title
string | text
string | relevans
float64 | popularity
float64 | ranking
float64 |
|---|---|---|---|---|
External validity | External validity is the validity of applying the conclusions of a scientific study outside the context of that study. In other words, it is the extent to which the results of a study can generalize or transport to other situations, people, stimuli, and times. Generalizability refers to the applicability of a predefined sample to a broader population while transportability refers to the applicability of one sample to another target population. In contrast, internal validity is the validity of conclusions drawn within the context of a particular study.
Mathematical analysis of external validity concerns a determination of whether generalization across heterogeneous populations is feasible, and devising statistical and computational methods that produce valid generalizations.
In establishing external validity, scholars tend to identify the "scope" of the study, which refers to the applicability or limitations of the theory or argument of the study. This entails defining the sample of the study and the broader population that the sample represents.
Threats
"A threat to external validity is an explanation of how you might be wrong in making a generalization from the findings of a particular study." In most cases, generalizability is limited when the effect of one factor (i.e. the independent variable) depends on other factors. Therefore, all threats to external validity can be described as statistical interactions. Some examples include:
Aptitude by treatment interaction: The sample may have certain features that interact with the independent variable, limiting generalizability. For example, comparative psychotherapy studies often employ specific samples (e.g. volunteers, highly depressed, no comorbidity). If psychotherapy is found effective for these sample patients, will it also be effective for non-volunteers or the mildly depressed or patients with concurrent other disorders? If not, the external validity of the study would be limited.
Situation by treatment interactions: All situational specifics (e.g. treatment conditions, time, location, lighting, noise, treatment administration, investigator, timing, scope and extent of measurement, etc.) of a study potentially limit generalizability.
Pre-test by treatment interactions: If cause-effect relationships can only be found when pre-tests are carried out, then this also limits the generality of the findings. This sometimes goes under the label "sensitization", because the pretest makes people more sensitive to the manipulation of the treatment.
Note that a study's external validity is limited by its internal validity. If a causal inference made within a study is invalid, then generalizations of that inference to other contexts will also be invalid.
Cook and Campbell made the crucial distinction between generalizing to some population and generalizing across subpopulations defined by different levels of some background factor. Lynch has argued that it is almost never possible to generalize to meaningful populations except as a snapshot of history, but it is possible to test the degree to which the effect of some cause on some dependent variable generalizes across subpopulations that vary in some background factor. That requires a test of whether the treatment effect being investigated is moderated by interactions with one or more background factors.
Disarming threats
Whereas enumerating threats to validity may help researchers avoid unwarranted generalizations, many of those threats can be disarmed, or neutralized in a systematic way, so as to enable a valid generalization. Specifically, experimental findings from one population can be "re-processed", or "re-calibrated" so as to circumvent population differences and produce valid generalizations in a second population, where experiments cannot be performed. Pearl and Bareinboim classified generalization problems into two categories: (1) those that lend themselves to valid re-calibration, and (2) those where external validity is theoretically impossible. Using graph-based causal inference calculus, they derived a necessary and sufficient condition for a problem instance to enable a valid generalization, and devised algorithms that automatically produce the needed re-calibration, whenever such exists. This reduces the external validity problem to an exercise in graph theory, and has led some philosophers to conclude that the problem is now solved.
An important variant of the external validity problem deals with selection bias, also known as sampling bias—that is, bias created when studies are conducted on non-representative samples of the intended population. For example, if a clinical trial is conducted on college students, an investigator may wish to know whether the results generalize to the entire population, where attributes such as age, education, and income differ substantially from those of a typical student. The graph-based method of Bareinboim and Pearl identifies conditions under which sample selection bias can be circumvented and, when these conditions are met, the method constructs an unbiased estimator of the average causal effect in the entire population. The main difference between generalization from improperly sampled studies and generalization across disparate populations lies in the fact that disparities among populations are usually caused by preexisting factors, such as age or ethnicity, whereas selection bias is often caused by post-treatment conditions, for example, patients dropping out of the study, or patients selected by severity of injury. When selection is governed by post-treatment factors, unconventional re-calibration methods are required to ensure bias-free estimation, and these methods are readily obtained from the problem's
graph.
Examples
If age is judged to be a major factor causing treatment effect to vary from individual to individual, then age differences between the sampled students and the general population would lead to a biased estimate of the average treatment effect in that population. Such bias can be corrected though by a simple re-weighing procedure: We take the age-specific effect in the student subpopulation and compute its average using the age distribution in the general population. This would give us an unbiased estimate of the average treatment effect in the population. If, on the other hand, the relevant factor that distinguishes the study sample from the general population is in itself affected by the treatment, then a different re-weighing scheme need be invoked. Calling this factor Z, we again average the z-specific effect of X on Y in the experimental sample, but now we weigh it by the "causal effect" of X on Z. In other words, the new weight is the proportion of units attaining level Z=z had treatment X=x been administered to the entire population. This interventional probability, often written using Do-calculus , can sometimes be estimated from
observational studies in the general population.
A typical example of this nature occurs when Z is a mediator between the treatment and outcome, For instance, the treatment may be a cholesterol-reducing drug, Z may be cholesterol level, and Y life expectancy. Here, Z is both affected by the treatment and a major factor in determining the outcome, Y. Suppose that subjects selected for the experimental study
tend to have higher cholesterol levels than is typical in the general population. To estimate the average effect of the drug on survival in the entire population, we first compute the z-specific treatment effect in the experimental study, and then average it using as a weighting function. The estimate obtained will be bias-free even when Z and Y are confounded—that is, when there is an unmeasured common factor that affects both Z and Y.
The precise conditions ensuring the validity of this and other weighting schemes are formulated in Bareinboim and Pearl, 2016 and Bareinboim et al., 2014.
External, internal, and ecological validity
In many studies and research designs, there may be a trade-off between internal validity and external validity: Attempts to increase internal validity may also limit the generalizability of the findings, and vice versa.
This situation has led many researchers call for "ecologically valid" experiments. By that they mean that experimental procedures should resemble "real-world" conditions. They criticize the lack of ecological validity in many laboratory-based studies with a focus on artificially controlled and constricted environments. Some researchers think external validity and ecological validity are closely related in the sense that causal inferences based on ecologically valid research designs often allow for higher degrees of generalizability than those obtained in an artificially produced lab environment. However, this again relates to the distinction between generalizing to some population (closely related to concerns about ecological validity) and generalizing across subpopulations that differ on some background factor. Some findings produced in ecologically valid research settings may hardly be generalizable, and some findings produced in highly controlled settings may claim near-universal external validity. Thus, external and ecological validity are independent—a study may possess external validity but not ecological validity, and vice versa.
Qualitative research
Within the qualitative research paradigm, external validity is replaced by the concept of transferability. Transferability is the ability of research results to transfer to situations with similar parameters, populations and characteristics.
In experiments
It is common for researchers to claim that experiments are by their nature low in external validity. Some claim that many drawbacks can occur when following the experimental method. By the virtue of gaining enough control over the situation so as to randomly assign people to conditions and rule out the effects of extraneous variables, the situation can become somewhat artificial and distant from real life.
There are two kinds of generalizability at issue:
The extent to which we can generalize from the situation constructed by an experimenter to real-life situations (generalizability across situations), and
The extent to which we can generalize from the people who participated in the experiment to people in general (generalizability across people)
However, both of these considerations pertain to Cook and Campbell's concept of generalizing to some target population rather than the arguably more central task of assessing the generalizability of findings from an experiment across subpopulations that differ from the specific situation studied and people who differ from the respondents studied in some meaningful way.
Critics of experiments