are collected and analyzed, then common and conflicting viewpoints are identified. If consensus is not reached, the process continues through thesis and antithesis, to gradually work towards synthesis, and building consensus.
During the past decades, facilitators have used many different measures and thresholds to measure the degree of consensus or dissent. A comprehensive literature review and summary is compiled in an article by von der Gracht.
Applications
Use in forecasting
First applications of the Delphi method were in the field of science and technology forecasting. The objective of the method was to combine expert opinions on likelihood and expected development time, of the particular technology, in a single indicator. One of the first such reports, prepared in 1964 by Gordon and Helmer, assessed the direction of long-term trends in science and technology development, covering such topics as scientific breakthroughs, population control, automation, space progress, war prevention and weapon systems. Other forecasts of technology were dealing with vehicle-highway systems, industrial robots, intelligent internet, broadband connections, and technology in education.
Later the Delphi method was applied in other places, especially those related to public policy issues, such as economic trends, health and education. It was also applied successfully and with high accuracy in business forecasting. For example, in one case reported by Basu and Schroeder (1977), the Delphi method predicted the sales of a new product during the first two years with inaccuracy of 3–4% compared with actual sales. Quantitative methods produced errors of 10–15%, and traditional unstructured forecast methods had errors of about 20%. (This is only one example; the overall accuracy of the technique is mixed.)
The Delphi method has also been used as a tool to implement multi-stakeholder approaches for participative policy-making in developing countries. The governments of Latin America and the Caribbean have successfully used the Delphi method as an open-ended public-private sector approach to identify the most urgent challenges for their regional ICT-for-development eLAC Action Plans. As a result, governments have widely acknowledged the value of collective intelligence from civil society, academic and private sector participants of the Delphi, especially in a field of rapid change, such as technology policies.
Use in patent participation identification
In the early 1980s Jackie Awerman of Jackie Awerman Associates, Inc. designed a modified Delphi method for identifying the roles of various contributors to the creation of a patent-eligible product. (Epsilon Corporation, Chemical Vapor Deposition Reactor) The results were then used by patent attorneys to determine bonus distribution percentage to the general satisfaction of all team members.
Use in policy-making
From the 1970s, the use of the Delphi technique in public policy-making introduces a number of methodological innovations. In particular:
the need to examine several types of items (not only forecasting items but, typically, issue items, goal items, and option items) leads to introducing different evaluation scales which are not used in the standard Delphi. These often include desirability, feasibility (technical and political) and probability, which the analysts can use to outline different scenarios: the desired scenario (from desirability), the potential scenario (from feasibility) and the expected scenario (from probability);
the complexity of issues posed in public policy-making tends to increase weighting of panelists’ arguments, such as soliciting pros and cons for each item along with new items for panel consideration;
likewise, methods measuring panel evaluations tend to increase sophistication such as multi-dimensional scaling.
Further innovations come from the use of computer-based (and later web-based) Delphi conferences. According to Turoff and Hiltz, in computer-based Delphis:
the iteration structure used in the paper Delphis, which is divided into three or more discrete rounds, can be replaced by a process of continuous (roundless) interaction, enabling panelists to change their evaluations at any time;
the statistical group response can be updated in real-time, and shown whenever a panelist provides a new evaluation.
According to Bolognini, web-based Delphis offer two further possibilities, relevant in the context of interactive policy-making and e-democracy. These are:
the involvement of a large number of participants,
the use of two or more panels representing different groups (such as policy-makers, experts, citizens), which the administrator can give tasks reflecting their diverse roles and expertise, and make them to interact within ad hoc communication structures. For example, the policy community members (policy-makers and experts) may interact as part of the main conference panel, while they receive inputs from a virtual community (citizens, associations etc.) involved in a side conference. These web-based variable communication structures, which he calls Hyperdelphi (HD), are designed to make Delphi conferences "more fluid and adapted to the hypertextual and interactive nature of digital communication".
One successful example of a (partially) web-based policy Delphi is the five-round Delphi exercise (with 1,454 contributions) for the creation of the eLAC Action Plans in Latin America. It is believed to be the most extensive online participatory policy-making foresight exercise in the history of intergovernmental processes in the developing world at this time. In addition to the specific policy guidance provided, the authors list the following lessons learned: "(1) the potential of Policy Delphi methods to introduce transparency and accountability into public decision-making, especially in developing countries; (2) the utility of foresight exercises to foster multi-agency networking in the development community; (3) the usefulness of embedding foresight exercises into established mechanisms of representative democracy and international multilateralism, such as the United Nations; (4) the potential of online tools to facilitate participation in resource-scarce developing countries; and (5) the resource-efficiency stemming from the scale of international foresight exercises, and therefore its adequacy for resource-scarce regions."
Use in health settings
The Delphi technique is widely used to help reach expert consensus in health-related settings. For example, it is frequently employed in the development of medical guidelines and protocols.
Use in public health
Some examples of its application in public health contexts include non-alcoholic fatty liver disease, iodine deficiency disorders, building responsive health systems for communities affected by migration, the role of health systems in advancing well-being for those living with HIV, and in creating a 2022 paper on recommendations to end the COVID-19 pandemic.
Use in reporting guidelines
Use of the Delphi method in the development of guidelines for the reporting of health research is recommended, especially for experienced developers. Since this advice was made in 2010, two systematic reviews have found that fewer than 30% of published reporting guidelines incorporated Delphi methods into the development process.
Online Delphi systems
A number of Delphi forecasts are conducted using web sites that allow the process to be conducted in real-time. For instance, the TechCast Project uses a panel of 100 experts worldwide to forecast breakthroughs in all fields of science and technology. Another example is the Horizon Project, where educational futurists collaborate online using the Delphi method to come up with the technological advancements to look out for in education for the next few years.
Variations
Traditionally the Delphi method has aimed at a consensus of the most probable future by iteration. Other versions, such as the Policy Delphi, offer decision support methods aiming at structuring and discussing the diverse views of the preferred future.
In Europe, more recent web-based experiments have used the Delphi method as a communication technique for interactive decision-making and e-democracy.
The Argument Delphi, developed by Osmo Kuusi, focuses on ongoing discussion and finding relevant arguments rather than focusing on the output. The Disaggregative Policy Delphi, developed by Petri Tapio, uses cluster analysis as a systematic tool to construct various scenarios of the future in the latest Delphi round. The respondent's view on the probable and the preferable future are dealt with as separate cases. The computerization of Argument Delphi is relatively difficult because of several problems like argument resolution, argument aggregation and argument evaluation. The computerization of Argument Delphi, developed by Sadi Evren Seker, proposes solutions to such problems.
Accuracy
Today the Delphi method is a widely accepted forecasting tool and has been used successfully for thousands of studies in areas varying from technology forecasting to drug abuse.
Overall the track record of the Delphi method is mixed. There have been many cases when the method produced poor results. Still, some authors attribute this to poor application of the method and not to the weaknesses of the method itself. The RAND Methodological Guidance for Conducting and Critically Appraising Delphi Panels is a manual for doing Delphi research which provides guidance for doing research and offers a appraisal tool.This manual gives guidance on best practices that will help to avoid, or mitigate, potential drawbacks of Delphi Method Research; it also helps to understand the confidence that can be given to study results.
It must also be realized that in areas such as science and technology forecasting, the degree of uncertainty is so great that exact and always correct predictions are impossible, so a high degree of error is to be expected. An important challenge for the method is ensuring sufficiently knowledgeable panelists. If panelists are misinformed about a topic, the use of Delphi may only add confidence to their ignorance.
One of the initial problems of the method was its inability to make complex forecasts with multiple factors. Potential future outcomes were usually considered as if they had no effect on each other. Later on, several extensions to the Delphi method were developed to address this problem, such as cross impact analysis, that takes into consideration the possibility that the occurrence of one event may change probabilities of other events covered in the survey. Still the Delphi method can be used most successfully in forecasting single scalar indicators.
Delphi vs. prediction markets
Delphi has characteristics similar to prediction markets as both are structured approaches that aggregate diverse opinions from groups. Yet, there are differences that may be decisive for their relative applicability for different problems.
Some advantages of prediction markets derive from the possibility to provide incentives for participation.
They can motivate people to participate over a long period of time and to reveal their true beliefs.
They aggregate information automatically and instantly incorporate new information in the forecast.
Participants do not have to be selected and recruited manually by a facilitator. They themselves decide whether to participate if they think their private information is not yet incorporated in the forecast.
Delphi seems to have these advantages over prediction markets:
Participants reveal their reasoning
It is easier to maintain confidentiality
Potentially quicker forecasts if experts are readily available.
Delphi is applicable in situations where the bets involved might affect the value of the currency used in bets (e.g. a bet on the collapse of the dollar made in dollars might have distorted odds).
More recent research has also focused on combining both, the Delphi technique and prediction markets. More specifically, in a research study at Deutsche Börse elements of the Delphi method had been integrated into a prediction market.
See also
Computer supported brainstorming
DARPA's Policy Analysis Market
Horizon scanning
Nominal group technique
Planning poker
Reference class forecasting
Wideband delphi
The Wisdom of Crowds
References
Further reading
This article provides a detailed description of the use of modified Delphi for qualitative, participatory action research.
A cross-validation study replicating one completed in the Netherlands and Belgium, and exploring US experts' views on the diagnosis and treatment of older adults with personality disorders.
External links
RAND publications on the Delphi Method Downloadable documents from RAND concerning applications of the Delphi Technique.
Estimation methods
Forecasting
Systems thinking
Futures techniques | 0.761412 | 0.996744 | 0.758933 |
Supportive housing | Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance use disorders (including alcoholism), mental health, HIV/AIDS, chronic illness, diverse disabilities (e.g., intellectual disabilities, mobility or sensory impairments) or other serious challenges to stable housing.
Supportive housing in rehabilitation
Supportive housing can be coupled with such social services as job training, life skills training, alcohol and substance use disorder treatment, community support services (e.g., child care, educational programs, coffee klatches), and case management to populations in need of assistance. Supportive housing is intended to be a pragmatic solution that helps people have better lives while reducing, to the extent feasible, the overall cost of care. As community housing, supportive housing can be developed as mixed income, scattered site housing not only through the traditional route of low income and building complexes.
Supportive housing has been widely researched in the field of psychiatric disabilities and psychiatric rehabilitation, based in part on housing and support principles from studies of leading community integration organizations nationally. In addition, supportive housing has been tied to national initiatives in supportive living (usually developmental and intellectual disabilities) to cross-disability transfer and to national and international efforts on developing homes of one's own. Supported housing in the field of mental health is considered to be a critical component of a community support system which may involve supported education, supported or transitional employment, case management services, clubhouses, supported recreation and involvement of family and friends often translated into psycho-educational programs.
From 2002 to 2007, an estimated 65,000 to 72,000 units of supportive housing were created in the United States. This represents about half the supply of supported housing units. Of the new units added, about half were targeted towards chronically homeless individuals, and one-fifth were for homeless families. According to the United States Department of Housing and Urban Development (HUD), the number of Permanent Supportive Housing beds in the US increased from 188,636 to 353,800 between 2007 and 2017. Although of the shelter population, the majority remain as single, adult males of minority groups (approximately 65%), 38% were between 31 and 50 years old, and 38% had a disability; the rest were homeless families with a high concentration (likely due to high housing costs) in the states of California, New York and Florida.
Populations served
Sponsors of supportive housing projects generally aim to serve a specific population; the characteristics of those served and the housing program range widely: However, supporters of regular housing and support services in the community suggest choice based on other personal, social, and situational factors than specific population basis (e.g., choice of roommates or housemates, neighborhoods they live in).
Today, important new populations for supported housing in regular neighborhoods include working families, especially those with high proportional housing costs, older adults who need intensive (enriched) services to avoid nursing home placements, and people who need places to live due to the closure of the old style, institutional psychiatric care. Increasingly, supportive housing may be required as unemployment increases, for newly emerging groups such as newly legalized gay and lesbian partners, multi-generational immigrant groups in the new multicultural world, and for those adolescents aging out of their parents' homes to new community options. One of the 2000s textbooks on Supported/supportive Housing is a report on state projects in the US for older adults which includes use of the home and community-based (HCBS) waiver, efforts to reform more than 43 congregate residential categories in states, use of housing subsidies for low income persons, assisted living options, "comprehensive case/care management", and technical area such as "at-risk" housing and non-profit development.
Benefits of supportive housing for specific populations groups
Supportive housing proposes to be a comprehensive solution to a problem rather than a band-aid fix (such as a shelter). While many of those who stay in the shelter system remain in or return to the system for extended periods of time, a much higher percentage of those who are placed in supportive housing remain housed on a more permanent basis. This idea is also referred to as the Housing First model, an approach to combating chronic homelessness by providing homes upfront and offering help for illnesses and addictions. The concept turns the traditional model, which typically requires sobriety (or prerequisites that can be used for enhanced services before a person can get housing), upside down.
Research has shown that coupling permanent housing with supportive services is highly effective at maintaining housing stability, as well as helps improve health outcomes and decreases the use of publicly funded institutions. A review of the impact of these services found that they can improve health outcomes among chronically homeless individuals, including positive changes in self-reported mental health status, substance use, and overall well-being. In the Collaborative Initiative to Help End Chronic Homelessness (CICH), participants who had been homeless for an average of eight years were immediately placed into permanent housing. The CICH evaluation reported that 95% of those individuals were in independent housing after 12 months. A study of homeless people in New York City with serious mental illness found that providing supportive housing to the individuals directly resulted in a 60% decrease in emergency shelter use for clients, as well as decreases in the use of public medical and mental health services and city jails and state prisons. Another study in Seattle in 2009 found that moving "people with chronic alcoholism" into supportive housing resulted in a 33% decline in alcohol use for clients.
There is significant support for the contention that supportive housing also costs less than other systems where its tenant base may reside, such as jails, hospitals, mental health facilities, and even shelters. Research on the overall costs to the taxpayer of supportive housing has consistently found the costs to the taxpayer to be about the same or lower than the alternative of a chronically homeless person sleeping in a shelter. The CICH evaluation showed that average costs for healthcare and treatment were reduced by about half, which the largest decline associated with inpatient hospital care. The use of supportive housing has been shown to be cost-effective, resulting in reductions in the use of shelter, ambulance, police/jail, health care, emergency room, behavior health, and other service costs. For example, one 2016 report identified studies documenting that these services can reduce health care costs, emergency department visits, and length of stays in psychiatric hospitals. The Denver Housing First Collaborative documented that the annual cost of supportive housing for a chronically homeless individual was $13,400. However, the per-person reduction in public services recorded by the Denver Housing First Collaborative came to $15,773 per person per year, more than compensating for the annual supportive housing costs.
When paired with low-income housing (or mixed-income housing), government subsidies (such as section 8 or Housing choice vouchers) and other revenue generating operations, supportive housing residences are claimed by their supporters to be capable of supporting themselves and even turning a profit (which can be used for enhanced services and amenities for the residents by a non-profit organization). According to a 2007 study done by the National Alliance to End Homelessness, supportive housing helps tenants increase their incomes, work more, get arrested less, make more progress toward recovery, and become more active, valued and productive members of their communities.
Impact on neighborhoods
Supportive housing can help people facing health challenges to continue to live in the community. However, proposals for new housing projects often faced local opposition, largely based on fears regarding adverse effects on property values and crime rates, local businesses, and the quality of life in the surrounding neighborhood. A 2008 study in Toronto, Canada reported:
There is no evidence linking supportive housing to property values and crime rates
Supportive housing tenants contribute to local businesses
Neighbors do not think the supportive housing buildings have a negative impact
Positive contributions of supportive housing tenants to the community
One of the benefits of supportive housing which is integrated into the community is that local opposition and fears are minimized. Neighborhoods have been studied as part of the development of community support, and as places for the development of personal connections and neighborhood relations. In addition, a capacity-based approach to neighborhood development can be made integral to the development of supportive housing, including aspects of neighborhood asset building. In many ways, these projects can restore neighborhood-based control of services' planning. Examples include new housing developments, after-school programs, parent support groups, respite care and similar initiatives in the field of children's mental health.
Limitations, impediments and challenges affecting the development of Supportive Housing
Financial feasibility
Some projects fail to materialize because of a real or perceived lack of government program funds, charitable grants, bank loans or a combination of such funding to pay for the cost of creating and operating financially viable supportive housing. Other organizations, however, have accessed diverse mix and match funding for highly visible community demonstrations for special population groups.
Early directions for financing of housing and support services in the community included financing sources, such as housing cooperative programs, mixed income housing associations, community development block grants, loans for accessibility programs, tax exempt bonds, trust funds, housing subsidies, and low interest loans. The housing communities and institutes in the US, as early as the early 1980s, included Institute for Community Economics, McAuley Institute, Women's Institute for Housing and Economic Development, Habitat for Humanity, the Housing Technical Assistance Project of the ARCs, Local Support Corporation (LISC), University of Vermont (Center for Community Change through Housing and Support), Creative Management Associates, Enterprise Foundation, and National Housing Coalition.
The US Department of Housing and Urban Development regularly makes available free information on housing financing and developments in the US through their website, including "Research Works" (in 2011, also on sustainability and green initiatives) and "US Housing Market Conditions". Specific technical resources are available to providers and researchers such as on Section 8 or housing vouchers (portable vouchers).
Government policies and plans
Where traditional solutions—institutions, charitable organizations or other methods—are recognized as inadequate solutions for the situation, national, regional and local officials have come to believe that homelessness is a problem that can and should be solved by other means. In some areas, this produced a movement to find alternative solutions rather than continuing to fund the traditional solutions, including shelter system, jails, asylums and hospitals. In addition to homelessness, the movement today is to downsize or close psychiatric centers (e.g., Olmstead initiative).
In the US, hundreds of city governments have produced "10-year plans" that provide for supportive housing to end chronic homelessness because the Bush administration began pushing for creation of the plans in 2003. The goal: put the homeless people with complex situations and needs into permanent or transitional "supportive" housing with counseling services that help them get healthy lifestyles of their own choosing. The evidence shows supportive housing may be a viable solution: the number of street people in cities across the United States has plummeted for the first time since the 1980s. In 2005–2006, Miami, Florida reported a 20% decline in homeless populations and dozens of other US cities reported similar census results: San Francisco, CA (30%), Portland, OR (20%), Dallas, TX (28%), New York, NY (13%).
Guided by research, Congress has taken several steps to encourage the development of permanent supportive housing. Beginning in the late 1990s, appropriations bills have increased funding for the United States Department of Housing and Urban Development's homeless assistance programs and targeted at least 30 percent of funding to permanent supportive housing. Congress has also provided funding to ensure that permanent supportive housing funded by one of the United States Department of Housing and Urban Development programs (Shelter Plus Care) would be renewed non-competitively, helping to ensure that chronically homeless people could remain in their housing. The 2009 legislative mandate from the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act created bipartisan political support to adopt a collaborative approach to end homelessness. From this effort spawned the United States Interagency Council on Homelessness's Opening Doors Strategic Plan to Prevent and End Homelessness in 2010. With a focus on permanent supportive housing as a means of ending chronic homelessness, the plan outlines an interagency effort aligning mainstream housing, health, education, and human services.
Lack of expertise in development and operations
One impediment to the development of additional housing stock where it is otherwise needed, permissible and feasible is the lack of real estate acquisition, development & financing expertise in the government agencies and non-profit (non-governmental) organizations interested in serving those who need and want supportive housing. The United States Department of Housing and Urban Development is trying to bridge that information and knowledge gap with the availability of regular reports on market and housing conditions throughout the nation, and statistics on all kinds of housing developments (e.g., home ownership, multifamily structures).
In addition, there is a widening affordability gap in housing, especially with the lowest income households. Experts point to several factors contributing to this gap: erosion in the housing stock, high housing prices, a drop in real wages, a decline in middle wage jobs, increases in transportation costs, expensive development requirements, regulatory constraints, and insufficient housing assistance funds to meet the needs.
Economic impact on society
Studies cited by supporters (who represent the advocacy and provider sectors listed below) conclude that supportive housing is a cost-effective solution for the problems of several populations; it is substantially less costly than most alternatives used to address the problems of homeless people, including shelters, institutions and hospitals. Current arguments are that supportive housing often reduces the cost of emergency services for health care provided by governmental and non-profit agencies. The chronically homeless, the 10-20% who are continually on the street with addiction and mental problems impose heavy costs on their communities in hospital, jail and other services—hundreds of thousands of dollars apiece annually in some instances.
For example, the average daily cost to house a person in various institutional settings in New York City (2004)
Supportive housing $41.85
Shelter $54.42
Prison $74.00
Jail $164.57
Psychiatric hospital $467
Hospital $1185
Per a study published in JAMA in 2009, a supportive housing development called 1811 Eastlake saved taxpayers $4 million in the first year of operation alone, because these residents are now off the streets and out of emergency rooms and in a safe, steady and supportive living environment. The 1811 Eastlake study compared 95 Housing First participants, with 39 wait-list control members and found cost reductions of over 50 percent for the Housing First group. While it is not the first published evidence of the service use reductions and cost savings that permanent supportive housing interventions can provide, it is worth highlighting because the level of the cost savings – almost $30,000 per person per year after accounting for housing program costs – are greater than some seminal studies that have shown more modest cost offsets through permanent supportive housing. 1811 Eastlake provided assistance to homeless people with extensive health issues and still saw a savings of nearly $30,000 per tenant per year in publicly funded services, all while achieving improved housing and health outcomes.
However, supportive housing, especially as assisted living, may be congregate in nature either related to hospital and nursing home systems reform on one hand (e.g., Pynoos et al., 2004), or in psychiatric, to its categorical disability service system with roots in community services systems and psychiatric hospitals. In the field of intellectual disabilities, the term supportive living is more common with , small size homes and apartments with choice options throughout local communities.
From supported housing to housing and support
The US has experienced an effort to move from facility-based services to more of a housing and support approach in regular homes in typical neighborhoods. This movement, involving state-federal and university collaboration, has involved the development of principles of housing and support which could apply across different disability groups interested in moving from the facility-based (bundled program) approach to housing and support. These principles are:
Housing for all.
Integrated housing.
Choice.
Supports based on the individual.
Separation of housing and support. Supported housing, in particular, involves moving from traditional residential models in mental health community services (e.g., halfway houses and group homes, transitional residences/apartment programs, Fairweather Lodges) to the newer community support approaches which allow greater choice and flexibility in roommates, homes, and neighborhoods. In particular, this period supported consumer housing preferences to form the basis for better quality housing and recognition of consumer choice. However, the primary concern remained the requirements of residential providers (no zero reject policy, this field), especially when addictions were identified as the primary concern for a few people/residents.
Supportive housing, in addition to quality assurance procedures, are meant to ensure quality of care and quality of life; Sheehan and Oakes (2004) indicate that residents may be reluctant to complain on satisfaction surveys since they may be relocated to even stricter nursing facilities. However, these projects have included Real Systems Change Grants to enhance opportunities for independent living for people with disabilities and to assist 3 communities (in Connecticut) to become models of inclusion of people with disabilities and to transition from the nursing facilities. Supported housing (which is the first community living to involve housing, though NGO purchasing and leasing of community homes preceded this development) now is in its 4th decade in the university-governmental and community sectors, and was also succeeded by models of housing and health from the traditional medical sectors.
Supportive housing providers
The United States Department of Housing and Urban Development supports plans for the development or redevelopment of communities ("planned communities", US Congress) in 2019 and the development of "large scale housing and mixed use developments" (e.g., mixed income housing projects such as through the Madison Mutual Housing Association and Cooperatives; housing-business-transportation-recreation-schools projects), including on Indian reservations and land in the US.
Supported/supportive housing governmental assistance
US Department of Housing and Urban Development – USA
Crisis – UK
Supportive housing program, Winnipeg, Manitoba, Canada
Supported housing, state of New York
See also
Permanent Supportive Housing for Homeless People — Reframing the Debate
Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness
Permanent Supportive Housing: Addressing Homelessness and Health Disparities?
Addressing Chronic Disease Within Supportive Housing Programs
Detroit’s focus on supportive housing drives down homelessness 15 percent
References
Further reading
AcademyHealth. (2016, July). Rapid Evidence Review: What Housing-related Services and Supports Improve Health Outcomes among Chronically Homeless Individuals?.
Bassuk, Ellen L.; Geller, Stephanie, The Role of Housing and Services in Ending Family Homelessness (2006). Housing Policy Debate 17(4): 781–806.
Braisby, D., Echlin, R., Hill, S. & Smith, H. (1984). Changing Futures: Housing and Support Services for People Discharged from Psychiatric Hospitals. London: King's Fund Project Paper.
Carling, P.J., Randolph, F.L., Blanch, A.K. & Ridgeway, P. (1988). A review of the research on housing and community integration for people with psychiatric disabilities. National Rehabilitation Information Center Quarterly, 1(3), 1–18.
Carling, P.J. (1993, May). Housing and supports for persons with mental illness: Emerging approaches to research and practice. Hospital and Community Psychiatry, 44(5): 439–449. PMID: 8509074; DOI: 10.1176/ps.44.5.439
Cuomo, A.M. (2014). HELP. All Things Possible: Setbacks and Successes in Politics and Life (pp. 80–136). NY, NY: Harper Collins Publishers. ;
Dilys Page. (1995, April). Whose services? Whose needs? Community Development Journal, 30(2), 217–235. DOI: 10.1093/cdj/30.2.217
Fitton, P. & Wilson, J. (1995). "A home of their own: Achieving supported housing". In: T. Philpot & L. Ward (Eds.), Changing Ideas and Services for People with Learning Disabilities. (pp. 43–54). Oxford: Butterworth-Heinemann, Ltd. ;
Friedman, Donna Haig, et al., Preventing Homelessness and Promoting Housing Stability: A Comparative Analysis, The Boston Foundation, June 2007.
Knisley, M. B. & Fleming, M. (1993, May). Implementing supported housing in state and local mental health systems. Hospital and Community Psychiatry, 44(5),456–460. PMID: 8509076 l DOI: 10.1176/ps.44.5.456
Lakin, K. C. & Racino, J.A. (1990). Formation of the Rehabilitation Research and Training Centers on Families and Community Living in US Education. Washington, DC: University of Minnesota and Syracuse University in conjunction with the RRTCS of the USA.
Livingston, J. & Srebnik, D. (1991, November). States' strategies for promoting supported housing for persons with psychiatric disabilities. Hospital and Community Psychiatry, 42(11), 1116–1119. PMID: 1743638; DOI: 10.1176/ps.42.11.1116
McCarroll, Christina, "Pathways to housing the homeless", The Christian Science Monitor, May 1, 2002
O’Flaherty, Brendan, Making room : the economics of homelessness, Cambridge, Mass. : Harvard University Press, 1996. ;
Quigley, John M.; Raphael, Steven, The Economics of Homelessness: The Evidence from North America, European Journal of Housing Policy 1(3), 2001, 323–336.
O'Hara, A. & Day, S. (2001, December). Olmstead and Supportive Housing: A Vision for the Future. Washington, DC: Center for Health Care Strategies and the Technical Assistance Collaborative.
Pynoos, J., Hollander-Feldman, P., & Ahrens, J. (2004). Linking Housing and Services for Older Adults: Obstacles, Options, and Opportunities. NY, NY: The Haworth Press. ;
Racino, J. A. (1989, August). Selected Issues in Housing. Prepared for US conference distribution, Rehabilitation Research and Training Center on Community Integration, Syracuse University, Center on Human Policy.
Racino, J. (1999). "State policy in housing and support: Evaluation and policy analysis of state systems". In: Policy, Program Evaluation and Research in Disability: Community Support for All. (pp. 263–287). London: Haworth Press. ;
Racino, J. (2014). "Housing and disability: Toward inclusive, equitable, and sustainable housing and communities". Public Administration and Disability: Community Services Administration in the US. NY, NY: CRC Press, Francis and Taylor. ;
Ridgeway, P. & Zipple, A.M.(1990, April). "The paradigm shift in residential services: From the linear continuum to supported housing approaches." Special Issue: Supported Housing: New approaches to residential services. Psychosocial Rehabilitation. Boston, MA: Center for Psychiatric Rehabilitation, Sargent College of Allied Health Professions, Boston University. DOI: 10.1037/h0099479
Rogers, E.S., Farkas, M., Anthony, W., Kash, M., Harding, C., & Olschewski, A. (2009). Systematic Review of Supported Housing Literature 1993–2008. Boston, MA: Boston University Center for Psychiatric Rehabilitation.
Roncarati, Jill, Homeless, housed, and homeless again, Journal of the American Academy of Physician's Assistants (authorized for involuntary care by psychiatrists; active legal cases), June 2008. PMID: 18619107; DOI: 10.1097/01720610-200806000-00090
Sheehan, N. & Oakes, C. (2004). "Public policy initiatives addressing supportive housing: The experience of Connecticut". In: Pynoos, J., Holander-Feldman, P. & Ahrens, J. (Eds.), Linking Housing and Services for Older Adults: Obstacles, Options, and Opportunities. pp. 81–113). New York: Haworth Press. ;
Surles, R.C. (1989). Supported Housing Implementation: A Report to the New York State Legislature. Albany, NY: New York State Office of Mental Health.
Taylor, S.J. (1987). A Policy Analysis of the Supported Housing Demonstration Project: Pittsburgh, PA. Syracuse, NY: Syracuse University, Center on Human Policy, Community Integration Project.
US Housing and Urban Development. (2010, July). Homeless Costs and Interventions: A Portrait of Homelessness in 2009; Low Income Housing Tax Credits' Boost Affordable Rental Housing Supplies; Snapshot of Worst Case Housing Needs in the US. "Research Works." Washington, DC.
External links
Corporation for Supportive Housing
Supportive Housing Network of New York
The Supportive Housing Providers Association (SHPA)
Child Welfare & Supportive Housing Resource Center
Homelessness solutions
Deinstitutionalisation
Public housing
Living arrangements
Social care in the United States
Housing in the United States | 0.771365 | 0.983855 | 0.758911 |
Social skills | A social skill is any competence facilitating interaction and communication with others where social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning these skills is called socialization. Lack of such skills can cause social awkwardness.
Interpersonal skills are actions used to effectively interact with others. Interpersonal skills relate to categories of dominance vs. submission, love vs. hate, affiliation vs. aggression, and control vs. autonomy (Leary, 1957). Positive interpersonal skills include persuasion, active listening, delegation, and stewardship, among others. Social psychology, an academic discipline focused on research relating to social functioning, studies how interpersonal skills are learned through societal-based changes in attitude, thinking, and behavior.
Enumeration and categorization
Social skills are the tools that enable people to communicate, learn, ask for help, get needs met in appropriate ways, get along with others, make friends, develop healthy relationships, protect themselves, and in general, be able to interact with the society harmoniously. Social skills build essential character traits like trustworthiness, respectfulness, responsibility, fairness, caring, and citizenship. These traits help build an internal moral compass, allowing individuals to make good choices in thinking and behavior, resulting in social competence.
The important social skills identified by the Employment and Training Administration are:
Coordination – Adjusting actions in relation to others' actions.
Mentoring – Teaching and helping others learn how to do something (e.g. being a study partner).
Negotiation – Discussion aimed at reaching an agreement.
Persuasion – The action or fact of persuading someone or of being persuaded to do or believe something.
Service orientation – Actively looking for ways to evolve compassionately and grow psycho-socially with people.
Social perceptiveness – Being aware of others' reactions and able to respond in an understanding manner.
Social skills are goal oriented with both main goals and sub-goals. For example, a workplace interaction initiated by a new employee with a senior employee will first contain a main goal. This will be to gather information, and then the sub-goal will be to establish a rapport in order to obtain the main goal. Takeo Doi in his study of consciousness distinguished this as tatemae, meaning conventions and verbal expressions and honne, meaning true motive behind the conventions.
Causes of deficits
Deficits in social skills were categorized by Gresham in 1998, as failure to recognize and reflect social skills, a failure to model appropriate models, and failure to perform acceptable behavior in particular situations in relation to developmental and transitional stages. Social skill deficits are also a discouragement for children with behavioral challenges when it comes to adult adjustment.
Alcohol misuse
Social skills are often significantly impaired in people suffering from alcoholism. This is due to the neurotoxic long-term effects of alcohol misuse on the brain, especially the prefrontal cortex area of the brain. The social skills that are typically impaired by alcohol abuse, include impairments in perceiving facial emotions, prosody perception problems, and theory of mind deficits. The ability to understand humor is also often impaired in alcohol abusers. Impairments in social skills can also occur in individuals who have fetal alcohol spectrum disorders. These deficits persist throughout the affected people's lives, and may worsen over time due to the effects of aging on the brain.
ADHD and hyperkinetic disorder
People with ADHD and hyperkinetic disorder often have difficulties with social skills, such as social interaction. Approximately half of children and adolescents with ADHD will experience peer rejection, compared to 10–15 percent of non-ADHD youth. Adolescents with ADHD are less likely to develop close friendships and romantic relationships; they are usually regarded by their peers as immature or as social outcasts, with an exception for peers that have ADHD or related conditions themselves, or a high level of tolerance for such symptoms. As they begin to mature, however, it becomes easier to make such relationships. Training in social skills, behavioral modification, and medication have some beneficial effects. It is important for youth with ADHD to form friendships with people who are not involved in deviant or delinquent activities, people who do not have significant mental illnesses or developmental disabilities, in order to reduce emergence of later psychopathology. Poor peer relationships can contribute to major depression, criminality, school failure, and substance use disorders.
Autistic spectrum disorders
Individuals with autistic spectrum disorders including autism and Asperger syndrome are often characterized by their deficiency in social functioning. The concept of social skills has been questioned in terms of the autistic spectrum. In response to the needs of autistic children, Romanczyk has suggested adapting a comprehensive model of social acquisitions with behavioral modification rather than specific responses tailored for social contexts.
Anxiety and depression
Individuals with few opportunities to socialize with others often struggle with social skills. This can often create a downward spiral effect for people with mental illnesses like anxiety or depression. Due to anxiety experienced from concerns with interpersonal evaluation and fear of negative reaction by others, surfeit expectations of failure or social rejection in socialization leads to avoiding or shutting down from social interactions. Individuals who experience significant levels of social anxiety often struggle when communicating with others, and may have impaired abilities to demonstrate social cues and behaviors appropriately.
The use of social media can also cause anxiety and depression. The Internet is causing many problems, according to a study with a sample size of 3,560 students. Problematic internet use may be present in about 4% of high school students in the United States, it may be associated with depression. About one fourth of respondents (28.51%) reported spending fifteen or more hours per week on the internet. Although other studies show positive effects from internet use.
Depression can also cause people to avoid opportunities to socialize, which impairs their social skills, and makes socialization unattractive.
Anti-social behaviors
The authors of the book Snakes in Suits: When Psychopaths Go to Work explore psychopathy in workplace. The FBI consultants describe a five phase model of how a typical psychopath climbs to and maintains power. Many traits exhibited by these individuals include: superficial charm, insincerity, egocentricity, manipulativeness, grandiosity, lack of empathy, low agreeableness, exploitativeness, independence, rigidity, stubbornness and dictatorial tendencies. Babiak and Hare say for corporate psychopaths, success is defined as the best revenge and their problem behaviors are repeated "ad infinitum" due to little insight and their proto-emotions such as "anger, frustration, and rage" are refracted as irresistible charm. The authors note that lack of emotional literacy and moral conscience is often confused with toughness, the ability to make hard decisions, and effective crisis management. Babiak and Hare also emphasizes a reality they identified with psychopaths from studies that psychopaths are not able to be influenced by any sort of therapy.
At the University at Buffalo in New York, Emily Grijalva has investigated narcissism in business; she found there are two forms of narcissism: "vulnerable" and "grandiose". It is her finding that "moderate" level of grandiose narcissism is linked to becoming an effective manager. Grandiose narcissists are characterized as confident; they possess unshakable belief that they are superior, even when it is unwarranted. They can be charming, pompous show-offs, and can also be selfish, exploitative and entitled. Jens Lange and Jan Crusius at the University of Cologne, Germany associates "malicious-benign" envy within narcissistic social climbers in workplace. It is their finding that grandiose narcissists are less prone to low self-esteem and neuroticism and are less susceptible to the anxiety and depression that can affect vulnerable narcissists when coupled with envy. They characterize vulnerable narcissists as those who "believe they are special, and want to be seen that way–but are just not that competent, or charming." As a result, their self-esteem fluctuates a lot. They tend to be self-conscious and passive, but also prone to outbursts of potentially violent aggression if their inflated self-image is threatened." Richard Boyatzis says this is an unproductive form of expression of emotions that the person cannot share constructively, which reflects lack of appropriate skills. Eddie Brummelman, a social and behavioral scientist at the University of Amsterdam in the Netherlands and Brad Bushman at Ohio State University in Columbus says studies show that in western culture narcissism is on the rise from shifting focus on the self rather than on relationships and concludes all narcissism to be socially undesirable ("unhealthy feelings of superiority"). David Kealy at the University of British Columbia in Canada states that narcissism might aid temporarily but in the long run it is better to be true to oneself, have personal integrity, and be kind to others.
Management
Behavioral therapy
Behaviorism interprets social skills as learned behaviors that function to facilitate social reinforcement. According to Schneider & Byrne (1985), operant conditioning procedures for training social skills had the largest effect size, followed by modeling, coaching, and social cognitive techniques. Behavior analysts prefer to use the term behavioral skills to social skills. Behavioral skills training to build social and other skills is used with a variety of populations including in packages to treat addictions as in the community reinforcement approach and family training (CRAFT).
Behavioral skills training is also used for people with borderline personality disorder,
depression, and developmental disabilities. Typically, behaviorists try to develop what are considered cusp skills, which are critical skills to open access to a variety of environments. The rationale for this type of approach to treatment is that people meet a variety of social problems and can reduce the stress and punishment from the encounter in a safe environment. It also addresses how they can increase reinforcement by having the correct skills.
See also
References
External links
National Association of School Psychologists on Social Skills
Group processes
Human communication
Zoosemiotics
Behaviorism
Life skills | 0.761322 | 0.996823 | 0.758904 |
The Body Keeps the Score | The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma is a 2014 book by Bessel van der Kolk about the purported effects of psychological trauma. The book describes van der Kolk's research and experiences on how people are affected by traumatic stress, including its effects on the mind and body.
Scientists have criticized the book for promoting pseudoscientific claims about trauma, memory, brains, and development.
The Body Keeps the Score has been published in 36 languages. As of July 2021, it had spent more than 141 weeks on the New York Times Bestseller List for nonfiction, 27 of them in the No. 1 position.
Publication history
The book is based on van der Kolk’s 1994 Harvard Review of Psychiatry article "The body keeps the score: memory and the evolving psychobiology of posttraumatic stress".
Overview
In the book, van der Kolk focuses on the central role of the attachment system and social environment to protect against developing trauma related disorders. Where trauma does occur, he discusses the effects and possible forms of healing, including a large variety of interventions to recover from the impacts of traumatic experiences. These include EMDR (eye movement desensitization and reprocessing), yoga, and limbic system therapy.
Reception
The Body Keeps the Score was well-received, including a starred review from Library Journal. Reviewing the book for New Scientist magazine, Shaoni Bhattacharya wrote that "[p]acked with science and human stories, the book is an intense read that can get technical. Stay with it, though: van der Kolk has a lot to say, and the struggle and resilience of his patients is very moving."
In 2019, The Body Keeps the Score was ranked second in the science category of The New York Times Best Seller list. As of July 2021, the book had spent more than 141 weeks on the New York Times Bestseller List for nonfiction, with 27 of those weeks spent in the No. 1 position.
By the end of October 2023, The Body Keeps the Score had spent 153 weeks (nearly 3 years) on Amazon’s bestseller list.
In his 2005 Canadian Journal of Psychiatry article psychologist Richard McNally described the reasoning of Kolk's 1994 article "The Body Keeps the Score" as "mistaken", his theory as "plague[d]" by "[c]onceptual and empirical problems", and the therapeutic approach inspired by it as "arguably the most serious catastrophe to strike the mental health field since the lobotomy era". McNally's 2003 book Remembering Trauma gave a detailed critique (pp. 177-82) of Kolk's article, concluding Kolk's theory was one "in search of a phenomenon".
The book received a negative review in the Washington Post in 2023 for promoting "uncertain science".
A 2023 editorial published in Research on Social Work Practice criticized the book for promoting treatments that have limited to no evidence. It states that van der Kolk and Levine "regularly ignore, misrepresent, and sometimes veer into or close to pseudoscience when it comes to the scientific knowledge base of PTSD treatment".
A 2024 FT article said "In recent years, his 2014 masterwork The Body Keeps the Score has become an improbable sensation. Buoyed by a groundswell of popular interest in trauma and psychology in the wake of the pandemic, the dense, scientifically rigorous text has become a latent, runaway success, spending nearly 300 weeks on the New York Times bestseller list."
References
2014 non-fiction books
Books about mental health
Books about post-traumatic stress disorder
Viking Press books
Books about trauma | 0.760566 | 0.997802 | 0.758894 |
Bromism | Bromism is the syndrome which results from the long-term consumption of bromine, usually through bromine-based sedatives such as potassium bromide and lithium bromide. Bromism was once a very common disorder, being responsible for 5 to 10% of psychiatric hospital admissions, but is now uncommon since bromide was withdrawn from clinical use in many countries and was severely restricted in others.
Presentation
Neurological and psychiatric
Neurological and psychiatric symptoms are widely variable. Common symptoms may include restlessness, irritability, ataxia, confusion, hallucinations, psychosis, weakness, stupor, and, in severe cases, coma.
Gastrointestinal
Gastrointestinal effects include nausea and vomiting as acute adverse effects. Chronic exposure may lead to anorexia or constipation.
Dermatological
Dermatological effects include cherry angiomas, acneiform, and pustular and erythematous rashes.
Cause
High levels of bromide chronically impair the membrane of neurons, which progressively impairs neuronal transmission, leading to toxicity, known as bromism. Bromide has an elimination half-life of 9 to 12 days, which can lead to excessive accumulation. Doses of 0.5 to 1 gram per day of bromide can lead to bromism. Historically, the therapeutic dose of bromide is about 3 to 5 grams of bromide, thus explaining why chronic toxicity (bromism) was once so common. While significant and sometimes serious disturbances occur to neurologic, psychiatric, dermatological, and gastrointestinal functions, death is rare from bromism.
Bromism is caused by a neurotoxic effect on the brain which results in somnolence, psychosis, seizures, and delirium. Bromism has also been caused by excessive consumption of soda that contains brominated vegetable oil, leading to headache, fatigue, ataxia, memory loss, and potentially inability to walk as observed in one case.
Diagnosis
Bromism is diagnosed by checking the serum chloride level, electrolytes, glucose, BUN and creatinine, as well as symptoms such as psychosis. Bromine is also radiopaque, so an abdominal X-ray may also help in the diagnosis.
Treatment
There are no specific antidotes or protocols for bromide poisoning of the body. Increased intake of regular salt and water, which increases the flow of the related chloride ion through the body, is one way of flushing out the bromide. Furosemide may help aid urinary excretion in individuals with renal impairment or where bromide toxicity is severe. In one case, hemodialysis was used to reduce bromide's half-life to 1.38h, dramatically improving the patient's condition.
Iodine deficiency is also linked to weaker (less detectable) forms of bromism. Iodine and bromine are closely related to each other in behavior (and location on the periodic table) and high levels of bromine will displace iodine in tissues and blood when there is an opportunity to do so. Supplementary intake of iodine should be preceded by a salt loading protocol, or consumption of dietary sulfur beforehand.
References
External links
Neurological disorders
Substance-related disorders
Syndromes affecting the gastrointestinal tract
Syndromes affecting the nervous system
Syndromes affecting the skin
Toxic effects of dietary elements | 0.766056 | 0.990642 | 0.758888 |
Teratology | Teratology is the study of abnormalities of physiological development in organisms during their life span. It is a sub-discipline in medical genetics which focuses on the classification of congenital abnormalities in dysmorphology caused by teratogens. Teratogens are substances that may cause non-heritable birth defects via a toxic effect on an embryo or fetus. Defects include malformations, disruptions, deformations, and dysplasia that may cause stunted growth, delayed mental development, or other congenital disorders that lack structural malformations. The related term developmental toxicity includes all manifestations of abnormal development that are caused by environmental insult. The extent to which teratogens will impact an embryo is dependent on several factors, such as how long the embryo has been exposed, the stage of development the embryo was in when exposed, the genetic makeup of the embryo, and the transfer rate of the teratogen.
Etymology
The term was borrowed in 1842 from the French , where it was formed in 1830 from the Greek (word stem ), meaning "sign sent by the gods, portent, marvel, monster", and (-ology), used to designate a discourse, treaty, science, theory, or study of some topic.
Old literature referred to abnormalities of all kinds under the Latin term Lusus naturae (lit. "freak of nature"). As early as the 17th century, Teratology referred to a discourse on prodigies and marvels of anything so extraordinary as to seem abnormal. In the 19th century, it acquired a meaning more closely related to biological deformities, mostly in the field of botany. Currently, its most instrumental meaning is that of the medical study of teratogenesis, congenital malformations or individuals with significant malformations. Historically, people have used many pejorative terms to describe/label cases of significant physical malformations. In the 1960s, David W. Smith of the University of Washington Medical School (one of the researchers who became known in 1973 for the discovery of fetal alcohol syndrome), popularized the term teratology. With the growth of understanding of the origins of birth defects, the field of teratology overlaps with other fields of science, including developmental biology, embryology, and genetics.
Until the 1940s, teratologists regarded birth defects as primarily hereditary. In 1941, the first well-documented cases of environmental agents being the cause of severe birth defects were reported.
Teratogenesis
Wilson's principles
In 1959 and in his 1973 monograph Environment and Birth Defects, embryologist James Wilson put forth six principles of teratogenesis to guide the study and understanding of teratogenic agents and their effects on developing organisms. These principles were derived from and expanded on by those laid forth by zoologist Camille Dareste in the late 1800s:
Susceptibility to teratogenesis depends on the genotype of the conceptus and the manner in which this interacts with adverse environmental factors.
Susceptibility to teratogenesis varies with the developmental stage at the time of exposure to an adverse influence. There are critical periods of susceptibility to agents and organ systems affected by these agents.
Teratogenic agents act in specific ways on developing cells and tissues to initiate sequences of abnormal developmental events.
The access of adverse influences to developing tissues depends on the nature of the influence. Several factors affect the ability of a teratogen to contact a developing conceptus, such as the nature of the agent itself, route and degree of maternal exposure, rate of placental transfer and systemic absorption, and composition of the maternal and embryonic/fetal genotypes.
There are four manifestations of deviant development (death, malformation, growth retardation and functional defect).
Manifestations of deviant development increase in frequency and degree as dosage increases from the No Observable Adverse Effect Level (NOAEL) to a dose producing 100% lethality (LD100).
Research
Studies designed to test the teratogenic potential of environmental agents use animal model systems (e.g., rat, mouse, rabbit, dog, and monkey). Early teratologists exposed pregnant animals to environmental agents and observed the fetuses for gross visceral and skeletal abnormalities. While this is still part of the teratological evaluation procedures today, the field of Teratology is moving to a more molecular level, seeking the mechanism(s) of action by which these agents act. One example of this is the use of mammalian animal models to evaluate the molecular role of teratogens in the development of embryonic populations, such as the neural crest, which can lead to the development of neurocristopathies. Genetically modified mice are commonly used for this purpose. In addition, pregnancy registries are large, prospective studies that monitor exposures women receive during their pregnancies and record the outcome of their births. These studies provide information about possible risks of medications or other exposures in human pregnancies. Prenatal alcohol exposure (PAE) can produce craniofacial malformations, a phenotype that is visible in Fetal Alcohol Syndrome. Current evidence suggests that craniofacial malformations occur via: apoptosis of neural crest cells, interference with neural crest cell migration, as well as the disruption of sonic hedgehog (shh) signaling.
Understanding how a teratogen causes its effect is not only important in preventing congenital abnormalities but also has the potential for developing new therapeutic drugs safe for use with pregnant women.
Causes
Common causes of teratogenesis include:
Genetic disorders and chromosomal abnormalities
Maternal health factors
Nutrition during pregnancy (e.g., spina bifida resulting from folate deficiency)
Metabolic disorders such as diabetes and thyroid disease
Stress
Chemical agents
Prescription and recreational drugs (e.g., alcohol, thalidomide)
Environmental toxins and contaminants (e.g., heavy metals such as mercury and lead, polychlorinated biphenyls (PCBs))
Vertically transmitted infections such as rubella and syphilis
Ionizing radiation such as X-rays and that emitted from nuclear fallout
Temperatures outside the accepted range for a given organism
Human pregnancy
In humans, congenital disorders resulted in about 510,000 deaths globally in 2010.
About 3% of newborns have a "major physical anomaly", meaning a physical anomaly that has cosmetic or functional significance. Congenital disorders are responsible for 20% of infant deaths. The most common congenital diseases are heart defects, Down syndrome, and neural tube defects. Trisomy 21 is the most common type of Down Syndrome. About 95% of infants born with Down Syndrome have this disorder and it consists of 3 separate copies of chromosomes. Translocation Down syndrome is not as common, as only 3% of infants with Down Syndrome are diagnosed with this type. VSD, ventricular septal defect, is the most common type of heart defect in infants. If an infant has a large VSD it can result into heart failure. Infants with a smaller VSD have a 96% survival rate and those with a moderate VSD have about an 86% survival rate. Lastly, NTD, neural tube defect, is a defect that forms in the brain and spine during early development. If the spinal cord is exposed and touching the skin it can require surgery to prevent an infection.
Medicines
Acitretin
Acitretin is highly teratogenic and noted for the possibility of severe birth defects. It should not be used by pregnant women or women planning to get pregnant within 3 years following the use of acitretin. Sexually active women of childbearing age who use acitretin should also use at least two forms of birth control concurrently. Men and women who use it should not donate blood for three years after using it, because of the possibility that the blood might be used in a pregnant patient and cause birth defects. In addition, it may cause nausea, headache, itching, dry, red or flaky skin, dry or red eyes, dry or chapped lips, swollen lips, dry mouth, thirst, cystic acne or hair loss.
Etretinate
Etretinate (trade name Tegison) is a medication developed by Hoffmann–La Roche that was approved by the FDA in 1986 to treat severe psoriasis. It is a second-generation retinoid. It was subsequently removed from the Canadian market in 1996 and the United States market in 1998 due to the high risk of birth defects. It remains on the market in Japan as Tigason.
Vaccination
In humans, vaccination has become readily available, and is important for the prevention of various communicable diseases such as polio and rubella, among others. There has been no association between congenital malformations and vaccination — for example, a population-wide study in Finland in which expectant mothers received the oral polio vaccine found no difference in infant outcomes when compared with mothers from reference cohorts who had not received the vaccine.
However, on grounds of theoretical risk, it is still not recommended to vaccinate for polio while pregnant unless there is risk of infection.
An important exception to this relates to provision of the influenza vaccine while pregnant.
During the 1918 and 1957 influenza pandemics, mortality from influenza in pregnant women was 45%. In a 2005 study of vaccination during pregnancy, Munoz et al. demonstrated that there was no adverse outcome observed in the new infants or mothers, suggesting that the balance of risk between infection and vaccination favored preventative vaccination.
Reproductive hormones and hormone replacement therapy
There are a number of ways that a fetus can be affected in pregnancy, specifically due to exposure to various substances. There are a number of drugs that can do this, specifically drugs such as female reproductive hormones or hormone replacement drugs such as estrogen and progesterone that are not only essential for reproductive health, but also pose concerns when it comes to the synthetic alternatives to these. This can cause a multitude of congenital abnormalities and deformities, many of which can ultimately affect the fetus and even the mother's reproductive system in the long term. According to a study conducted from 2015 till 2018, it was found that there was an increased risk of both maternal and neonatal complications developing as a result of hormone replacement therapy cycles being conducted during pregnancy, especially in regards to hormones such as estrogen, testosterone and thyroid hormone. When hormones such as estrogen and testosterone are replaced, this can cause the fetus to become stunted in growth, born prematurely with a lower birth weight, develop mental retardation, while in turn causing the mother's ovarian reserve to be depleted while increasing ovarian follicular recruitment.
Withdrawn drugs
Thalidomide
Thalidomide was once prescribed therapeutically from the 1950s to early 1960s in Europe as an anti-nausea medication to alleviate morning sickness among pregnant women. While the exact mechanism of action of thalidomide is not known, it is thought to be related to inhibition of angiogenesis through interaction with the insulin like growth factor(IGF-1) and fibroblast like growth factor 2 (FGF-2) pathways. In the 1960s, it became apparent that thalidomide altered embryo development and led to limb deformities such as thumb absence, underdevelopment of entire limbs, or phocomelia. Thalidomide may have caused teratogenic effects in over 10,000 babies worldwide.
Recreational drugs
Alcohol
In the US, alcohol is subject to the FDA drug labeling Pregnancy Category X (Contraindicated in pregnancy). Alcohol is known to cause fetal alcohol spectrum disorder.
There are a wide range of affects that Prenatal Alcohol Exposure (PAE) can have on a developing fetus. Some of the most prominent possible outcomes include the development of Fetal Alcohol Syndrome, a reduction in brain volume, still births, spontaneous abortions, impairments of the nervous system, and much more. Fetal Alcohol Syndrome has numerous symptoms which may include cognitive impairments and impairment of the facial features. PAE remains the leading cause of birth defects and neurodevelopmental abnormalities in the United States, affecting 9.1 to 50 per 1000 live births in the U.S. and 68.0 to 89.2 per 1000 in populations with high levels of alcohol use.
Tobacco
Consuming tobacco products while pregnant or breastfeeding can have significant negative impacts on the health and development of the unborn child and newborn infant.
Lead exposure during pregnancy
Long before modern science, it was understood that heavy metals could cause negative effects to those who were exposed. The Greek physician Pedanius Dioscorides described the effects of lead exposure as something that "makes the mind give way." Lead exposure in adults can lead to cardiological, renal, reproductive, and cognitive issues that are often irreversible, however, lead exposure during pregnancy can be detrimental to the long-term health of the fetus. Exposure to lead during pregnancy is well known to have teratogenic effects on the development of a fetus. Specifically, fetal exposure to lead can cause cognitive impairment, premature births, unplanned abortions, ADHD, and much more. Lead exposure during the first trimester of pregnancy leads to the greatest predictability of cognitive development issues after birth.
Low socioeconomic status correlates to a higher probability of lead exposure. A well-known recent example of lead poisoning - and the impacts it can have on a community - was the 2014 water crisis in Flint, Michigan. Researchers have found that female fetuses developed at a higher rate than male fetuses in Flint when compared to surrounding areas. The higher rate of female births indicated a problem because male fetuses are more sensitive to pregnancy hazards than female fetuses.
Other animals
Fossil record
Evidence for congenital deformities found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. Fossils bearing evidence of congenital deformity are scientifically significant because they can help scientists infer the evolutionary history of life's developmental processes. For instance, because a Tyrannosaurus rex specimen has been discovered with a block vertebra, it means that vertebrae have been developing the same basic way since at least the most recent common ancestor of dinosaurs and mammals. Other notable fossil deformities include a hatchling specimen of the bird-like dinosaur, Troodon, the tip of whose jaw was twisted. Another notably deformed fossil was a specimen of the Choristodera Hyphalosaurus, which had two heads- the oldest known example of polycephaly.
Thalidomide and chick limb development
Thalidomide is a teratogen known to be significantly detrimental to organ and limb development during embryogenesis. It has been observed in chick embryos that exposure to thalidomide can induce limb outgrowth deformities, due to increased oxidative stress interfering with the Wnt signaling pathway, increasing apoptosis, and damaging immature blood vessels in developing limb buds.
Retinoic acid and mouse limb development
Retinoic acid (RA) is significant in embryonic development. It induces the function of limb patterning of a developing embryo in species such as mice and other vertebrate limbs. For example, during the process of regenerating a newt limb an increased amount of RA moves the limb more proximal to the distal blastoma and the extent of the proximalization of the limb increases with the amount of RA present during the regeneration process. A study looked at the RA activity intracellularly in mice in relation to human regulating CYP26 enzymes which play a critical role in metabolizing RA. This study also helps to reveal that RA is significant in various aspects of limb development in an embryo, however irregular control or excess amounts of RA can have teratogenic impacts causing malformations of limb development. They looked specifically at CYP26B1 which is highly expressed in regions of limb development in mice. The lack of CYP26B1 was shown to cause a spread of RA signal towards the distal section of the limb causing proximo-distal patterning irregularities of the limb. Not only did it show spreading of RA but a deficiency in the CYP26B1 also showed an induced apoptosis effect in the developing mouse limb but delayed chondrocyte maturation, which are cells that secrete a cartilage matrix which is significant for limb structure. They also looked at what happened to development of the limbs in wild type mice, that are mice with no CYP26B1 deficiencies, but which had an excess amount of RA present in the embryo. The results showed a similar impact to limb patterning if the mice did have the CYP26B1 deficiency meaning that there was still a proximal distal patterning deficiency observed when excess RA was present. This then concludes that RA plays the role of a morphogen to identify proximal distal patterning of limb development in mice embryos and that CYP26B1 is significant to prevent apoptosis of those limb tissues to further proper development of mice limbs in vivo.
Rat development and lead exposure
There has been evidence of teratogenic effects of lead in rats as well. An experiment was conducted where pregnant rats were given drinking water, before and during pregnancy, that contained lead. Many detrimental effects, and signs of teratogenesis were found, such as negative impacts on the formation of the cerebellum, fetal mortality, and developmental issues for various parts of the body.
Plants
In botany, teratology investigates the theoretical implications of abnormal specimens. For example, the discovery of abnormal flowers—for example, flowers with leaves instead of petals, or flowers with staminoid pistils—furnished important evidence for the "foliar theory", the theory that all flower parts are highly specialised leaves. In plants, such specimens are denoted as 'lusus naturae' ('sports of nature', abbreviated as 'lus.'); and occasionally as 'ter.', 'monst.', or 'monstr.'.
Types of deformations in plants
Plants can have mutations that leads to different types of deformations such as:
Fasciation: Development of the apex (growing tip) in a flat plane perpendicular to the axis of elongation
Variegation: Degeneration of genes, manifesting itself among other things by anomalous pigmentation
Virescence: Anomalous development of a green pigmentation in unexpected parts of the plant
Phyllody: Floral organs or fruits transformed into leaves
Witch's broom: Unusually high multiplication of branches in the upper part of the plant, mainly in a tree
Pelorism: Zygomorphic flower regress to their ancestral actinomorphic symmetry
Proliferation: Repetitive growth of an entire organ, such as a flower
See also
Carcinogen
Congenital abnormalities
Mutagen
Polydactyly
Retinoic acid
Teratoma
Thalidomide
References
Graham, Dr. Olga: (York University) AUTISM: THE TERATOGEN FALLOUT ISBN 978-0-9689383-1-7
External links
Society of Teratology
European Teratology Society
Organization of Teratology Information Specialists
March of Dimes Foundation
A Telling of Wonders: Teratology in Western Medicine through 1800 (New York Academy of Medicine Historical Collections)
The Reproductive Toxicology Center Database
Alcohol and health
Developmental biology
Radiation health effects
Substance-related disorders
Teratogens | 0.761703 | 0.996274 | 0.758864 |
Praxis (process) | Praxis is the process by which a theory, lesson, or skill is enacted, embodied, realized, applied, or put into practice. "Praxis" may also refer to the act of engaging, applying, exercising, realizing, or practising ideas. This has been a recurrent topic in the field of philosophy, discussed in the writings of Plato, Aristotle, St. Augustine, Francis Bacon, Immanuel Kant, Søren Kierkegaard, Ludwig von Mises, Karl Marx, Antonio Gramsci, Martin Heidegger, Hannah Arendt, Jean-Paul Sartre, Paulo Freire, Murray Rothbard, and many others. It has meaning in the political, educational, spiritual and medical realms.
Origins
The word praxis is from . In Ancient Greek the word praxis (πρᾶξις) referred to activity engaged in by free people. The philosopher Aristotle held that there were three basic activities of humans: theoria (thinking), poiesis (making), and praxis (doing). Corresponding to these activities were three types of knowledge: theoretical, the end goal being truth; poietical, the end goal being production; and practical, the end goal being action. Aristotle further divided the knowledge derived from praxis into ethics, economics, and politics. He also distinguished between eupraxia (εὐπραξία, "good praxis") and dyspraxia (δυσπραξία, "bad praxis, misfortune").
Marxism
Young Hegelian August Cieszkowski was one of the earliest philosophers to use the term praxis to mean "action oriented towards changing society" in his 1838 work Prolegomena zur Historiosophie (Prolegomena to a Historiosophy). Cieszkowski argued that while absolute truth had been achieved in the speculative philosophy of Hegel, the deep divisions and contradictions in man's consciousness could only be resolved through concrete practical activity that directly influences social life. Although there is no evidence that Karl Marx himself read this book, it may have had an indirect influence on his thought through the writings of his friend Moses Hess.
Marx uses the term "praxis" to refer to the free, universal, creative and self-creative activity through which man creates and changes his historical world and himself. Praxis is an activity unique to man, which distinguishes him from all other beings. The concept appears in two of Marx's early works: the Economic and Philosophical Manuscripts of 1844 and the Theses on Feuerbach (1845). In the former work, Marx contrasts the free, conscious productive activity of human beings with the unconscious, compulsive production of animals. He also affirms the primacy of praxis over theory, claiming that theoretical contradictions can only be resolved through practical activity. In the latter work, revolutionary practice is a central theme:
Marx here criticizes the materialist philosophy of Ludwig Feuerbach for envisaging objects in a contemplative way. Marx argues that perception is itself a component of man's practical relationship to the world. To understand the world does not mean considering it from the outside, judging it morally or explaining it scientifically. Society cannot be changed by reformers who understand its needs, only by the revolutionary praxis of the mass whose interest coincides with that of society as a whole—the proletariat. This will be an act of society understanding itself, in which the subject changes the object by the very fact of understanding it.
Seemingly inspired by the Theses, the nineteenth century socialist Antonio Labriola called Marxism the "philosophy of praxis". This description of Marxism would appear again in Antonio Gramsci's Prison Notebooks and the writings of the members of the Frankfurt School. Praxis is also an important theme for Marxist thinkers such as Georg Lukacs, Karl Korsch, Karel Kosik and Henri Lefebvre, and was seen as the central concept of Marx's thought by Yugoslavia's Praxis School, which established a journal of that name in 1964.
Jean-Paul Sartre
In the Critique of Dialectical Reason, Jean-Paul Sartre posits a view of individual praxis as the basis of human history. In his view, praxis is an attempt to negate human need. In a revision of Marxism and his earlier existentialism, Sartre argues that the fundamental relation of human history is scarcity. Conditions of scarcity generate competition for resources, exploitation of one over another and division of labor, which in its turn creates struggle between classes. Each individual experiences the other as a threat to his or her own survival and praxis; it is always a possibility that one's individual freedom limits another's. Sartre recognizes both natural and man-made constraints on freedom: he calls the non-unified practical activity of humans the "practico-inert". Sartre opposes to individual praxis a "group praxis" that fuses each individual to be accountable to each other in a common purpose. Sartre sees a mass movement in a successful revolution as the best exemplar of such a fused group.
Hannah Arendt
In The Human Condition, Hannah Arendt argues that Western philosophy too often has focused on the contemplative life (vita contemplativa) and has neglected the active life (vita activa). This has led humanity to frequently miss much of the everyday relevance of philosophical ideas to real life. For Arendt, praxis is the highest and most important level of the active life. Thus, she argues that more philosophers need to engage in everyday political action or praxis, which she sees as the true realization of human freedom. According to Arendt, our capacity to analyze ideas, wrestle with them, and engage in active praxis is what makes us uniquely human.
In Maurizio Passerin d'Etreves's estimation, "Arendt's theory of action and her revival of the ancient notion of praxis represent one of the most original contributions to twentieth century political thought. ... Moreover, by viewing action as a mode of human togetherness, Arendt is able to develop a conception of participatory democracy which stands in direct contrast to the bureaucratized and elitist forms of politics so characteristic of the modern epoch."
Education
Praxis is used by educators to describe a recurring passage through a cyclical process of experiential learning, such as the cycle described and popularised by David A. Kolb.
Paulo Freire defines praxis in Pedagogy of the Oppressed as "reflection and action directed at the structures to be transformed." Through praxis, oppressed people can acquire a critical awareness of their own condition, and, with teacher-students and students-teachers, struggle for liberation.
In the British Channel 4 television documentary New Order: Play at Home, Factory Records owner Tony Wilson describes praxis as "doing something, and then only afterwards, finding out why you did it".
Praxis may be described as a form of critical thinking and comprises the combination of reflection and action. Praxis can be viewed as a progression of cognitive and physical actions:
Taking the action
Considering the impacts of the action
Analysing the results of the action by reflecting upon it
Altering and revising conceptions and planning following reflection
Implementing these plans in further actions
This creates a cycle which can be viewed in terms of educational settings, learners and educational facilitators.
Scott and Marshall (2009) refer to praxis as "a philosophical term referring to human action on the natural and social world". Furthermore, Gramsci (1999) emphasises the power of praxis in Selections from the Prison Notebooks by stating that "The philosophy of praxis does not tend to leave the simple in their primitive philosophy of common sense but rather to lead them to a higher conception of life".
To reveal the inadequacies of religion, folklore, intellectualism and other such 'one-sided' forms of reasoning, Gramsci appeals directly in his later work to Marx's 'philosophy of praxis', describing it as a 'concrete' mode of reasoning. This principally involves the juxtaposition of a dialectical and scientific audit of reality; against all existing normative, ideological, and therefore counterfeit accounts. Essentially a 'philosophy' based on 'a practice', Marx's philosophy, is described correspondingly in this manner, as the only 'philosophy' that is at the same time a 'history in action' or a 'life' itself (Gramsci, Hoare and Nowell-Smith, 1972, p. 332).
Spirituality
Praxis is also key in meditation and spirituality, where emphasis is placed on gaining first-hand experience of concepts and certain areas, such as union with the Divine, which can only be explored through praxis due to the inability of the finite mind (and its tool, language) to comprehend or express the infinite. In an interview for YES! Magazine, Matthew Fox explained it this way:
According to Strong's Concordance, the Hebrew word ta‛am is, properly, a taste. This is, figuratively, perception and, by implication, intelligence; transitively, a mandate: advice, behaviour, decree, discretion, judgment, reason, taste, understanding.
Medicine
Praxis is the ability to perform voluntary skilled movements. The partial or complete inability to do so in the absence of primary sensory or motor impairments is known as apraxia.
See also
Apraxia
Christian theological praxis
Hexis
Lex artis
Orthopraxy
Praxeology
Praxis Discussion Series
Praxis (disambiguation)
Praxis intervention
Praxis school
Practice (social theory)
Theses on Feuerbach
References
Further reading
Paulo Freire (1970), Pedagogy of the Oppressed, Continuum International Publishing Group.
External links
Entry for "praxis" at the Encyclopaedia of Informal Education
Der Begriff Praxis
Concepts in the philosophy of mind
Marxism | 0.760794 | 0.997456 | 0.758858 |
Self-cultivation | Self-cultivation or personal cultivation is the development of one's mind or capacities through one's own efforts. Self-cultivation is the cultivation, integration, and coordination of mind and body. Although self-cultivation may be practiced and implemented as a form of cognitive therapy in psychotherapy, it goes beyond healing and self-help to also encompass self-development, self-improvement and self realisation. It is associated with attempts to go beyond and understand normal states of being, enhancing and polishing one's capacities and developing or uncovering innate human potential.
Self-cultivation also alludes to philosophical models in Mohism, Confucianism, Taoism and other Chinese philosophies, as well as in Epicureanism, and is an essential component of well-established East-Asian ethical values. Although this term applies to cultural traditions in Confucianism and Taoism, the goals and aspirations of self-cultivation in these traditions differ greatly.
Theoretical background
Purposes and applications
Self-cultivation is an essential component of the context of . It enhances individuality and personal growth and of human agency. Self-cultivation is a process that cultivates one's mind and body in an attempt to transcend ordinary habitual states of being, enhancing a person's coordination and integration of congruent thoughts, beliefs and actions. It aims to polish or enlighten their capacities and inborn potentials.
Self-cultivation: cultural and philosophical psychotherapies
Confucianism, Taoism, and Buddhism have adopted elements of doctrine from one another to form new branches and sects. Some of these have disseminated to East Asian regions including Taiwan, Japan, and Korea.
Confucianism and the relational self
Confucius believed that one's life is the continuation of one's parents' life. Therefore, followers of Confucianism teach their children in such way that the younger generation is educated to cultivate themselves to live with a satisfactory level of self-discipline. Even though individuals see a clear-cut boundary between themselves and others, each person in a dyadic relationship is seen embedded in a particular social network. By respecting the parents—the elder and the superior—a child is raised to be morally upright according to the expectations of others. This can be a social burden that causes stressful interpersonal relationships, and can cause disturbance and conflicts.
Taoism and the authentic self
Taoism tends to focus on linking the body and mind to the Nature. Taoism advocates the authentic self that is free from legal, social, or political restrictions. It seeks to cultivate an individual's self by healing and emancipating them from the ethical bounds of the human society. Taoism interprets the fortune or misfortune in one's life in terms of one's destiny, which is determined by the person's birth date and time. By avoiding the interference of personal desires and by relating everything to the system of the opposing elements of yin and yang, the cosmology of Taoism aims to keep individuals and everything in the harmonious balance. The explanation of self-cultivation in Taoism also corresponds to the equilibrium of the Five Transformative Phases ( Wu Xing): metal, wood, water, fire, and earth.
Buddhism and the non-self
After the introduction of Buddhism to China, "spiritual self-cultivation" became one of the terms used to translate the Buddhist concept of . The ultimate life goal in Buddhism is nirvana. People are encouraged to practice self-cultivation by detaching themselves from their desires and egos, and by attaining a mindful awareness of the non-self.
Chán and Zen Buddhist scholars emphasise that the key in self-cultivation is a "beginner's mind" which can allow the uncovering of the "luminous mind" and the realisation of innate Buddha-nature through the experience of sudden enlightenment.
In Japan, the Buddhist practice is equated with the notion of or personal cultivation.
Influences of self-cultivation on Chinese philosophy
Confucian self-cultivation as a psychological process
Self-cultivation in the Confucian tradition refers to keeping the balance between inner and outer selves, and between self and others. Self-cultivation in Chinese is an abbreviation of "", which literally translates to "rectifying one’s mind and nurturing one’s character (in particular through art, music and philosophy)".
Confucianism embodies metaphysics of self. It develops a complex model of self-cultivation. The cohering key concept is 'intellectual intuition', which is explained as a direct insight and cognition of present knowledge of reality, with no inference of bias toward discernment or logical reasoning. Confucianism has a large emphasis as its foundation the incorporation, application and implementation of filial piety.
Self-cultivation aims to achieve a harmonious society that is dependent on personal noble cultivation. The process entails the pursuit of moral perfection through knowledge and application.
In the Analects of Confucius there are two types of persons. One is the "profound person" (, ), and the other is "petty person" (, ). These two types are opposed to one another in terms of developed potential. Confucius takes something of a blank slate perspective: "all human beings are alike at birth" (Analects 17.2), but eventually "the profound person understands what is moral. The petty person understands what is profitable" (4.16).
The is the person who always manifests the quality of ("humaneness", "co-humanity" in an interdependent, hierarchical universe, "") in themselves and they display the quality of ("rightness", "righteousness") in their actions (4.5). Confucius highlights his fundamentally elitist, hierarchical model of relations by describing how the relates to their fellows:
According to D. C. Lau, is an attribute of actions, and is an attribute of agents. There are conceptual links between , ("ritual propriety"), ("virtue"), and the . According to what is , the exerts the moral force, which is , and thus demonstrates .
The following passages from the Analects point out the pathway towards self-cultivation that Confucius taught, with the ultimate goal of becoming the :
In the first passage, "self-reflection" is explained as "Do not do to others what you do not desire for yourself" (15.24). Confucius considers it extremely important for one to realise the necessity of concern and empathy for others, which can be achieved by reflecting upon oneself. The deeply relational self can then respond to inner reflection with outer virtue.
The second passage indicates the life-long timescale of the process of self-cultivation. It can begin during one's early teenage years, then extend well into more-mature age. The process includes the transformation of the individual, in which they realise that they should be able to distinguish and choose from what is right and what is desired.
Self-cultivation, Confucius expects, is an essential philosophical process for one to become by maximising . Confucius does not suffer from the Cartesian "mind-body problem". In Confucianism, there is no division between inner and outer self, thus the cumulative effect brought by Confucian self-cultivation is not just limited to one's self or person, but extends rather to the social and even cosmic.
Cultural and Ethical Values involved
Self-cultivation is one of the key principles of Confucianism, and may be considered the core of Chinese philosophy. The latter can be seen as the disciplined reflections on the insights of self-cultivation. While Étienne Balazs asserted that all Chinese philosophy is social philosophy and that the idea of the group takes precedence over conceptions of the individual self as the social dimension of the human condition features so prominently in the Chinese world of thought, Wing-Tsit Chan suggests a more comprehensive characterisation of Chinese philosophy as humanism: not the humanism that denies or slights a Supreme Power, but one that professes the unity of man and Heaven.
Similar to the Western sense of guilt, the Chinese sense of shame In Chinese ethics, .
Cultivation of self in East Asian philosophy of education
In East Asian cultures, . To help students and the younger generation understand the meaning of being a person, philosophers (mostly scholars) tried to explain their definitions of self with various theoretical approaches.
The legacy of Chinese philosopher Confucius, among others (for example, Laozi, Zhuangzi, and Mencius), has provided a rich domain of Chinese philosophical heritage in East Asia. Firstly, the goal of education, and one's most noble goal in life, is to properly develop oneself in order to become a "profound person" (, ). Young people were taught that it was shameful to become a "petty person" (, ), as that was the exact opposite to "sage" (, ). However, as both Confucian and Daoist philosophers adopted the term , there has been divergence that led to differences in educational concepts and practices. Besides Confucianism and Daoism, the Hundred Schools of Thought in Ancient China also included Buddhist and other varieties of philosophy, each of which offered different thoughts on the ideal conception of self.
In the modern era, some East Asian cultures have abandoned some of the archaic conceptions, or have replaced traditional humanistic education with a more common modern approach of self-cultivation that adapts the influences of globalisation. Nevertheless, the East Asian descendants and followers of Confucius still consider an ideal human being essential for their life-time education, with their cultural heritage deeply influenced by radical Confucian values.
Modern practices
The "self"-concept in Western culture
The "self" concept in western psychology originated from views of a number of empiricists and rationalists. Hegel (1770–1831) established a view of self-consciousness in which, by observation, our subject-object consciousness stimulates our rationale and reasoning, which then guides human behaviour. Freud (1856–1939) developed a three-part model of the psyche comprising the Id, the Ego, and the superego. Freud's self-concept influenced Erikson (1902–1994), who emphasized self-identity crisis and self-development. Following Erikson, J. Marcia described the continuum of identity development and the nature of our self-identity.
The concept of self-consciousness derives from self-esteem, self-regulation, and self-efficacy.
Morita therapy
Through case-based research, Japanese psychologist Morita Masatake (1874–1938) introduced Morita therapy. It is based on Masatake's theory of consciousness and his four-stage therapeutic method, and is described as an ecological therapy method that focuses on . Morita therapy resembles rational-emotive therapy by American psychologist Albert Ellis, and existential and cognitive behavioral therapy.
Naikan therapy
("", , self-reflection) is a Japanese psychotherapeutic method introduced and developed decades ago by Japanese businessman and Buddhist monk (Jōdo Shinshū) Yoshimoto Ishin (1916–1988).
Initially, therapy was more often used in correctional settings, however it has been adapted to situational and psychoneurotic disorders.
Similar to Morita therapy, requires subordination to a carefully structured period of "retreat" that is compassionately supervised by the practitioner. Contrary to Morita, is shorter (seven days) and utilizes long, regulated periods of daily meditation in which introspection is directed toward the resolution of contemporary conflicts and problems.
"In contrast to Western psychoanalytic psychotherapy, both and Morita tend to keep transference issues simplified and positive, while resistance is dealt with procedurally rather than interpretively."
The theory of constructive living
Based largely on the adaptions of two Japanese structured methods of self-reflection, Naikan therapy and Morita therapy, constructive living is a Western approach to mental health education. Purpose-centered and response-oriented, constructive living (sometimes abbreviated as CL) focuses on the mindfulness and purposes of one's life. It is considered as a process of action to approach the reality thoughtfully. It also emphasizes the ability to understand one's self by recognizing the past, in which it reflects upon the present. Constructive Living highlights the importance of acceptance, of the world we live in, as well as the emotions and feelings individuals have in unique situations.
D. Reynolds, Author of Constructive Living and Director of the Constructive Living Center in Oregon, U.S.A, argues that before taking the actions which may potentially bring positive changes, people are often hold back by the belief of "dealing with negative emotions first". According to Reynolds, the most crucial component of the process of effectuating affirmations is not getting the mind right. However, one's mind and emotions are effectively adjusted during the process of self-reflection, which indicates that there shall be a behavioural change taken place beforehand.
Epicurean meleta
At the closing of his Letter to Menoeceus, Epicurus instructs his disciple to practice (meleta) "both by yourself and with others of like mind". The first field of practice shares semantic roots with and is related to the Hellenistic philosophical concept of "epimeleia heauton" (self-care), which involves methods of self-cultivation. In addition to the study of philosophy, this may include other techniques for living (techne biou) or technologies of the soul, like the visualizing technique known as "placing before the eyes", a cognitive therapy technique known as "relabeling", moral portraiture, and other didactic and ethical methods. We find examples of these techniques in Philodemus of Gadara, the poet Lucretius, and other Epicurean guides.
Nietzsche's ethics of self-cultivation
"If you incorporate this thought within you, amongst your other thoughts" he maintains "It will transform you. If for everything you wish to do you begin by asking yourself: 'Am I certain I want to do this an infinite number of times?' this will become for you the greatest weight." (KSA 9:11 [143])
Nietzsche worked on the project of reviving Self-cultivation, an ancient ethics. "I hate everything that merely instructs me without augmenting or directly invigorating my own activity"(HL 2:1) "It follows therefore that he must conceive eternal recurrence among other things as a practice that stimulates self-cultivation. In fact in one of his characteristically grandiose moments he identified it as 'the great cultivating thought' in the sense that it might weed out those too weak to bear the thought of living again (WP 1053). In a more tempered fashion, however, he framed the thought of recurrence as part of an ethics of self-cultivation and self-transformation."
See also
Self
Neo-Confucianism
Eastern philosophy
References
Bibliography
Confucian Self-Cultivation and Daoist Personhood, H.Wang
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External links
Stanford Encyclopedia of Philosophy Entry: Confucius
Interfaith Online: Confucianism
Confucian Documents at the Internet Sacred Texts Archive.
Oriental Philosophy, "Topic:Confucianism"
Institutional
China Confucian Philosophy
China Confucian Religion
China Confucian Temples
China Kongzi Network
Chinese philosophy
Concepts in ethics
Confucian ethics
Taoist philosophy
Taoist practices
Buddhist practices
Buddhist philosophy
Psychotherapy
Self-care
Personal development
Philosophy of life
Concepts in Chinese philosophy | 0.765173 | 0.991723 | 0.758839 |
Psychological dependence | Psychological dependence is a cognitive disorder and a form of dependence that is characterized by emotional–motivational withdrawal symptoms upon cessation of prolonged drug use or certain repetitive behaviors. Consistent and frequent exposure to particular substances or behaviors is responsible for inducing psychological dependence, requiring ongoing engagement to prevent the onset of an unpleasant withdrawal syndrome driven by negative reinforcement. Neuronal counter-adaptation is believed to contribute to the generation of withdrawal symptoms through changes in neurotransmitter activity or altered receptor expression. Environmental enrichment and physical activity have been shown to attenuate withdrawal symptoms.
Symptoms
Psychological withdrawal symptoms include:
Anhedonia
Anxiety
Changes in appetite
Craving for responsible stimulus
Dysphoria
Exhaustion
Insomnia / Hypersomnia
Irritability
Panic attack
Stress
Development
Psychological dependence develops through consistent and frequent exposure to a stimulus. After sufficient exposure to a stimulus capable of inducing psychological dependence (e.g., drug use), an adaptive state develops that results in the onset of withdrawal symptoms that negatively affect psychological function upon cessation of exposure.
Psychostimulants (e.g., amphetamine) are a class of drugs that only induce psychological withdrawal symptoms in dependent users, as opposed somatic withdrawal symptoms associated with physical dependence. Whilst psychological dependence is commonly associated with prolonged drug use, a behavioral dependence-withdrawal syndrome can also manifest through certain behaviors. For instance, exercise dependence can develop in amateur and professional athletes whereby cognitive withdrawal symptoms (e.g., anxiety and irritability) arise during periods of abstinence, with symptom severity often correlating with the duration of abstinence. Other behaviors that can produce observable psychological withdrawal symptoms (i.e., cause psychological dependence) include shopping, sex and self-stimulation using pornography, and eating food with high sugar or fat content, among others.
The process responsible for the induction of psychological dependence is a negative feedback mechanism that involves neuronal-counter adaptation, leading to tolerance to the desirable effects of certain drugs or stimuli and a subsequent withdrawal syndrome upon abrupt cessation of exposure. While psychological dependence and addiction are distinct disease states mediated by opposite modes of reinforcement, they arise through partially overlapping biological processes. In the nucleus accumbens, both conditions involve overlapping signaling cascades that diverge at the CREB transcription factor. Upregulation of CREB expression in the nucleus accumbens plays a major role in mediating psychological dependence by inhibiting reward-related motivational salience, which mediates the onset of emotional-motivational withdrawal symptoms. Evidence indicates that the unpleasant nature of these withdrawal symptoms intensifies the desire to resume the associated drug or behavior.
Biomolecular mechanisms
Two factors have been identified as playing pivotal roles in psychological dependence: the neuropeptide "corticotropin-releasing factor" (CRF) and the gene transcription factor "cAMP response element binding protein" (CREB). The nucleus accumbens (NAcc) is one brain structure that has been implicated in the psychological component of drug dependence. In the NAcc, CREB is activated by cyclic adenosine monophosphate (cAMP) immediately after a high and triggers changes in gene expression that affect proteins such as dynorphin; dynorphin peptides reduce dopamine release into the NAcc by temporarily inhibiting the reward pathway. A sustained activation of CREB thus forces a larger dose to be taken to reach the same effect. In addition, it leaves the user feeling generally depressed and dissatisfied, and unable to find pleasure in previously enjoyable activities, often leading to a return to the drug for another dose.
In addition to CREB, it is hypothesized that stress mechanisms play a role in dependence. Koob and Kreek have hypothesized that during drug use, activates the hypothalamic–pituitary–adrenal axis (HPA axis) and other stress systems in the extended amygdala. This activation influences the dysregulated emotional state associated with psychological dependence. They found that as drug use escalates, so does the presence of CRF in human cerebrospinal fluid. In rat models, the separate use of CRF inhibitors and CRF receptor antagonists both decreased self-administration of the drug of study. Other studies in this review showed dysregulation of other neuropeptides that affect the HPA axis, including enkephalin which is an endogenous opioid peptide that regulates pain. It also appears that μ-opioid receptors, which enkephalin acts upon, is influential in the reward system and can regulate the expression of stress hormones.
Increased expression of AMPA receptors in nucleus accumbens MSNs is a potential mechanism of aversion produced by drug withdrawal.
Methods for reducing dependence
A study examined how rats experienced morphine withdrawal in different surroundings. The rats were either placed in a standard environment (SE) or in an enriched environment (EE). The study concluded that EE reduced depression and anxiety withdrawal symptoms.
Another study tested whether swimming exercises affected the intensity of perceivable psychological symptoms in rodents during morphine withdrawal. It concluded that the anxious and depressive states of the withdrawal were reduced in rats from the exercise group.
Distinction between psychological and physical dependence
The defining contrast between psychological dependence and physical dependence syndromes lies in the nature of the withdrawal symptoms experienced from removal of a particular stimulus following the development of tolerance. Psychological dependence is characterized by symptoms that are cognitive in nature and may include anxiety, dysphoria, exhaustion, hyperphagia, or irritability, among other symptoms. Conversely, physical dependence involves entirely somatic symptoms, such as diarrhea, myalgia, nausea, sweating, tremors, and other symptoms that are readily observable. Substance dependence is a general term that can refer to either psychological or physical dependence, or both, depending on the specific substance involved.
See also
Notes
References
Substance dependence
Psychopathological syndromes | 0.76749 | 0.988626 | 0.758761 |
Mindset | A mindset refers to an established set of attitudes of a person or group concerning culture, values, philosophy, frame of reference, outlook, or disposition. It may also arise from a person's worldview or beliefs about the meaning of life.
Some scholars claim that people can have multiple types of mindsets. Some of these types include a growth mindset, fixed mindset, poverty mindset, abundance mindset, and positive mindset among others that make up a person's overall mindset.
More broadly, scholars have found that mindset is associated with a range of functional effects in different areas of people's lives. This includes influencing a person's capacity for perception by functioning like a filter, a frame of reference, a meaning-making system, and a pattern of perception. Mindset is described as shaping a person's capacity for development by being associated with passive or conditional learning, incremental or horizontal learning, and transformative or vertical learning. Mindset is also believed to influence a person's behavior, having deliberative or implemental action phases, as well as being associated with technical or adaptive approaches to leadership.
A mindset could create an incentive to adopt (or accept) previous behaviors, choices, or tools, sometimes known as cognitive inertia or groupthink. When a prevailing mindset is limiting or inappropriate, it may be difficult to counteract the grip of mindset on analysis and decision-making.
In cognitive psychology, a mindset is the cognitive process activated in a task. In addition to the field of cognitive psychology, the study of mindset is evident in the social sciences and other fields (such as positive psychology). Characteristic of this area of study is its fragmentation among academic disciplines.
History
Numerous scholars have identified mindset history as being a critical gap in contemporary literature and also in current approaches to mindset education and training.
The first dedicated review of mindset history found that mindset psychology has a century-long history of explicit research and practice, with its origin phase taking place between 1908 and 1939, early inquiries occurring between 1940 and 1987, and contemporary bodies of work emerging in and beyond 1988. This review also identified some of the traditions of research and practice that are closely related to the origins and history of mindset psychology, some of which span back hundreds and thousands of years. Then, there are the lineages of research and practice that did not explicitly use the term mindset, but which bear some resemblance to it and are in some way related to this history. Peter Gollwitzer conducted explorations of mindset since the 1990s. Gollwitzer's contributions include his theory of mindset and the mindset theory of action phases.
Politics
A political example is the "Cold War mindset" in the U.S. and the USSR, which included belief in game theory, in a chain of command in control of nuclear materials, and in the mutual assured destruction of both in a nuclear war. This mindset prevented an attack by either country, but deterrence theory has made assessments of the Cold War mindset a subject of controversy.
Modern military theory attempts to challenge entrenched mindsets in asymmetric warfare, terrorism, and the proliferation of weapons of mass destruction. These threats are "a revolution in military affairs", requiring rapid adaptation to new threats and circumstances.
Systems theory
Building on Magoroh Maruyama's concept of mindscape, mindset includes a cultural and social orientation: hierarchical and egalitarian individualism, hierarchical and egalitarian collectivism, hierarchic and egalitarian synergism, and hierarchical and egalitarian populism.
Collective mindset
Collective mindsets are described in Edwin Hutchins's Cognition in the Wild (1995) and Maximilian Senges' Knowledge Entrepreneurship in Universities (2007). Hutchins analyzed a team of naval navigators as a cognitive unit or computational system, and Senges explained how a collective mindset is part of university strategy and practice.
Parallels exist in collective intelligence and the wisdom of the crowd. Zara said that since collective reflection is more explicit, discursive, and conversational, it needs a good Gestell.
Erik H. Erikson's analysis of group-identities and what he calls a "life-plan" is relevant to a collective mindset. Erikson cites Native Americans who were meant to undergo a reeducation process to instill a modern "life-plan" which advocated housing and wealth; the natives' collective historic identity as buffalo hunters was oriented around such fundamentally different motivations that communication about life plans was difficult.
An institution is related to collective mindset; an entrepreneurial mindset refers to a person who "values uncertainty in the marketplace and seeks to continuously identify opportunities with the potential to lead to important innovations". An institution with an entrepreneurial philosophy will have entrepreneurial goals and strategies. It fosters an entrepreneurial milieu, allowing each entity to pursue emerging opportunities. A collective mindset fosters values which lead to a particular practice. Hitt cites the five dimensions of an entrepreneurial mindset as "autonomy, innovativeness, risk taking, proactiveness, and competitive aggressiveness".
Theories
The study of mindsets includes definition, measurement, and categorization. Scholars in the same discipline differ.
Mindset agency
Sagiv and Schwarts defined cultural values to explain the nature, functions, and variables which characterize mindset agency. They posited three bipolar dimensions of culture, based on values: cognitive (embedded or autonomous), figurative (mastery or harmony), and operative (hierarchical or egalitarian).
Mindscape theory
The Myers–Briggs Type Indicator (MBTI) measures psychological functions which, paired with social attitudes, combine to generate personality types that may be evaluated by exploring individual preferences. Maruyama's mindscape theory measures individuals on a scale of characteristics and places them into one of four personality categories.
Fixed and growth mindsets
According to Carol Dweck, individuals can be placed on a continuum according to their views of where ability originate, from a fixed to a growth mindset. An individual's mindset affects the "motivation to practice and learn".
People with a fixed mindset believe that "intelligence is static", and little can be done to improve ability. Feedback is seen as "evaluation of their underlying ability" and success is seen as a result of this ability, not any effort expended. Failure is intimidating, since it "suggests constraints or limits they would not be able to overcome". Those with a fixed mindset tend to avoid challenges, give up easily, and focus on the outcome. They believe that their abilities are fixed, and effort has little value.
Those with a growth mindset believe that "intelligence can be developed", and their abilities can be increased by learning. They tend to embrace challenges, persevere in the face of adversity, accept and learn from failure, focus on process rather than outcome, and see abilities as skills which are developed through effort. Feedback and failure are seen as opportunities to increase ability, signaling the "need to pay attention, invest effort, apply time to practice, and master the new learning opportunity".
Grit, a personality trait combining determination and perseverance, is related to a growth mindset. Keown and Bourke discussed the importance of a growth mindset and grit. Their 2019 study found that people with lower economic status had a greater chance of success if they had a growth mindset and were willing to work through tribulation.
Much of Dweck's research was related to the effect of a student's mindset on classroom performance. For students to develop a growth mindset, a nurturing classroom culture must be established with appropriate praise and encouragement. According to Dweck, "Praising students for the process they have engaged in—the effort they applied, the strategies they used, the choices they made, the persistence they displayed, and so on—yields more long-term benefits than telling them they are 'smart' when they succeed". Teachers need to design meaningful learning activities for their students: "The teacher should portray challenges as fun and exciting, while portraying easy tasks as boring and less useful for the brain".
A second strategy to promote a growth mindset in the classroom is more explicit, establishing personal goals, and having students "write about and share with one another something they used to be poor at and now are very good at." Hinda Hussein studied the positive effect of reflective journal writing on students' growth mindset; journaling can improve a student's conceptual knowledge and enhance the understanding of their thoughts. Dweck has identified the word "yet" as a valuable tool to assess learning. If a teacher hears students saying that they are not good at something or cannot do something, they should interject "not yet" to reinforce the idea that ability and motivation are fluid.
Dweck and Jo Boaler indicate a fixed mindset can lead to sex differences in education, which can partially explain low achievement and participation by minority and female students. Boaler builds on Dweck's research to show that "gender differences in mathematics performance only existed among fixed mindset students". Boaler and Dweck say that people with growth mindsets can gain knowledge. Boaler said, "The key growth mindset message was that effort changes the brain by forming new connections, and that students control this process. The growth mindset intervention halted the students' decline in grades and started the students on a new pathway of improvement and high achievement".
L. S. Blackwell presented research in 2015 exploring whether growth mindsets can be promoted in minority groups. Blackwell builds on Dweck's research, observing minority groups and finding that "students with a growth mindset had stronger learning goals than the fixed mindset students." These students "had much more positive attitudes toward effort, agreeing that 'when something is hard, it just makes me want to work more on it, not less. Students with a fixed mindset were more likely to say that "if you're not good at a subject, working hard won't make you good at it” and “when I work hard at something, it makes me feel like I'm not very smart".
Dweck's research on growth and fixed mindsets is useful in intervening with at-risk students, dispelling negative stereotypes in education held by teachers and students, understanding the impacts of self-theories on resilience, and understanding how praise can foster a growth mindset and positively impact student motivation. There has also been movement towards the application of Dweck's mindset research in non-academic environments, such as the workplace. Other scholars have conducted research building on her findings. A 2018 study by Rhew et al. suggested that a growth-mindset intervention can increase the motivation of adolescent special-education participants. A 2019 study by Wang et al. suggested that substance use has adverse effects on adolescent reasoning. Developing a growth mindset in these adolescents was shown to reduce this adverse effect. These studies illustrate how educators can intervene, encouraging a growth mindset, by allowing students to see that their behavior can be changed with effort. Criticism has been directed at "growth mindset" and related research, however. Moreau et al. (2019) suggest "that overemphasizing the malleability of abilities and other traits can have negative consequences for individuals, science, and society."
Follow up research after the release of her book has led Dweck to be quoted as saying "Nobody has a growth mindset in everything all the time." along with the acknowledgement of the reality of the false growth mindset, and the truer growth mindset. One of Dweck's concerns being that educators were giving praise based on effort alone, when the results gained did not she believe merit praise. Researchers noted adults within a study "who agree with growth mindset, but do not behave as though they believe ability can change" as holding a false growth mindset.
Students and teachers
Elements of personality (such as sensitivity to mistakes and setbacks) may predispose toward a particular mindset, which can be developed and reshaped through interactions. In a number of studies, Dweck and her colleagues noted that alterations in mindset could be achieved through "praising the process through which success was achieved", "having [college aged students] read compelling scientific articles that support one view or the other", or teaching junior-high-school students "that every time they try hard and learn something new, their brain forms new connections that, over time, make them smarter."
Much research in education focuses on a student's ability to adopt a growth mindset, and less attention is paid to teachers' mindsets and their influence on students. Hattie writes, "Differing mindsets, or assumptions, that teachers possess about themselves and their students play a significant role in determining their expectations, teaching practices, and how students perceive their own mindset."
A study by Patrick and Joshi explored how teachers explain growth and fixed mindsets, with two major findings in 150 semi-structured interviews. First, they found that teachers' prior beliefs about learning and students influenced how they engaged with their mindsets. Second, they found that many teachers oversimplified growth and fixed mindsets as positive and negative traits.
A study conducted by Fiona S. Seaton (2018) examined the impact of teacher training to influence mindset. The teachers in this study had six training sessions, and Seaton found that the sessions had an impact on their mindsets which was sustained three months afterward. The results of this study suggest that adult mindsets are malleable, and can shift with appropriate supports.
Benefit mindset
In 2015, Ashley Buchanan and Margaret L. Kern proposed a benefit mindset: an evolution of the fixed and growth mindsets. The benefit mindset describes society's leaders, who promote individual and collective well-being: people who discover their strengths to contribute to causes greater than the self. They question why they do what they do, positioning their actions within a purposeful context.
Global mindset
Originating from the study of organizational leadership and coinciding with the growth of multinational corporations during the 1980s, organizations observed that executive effectiveness did not necessarily translate cross-culturally. A global mindset emerged as an explanation. Cross-cultural leaders were hypothesized to need an additional skill, ability, or proficiency (a global mindset) to be effective regardless of culture or context. Cultural agility refers to such a need. A defining characteristic of the study of global mindset is the variety with which scholars define it, but they typically agree that global mindset and its development increase global effectiveness for individuals and organizations.
Abundance and scarcity
People with an abundance mindset believe that there are enough resources for everyone, and see the glass as half-full; those with a scarcity mindset believe that there is a limited number of resources, and see the glass as half-empty. Mehta and Zhu found that an "abundance mindset makes people think beyond established functionalities to explore broadly for solutions, thereby heightening creativity. In contrast, a scarcity mindset induces functional fixedness, thereby reducing creativity."
Productive and defensive mindsets
According to Chris Argyris, organizations have two dominant mindsets: productive and defensive. The productive mindset is hinged in logic, focused on knowledge and its certifiable resultsa decision-making mindset which is transparent and auditable.
The defensive mindset is closed, self-protective and self-deceptive. It does not see the greater good, but centers on individual defense; truth, if perceived as harmful to the person concerned, would be denied. This may allow personal growth, but no organizational growth or development.
Deliberative and implemental mindsets
The deliberative and implemental mindsets are part of the decision making process in goal setting and goal striving. When someone has a deliberative mindset, they are considering a variety of actions and have not yet settled on what they are going to do. This person will tend to be open to alternative options when presented and will explore ideas until they have decided upon a course of action. This mindset is connected to the idea of goal setting.
After someone narrows down their options and makes a commitment to follow a particular path, they will have an implemental mindset. People with an implemental mindset are less open to alternative courses of action because they have already decided what they are going to do and now focus more energy on goal striving, rather than goal setting.
The deliberative mindset has been recognized as important for coming to conclusions in order to make a well-planned goal, but it has negative consequences for goal striving once a goal is already in place. On the other hand, the implemental mindset helps people to focus their behavior in a particular direction; this can be detrimental for someone who has not spent sufficient time with a deliberative mindset.
Promotion and prevention mindsets
The promotion and prevention mindsets are motivational orientations that are focused on the outcomes or consequences of behavior. People with a promotion mindset focus on achievement and accomplishment. Those with a prevention mindset pay closer attention to avoiding negative outcomes. They act more out of a sense of obligation and the fulfillment of duty than to seek any sort of reward. Both of these mindsets can be caused or influenced by individual disposition or by environmental stimuli. Those who are dispositionally in a promotion mindset seek to make good things happen, and situations that encourage a promotion mindset are those in which there is a promise of gain. Those with a dispositional prevention mindset believe that they need to keep bad things from happening, and situations conducive to the prevention mindset are those in which the idea of duty is emphasized.
Those with a promotion mindset are characterized as being eager and quick to act. They take initiative and move to cause improvements towards their ideal state. People with a prevention mindset are characterized as being cautious and careful, avoiding risks and any course of action that could potentially cause failure in reaching a goal.
Criticism
In 2019 a larger randomized controlled trial by the Education Endowment Foundation for growth mindset training showed no significant increase in numeracy or literacy. A 2024 study showed that growth mindset scales by Carol Dweck have psychometric comparability, however this study showed no connection between growth mindset and goal achievement.
See also
Dual mentality
Bounded rationality
Elitism
Ethical egoism
Game theory
Good and evil
Property dualism
Rational irrationality
Notes
Cognitive biases | 0.762359 | 0.995278 | 0.758759 |
Clinical neuropsychology | Clinical neuropsychology is a sub-field of cognitive science and psychology concerned with the applied science of brain-behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders. The branch of neuropsychology associated with children and young people is called pediatric neuropsychology.
Clinical neuropsychology is a specialized form of clinical psychology with stringent laws in place to maintain evidence as a focal point of treatment and research within the field. The assessment and rehabilitation of neuropsychopathologies is the focus for a clinical neuropsychologist. A clinical neuropsychologist must be able to determine whether a symptom(s) was caused by an injury to the head. This is done by interviewing the patient, then determining what actions should be taken to best help the patient. Another duty of a clinical neuropsychologist is to find cerebral abnormalities and possible correlations. Evidence based practice in both research and treatment is paramount to appropriate clinical neuropsychological practice.
Assessment is primarily by way of neuropsychological tests, but also includes patient history, qualitative observation and may draw on findings from neuroimaging and other diagnostic medical procedures. Clinical neuropsychology requires an in-depth knowledge of: neuroanatomy, neurobiology, psychopharmacology and neuropathology.
History
During the late 1800s, brain–behavior relationships were interpreted by European physicians who observed and identified behavioural syndromes that were related with focal brain dysfunction.
Clinical neuropsychology is a fairly new practice in comparison to other specialty fields in psychology with history going back to the 1960s. The specialty focus of clinical neuropsychology evolved slowly into a more defined whole as interest grew. Threads from neurology, clinical psychology, psychiatry, cognitive psychology, and psychometrics all have been woven together to create the intricate tapestry of clinical neuropsychology, a practice which is very much so still evolving. The history of clinical neuropsychology is long and complicated due to its ties to so many older practices. Researchers like Thomas Willis (1621–1675) who has been credited with creating neurology, John Hughlings Jackson (1835–1911) who theorized that cognitive processes occurred in specific parts of the brain, Paul Broca (1824–1880) and Karl Wernicke (1848–1905) who studied the human brain in relation to psychopathology, Jean Martin Charcot (1825–1893) who apprenticed Sigmund Freud (1856–1939) who created the psychoanalytic theory all contributed to clinical medicine which later contributed to clinical neuropsychology. The field of psychometrics contributed to clinical neuropsychology through individuals such as Francis Galton (1822–1911) who collected quantitative data on physical and sensory characteristics, Karl Pearson (1857–1936) who established the statistics which psychology now relies on, Wilhelm Wundt (1832–1920) who created the first psychology lab, his student Charles Spearman (1863–1945) who furthered statistics through discoveries like factor analysis, Alfred Binet (1857–1911) and his apprentice Theodore Simon (1872–1961) who together made the Binet-Simon scale of intellectual development, and Jean Piaget (1896–1980) who studied child development. Studies in intelligence testing made by Lewis Terman (1877–1956) who updated the Binet-Simon scale to the Stanford-Binet intelligence scale, Henry Goddard (1866–1957) who developed different classification scales, and Robert Yerkes (1876–1956) who was in charge of the Army Alpha and Beta tests also all contributed to where clinical neuropsychology is today.
Clinical neuropsychology focuses on the brain and goes back to the beginning of the 20th century. As a clinician a clinical neuropsychologist offers their services by addressing three steps; assessment, diagnosis, and treatment. The term clinical neuropsychologist was first made by Sir William Osler on April 16, 1913. While clinical neuropsychology was not a focus until the 20th century evidence of brain and behavior treatment and studies are seen as far back as the neolithic area when trephination, a crude surgery in which a piece of the skull is removed, has been observed in skulls. As a profession, clinical neuropsychology is a subspecialty beneath clinical psychology. During World War I (1914–1918) the early term shell shock was first observed in soldiers who survived the war. This was the beginning of efforts to understand traumatic events and how they affected people. During the Great Depression (1929–1941) further stressors caused shell shock like symptoms to emerge. In World War II (1939–1945) the term shell shock was changed to battle fatigue and clinical neuropsychology became even more involved with attempting to solve the puzzle of peoples' continued signs of trauma and distress. The Veterans Administration or VA was created in 1930 which increased the call for clinical neuropsychologists and by extension the need for training. The Korean (1950–1953) and Vietnam Wars (1960–1973) further solidified the need for treatment by trained clinical neuropsychologists. In 1985 the term post-traumatic stress disorder or PTSD was coined and the understanding that traumatic events of all kinds could cause PTSD started to evolve.
The relationship between human behavior and the brain is the focus of clinical neuropsychology as defined by Meir in 1974. There are two subdivisions of clinical neuropsychology which draw much focus; organic and environmental natures. Ralph M. Reitan, Arthur L. Benton, and A.R. Luria are all past neuropsychologists whom believed and studied the organic nature of clinical neuropsychology. Alexander Luria is the Russian neuropsychologist responsible for the origination of clinical psychoneurological assessment after WWII. Building upon his originative contribution connecting the voluntary and involuntary functions influencing behavior, Luria further conjoins the methodical structures and associations of neurological processes in the brain. Luria developed the 'combined motor method' to measure thought processes based on the reaction times when three simultaneous tasks are appointed that require a verbal response. On the other side, environmental nature of clinical neuropsychology did not appear until more recently and is characterized by treatments such as behavior therapy. The relationship between physical brain abnormalities and the presentation of psychopathology is not completely understood, but this is one of the questions which clinical neuropsychologists hope to answer in time. In 1861 the debate over human potentiality versus localization began. The two sides argued over how human behavior presented in the brain. Paul Broca postulated that cognitive problems could be caused by physical damage to specific parts of the brain based on a case study of his in which he found a lesion on the brain of a deceased patient who had presented the symptom of being unable to speak, that portion of the brain is now known as Broca's Area. In 1874 Carl Wernicke also made a similar observation in a case study involving a patient with a brain lesion whom was unable to comprehend speech, the part of the brain with the lesion is now deemed Wernicke's Area. Both Broca and Wernicke believed and studied the theory of localization. On the other hand, equal potentiality theorists believed that brain function was not based on a single piece of the brain but rather on the brain as a whole. Marie J.P Flourens conducted animal studies in which he found that the amount of brain tissue damaged directly affected the amount that behavior ability was altered or damaged. Kurt Goldstein observed the same idea as Flourens except in veterans who had fought in World War I. In the end, despite all of the disagreement, neither theory completely explains the human brains complexity. Thomas Hughlings Jackson created a theory which was thought to be a possible solution. Jackson believed that both potentiality and localization were in part correct and that behavior was made by multiple parts of the brain working collectively to cause behaviors, and Luria (1966–1973) furthered Jackson's theory.
The job
Neuropsychologists commonly work in hospitals There are three main variations in which a clinical neuropsychologist may work at a hospital; as an employee, consultant, or independent practitioner. A clinical neuropsychologist working as an employee of a hospital would receive a salary, benefits, and have a contract for employment. The hospital is in charge of legal and financial responsibilities for their neuropsychologists. The second option of working as a consultant implies that the clinical neuropsychologist is part of a private practice or is a member of a physicians group. In this scenario, the clinical neuropsychologist may work in the hospital like the employee of the hospital but all financial and legal responsibilities go through the group which the clinical neuropsychologist is a part of. The third option is to be an independent practitioner, who works alone and may even have their office outside of the hospital or rent a room in the hospital. In the third case, the clinical neuropsychologist is completely on their own and in charge of their own financial and legal responsibilities.
Assessment
Assessments are used in clinical neuropsychology to find brain psychopathologies of the cognitive, behavioral, and emotional variety. Physical evidence is not always readily visible so clinical neuropsychologists must rely on assessments to tell them the extent of the damage. The cognitive strengths and weaknesses of the patient are assessed to help narrow down the possible causes of the brain pathology. A clinical neuropsychologist is expected to help educate the patient on what is happening to them so that the patient can understand how to work with their own cognitive deficits and strengths. An assessment should accomplish many goals such as; gauge consequences of impairments to quality of life, compile symptoms and the change in symptoms over time, and assess cognitive strengths and weaknesses. Accumulation of the knowledge earned from the assessment is then dedicated to developing a treatment plan based on the patient's individual needs. An assessment can also help the clinical neuropsychologist gage the impact of medications and neurosurgery on a patient. Behavioral neurology and neuropsychology tools can be standardized or psychometric tests and observational data collected on the patient to help build an understanding of the patient and what is happening with them. There are essential prerequisites which must be present in a patient in order for the assessment to be effective; concentration, comprehension, and motivation and effort.
Lezak lists six primary reasons neuropsychological assessments are carried out: diagnosis, patient care and its planning, treatment planning, treatment evaluation, research and forensic neuropsychology. To conduct a comprehensive assessment will typically take several hours and may need to be conducted over more than a single visit. Even the use of a screening battery covering several cognitive domains may take 1.5–2 hours. At the commencement of the assessment it is important to establish a good rapport with the patient and ensure they understand the nature and aims of the assessment.
Neuropsychological assessment can be carried out from two basic perspectives, depending on the purpose of assessment. These methods are normative or individual. Normative assessment, involves the comparison of the patient's performance against a representative population. This method may be appropriate in investigation of an adult onset brain insult such as traumatic brain injury or stroke. Individual assessment may involve serial assessment, to establish whether declines beyond those which are expected to occur with normal aging, as with dementia or another neurodegenerative condition.
Assessment can be further subdivided into sub-sections:
History taking
Neuropsychological assessments usually commence with a clinical interview as a means of collecting a history, which is relevant to the interpretation of any later neuropsychological tests. In addition, this interview provides qualitative information about the patient's ability to act in a socially apt manner, organise and communicate information effectively and provide an indication as to the patient's mood, insight and motivation. It is only within the context of a patient's history that an accurate interpretation of their test data and thus a diagnosis can be made. The clinical interview should take place in a quiet area free from distractions. Important elements of a history include demographic information, description of presenting problem, medical history (including any childhood or developmental problems, psychiatric and psychological history), educational and occupational history (and if any legal history and military history.)
Selection of neuropsychological tests
It is not uncommon for patients to be anxious about being tested; explaining that tests are designed so that they will challenge everyone and that no one is expected to answer all questions correctly may be helpful. An important consideration of any neuropsychological assessment is a basic coverage of all major cognitive functions. The most efficient way to achieve this is the administration of a battery of tests covering: attention, visual perception and reasoning, learning and memory, verbal function, construction, concept formation, executive function, motor abilities and emotional status. Beyond this basic battery, choices of neuropsychological tests to be administered are mainly made on the basis of which cognitive functions need to be evaluated in order to fulfill the assessment objectives.
Report writing
Following a neuropsychological assessment it is important to complete a comprehensive report based on the assessment conducted. The report is for other clinicians, as well as the patient and their family, so it is important to avoid jargon or the use of language which has different clinical and lay meanings (e.g. intellectually disabled as the correct clinical term for an IQ below 70, but offensive in lay language). The report should cover background to the referral, relevant history, reasons for assessment, neuropsychologists observations of patient's behaviour, test administered and results for cognitive domains tested, any additional findings (e.g. questionnaires for mood) and finish the report with a summary and recommendations. In the summary it is important to comment on what the profile of results indicates regarding the referral question. The recommendations section contains practical information to assist the patient and family, or improve the management of the patient's condition.
Educational requirements of different countries
The educational requirements for becoming a clinical neuropsychologist differ between countries. In some countries it may be necessary to complete a clinical psychology degree, before specialising with further studies in clinical neuropsychology, while other countries offer clinical neuropsychology courses to students who have completed 4 years of psychology studies. All clinical neuropsychologists require a postgraduate qualification, whether it be a Masters or Doctorate (PhD, PsyD or D.Psych).
Australia
To become a clinical neuropsychologist in Australia requires the completion of a 3-year Australian Psychology Accreditation Council (APAC) approved undergraduate degree in psychology, a 1-year psychology honours, followed by a 2-year Masters or 3-year Doctorate of Psychology (D.Psych) in clinical neuropsychology. These courses involve coursework (lectures, tutorials, practicals etc.), supervised practice placements and the completion of a research thesis.
Masters and D.Psych courses involve the same amount of coursework units, but differ in the amount of supervised placements undertaken and length of research thesis. Masters courses require a minimum of 1,000 hours (125 days) and D.Psych courses require a minimum of 1,500 hours (200 days), it is mandatory that these placements expose students to acute neurology/neurosurgery, rehabilitation, psychiatric, geriatric and paediatric populations.
Canada
To become a clinical neuropsychologist in Canada requires the completion of a 4-year honours degree in psychology and a 4-year doctoral degree in clinical neuropsychology. Often a 2-year master's degree is required before commencing the doctoral degree. The doctoral degree involves coursework and practical experience (practicum and internship). Practicum is between 600 and 1,000 hours of practical application of skills acquired in the program. At least 300 hours must be supervised, face-to-face client contact. The practicum is intended to prepare students for the internship/residency. Internships/residencies are a year long experience in which the student functions as a neuropsychologist, under supervision. Currently, there are 3 CPA-accredited Clinical Neuropsychology internships/residencies in Canada, although other unaccredited ones exist. Prior to commencing the internship students must have completed all doctoral coursework, received approval for their thesis proposal (if not completed the thesis) and the 600 hours of practicum.
United Kingdom
To become a clinical neuropsychologist in the UK, requires prior qualification as a clinical or educational psychologist as recognised by the Health Professions Council, followed by further postgraduate study in clinical neuropsychology. In its entirety, education to become a clinical neuropsychologist in the UK consists of the completion of a 3-year British Psychological Society accredited undergraduate degree in psychology, 3-year Doctorate in clinical (usually D.Clin.Psy.) or educational psychology (D.Ed.Psy.), followed by a 1-year Masters (MSc) or 9-month Postgraduate Diploma (PgDip) in Clinical Neuropsychology.
The British Psychological Division of Counselling Psychology are also currently offering training to its members in order to ensure that they can apply to be registered Neuropsychologists also.
United States
In order to become a clinical neuropsychologist in the US and be compliant with Houston Conference Guidelines, the completion of a 4-year undergraduate degree in psychology and a 4 to 5-year doctoral degree (PsyD or PhD) must be completed. After the completion of the doctoral coursework, training and dissertation, students must complete a 1-year internship, followed by an additional 2 years of supervised residency. The doctoral degree, internship and residency must all be undertaken at American Psychological Association approved institutions.
After the completion of all training, students must apply to become licensed in their state to practice psychology. The American Board of Clinical Neuropsychology, The American Board of Professional Neuropsychology, and The American Board of Pediatric Neuropsychology all award board certification to neuropsychologists that demonstrate competency in specific areas of neuropsychology, by reviewing the neuropsychologist's training, experience, submitted case samples, and successfully completing both written and oral examinations. Although these requirements are standard according to Houston Conference Guidelines, even these guidelines have stated that the completion of all of these requirements is still aspirational, and other ways of achieving clinical neuropsychologist status are possible.
Journals
The following represents an (incomplete) listing of significant journals in or related to the field of clinical neuropsychology.
Aging, Neuropsychology and Cognition
Applied Neuropsychology
Archives of Clinical Neuropsychology
Archives of Neurology
Brain
Child Neuropsychology
The Clinical Neuropsychologist
Cognitive Neuropsychology
Cortex
Developmental Neuropsychology
Journal of Clinical and Experimental Neuropsychology
Journal of Cognitive Neuroscience
Journal of the International Neuropsychological Society
Journal of Neuropsychology
Neurocase
Neuropsychologia
Neuropsychological Rehabilitation
Neuropsychology
Neuropsychology Review
Psychological Assessment
See also
Abnormal psychology
Neurolaw
Neuropsychological test
Neuropsychological assessment
Neuropsychology
References
Further reading
This standard reference book includes entries by Kimford J. Meador, Ida Sue Baron, Steven J. Loring, Kerry deS. Hamsher, Nils R. Varney, Gregory P. Lee, Esther Strauss, and Tessa Hart.
This handbook for practitioners includes chapters by Michael W. Parsons, Alexander Rae-Grant, Ekaterina Keifer, Marc W. Haut, Harry W. McConnell, Stephen E. Jones, Thomas Krewson, Glenn J. Larrabee, Amy Heffelfinger, Xavier E. Cagigas, Jennifer J. Manly, David Nyenhuis, Sara J. Swanson, Jessica S. Chapin, Julie K. Janecek, Michael McCrea, Matthew R. Powell, Thomas A. Hammeke, Andrew J. Saykin, Laura A. Rabin, Alexander I. Tröster, Sonia Packwood, Peter A. Arnett, Lauren B. Strober, Mariana E. Bradshaw, Jeffrey S. Wefel, Roberta F. White, Maxine Krengel, Rachel Grashow, Brigid Waldron-Perrine, Kenneth M. Adams, Margaret G. O'Connor, Elizabeth Race, David S. Sabsevitz, Russell M. Bauer, Ronald A. Cohen, Paul Malloy, Melissa Jenkins, Robert Paul, Darlene Floden, Lisa L. Conant, Robert M. Bilder, Rishi K. Bhalla, Ruth O'Hara, Ellen Coman, Meryl A. Butters, Michael L. Alosco, Sarah Garcia, Lindsay Miller, John Gunstad, Dawn Bowers, Jenna Dietz, Jacob Jones, Greg J. Lamberty, and Anita H. Sim.
This collection of articles for practitioners includes chapters by Linda A. Reddy, Adam S. Weissman, James B. Hale, Allison Waters, Lara J. Farrell, Elizabeth Schilpzand, Susanna W. Chang, Joseph O'Neill, David Rosenberg, Steven G. Feifer, Gurmal Rattan, Patricia D. Walshaw, Carrie E. Bearden, Carmen Lukie, Andrea N. Schneider, Richard Gallagher, Jennifer L. Rosenblatt, Jean Séguin, Mathieu Pilon, Matthew W. Specht, Susanna W. Chang, Kathleen Armstrong, Jason Hangauer, Heather Agazzi, Justin J. Boseck, Elizabeth L. Roberds, Andrew S. Davis, Joanna Thome, Tina Drossos, Scott J. Hunter, Erin L. Steck-Silvestri, LeAdelle Phelps, William S. MacAllister, Jonelle Ensign, Emilie Crevier-Quintin, Leonard F. Koziol, and Deborah E. Budding.
External links
Neuropsychology | 0.771675 | 0.983163 | 0.758683 |
Sophrology | Sophrology is a dynamic relaxation method developed by neuropsychiatrist Alfonso Caycedo from 1960 to 2001 and includes physical and mental exercises to promote health and well-being. (pp. 35–42) Although it is considered a pseudoscience in some circles, Sophrology has been called “a method, a practice and a philosophy” that uses the mind-body connection to increase awareness and conscious living, with the aim of enabling individuals to create more balance and harmony in themselves and in the world around them. (pp. 17–18, 45–46, 57, 60–61)
The influences on Sophrology include phenomenology, hypnosis, yoga, Tibetan Buddhism meditation, Japanese Zen meditation, progressive muscle relaxation, autogenic training, psychology, neurology, and the method created contains a set of exercises that combine breathing and relaxation techniques, gentle movement, creative visualization, meditation, and mindfulness. (pp. 22, 38–39)
It claims beneficial uses in a number of areas ranging from self-development to well-being. (pp. 17–22, 41, 45–46) As of 2023, there are limited published studies that scientifically validate beneficial effects, quantitative or qualitative, of the Sophrology method.
The practice is popular in parts of Europe. In Switzerland and France it is offered to students in schools and at least one insurance company offers reimbursement under their most expensive plan. (pp. 40–41)
Since 2007, leading French cancer center Institute Curie has offered patients in the Outpatient Medical Oncology unit the opportunity to attend individual sophrology sessions to "help cancer patients manage the distress caused by the disease and its treatment, including anxiety, nausea, fatigue, insomnia, and body-image disruptions."
Etymology
The word Sophrology comes from three Ancient Greek words σῶς / sos ("harmony"), φρήν / phren ("mind"), and -λογία / logos ("study, science") and means “the study of the consciousness in harmony” or “the science of the harmony of consciousness”.
History
Alfonso Caycedo
Western roots (1960–1963)
Professor Alfonso Caycedo (1932–2017) a neuropsychiatrist (doctor, psychiatrist, and neurologist) of Spanish Basque origin was born in Bogota, Colombia, in 1932 and studied medicine in Spain. Caycedo began his medical career at the Provincial Hospital of Madrid administering electric shock therapy and insulin induced comas to patients at the hospital and was unsettled by the severity of these treatments. He then set out to find a way of healing depressed and traumatized clients by leading them to an improved quality of life with the least possible use of drugs and psychiatric treatments. (pp. 36–37)
This led Caycedo to study human consciousness and the means of varying its states and levels. He studied clinical hypnosis, Edmund Husserl’s phenomenology and the relaxation techniques of Edmund Jacobson’s progressive relaxation, Johannes Heinrich Schultz’s autogenic training. From Jacobson’s technique, Caycedo mainly kept the idea of differential relaxation, the ability to reduce anxiety by relaxing muscular tension using only the minimum muscle tension necessary for an action and without additional suggestion or psychotherapy – that muscular relaxation is sufficient for mental relaxation or harmony. With Schultz’s technique, Caycedo was inspired by the human ability to achieve relaxation by visualization alone.
Originally Caycedo based the new method on hypnosis although due to the reception to hypnosis he created the term “Sophrology” in October 1960 and in December 1960 he opened the first department of clinical Sophrology in the Santa Isabel Hospital in Madrid.
Phenomenology (1963–1964)
Between 1963 and 1964, Caycedo moved to Switzerland and worked under the psychiatrist and phenomenologist Ludwig Binswanger at the Bellevue Clinic In Kreuzlingen and was very much influenced by his work.
Eastern roots (1965–1968)
In 1963, Caycedo married a French yoga enthusiast. Intrigued by the works of yoga and encouraged by Binswanger, Caycedo travelled to India and Japan from 1965 to 1968 where he studied yoga, Tibetan Buddhist meditation and Japanese Zen. He approached each discipline, theory and philosophy with the intention of discovering what, exactly, improved people's health, both physically and mentally. In India, he discovered Raja Yoga in the ashram of Swami Anandanand and Sri Aurobindo's integral yoga. He then travelled to Dharamsala to study Tibetan Buddhism and to meet the Dalai Lama. Lastly, he went to Japan to learn Zen in several monasteries. (p. 38)
During his absence, Caycedo asked Doctors Raymond Abrezol and Armand Dumont to take charge and continue the dissemination of Sophrology.
Spain, Colombia, Andorra (1968–2017)
In 1968, on his return from his travels in India and Japan, Caycedo settled in Barcelona, Spain, where he started expanding Sophrology and created the first three levels of what he called Dynamic Relaxation. Caycedo initiated Sophrology group work in Paris and continued the dissemination of Sophrology at scientific conferences in Spain, Switzerland and Belgium. From then on, Sophrology started to move away from clinical hypnosis and concentrated more on body work and the presence of the body in the mind. His idea was to help the Western mind use Eastern methods in a simple way, leaving aside the philosophy and religion, with the aim of enabling people to experience new ways of working on their levels of consciousness.
In 1970, at the first International Sophrology Conference, he said that Sophrology was born from his studies on human consciousness. Sophrology is both philosophy and a way of life, as well as a therapy and a personal development technique. He later said that Sophrology is “learning to live”.
During the early years Sophrology was kept exclusively within the field of medicine and the Association of Medical Sophrology was formed which created the branch of “medical” Sophrology. Subsequently, a second branch was created, that of “social” Sophrology, which was inaugurated at the Recife Congress in August 1977.
In 1985, while in Colombia, Caycedo created the fourth level of Dynamic Relaxation.
In 1988, Caycedo moved to Andorra and created the concept of Caycedo Sophrology which he later trademarked.
In 1992, Caycedo started the following levels and created a master's degree.
By 2001, Caycedo had completed the twelve levels, or twelve degrees, of Caycedian Dynamic Relaxation (CDR) and their specific techniques.
Raymond Abrezol
In Switzerland, Raymond Abrezol (1931–2010), a Swiss doctor and dentist, discovered Sophrology and brought it to the attention of the general public. Abrezol started practicing Sophrology in 1963, met Caycedo in 1964 in Kreuzlingen, and became one of the pioneers of this method.
After finishing his Sophrology studies in 1965, Abrezol helped two friends improve their performance, one in tennis and the other in skiing, using Sophrology. In 1967, a national ski coach asked Abrezol to train four Swiss ski athletes for the Grenoble Winter Olympic Games of 1968, resulting in three winning Olympic medals. This led to Abrezol training athletes in boxing, cycling, fencing, sailing, skating, aerobatic pilots, tennis, water polo, golf, and other sports and athletes coached by Abrezol won over 200 Olympic and World Championship medals between 1967 and 2004.
Athletes that included specifically designed Sophrology exercises as part of their preparation included Bernhard Russi, Roland Collombin, Walter Tresch, Werner Mattle, Lise Marie Morerod and Marie-Therese Nadig (skiers); Walther Steiner and Hans Schmid (ski jumpers); Fritz Chervet (boxer), Dill Bundi (cyclist), Silvio Giobelina (bobsledder), and Pierre Fehlmann (navigator).
Following this success, Sophrology grew rapidly throughout the French-speaking world. Abrezol ran training programmes for a large number of doctors and sports coaches, many of whom then ran Training Centers throughout France. Although initially used only in medicine, Abrezol's success with athletes opened doors for Sophrology to be taught in many areas of life from sports to education, the arts, well-being in the corporate world, and in other disciplines.
Fundamental principles
Positive action
Sophrology doesn't concentrate on the problem itself but on the inner resources and positive elements of the individual. The assumption is that positive action on consciousness starts a positive chain reaction. According to Pascal Gautier, "Through an everyday practice, Sophrology aims at harmony in human beings! In practice, it does not mean seeing life through pink-tinted glasses but putting an end to an unrealistic or negative vision of life to see things as they are (as much as possible) and reinforce whatever positive we have in us."
Objective reality
Be free from judgement – awareness of any judgement, either of others or of ourselves, and adopting a non-judgmental attitude.
As if for the first time – having a "beginner's mind" and taking it in without using previous knowledge or experiences.
Applications
Sophrology use has been indicated in the following areas:
Self-development
Stress management (p. 41)
Disease-related distress
Sleep improvement
Exam preparation – in Switzerland and France Sophrology is offered to students in schools to help with exam preparation and exam stress
Sports performance – athletes coached by Raymond Abrezol won over 200 Olympic and World Championship medals; it has reportedly been used by the French rugby team; it has been used by the Swiss Clay Pigeon Shooting champions to train for the European Championships 2012
“Meditation alternatives for people who can’t sit still”
Preparing for a specific event
Birth preparation (p. 40)
In Japanese popular culture, Sophrology (ソフロロジー) is known as a relaxation method for childbirth (ソフロロジー分娩法)
Criticisms
Scientific validity of the beneficial effects
There are limited studies to scientifically validate the beneficial effects, quantitative or qualitative, claimed by the Sophrology method.
In 2019, a randomized controlled trial in Spain was carried out to determine the effects of sophrology’s dynamic relaxation techniques on anxiety and mood in primary care patients. Seventy patients with moderate and high anxiety levels, according to the HADS-Anxiety subscale questionnaire (cut-off >8), were randomly distributed to i) sophrology (wellbeing and sophrology program) or ii) a physical and mental health recommendations (PMHR) program.
Conclusion: An intensive four-week structured group relaxation-training program “well-being and sophrology” was highly effective in reducing anxiety and depression symptoms in primary care patients with moderate and high anxiety levels. The results demonstrated that the sophrology program was equally effective in persons of any age and gender.
Authors added that Sophrology training might be a choice for those patients with medium or high anxiety levels, suffering from important psychopharmacological side effects or intolerance but also for those patients at medium risk for anxiety disorders, interested in developing healthy psycho-physical habits, personal resources and coping strategies.
Divergence from Caycedian Sophrology
To protect the method that he created, Caycedo trademarked “Caycedian Sophrology” while the word “Sophrology” remains available to the public. The drift from the original method, as developed by Caycedo, means that today a distinction exists between “Caycedian Sophrology” and “Sophrology”, with non-Caycedian training schools offering potentially adulterated versions of the method.
References
1960s neologisms
Alternative medicine
Colombian inventions
Hypnosis | 0.7681 | 0.987735 | 0.758679 |
Co-Dependents Anonymous | Co-Dependents Anonymous (CoDA) is a twelve-step program for people who share a common desire to develop functional and healthy relationships. Co-Dependents Anonymous was founded by Ken and Mary Richardson and the first CoDA meeting attended by 30 people was held October 22, 1986 in Phoenix, Arizona. Within four weeks there were 100 people and before the year was up there were 120 groups. CoDA held its first National Service Conference the next year with 29 representatives from seven states. CoDA has stabilized at about a thousand meetings in the US, and with meetings active in 60 other countries and dozens online that can be reached at www.coda.org.
CoDA meeting indexes managed independently include:
Alternative Format VE (Virtual meetings) Australasia, Canada, Germany, Ireland, Israel, Netherlands, South Africa, United Kingdom, France, other francophone countries
See also
Alcoholism in family systems
Adult Children of Alcoholics
Al-Anon/Alateen
Codependency
Emotions Anonymous
List of twelve-step groups
Nar-Anon
Self-help groups for mental health
Twelve Traditions
References
External links
Co-Dependents Anonymous
Co-Dependents Anonymous - Australasia
Co-Dependents Anonymous Belgium
Co-Dependents Anonymous Brazil (Portuguese)
Co-Dependents Anonymous Canada
Co-Dependientes anónimos (Colombia)
Co-Dependents Anonymous Finland
Co-Dependents Anonymous France
Co-Dependents Anonymous - Francophone
Co-Dependents Anonymous Germany
Co-Dependents Anonymous - Iceland
Co-Dependents Anonymous - Iran
Co-Dependents Anonymous - Ireland
Co-Dependents Anonymous - Israel
Co-Dependents Anonymous - Latvia
Co-Dependents Anonymous - Malaysia
Co-Dependents Anonymous - Mexico
Co-Dependents Anonymous Netherlands
Co-Dependents Anonymous United Kingdom (and Meeting Information)
Co-Dependents Anonymous New Zealand
Co-Dependents Anonymous - Russia
Co-Dependents Anonymous Russia - St Petersburg
Co-Dependents Anonymous - Spain
Co-Dependents Anonymous - Sweden
Co-Dependents Anonymous Online Forum
CoDA Literature
Co-Dependents Anonymous UK & Europe Literature
Co-Dependents Recovery Society (Canadian Store)
US States
Co-Dependents Anonymous Arizona
Desert CoDA
LA CoDA
NorCal - North California CoDA
Co-Dependents Anonymous Portland, Oregon and Metro Area
SoCal - South California CoDA
Co-Dependents Anonymous Texas
Co-Dependents Anonymous Tucson
Codependency
Twelve-step programs
Mental health support groups
Organizations established in 1986
Non-profit organizations based in the United States
International non-profit organizations | 0.769758 | 0.985598 | 0.758672 |
Somatic experiencing | Somatic Experiencing (SE) is a form of alternative therapy aimed at treating trauma and stress-related disorders, such as PTSD. The primary goal of SE is to modify the trauma-related stress response through bottom-up processing. The client's attention is directed toward internal sensations, (interoception, proprioception and kinaesthesis), rather than to cognitive or emotional experiences. The method was developed by Peter A. Levine.
SE sessions are normally held in person and involve clients tracking their physical experiences. Practitioners are often mental health practitioners such as social workers, psychologists, therapists, psychiatrists, rolfers, Feldenkrais practitioners, yoga and Daoyin therapists, educators, clergy, occupational therapists, etc.
Theory and methods
Basis
Somatic Experiencing (also known as Somatic Therapy) is heavily predicated on psychoanalyst Wilhelm Reich's theories of blocked emotion and how this emotion is held and released from the body. It differs from traditional talk therapies such as CBT, which has a main focus on the mind and not the body, by prioritizing disturbing thoughts and behavior patterns and seeking to change them. Rather, Somatic Therapy treats the body as the starting point for healing. It is less about desensitizing people to uncomfortable sensations, and more about relieving tension in the body.
Many Western somatic psychotherapy approaches are based on either Reich or Elsa Gindler. Gindler's vision preceded Reich's and greatly influenced him. Gindler's direct link to the United States was Charlotte Selver. Selver greatly influenced Peter Levine's work and the development of fine somatic tracking. Selver taught thousands of Americans her "sensory awareness" method at Esalen Institute, including Peter Levine. Somatic Experiencing, like many of its sister modalities, is beholden to both Gindler and Reich. Each method has its own twist that differentiates it in style "in a manner alike to the different sects of an overarching religion" and even becoming "cult-like" at one time.
Definitions
Payne et al. describe SE as "not a form of exposure therapy" in that it "avoids direct and intense evocation of traumatic memories, instead approaching the charged memories indirectly and very gradually". Leitch et al. describe the approach similarly as "working with small gradations of traumatic activation alternated with the use of somatic resources. Working with small increments of traumatic material is a key component of SE, as is the development of somatic resources". In SE people "gently and incrementally reimagine and experience" and are "slowly working in graduated "doses"". Anderson et al., however, states that SE "includes techniques known from interoceptive exposure for panic attacks, by combining arousal reduction strategies with mild exposure therapy."
Systematic desensitization
One of the first exposure therapies, systematic desensitization, which was developed by Joseph Wolpe in the 1940s to treat anxiety disorders and phobias, is similarly described. Wolpe's systematic desensitization "consists of exposing the patient, while in a state of emotional calmness, to a small "dose" of something he fears" using imaginal methods that allow the therapist to "control precisely the beginning and ending of each presentation". This graduated exposure is similar to the SE concept of "titration". Wolpe also relied on relaxation responses alternating with incremental or graduated exposure to anxiety-provoking stimuli, and this practice was standard within cognitive-behavioral protocols long before Somatic Experiencing arrived on the scene as a trademarked approach in 1989.
Pendulation
One element of Somatic Experiencing therapy is "pendulation", a supposed natural intrinsic rhythm of the organism between contraction and expansion. The concept and its comparison to unicellular organisms can be traced to Wilhelm Reich, the father of somatic psychotherapy. Alexander Lowen and John Pierrakos, both psychiatrists, built upon Reich's foundational theories, developing Bioenergetics, and also compared the rhythm of this life force energy to a pendulum. The SE concept of the "healing vortex", is grounded in Ackert Ahsen's "law of bipolarity" according to Eckberg. Levine credits his inspiration for the healing vortex to a dream and not Ahsen. This principle involves the pendulatory tendency to weave back and forth between traumatic material and healing images and parasympathetic responses. Ahsen's "principle of bipolar configurations" asserts that "every significant eidetic state involves configuration . . . around two opposed nuclei which contend against each other. Every ISM of the negative type has a counter-ISM of the positive type."
SIBAM (Sensation, Image, Behavior, Affect and Meaning)
Peter Levine indicates that during the 1970's he "developed a model" called SIBAM, which broke down experience into five channels of Sensation, Image, Behavior, Affect and Meaning (or Cognition). SIBAM is considered both a model of experience and a model of dissociation. Multimodal Therapy, developed by Arnold Lazarus in the 1970's, is similar to the SIBAM model in that it broke down experience into Behavior, Affect, Sensation, Image, and Cognition (or Meaning). Somatic Experiencing integrates the tracking of Eugene Gendlin's "felt sense" into the model. Peter Levine has made good use of Gendlin’s focusing approach in Somatic Experiencing. "Dr. Levine emphasizes that the felt sense is the medium through which we understand all sensation, and that it reflects our total experience at a given moment."
Lazarus also incorporated Eugene Gendlin's Focusing method into his model as a technique to circumvent cognitive blocks. Incorporation of this "bottom up" "felt sense" method is shared by both SE and Multimodal Therapy. Lazarus, like Levine, was heavily influenced by Akhter Ahsen's "ISM unity" or "eidetic" concept. In 1968, Ahsen explains the ISM this way:
"It is a tri-dimensional unity. . . . With this image is attached a characteristic body feeling peculiar to the image, which we call the somatic pattern. With this somatic pattern is attached a third state composed of a constellation of vague and clear meanings, which we call the meaning." It is important to note that sensation, for Ahsen, included affective and physiological states.
Ahsen went on to apply his ISM concept to traumatic experiences, which is strikingly similar to Peter Levine's later developed model. In the SIBAM model, like in the ISM model, the separate dimensions of experience in trauma can be "dissociated from one another".
Coupling dynamics
In the Somatic Experiencing method there is the concept of "coupling dynamics" in which the "under-coupled" state, where the traumatic experience exists, not as a unity, but as dissociated elements of the SIBAM. In SE "the arousal in one element can trigger the arousal in other elements (overcoupling) or it can restrict arousal in other elements (undercoupling)." An SE therapist "often has to work to uncouple responses (if responses are overcoupled) or to find ways to couple them (if the responses are undercoupled) in order for therapy to progress and to help the individual to restore balance in his or her emotional life." Ashen's description clearly matches this concept. Additionally, treatment of "post-traumatic stress through imagery", like SE, "emphasizes exploitation of the somatic aspect over the visual component of Ashen's ISM model because of the strong emotional and physiological components that present themselves frontally in these cases."
Stress
According to SE, post-traumatic stress symptoms originate from an "overreaction of the innate stress system due to the overwhelming character of the traumatic event. In the traumatic situation, people are unable to complete the initiated psychological and physiological defensive reaction."
Standard cognitive behavioral understanding of PTSD and anxiety disorders was grounded in an understanding of fight, flight freeze mechanisms in addition to conscious and unconscious, preprogramed, automatic primal defensive action systems. SE is theorised to work through the "generation of new corrective interoceptive experiences" or the therapeutic ‘renegotiating’ of the traumatic response. Somatic Experiencing claims it is unique in this manner and therefore may be more effective than cognitive behavioral models due to this focus. The coupling dynamics model/SIBAM model in SE, however, is reminiscent to the pavlovian fear conditioning and extinction models underlying exposure based extinction paradigms of cognitive behavior therapy. Additionally, graduated exposure therapy and other fear extinction methods are similarly theorized to work due to the power of corrective experiences enhanced by "active coping" methods.
Discharge
In Somatic Experiencing therapy, "discharge" is facilitated in response to arousal to enable the client's body to return to a controlled condition. Discharge may be in the form of tears, a warm sensation, unconscious movement, the ability to breathe easily again, or other responses that demonstrate the autonomic nervous system returning to its baseline. The intention of this process is to reinforce the client's inherent capacity to self-regulate. The charge/discharge concept in Somatic Experiencing has its origins in Reichian therapy and Bioenergetics. Levine's predecessors in the somatic psychotherapy field clearly understood the dynamics of shock trauma and the failure of mobilization of fight or flight impulses in creating symptoms of anxiety neuroses and to maintain a chronic "state of emergency". They also understood that healing involved the completion of this "charge" associated with the truncated fight or flight impulses.
Polyvagal theory
Somatic Experiencing is also predicated on the Polyvagal Theory of human emotion developed by Stephen Porges. Many of the tenets of the Polyvagal theory incorporated in the Somatic Experiencing training are controversial and unproven. The SE therapy concepts such as "dorsal vagal shutdown" with bradycardia that are used to describe "freeze" and collapse states of trauma patients is controversial since it appears the ventral vagal branch, not the dorsal vagal branch, mediates this lowered heart rate and blood pressure state. Neurophysiological studies have shown that the dorsal motor nucleus has little to do with traumatic or psychologically related heart rate responses.
Link to shamanism
Levine's model, influenced by his work with shamans of "several cultures", makes wider connections "to myth and shamanism" and is "connected to these traditions". Levine "uses a story from shamanistic medicine to describe the work of body-centred trauma counselling. In shamanism, it is believed that when a person is overwhelmed by tragedy his soul will leave his body, a belief which is concordant with our present understanding of dissociation." Levine even notes that while developing his "theoretical biophysics doctoral dissertation on accumulated stress, as well as on my body-mind approach to resolving stress and healing trauma" he had a mystical experience where he engaged in a year-long socratic dialogue with an apparition of Albert Einstein. After reportedly having a "profound" dream Peter Levine believed he had been "assigned" the task "to protect this ancient knowledge from the Celtic Stone Age temples, and the Tibetan tradition, and to bring it to the scientific Western way of looking at things..."
Evidence
A 2019 systemic literature review noted that a stronger investment in clinical trials was needed to determine the efficacy of Somatic Experiencing. A 2021 literature review noted that "SE attracts growing interest in clinical application despite the lack of empirical research. Yet, the current evidence base is weak and does not (yet) fully accomplish the high standards for clinical effectiveness research."
Regulation
Unlike some of its sister somatic modalities (biodynamic craniosacral therapy, polarity therapy, etc.), Somatic Experiencing is not listed as an exempt modality from massage practice acts in the United States, and is not eligible to belong to The Federation of Therapeutic Massage, Bodywork and Somatic Practice Organizations, which was formed to protect the members' right to practice as an independent profession. Members of the Federation each have a professional regulating body with an enforceable code of ethics and standards of practice, continuing education requirements, a process of certifying and ensuring competency and a minimum of 500 hours of training. Somatic Experiencing practitioners do not meet any of these criteria unless they are already certified or licensed in another discipline. While the model has a growing evidence base as a modality "for treating people with post-traumatic stress disorder (PTSD)" that "integrates body awareness into the psychotherapeutic process", it is important to note that not all Somatic Experiencing practitioners practice psychotherapy and therefore have varying scopes of practice, for example, not all are qualified to work with people with mental disorders. SE instructs participants that they "are responsible for operating within their professional scope of practice and for abiding by state and federal laws".
See also
Further reading
Peter A. Levine, Trauma and Memory: Brain and Body in a Search for the Living Past: A Practical Guide for Understanding and Working with Traumatic Memory Paperback – Illustrated, North Atlantic Books, October 27, 2015
Peter A. Levine, Waking the Tiger: Healing Trauma: explains how trauma effects the brain-body: Paperback - North Atlantic Books, July 7, 1997
References
Alternative medical systems
Mind–body interventions
Post-traumatic stress disorder
Somatics
Somatic psychology
Therapy | 0.760999 | 0.996921 | 0.758656 |
Yavis | YAVIS (sometimes "YAVIS Syndrome") is an acronym that stands for "young, attractive, verbal, intelligent, and successful." It describes a group of patients that are said to be preferred by mental health professionals. It is based on the perception that this group is characteristically and without external intervention able to form a more positive therapeutic relationship.
Origin
The term was coined by University of Minnesota professor William Schofield in his 1964 book Psychotherapy: The Purchase of Friendship in which he claimed to have demonstrated that mental health professionals often have a positive bias towards clients exhibiting the YAVIS traits. In other words, individuals with these characteristics are assumed to represent a psychotherapist's “ideal patient.” Schofield explained that such a bias may in turn predispose the professional to work harder to help these clients at the expense of the patients who have much greater needs. Such an inclination, although mostly unconscious, was thought to be driven by an expectation that clients with such traits would be motivated to work harder in therapy, thereby increasing the therapist's hope that the treatment would be effective. Asians, for instance, are stereotyped as "inscrutable" making them less preferred than the YAVIS patients. Further, this process would work to enhance the therapist's experience of him/herself as competent, which may help explain why YAVIS clients are unconsciously seen as more desirable.
In a chapter titled "Why I Do Not Attend Case Conferences" of his book Psychodiagnosis: Selected Papers (1973), psychologist Paul Meehl describes several logical fallacies that may arise in the context of medical case conferences, including hidden decisions that health professionals (and people in general) tend to make about others. Meehl discusses YAVIS among the biases that lead to hidden decisions, and he specifically points to the fact that research has shown that clients of a lower socioeconomic status are more likely to receive medication or electroconvulsive or supportive therapy. Middle and upper class clients (or those seen as more “successful”), on the other hand, are more likely to receive intensive, long-term psychotherapy. Meehl outlines that the latter types of treatments are generally more in line with the interests and theoretical frameworks of most practicing psychologists. Meehl uses this example to illustrate that psychotherapists may unknowingly give preferential treatment to clients of higher SES, or individuals with other YAVIS characteristics.
Many psychologists identify that hidden decisions such as YAVIS pose ethical dilemmas when it comes to deciding which treatment options are most appropriate for any given client. Meehl points to the necessity of making such quick decisions due to a lack of resources, and identifies that there simply are not enough practitioners to be able to treat all clients on a long-term basis. He advocates, ideally, for the use of more objective ways in which to make clinical decisions, but he also highlights the practical importance of being aware of YAVIS and the hidden decisions that these biases might elicit.
Some commenters have begun using the acronym HOUND ("Homely, Old, Unsuccessful, Nonverbal, and Dumb") as an antonym .
References
External links
The Ideal Psychotherapy Client: Are you a YAVIS?
A Simple Solution To An Epidemic Problem
Psychotherapy | 0.785959 | 0.965258 | 0.758653 |
Rumination syndrome | Rumination syndrome, or merycism, is a chronic motility disorder characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. There is no retching, nausea, heartburn, odour, or abdominal pain associated with the regurgitation as there is with typical vomiting, and the regurgitated food is undigested. The disorder has been historically documented as affecting only infants, young children, and people with cognitive disabilities (the prevalence is as high as 10% in institutionalized patients with various mental disabilities).
It is increasingly being diagnosed in a greater number of otherwise healthy adolescents and adults, though there is a lack of awareness of the condition by doctors, patients, and the general public.
Rumination syndrome presents itself in a variety of ways, with especially high contrast existing between the presentation of the typical adult patient without a mental disability and the presentation of an adult with a mental disability. Like related gastrointestinal disorders, rumination can adversely affect normal functioning and the social lives of individuals. It has been linked with depression.
Little comprehensive data regarding rumination syndrome in otherwise healthy individuals exists because most people are private about their illness and are often misdiagnosed due to the number of symptoms and the clinical similarities between rumination syndrome and other disorders of the stomach and esophagus, such as gastroparesis and bulimia nervosa. These symptoms include the acid-induced erosion of the esophagus and enamel, halitosis, malnutrition, severe weight loss and an unquenchable appetite. Individuals may begin regurgitating within a minute following ingestion, and the full cycle of ingestion and regurgitation can mimic the binging and purging of bulimia.
Diagnosis of rumination syndrome is non-invasive and based on a history of the individual. Treatment is promising, with upwards of 85% of individuals responding positively to treatment, including infants and mentally disabled people.
Signs and symptoms
While the number and severity of symptoms vary among individuals, repetitive regurgitation of undigested food (known as rumination) after the start of a meal is always present. In some individuals, the regurgitation is small, occurring over a long period of time following ingestion, and can be rechewed and swallowed. In others, the amount can be bilious and short-lasting, and must be expelled.
While some only experience symptoms following some meals, most experience episodes following any ingestion, from a single bite to a large meal. However, some long-term patients will find a select couple of food or drink items that do not trigger a response.
Unlike typical vomiting, regurgitation is typically described as effortless and unforced. There is seldom nausea preceding the expulsion, and the undigested food lacks the bitter taste and odour of stomach acid and bile.
Symptoms can begin to manifest at any point from the ingestion of the meal to two hours thereafter. However, the more common range is between thirty seconds and one hour after the completion of a meal. Symptoms tend to cease when the ruminated contents become acidic.
Abdominal pain (38.1%), lack of fecal production or constipation (21.1%), nausea (17.0%), diarrhea (8.2%), bloating (4.1%), and dental decay (3.4%) are also described as common symptoms in day-to-day life. These symptoms are not necessarily prevalent during regurgitation episodes, and can happen at any time. Weight loss is often observed (42.2%) at an average loss of 9.6 kilograms, and is more common in cases where the disorder has gone undiagnosed for a longer period of time, though this may be expected of the nutrition deficiencies that often accompany the disorder as a consequence of its symptoms. Depression has also been linked with rumination syndrome, though its effects on rumination syndrome are unknown.
Acid erosion of the teeth can be a feature of rumination, as can halitosis (bad breath).
Causes
The cause of rumination syndrome is unknown. However, studies have drawn a correlation between hypothesized causes and the history of patients with the disorder. In infants and the cognitively impaired, the disease has normally been attributed to overstimulation and under-stimulation from parents and caregivers, causing the individual to seek self-gratification and self-stimulus due to the lack or abundance of external stimuli. The disorder has also commonly been attributed to a bout of illness, a period of stress in the individual's recent past, and to changes in medication.
In adults and adolescents, hypothesized causes generally fall into one of either category: habit-induced, and trauma-induced. Habit-induced individuals generally have a history of bulimia nervosa or of intentional regurgitation (magicians and professional regurgitators, for example), which though initially self-induced, forms a subconscious habit that can continue to manifest itself outside the control of the affected individual. Trauma-induced individuals describe an emotional or physical injury (such as recent surgery, psychological distress, concussions, deaths in the family, etc.), which preceded the onset of rumination, often by several months.
Pathophysiology
Rumination syndrome is a poorly understood disorder, and a number of theories have speculated the mechanisms that cause the regurgitation, which is a unique symptom to this disorder. While no theory has gained a consensus, some are more notable and widely published than others.
The most widely documented mechanism is that the ingestion of food causes gastric distention, which is followed by abdominal compression and the simultaneous relaxation of the lower esophageal sphincter (LES). This creates a common cavity between the stomach and the oropharynx that allows the partially digested material to return to the mouth. There are several offered explanations for the sudden relaxation of the LES. Among these explanations is that it is a learned voluntary relaxation, which is common in those with or having had bulimia. While this relaxation may be voluntary, the overall process of rumination is still generally involuntary. Relaxation due to intra-abdominal pressure is another proposed explanation, which would make abdominal compression the primary mechanism. The third is an adaptation of the belch reflex, which is the most commonly described mechanism. The swallowing of air immediately prior to regurgitation causes the activation of the belching reflex that triggers the relaxation of the LES. Patients often describe a feeling similar to the onset of a belch preceding rumination.
Diagnosis
Rumination syndrome is diagnosed based on a complete history of the individual. Costly and invasive studies such as gastroduodenal manometry and esophageal pH testing are unnecessary and will often aid in misdiagnosis. Based on typical observed features, several criteria have been suggested for diagnosing rumination syndrome. The primary symptom, the regurgitation of recently ingested food, must be consistent, occurring for at least six weeks of the past twelve months. The regurgitation must begin within 30 minutes of the completion of a meal. Patients may either chew the regurgitated matter or expel it. The symptoms must stop within 90 minutes, or when the regurgitated matter becomes acidic. The symptoms must not be the result of a mechanical obstruction, and should not respond to the standard treatment for gastroesophageal reflux disease.
In adults, the diagnosis is supported by the absence of classical or structural diseases of the gastrointestinal system. Supportive criteria include a regurgitant that does not taste sour or acidic, is generally odourless, is effortless, or at most preceded by a belching sensation, that there is no retching preceding the regurgitation, and that the act is not associated with nausea or heartburn.
Patients visit an average of five physicians over 2.75 years before being correctly diagnosed with rumination syndrome.
Differential diagnosis
Rumination syndrome in adults is a complicated disorder whose symptoms can mimic those of several other gastroesophageal disorders and diseases. Bulimia nervosa and gastroparesis are especially prevalent among the misdiagnoses of rumination.
Bulimia nervosa, among adults and especially adolescents, is by far the most common misdiagnosis patients will hear during their experiences with rumination syndrome. This is due to the similarities in symptoms to an outside observer—"vomiting" following food intake—which, in long-term patients, may include ingesting copious amounts to offset malnutrition, and a lack of willingness to expose their condition and its symptoms. While it has been suggested that there is a connection between rumination and bulimia, unlike bulimia, rumination is not self-inflicted. Adults and adolescents with rumination syndrome are generally well aware of their gradually increasing malnutrition, but are unable to control the reflex. In contrast, those with bulimia intentionally induce vomiting, and seldom re-swallow food.
Gastroparesis is another common misdiagnosis. Like rumination syndrome, patients with gastroparesis often bring up food following the ingestion of a meal. Unlike rumination, gastroparesis causes vomiting (in contrast to regurgitation) of food, which is not being digested further, from the stomach. This vomiting occurs several hours after a meal is ingested, preceded by nausea and retching, and has the bitter or sour taste typical of vomit.
Classification
Rumination syndrome is a condition which affects the functioning of the stomach and esophagus, also known as a functional gastroduodenal disorder. In patients that have a history of eating disorders, Rumination syndrome is grouped alongside eating disorders such as bulimia and pica, which are themselves grouped under non-psychotic mental disorder. In most healthy adolescents and adults who have no mental disability, Rumination syndrome is considered a motility disorder instead of an eating disorder, because the patients tend to have had no control over its occurrence and have had no history of eating disorders.
Treatment and prognosis
There is presently no known cure for rumination. Proton pump inhibitors and other medications have been used to little or no effect.
Treatment is different for infants and mentally disabled adults than for adults and adolescents of typical intelligence. Among infants and mentally disabled adults, behavioral and mild aversion training has been shown to cause improvement in most cases. Aversion training involves associating the ruminating behavior with negative results, and rewarding good behavior and eating. Placing a sour or bitter taste on the tongue when the individual begins the movements or breathing patterns typical of his or her ruminating behavior is the generally accepted method for aversion training,
although some older studies advocate the use of pinching.
In patients of normal intelligence, rumination is not an intentional behavior and is habitually reversed using diaphragmatic breathing to counter the urge to regurgitate. Alongside reassurance, explanation and habit reversal, patients are shown how to breathe using their diaphragms prior to and during the normal rumination period. A similar breathing pattern can be used to prevent normal vomiting. Breathing in this method works by physically preventing the abdominal contractions required to expel stomach contents.
Supportive therapy and diaphragmatic breathing has shown to cause improvement in 56% of cases, and total cessation of symptoms in an additional 30% in one study of 54 adolescent patients who were followed up 10 months after initial treatments. Patients who successfully use the technique often notice an immediate change in health for the better. Individuals who have had bulimia or who intentionally induced vomiting in the past have a reduced chance for improvement due to the reinforced behavior. The technique is not used with infants or young children due to the complex timing and concentration required for it to be successful. Most infants grow out of the disorder within a year or with aversive training.
Epidemiology
Rumination disorder was initially documented
as affecting newborns,
infants, children
and individuals with mental and functional disabilities (cognitively disabled).
It has since been recognized to occur in both males and females of all ages and cognitive abilities.
Among cognitively disabled people, it is described with almost equal prevalence among infants (6–10% of the population) and institutionalized adults (8–10%).
In infants, it typically occurs within the first 3–12 months of age.
The occurrence of rumination syndrome within the general population has not been defined. Rumination is sometimes described as rare, but has also been described as not rare, but rather rarely recognized.
The disorder has a female predominance. The typical age of adolescent onset is 12.9, give or take 0.4 years (±), with males affected sooner than females (11.0 ± 0.8 for males versus 13.8 ± 0.5 for females).
There is little evidence concerning the impact of hereditary influence in rumination syndrome. However, case reports involving entire families with rumination exist.
History
The term rumination is derived from the Latin word ruminare, which means to chew the cud. First described in ancient times, and mentioned in the writings of Aristotle, rumination syndrome was clinically documented in 1618 by Italian anatomist Fabricus ab Aquapendente, who wrote of the symptoms in a patient of his.
Among the earliest cases of rumination was that of a physician in the nineteenth century, Charles-Édouard Brown-Séquard, who acquired the condition as the result of experiments upon himself. As a way of evaluating and testing the acid response of the stomach to various foods, the doctor would swallow sponges tied to a string, then intentionally regurgitate them to analyze the contents. As a result of these experiments, the doctor eventually regurgitated his meals habitually by reflex.
Numerous case reports exist from before the twentieth century, but were influenced greatly by the methods and thinking used in that time. By the early twentieth century, it was becoming increasingly evident that rumination presented itself in a variety of ways in response to a variety of conditions. Although still considered a disorder of infancy and cognitive disability at that time, the difference in presentation between infants and adults was well established.
Studies of rumination in otherwise healthy adults became increasingly common starting in the 1900s, and the majority of published reports analyzing the syndrome in mentally healthy patients appeared thereafter. At first, adult rumination was described and treated as a benign condition. It is now described as otherwise. While the base of patients to examine has gradually increased as more and more people come forward with their symptoms, awareness of the condition by the medical community and the general public is still limited.
In other animals
The chewing of cud by animals such as cows, goats, and giraffes is considered normal behavior. These animals are known as ruminants. Such behavior, though termed rumination, is not related to human rumination syndrome, but is ordinary. Involuntary rumination, similar to what is seen in humans, has been described in gorillas and other primates. Macropods such as kangaroos also regurgitate, re-masticate, and re-swallow food, but these behaviors are not essential to their normal digestive process, are not observed as predictably as the ruminants', and hence were termed "merycism" in contrast with "true rumination".
See also
Professional regurgitator
References
External links
Pediatrics - Rumination Syndrome - The Mayo Clinic. Website provides an overview of the effect of the disorder on children.
Rumination disorder - Web MD. Provides a general overview of the disease.
Eating disorders
Syndromes
de:Essstörung | 0.765257 | 0.991346 | 0.758635 |
Dysfunctional family | A dysfunctional family is a family in which conflict, misbehavior and often child neglect or abuse on the part of individual parents occur continuously and regularly. Children that grow up in such families may think such a situation is normal. Dysfunctional families are primarily a result of two adults, one typically overtly abusive and the other codependent, and may also be affected by substance abuse or other forms of addiction, or sometimes by an untreated mental illness. Parents having grown up in a dysfunctional family may over-correct or emulate their own parents. In some cases, the dominant parent will abuse or neglect their children and the other parent will not object, misleading a child to assume blame.
Examples
Dysfunctional family members have common features and behavior patterns as a result of their experiences within the family structure. This tends to reinforce the dysfunctional behavior, either through enabling or perpetuation. The family unit can be affected by a variety of factors.
Common features
Nearly universal
Some features are common to most dysfunctional families:
Lack of empathy, understanding, and sensitivity towards certain family members, while expressing extreme empathy or appeasement towards one or more members who have real or perceived special needs. In other words, one family member continuously receives far more than they deserve, while another is marginalized.
Denial (refusal to acknowledge abusive behavior, possibly believing that the situation is normal or even beneficial; also known as the "elephant in the room".)
Inadequate or missing boundaries for self (e.g. tolerating inappropriate treatment from others, failing to express what is acceptable and unacceptable treatment, tolerance of physical, emotional or sexual abuse.)
Disrespect of others' boundaries (e.g. physical contact that other person dislikes; breaking important promises without just cause; purposefully violating a boundary another person has expressed.)
Extremes in conflict (either too much fighting or insufficient peaceful arguing between family members.)
Unequal or unfair treatment of one or more family members due to their birth order, gender (or gender identity), age, sexual orientation, family role (mother, etc.), abilities, race, caste, etc. (may include frequent appeasement of one member at the expense of others, or an uneven/inconsistent enforcement of rules.)
Not universal
Though not universal among dysfunctional families, and by no means exclusive to them, the following features are typical of dysfunctional families:
Abnormally high levels of jealousy or other controlling behaviors.
Conflict influenced by marital status:
Between separated or divorced parents, usually related to, or arising from their breakup.
Conflict between parents who remain married, often for the perceived sake of the children, but whose separation or divorce would in fact remove a detrimental influence on those children (must be evaluated on a case-by-case basis, as a breakup may harm children.)
Parents who wish to divorce, but cannot due to financial, societal (including religious), or legal reasons.
Children afraid to talk (within or outside the family) about what is happening at home, or are otherwise fearful of their parents.
Abnormal sexual behavior such as adultery, promiscuity, or incest.
Lack of time spent together, especially in recreational activities and social events ("We never do anything as a family.")
Parents insist that they treat their children fairly and equitably when that is not the case.
Family members (including children) who disown each other, or refuse to be seen together in public (either unilaterally or bilaterally.)
Children of parents who are experiencing a substance use disorder or who engage in binge drinking have an increased tendency to adopt substance use disorders later in life.
Specific examples
There are certain times where families can become dysfunctional due to specific situational examples. Some of these include difficulty integrating into a new culture, strain in the relationship between nuclear and extended family members, children in a rebellion phase, and ideological differences in belief systems.
Laundry List
The program Adult Children of Alcoholics includes a "Laundry List", core literature of the program. This list has 14 different statements that relate to being an adult child of a parent with an alcohol addiction. These statements provide commentary on how children have been affected by the trauma of having alcoholic parents. Some highlights of the statements include, "confusing love and pity", "having low self-esteem", and having a "loss of identity". The Laundry List is a helpful tool in group therapy in order to show families that they are not alone in their struggles. Female children whose parents were alcoholics have an increased risk of developing depression. Male children of alcoholics are at a significantly higher risk for developing a substance use disorder.
Parenting
Unhealthy signs
Unhealthy parenting signs, which could lead to a family becoming dysfunctional include:
Unrealistic expectations
Ridicule
Conditional love
Disrespect; especially contempt.
Emotional intolerance (family members not allowed to express the "wrong" emotions.)
Social dysfunction or isolation (for example, parents unwilling to reach out to other families—especially those with children of the same gender and approximate age, or do nothing to help their "friendless" child.)
Stifled speech (children not allowed to dissent or question authority.)
Denial of an "inner life" (children are not allowed to develop their own value systems.)
Being under- or over-protective
Apathy ("I don't care!")
Belittling ("You can't do anything right!")
Shame ("Shame on you!")
Bitterness (regardless of what is said, using a bitter tone of voice.)
Hypocrisy ("Do as I say, not as I do.")
Lack of forgiveness for minor misdeeds or accidents
Judgmental statements or demonization ("You are a liar!")
Being overly critical and withholding proper praise. (experts say 80–90% praise, and 10–20% constructive criticism is the most healthy.)
Double standards or giving "mixed messages" by having a dual system of values (i.e. one set for the outside world, another when in private, or teaching divergent values to each child.)
The absentee parent (seldom available for their child due to work overload, alcohol/drug abuse, gambling, or other addictions.)
Unfulfilled projects, activities, and promises affecting children ("We'll do it later.")
Giving to one child what rightly belongs to another
Gender prejudice (treats one gender of children fairly; the other unfairly.)
Discussion and exposure to sexuality: either too much, too soon or too little, too late
Faulty discipline based more on emotions or family politics than on established rules (e.g., punishment by "surprise".)
Having an unpredictable emotional state due to substance abuse, personality disorder(s), or stress
Parents always (or never) take their children's side when others report acts of misbehavior, or teachers report problems at school
Scapegoating (knowingly or recklessly blaming one child for the misdeeds of another)
"Tunnel vision" diagnosis of children's problems (for example, a parent may think their child is either lazy or has learning disabilities after falling behind in school despite recent absence due to illness.)
Older siblings given either no or excessive authority over younger siblings with respect to their age difference and level of maturity.
Frequent withholding of consent ("blessing") for culturally common, lawful, and age-appropriate activities a child wants to take part in
The "know-it-all" (has no need to obtain child's side of the story when accusing, or listen to child's opinions on matters which greatly impact them.)
Regularly forcing children to attend activities for which they are extremely over- or under-qualified (e.g. using a preschool to babysit a typical nine-year-old boy, taking a young child to poker games, etc.)
Either being a miser ("scrooge") in totality or selectively allowing children's needs to go unmet (e.g. a father will not buy a bicycle for his son because he wants to save money for retirement or "something important".)
Disagreements about nature and nurture (parents, often non-biological, blame common problems on child's heredity, when faulty parenting may be the actual cause.)
Dysfunctional styles
"Children as pawns"
One common dysfunctional parental behavior is a parent's manipulation of a child in order to achieve some outcome adverse to the other parent's rights or interests. Examples include verbal manipulation such as spreading gossip about the other parent, communicating with the parent through the child (and in the process exposing the child to the risks of the other parent's displeasure with that communication) rather than doing so directly, trying to obtain information through the child (spying), or causing the child to dislike the other parent, with insufficient or no concern for the damaging effects of the parent's behavior on the child. While many instances of such manipulation occur in shared custody situations that have resulted from separation or divorce, it can also take place in intact families, where it is known as triangulation.
List of other dysfunctional styles
"Using" (destructively narcissistic parents who rule by fear and conditional love.)
Abusing (parents who use physical violence, or emotionally, or sexually abuse their children.)
Perfectionist (fixating on order, prestige, power, or perfect appearances, while preventing their child from failing at anything.)
Dogmatic or cult-like (harsh and inflexible discipline, with children not allowed, within reason, to dissent, question authority, or develop their own value system.)
Inequitable parenting (going to extremes for one child while continually ignoring the needs of another.)
Deprivation (control or neglect by withholding love, support, necessities, sympathy, praise, attention, encouragement, supervision, or otherwise putting their children's well-being at risk.)
Abuse among siblings (parents fail to intervene when a sibling physically or sexually abuses another sibling.)
Abandonment (a parent who willfully separates from their children, not wishing any further contact, and in some cases without locating alternative, long-term parenting arrangements, leaving them as orphans.)
Appeasement (parents who reward bad behavior—even by their own standards—and inevitably punish another child's good behavior in order to maintain the peace and avoid temper tantrums. "Peace at any price.")
Loyalty manipulation (giving unearned rewards and lavish attention trying to ensure a favored, yet rebellious child will be the one most loyal and well-behaved, while subtly ignoring the wants and needs of their most loyal child currently.)
"Helicopter parenting" (parents who micro-manage their children's lives or relationships among siblings—especially minor conflicts.)
"The deceivers" (well-regarded parents in the community, likely to be involved in some charitable/non-profit works, who abuse or mistreat one or more of their children.)
"Public image manager" (sometimes related to above, children warned to not disclose what fights, abuse, or damage happens at home, or face severe punishment "Don't tell anyone what goes on in this family".)
"The paranoid parent" (a parent having persistent and irrational fear accompanied by anger and false accusations that their child is up to no good or others are plotting harm.)
"No friends allowed" (parents discourage, prohibit, or interfere with their child from making friends of the same age and gender.)
Role reversal (parents who expect their minor children to take care of them instead.)
"Not your business" (children continuously told that a particular brother or sister who is often causing problems is none of their concern.)
Ultra-egalitarianism (either a much younger child is permitted to do whatever an older child may, or an older child must wait years until a younger child is mature enough.)
"The guard dog" (a parent who blindly attacks family members perceived as causing the slightest upset to their esteemed spouse, partner, or child.)
"My baby forever" (a parent who will not allow one or more of their young children to grow up and begin taking care of themselves.)
"The cheerleader" (one parent "cheers on" the other parent who is simultaneously abusing their child.)
"Along for the ride" (a reluctant de facto, step, foster, or adoptive parent who does not truly care about their non-biological child, but must co-exist in the same home for the sake of their spouse or partner) (See also: Cinderella effect).
"The politician" (a parent who repeatedly makes or agrees to children's promises while having little to no intention of keeping them.)
"It's taboo" (parents rebuff any questions children may have about sexuality, pregnancy, romance, puberty, certain private body areas, nudity, etc.)
Identified patient (one child, usually selected by the mother, who is forced into going to therapy while the family's overall dysfunction is kept hidden.)
Münchausen syndrome by proxy (a much more extreme situation than above, where the child is intentionally made ill by a parent seeking attention from physicians and other professionals.)
Dynamical
Coalitions are subsystems within families with more rigid boundaries and are thought to be a sign of family dysfunction.
The isolated family member (either a parent or child up against the rest of the otherwise united family.)
Parent vs. parent (frequent fights amongst adults, whether married, divorced, or separated, conducted away from the children.)
The polarized family (a parent and one or more children on each side of the conflict.)
Parents vs. kids (intergenerational conflict, generation gap or culture shock dysfunction.)
The balkanized family (named after the three-way war in the Balkans where alliances shift back and forth.)
Free-for-all (a family that fights in a "free-for-all" style, though may become polarized when range of possible choices is limited.)
Children
Unlike divorce, and to a lesser extent, separation, there is often no record of an "intact" family being dysfunctional. As a result, friends, relatives, and teachers of such children may be completely unaware of the situation. In addition, a child may be unfairly blamed for the family's dysfunction, and placed under even greater stress than those whose parents separate.
The six basic roles
Children growing up in a dysfunctional family have been known to adopt or be assigned one or more of the following six basic roles:
The Golden Child (also known as the Hero or Superkid): a child who becomes a high achiever or overachiever outside the family (e.g., in academics or athletics) as a means of escaping the dysfunctional family environment, defining themselves independently of their role in the dysfunctional family, currying favor with parents, or shielding themselves from criticism by family members.
The Problem Child, Rebel, or Truth Teller: the child who a) causes most problems related to the family's dysfunction or b) "acts out" in response to preexisting family dysfunction, in the latter case often in an attempt to divert attention paid to another member who exhibits a pattern of similar misbehavior.
A variant of the "problem child" role is the Scapegoat, who is unjustifiably assigned the "problem child" role by others within the family or even wrongfully blamed by other family members for those members' own individual or collective dysfunction, often despite being the only emotionally stable member of the family.
The Caretaker: the one who takes responsibility for the emotional well-being of the family, often assuming a parental role; the intra-familial counterpart of the "Good Child"/"Superkid."
The Lost Child or Passive Kid: the inconspicuous, introverted, quiet one, whose needs are usually ignored or hidden.
The Mascot or Family Clown: uses comedy to divert attention away from the increasingly dysfunctional family system.
The Mastermind: the opportunist who capitalizes on the other family members' faults to get whatever they want; often the object of appeasement by grown-ups.
Effects on children
Children that are a product of dysfunctional families, either at the time or as they grow older, may exhibit behavior that is inappropriate for their expected stage of development due to psychological distress. Children of dysfunctional families may also behave in a manner that is relatively immature when compared to their peers. Conversely, other children may appear to emotionally "grow up too fast"; or be in a mixed mode (e.g. well-behaved, but unable to care for themselves.) Children from dysfunctional environments also have a tendency to demonstrate learned unhealthy attachments due to intergenerational dysfunctional parenting.
The effects of a disordered upbringing may induce an array of mental health issues, including depression and anxiety. A disordered family environment unfortunately places these young individuals at a higher risk of engaging in more severe actions of self-harm and problematic conduct. This troubled environment can also subject the youth to a significantly higher risk of becoming addicted to drugs or developing alcoholism, especially if parents or close peers have a history of substance use. Numerous studies have determined that deviant peer associations are generally associated with substance use and that parental use can account for one-half to two-thirds of future instances of chemical dependency. There is also an increased risk of the young individual developing behavioral addictions in the forms of gambling, pornography addictions, or engaging in other future detrimental activities such as compulsive spending.
Children who are raised in dysfunctional environments are also at a higher risk of developing an eating disorder, including anorexia nervosa or binge eating disorder as an emotional coping method due to psychological distress.
These young individuals may also have difficulty forming and maintaining healthy relationships within their peer group, due to social apprehensions, possible personality disorders, or post-traumatic stress disorders. A child may also demonstrate oppositional defiant characteristics by rebelling against parental authority, and non-family adults, or conversely, upholding their family's values in the face of peer pressure. Children of disordered environments may also demonstrate a lack of self-discipline when their parents are not around, or develop procrastinating tendencies that can have detrimental effects on their educational/occupational obligations.
Additionally, children may demonstrate social inadequacies by spending an inordinate amount of time engaging in activities that lack in-person social interaction. This disordered upbringing can also promote the child to project aggressive behaviors on their peers by bullying or harassing others or becoming a victim of bullying. Both of these roles often lead to an elevated risk of the child having low self-esteem issues, increased prevalence of isolation, and difficulties expressing emotions, a common effect related to emotional and physical abuse.
A lack of parental structure and positive peer influences can lead young individuals to seek alternative forms of peer alliances, including peer groups that engage in juvenile delinquency and those who perform acts that are knowingly illegal or demonstrate symptoms of an oppositional defiant disorder. This habitual behavior and environmental factors can also lead the troubled youth to a life of crime, or to become involved in gang activity.
This lack of socially normative structure and defiant behavior is also notable in cases where sexual abuse was prevalent. Early sexual experiences can lead to sexually inappropriate behavior that could lead to future interest in pedophilia, or facing charges that can result in the individual becoming a sex offender. A 1999 study determined that children who had experienced abusive sexual experiences, "as compared to those without, were more likely to be victims of physical family violence, to have run away, to be substance abusers, and to have family members with drug or alcohol problems" (Kellogg et al, 1999). Additionally, the young individual may be at an elevated risk of becoming poor or homeless, even in cases where the child's environment consisted of an average/above-average socioeconomic standing.
Further socialization problems can be demonstrated by children of dysfunctional families, including habitual or sudden academic performance problems. This notion can be more apparent as the child may exhibit a severe lack of organizational skills in their day-to-day lives. These individuals are also at an elevated inability to maintain healthy interpersonal relationships, which often includes distrusting others or even demonstrating paranoid behaviors that can be indicative of childhood trauma-induced psychosis and schizophrenia. There is also a higher probability of the youth engaging in future unstable empathetical relationships, with higher tendencies to engage in more risky behavior, including sex with multiple partners, becoming pregnant, or becoming a parent of illegitimate children.
Further dysfunctional behaviors can be perpetuated in other future relationships. An individual that was raised in a dysfunctional home environment may also pass this learned behavior on to their offspring, including their substance use habits, conflict resolution methods, and learned social boundaries. These social inadequacies can result in individuals demonstrating self-protective behaviors, to compensate for the difference in their childhoods, as they may have the inability to practice positive self-care and effective emotional coping strategies.
In popular culture
Films about dysfunctional families
Television series about dysfunctional families
Animated television series about dysfunctional families
See also
References
References Cont.
23. Palmer, Nancie. (August 1997). Resilience in Adult Children of Alcoholics:A Nonpathological Approach to Social Work Practice, Health & Social Work, 22 (3) pp. 201–209, https://doi.org/10.1093/hsw/22.3.201
24. ACA Worldwide. (2022, April 14). Adult Children of Alcoholics & Dysfunctional Families World Service Organization. Adult Children of Alcoholics & Dysfunctional Families. Retrieved April 19, 2022, from https://adultchildren.org/
Further reading
Lundy Bancroft, "Why Does He Do That? Inside the Minds of Angry and Controlling Men" 2002 Berkley Books,
John Bradshaw, Healing the Shame That Binds You
John Bradshaw, Homecoming: Reclaiming and Healing Your Inner Child
John Bradshaw, Bradshaw On: The Family
Stephanie Donaldson-Pressman, The Narcissistic Family. Diagnosis and Treatment
Beth Polson and Miller Newton, Not My Kid: A Family's Guide to Kids and Drugs, Arbor Books / Kids of North Jersey Nurses, 1984, ,
Charles L. Whitfield, Healing the Child Within: Discovery and Recovery for Adult Children of Dysfunctional Families
External links
Family disruption
Parenting
Child abuse | 0.760096 | 0.998076 | 0.758633 |
International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use | The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) is an initiative that brings together regulatory authorities and pharmaceutical industry to discuss scientific and technical aspects of pharmaceutical product development and registration. The mission of the ICH is to promote public health by achieving greater harmonisation through the development of technical guidelines and requirements for pharmaceutical product registration.
Harmonisation leads to a more rational use of human, animal and other resources, the elimination of unnecessary delay in the global development, and availability of new medicines while maintaining safeguards on quality, safety, efficacy, and regulatory obligations to protect public health. Junod notes in her 2005 treatise on clinical drug trials that "[a]bove all, the ICH has succeeded in aligning clinical trial requirements."
History
In the 1980s, the European Union began harmonising regulatory requirements. In 1989, Europe, Japan, and the United States began creating plans for harmonisation. The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) was created in April 1990 at a meeting in Brussels. ICH had the initial objective of coordinating the regulatory activities of the European, Japanese and American regulatory bodies in consultation with the pharmaceutical trade associations from these regions, to discuss and agree the scientific aspects arising from product registration. Since the new millennium, ICH's attention has been directed towards extending the benefits of harmonisation beyond the founding ICH regions.
In 2015, ICH underwent several reforms and changed its name to the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use while becoming a legal entity in Switzerland as a non-profit association. The aim of these reforms was to transform ICH into a truly global initiative supported by a robust and transparent governance structure. The ICH association established an assembly as the over-arching governing body with the aim of focusing global pharmaceutical regulatory harmonisation work in one venue that allows pharmaceutical regulatory authorities and concerned industry organisations to be more actively involved in ICH's harmonisation work. The new assembly met for the first time on 23 October 2015.
Structure
The ICH comprises the following bodies:
ICH Assembly
ICH Management Committee
MedDRA Management Committee
ICH Secretariat
The ICH assembly brings together all members and observers of the ICH association as the overarching governing body of ICH. It adopts decisions in particular on matters such as on the adoption of ICH guidelines, admission of new members and observers, and the ICH association's work plans and budget. Member representatives appointed to the assembly are supported by ICH coordinators who represent each member to the ICH secretariat on a daily basis.
The ICH Management Committee (MC) is the body that oversees operational aspects of ICH on behalf of all members, including administrative and financial matters and oversight of the working groups (WGs).
The MedDRA Management Committee (MC) is responsible for direction of MedDRA, ICH's standardised medical terminology. The MedDRA MC has the role of managing, supporting, and facilitating the maintenance, development, and dissemination of MedDRA.
The ICH secretariat is responsible for day-to-day management of ICH, coordinating ICH activities as well as providing support to the assembly, the MC and working groups. The ICH secretariat also provides support for the MedDRA MC. The ICH secretariat is located in Geneva, Switzerland.
The ICH WGs are established by the assembly when a new technical topic is accepted for harmonisation, and are charged with developing a harmonised guideline that meets the objectives outlined in the concept paper and business plan. Face-to-face meetings of the WG will normally only take place during the biannual ICH meetings. Interim reports are made at each meeting of the assembly and made publicly available on the ICH website.
Process of Harmonisation
ICH harmonisation activities fall into 4 categories: Formal ICH Procedure, Q&A Procedure, Revision Procedure and Maintenance Procedure, depending on the activity to be undertaken.
The development of a new harmonised guideline and its implementation (the formal ICH procedure) involves 5 steps:
Step 1: Consensus building
The WG works to prepare a consensus draft of the technical document, based on the objectives set out in the concept paper.
When consensus on the draft is reached within the WG, the technical experts of the WG will sign the Step 1 Experts sign-off sheet. The Step 1 Experts' technical document is then submitted to the assembly to request adoption under Step 2 of the ICH process.
Step 2a: Confirmation of consensus on the technical document
Step 2a is reached when the assembly agrees, based on the report of the WG, that there is sufficient scientific consensus on the technical issues for the technical document to proceed to the next stage of regulatory consultation. The assembly then endorses the Step 2a technical document.
Step 2b: Endorsement of draft guideline by regulatory members
Step 2b is reached when the regulatory members of the assembly further endorse the draft guideline.
Step 3: Regulatory consultation and discussion
Step 3 occurs in three distinct stages: regulatory consultation, discussion, and finalisation of the Step 3 expert draft guideline.
Stage I - Regional regulatory consultation: The guideline embodying the scientific consensus leaves the ICH process and becomes the subject of normal wide-ranging regulatory consultation in the ICH regions. Regulatory authorities and industry associations in other regions may also comment on the draft consultation documents by providing their comments to the ICH Secretariat.
Stage II - Discussion of regional consultation comments: After obtaining all comments from the consultation process, the EWG works to address the comments received and reach consensus on what is called the Step 3 experts draft guideline.
Stage III - Finalisation of Step 3 experts draft guideline: If, after due consideration of the consultation results by the WG, consensus is reached amongst the experts on a revised version of the Step 2b draft guideline, the Step 3 expert draft guideline is signed by the experts of the ICH regulatory members. The Step 3 expert draft guideline with regulatory EWG signatures is submitted to the regulatory members of the assembly to request adoption at Step 4 of the ICH process.
Step 4: Adoption of an ICH harmonised guideline
Step 4 is reached when the regulatory members of the assembly agree that there is sufficient scientific consensus on the draft guideline and adopt the ICH harmonised guideline.
Step 5: Implementation
The ICH harmonised guideline moves immediately to the final step of the process that is the regulatory implementation. This step is carried out according to the same national or regional procedures that apply to other regional regulatory guidelines and requirements in the ICH regions.
Information on the regulatory action taken and implementation dates are reported back to the assembly and published by the ICH secretariat on the ICH website.
Work products
Guidelines
The ICH topics are divided into four categories and ICH topic codes are assigned according to these categories:
Q: Quality Guidelines
S: Safety Guidelines
E: Efficacy Guidelines
M: Multidisciplinary Guidelines
ICH guidelines are not binding, and instead implemented by regulatory members through national and regional governance.
MedDRA
MedDRA is a rich and highly specific standardised medical terminology developed by ICH to facilitate sharing of regulatory information internationally for medical products used by humans. It is used for registration, documentation and safety monitoring of medical products both before and after a product has been authorised for sale. Products covered by the scope of MedDRA include pharmaceuticals, vaccines and drug-device combination products.
See also
Brazilian Health Regulatory Agency
Australia New Zealand Therapeutic Products Authority
Biotechnology Innovation Organization
Clinical study report
Clinical trial
Common Technical Document
Council for International Organizations of Medical Sciences
European Federation of Pharmaceutical Industries and Associations
Food and Drug Administration, US
Good clinical practice (GCP)
Health Canada
HSA, Singapore
International Federation of Pharmaceutical Manufacturers & Associations
International Pharmaceutical Federation
Japan Pharmaceutical Manufacturers Association
Ministry of Food and Drug Safety, Republic of Korea
Ministry of Health, Labour and Welfare, Japan
National pharmaceuticals policy
Pharmaceutical policy
Pharmacopoeia
Pharmaceutical Research and Manufacturers of America
Pharmaceuticals and Medical Devices Agency, Japan
Regulation of therapeutic goods
Swissmedic, Switzerland
Food and Drug Administration (Taiwan)
Uppsala Monitoring Centre
Notes
External links
ICH website
Analysis: New ICH M2 Requirements into eCTD NMV (=RPS)
ANVISA, Brazil
BIO
EC, Europe
EFPIA
FDA, US
Health Canada, Canada
HSA, Singapore
IGBA
JPMA
MedDRA website
MFDS, Republic of Korea
MHLW/PMDA, Japan
PhRMA
Swissmedic, Switzerland
TFDA, Chinese Taipei
WSMI
Clinical research
Pharmaceuticals policy
Drug safety
Life sciences industry
International standards | 0.767176 | 0.988845 | 0.758618 |
Anomie | In sociology, anomie or anomy is a social condition defined by an uprooting or breakdown of any moral values, standards or guidance for individuals to follow. Anomie is believed to possibly evolve from conflict of belief systems and causes breakdown of social bonds between an individual and the community (both economic and primary socialization).
The term, commonly understood to mean normlessness, is believed to have been popularized by French sociologist Émile Durkheim in his influential book Suicide (1897). Émile Durkheim suggested that Protestants exhibited a greater degree of anomie than Catholics. However, Durkheim first introduced the concept of anomie in his 1893 work The Division of Labour in Society. Durkheim never used the term normlessness; rather, he described anomie as "derangement", and "an insatiable will." Durkheim used the term "the malady of the infinite" because desire without limit can never be fulfilled; it only becomes more intense.
For Durkheim, anomie arises more generally from a mismatch between personal or group standards and wider social standards; or from the lack of a social ethic, which produces moral deregulation and an absence of legitimate aspirations, i.e.:
History
In 1893, Durkheim introduced the concept of anomie to describe the mismatch of collective guild labour to evolving societal needs when the guild was homogeneous in its constituency. He equated homogeneous (redundant) skills to mechanical solidarity whose inertia hindered adaptation. He contrasted this with the self-regulating behaviour of a division of labour based on differences in constituency, equated to organic solidarity, whose lack of inertia made it sensitive to needed changes.
Durkheim observed that the conflict between the evolved organic division of labour and the homogeneous mechanical type was such that one could not exist in the presence of the other. When solidarity is organic, anomie is impossible, as sensitivity to mutual needs promotes evolution in the division of labour:Durkheim contrasted the condition of anomie as being the result of a malfunction of organic solidarity after the transition to mechanical solidarity:
Durkheim's use of anomie was in regards to the phenomenon of industrialization—mass-regimentation that could not adapt due to its own inertia. More specifically, its resistance to change causes disruptive cycles of collective behavior (e.g. economics) due to the necessity of a prolonged buildup of sufficient force or momentum to overcome the inertia.
Later in 1897, in his studies of suicide, Durkheim associated anomie to the influence of a lack of norms or norms that were too rigid. However, such normlessness or norm-rigidity was a symptom of anomie, caused by the lack of differential adaptation that would enable norms to evolve naturally due to self-regulation, either to develop norms where none existed or to change norms that had become rigid and obsolete. Durkheim found that Protestant communities have noticeably higher suicide rates than Catholic ones, and justified it with individualism and lack of social cohesion prevalent amongst Protestants, creating poorly integrated society and making Protestants less likely to develop close communal ties that would be crucial in times of hardship. Conversely, he states that the Catholic faith binds individuals stronger together and builds strong social ties, decreasing the risk of suicide and alienation. In this, Durkheim argued that religion is much more important than culture in regards to anomic suicide. This allowed Durkheim to successfully tie social cohesion to suicide rates:
In 1938, Robert K. Merton linked anomie with deviance, arguing that the discontinuity between culture and structure have the dysfunctional consequence of leading to deviance within society. He described 5 types of deviance in terms of the acceptance or rejection of social goals and the institutionalized means of achieving them.
Etymology
The term anomie—"a reborrowing with French spelling of anomy"—comes from , namely the privative alpha prefix (a-, 'without'), and nomos. The Greeks distinguished between nomos, and arché. For example, a monarch is a single ruler but he may still be subject to, and not exempt from, the prevailing laws, i.e. nomos. In the original city state democracy, the majority rule was an aspect of arché because it was a rule-based, customary system, which may or may not make laws, i.e. nomos. Thus, the original meaning of anomie defined anything or anyone against or outside the law, or a condition where the current laws were not applied resulting in a state of illegitimacy or lawlessness.
The contemporary English understanding of the word anomie can accept greater flexibility in the word "norm", and some have used the idea of normlessness to reflect a similar situation to the idea of anarchy. However, as used by Émile Durkheim and later theorists, anomie is a reaction against or a retreat from the regulatory social controls of society, and is a completely separate concept from anarchy, which consists of the absence of the roles of rulers and submitted.
Social disorder
Nineteenth-century French pioneer sociologist Émile Durkheim borrowed the term anomie from French philosopher Jean-Marie Guyau. Durkheim used it in his influential book Suicide (1897) in order to outline the social (and not individual) causes of suicide, characterized by a rapid change of the standards or values of societies (often erroneously referred to as normlessness), and an associated feeling of alienation and purposelessness. He believed that anomie is common when the surrounding society has undergone significant changes in its economic fortunes, whether for better or for worse and, more generally, when there is a significant discrepancy between the ideological theories and values commonly professed and what was actually achievable in everyday life. This was contrary to previous theories on suicide which generally maintained that suicide was precipitated by negative events in a person's life and their subsequent depression.
In Durkheim's view, traditional religions often provided the basis for the shared values which the anomic individual lacks. Furthermore, he argued that the division of labor that had been prevalent in economic life since the Industrial Revolution led individuals to pursue egoistic ends rather than seeking the good of a larger community. Robert King Merton also adopted the idea of anomie to develop strain theory, defining it as the discrepancy between common social goals and the legitimate means to attain those goals. In other words, an individual suffering from anomie would strive to attain the common goals of a specific society yet would not be able to reach these goals legitimately because of the structural limitations in society. As a result, the individual would exhibit deviant behavior. Friedrich Hayek notably uses the word anomie with this meaning.
According to one academic survey, psychometric testing confirmed a link between anomie and academic dishonesty among university students, suggesting that universities needed to foster codes of ethics among students in order to curb it. In another study, anomie was seen as a "push factor" in tourism.
As an older variant, the 1913 Webster's Dictionary reports use of the word anomie as meaning "disregard or violation of the law." However, anomie as a social disorder is not to be confused with anarchy: proponents of anarchism claim that anarchy does not necessarily lead to anomie and that hierarchical command actually increases lawlessness. Some anarcho-primitivists argue that complex societies, particularly industrial and post-industrial societies, directly cause conditions such as anomie by depriving the individual of self-determination and a relatively small reference group to relate to, such as the band, clan or tribe.
In 2003, José Soltero and Romeo Saravia analyzed the concept of anomie in regards to Protestantism and Catholicism in El Salvador. Massive displacement of population in the 1970s, economic and political crises as well as cycles of violence are credited with radically changing the religious composition of the country, rendering it one of the most Protestant countries in Latin America. According to Soltero and Saravia, the rise of Protestantism is conversationally claimed to be caused by a Catholic failure to "address the spiritual needs of the poor" and the Protestant "deeper quest for salvation, liberation, and eternal life". However, their research does not support these claims, and showed that Protestantism is not more popular amongst the poor. Their findings do confirm the assumptions of anomie, with Catholic communities of El Salvador enjoying high social cohesion, while the Protestant communities have been associated with poorer social integration, internal migration and tend to be places deeply affected by the Salvadoran Civil War. Additionally, Soltero and Saravia found that Salvadoran Catholicism is tied to social activism, liberation theology and the political left, as opposed to the "right wing political orientation, or at least a passive, personally inward orientation, expressed by some Protestant churches". They conclude that their research contradicts the theory that Protestantism responds to the spiritual needs of the poor more adequately than Catholicism, while also disproving the claim that Protestantism appeals more to women:
The study by Soltero and Saravia has also found a link between Protestantism and no access to healthcare:
Synnomie
Freda Adler coined synnomie as the opposite of anomie. Using Émile Durkheim's concept of social solidarity and collective consciousness, Adler defined synnomie as "a congruence of norms to the point of harmonious accommodation".
Adler described societies in a synnomie state as "characterized by norm conformity, cohesion, intact social controls and norm integration". Social institutions such as the family, religion and communities, largely serve as sources of norms and social control to maintain a synnomic society.
In culture
In Albert Camus's existentialist novel The Stranger, Meursault—the bored, alienated protagonist—struggles to construct an individual system of values as he responds to the disappearance of the old. He exists largely in a state of anomie, as seen from the apathy evinced in the opening lines: "" ("Today mum died. Or maybe yesterday, I don't know").
Fyodor Dostoyevsky expresses a similar concern about anomie in his novel The Brothers Karamazov. The Grand Inquisitor remarks that in the absence of God and immortal life, everything would be lawful. In other words, that any act becomes thinkable, that there is no moral compass, which leads to apathy and detachment.
In The Ink Black Heart of the Cormoran Strike novels, written by J. K. Rowling under the pseudonym Robert Galbraith, the main antagonist goes by the online handle of "Anomie".
See also
References
Sources
Durkheim, Émile. 1893. The Division of Labour in Society.
Marra, Realino. 1987. Suicidio, diritto e anomia. Immagini della morte volontaria nella civiltà occidentale. Napoli: Edizioni Scientifiche Italiane.
—— 1989. "Geschichte und aktuelle Problematik des Anomiebegriffs." Zeitschrift für Rechtssoziologie 11(1):67–80.
Orru, Marco. 1983. "The Ethics of Anomie: Jean Marie Guyau and Émile Durkheim." British Journal of Sociology 34(4):499–518.
Riba, Jordi. 1999. La Morale Anomique de Jean-Marie Guyau. L'Harmattan. .
External links
Deflem, Mathieu. 2015. "Anomie: History of the Concept." pp. 718–721 in International Encyclopedia of Social and Behavioral Sciences, Second Edition (Volume 1), edited by James D. Wright. Oxford, UK: Elsevier.
"Anomie" discussed at the Émile Durkheim Archive.
Featherstone, Richard, and Mathieu Deflem. 2003. "Anomie and Strain: Context and Consequences of Merton's Two Theories." Sociological Inquiry 73(4):471–489, 2003.
Deviance (sociology)
Émile Durkheim
Social philosophy
Sociological terminology
Sociological theories | 0.760722 | 0.997212 | 0.758601 |
Physical medicine and rehabilitation | Physical medicine and rehabilitation (PM&R), also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions such as spinal cord injury, brain injury, musculoskeletal injury, stroke, pain and spasticity from muscle, ligament, or nerve damage. PM&R physicians lead rehabilitation teams and are trained in medication management, electrodiagnosis, and targeted injections. A physician having completed training in this field may be referred to as a physiatrist.
Scope of the field
Physical medicine and rehabilitation encompasses a variety of clinical settings and patient populations.
In hospital settings, physiatrists commonly treat patients who have had an amputation, spinal cord injury, stroke, traumatic brain injury, and other debilitating injuries or conditions. In treating these patients, physiatrists lead a team of physical, occupational, respiratory, and speech therapists, as well as nurses, psychologists, and social workers. .
In outpatient settings, physiatrists treat patients with muscle and joint injuries, pain syndromes, non-healing wounds, and other disabling conditions. Physiatrists are trained to perform injections into joints or muscle as a pain treatment option. Physiatrists are also trained in nerve conduction studies and electromyography.
History
During the first half of the 20th century, two unofficial specialties, physical medicine and rehabilitation medicine, developed separately, but in practice both treated similar patient populations consisting of those with disabling injuries. Frank H. Krusen was a pioneer of physical medicine, which emphasized the use of physical agents, such as hydrotherapy and hyperbaric oxygen, at Temple University and then at Mayo Clinic and it was he that coined the term 'physiatry' in 1938. Rehabilitation medicine gained prominence during both World Wars in the treatment of injured soldiers and laborers. Howard A. Rusk, an internal medicine physician from Missouri, became a pioneer of rehabilitation medicine after being appointed to rehabilitate airmen during World War II. In 1944, the Baruch Committee, commissioned by philanthropist Bernard Baruch, defined the specialty as a combination of the two fields and laid the framework for its acceptance as an official medical specialty. The committee also distributed funds to establish training and research programs across the nation. The specialty that came to be known as physical medicine and rehabilitation in the United States was officially established in 1947, when an independent Board of Physical Medicine was established under the authority of the American Board of Medical Specialties. In 1949, at the insistence of Rusk and others, the specialty incorporated rehabilitation medicine and changed its name to Physical Medicine and Rehabilitation.
Treatment
The major goal of physical medicine and rehabilitation treatment is to help a person function optimally within the limitations placed upon them by a disabling impairment or disease process for which there is no known cure. The emphasis is not on the full restoration to the premorbid level of function, but rather the optimization of the quality of life for those not able to achieve full restoration. A team approach to chronic conditions is emphasized to coordinate care of patients. Comprehensive rehabilitation is provided by specialists in this field, who act as facilitators, team leaders, and medical experts for rehabilitation.
In rehabilitation, goal setting is often used by the clinical care team to provide the team and the person undergoing rehabilitation for an acquired disability a direction to work towards. Very low quality evidence indicates that goal setting may lead to a higher quality of life for the person with the disability, and it not clear if goal setting used in this context reduces or increases re-hospitalization or death.
Not only must a physiatrist have medical knowledge regarding a patient's condition, but they also need to have practical knowledge regarding it as well. This involves issues such as: what type of wheelchair best suits the patient, what type of prosthetic would fit best, does their current house layout accommodate their handicap well, and other every day complications that their patients might have.
Training
In the United States, residency training for physical medicine and rehabilitation is four years long, including an intern year of general medical training. There are 83 programs in the United States accredited by the Accreditation Council for Graduate Medical Education, in 28 states.
Specifics of training differs from program to program but all residents must obtain the same fundamental skills. Residents are trained in the inpatient setting to take care of multiple types of rehabilitation including: spinal cord injury, traumatic brain injury, stroke, orthopedic injuries, cancer, cerebral palsy, burn, pediatric rehab, and other disabling injuries. The residents are also trained in the outpatient setting to know how to take care of the chronic conditions patients have following their inpatient stay. During training, residents are instructed on how to properly perform several diagnostic procedures which include electromyography, nerve conduction studies and also procedures such as joint injections and trigger point injections.
Subspecialties
Seven accredited sub-specializations are recognized in the United States:
Neuromuscular medicine
Pain medicine
Pediatric rehabilitation medicine
Spinal cord injury
Sports medicine
Brain damage
Hospice and palliative medicine
Fellowship training for other unaccredited subspecialties within the field include the following:
Musculoskeletal/Spine
Stroke
Multiple sclerosis
Neurorehabilitation
Electrodiagnostic medicine
Cancer rehabilitation
Occupational and environmental medicine
See also
American Osteopathic Board of Physical Medicine and Rehabilitation
American Academy of Physical Medicine and Rehabilitation
References
External links
What Is PM&R? gives a physical medicine and rehabilitation resident's description of the specialty and its appeal as a physician | 0.761316 | 0.996416 | 0.758588 |
Subsets and Splits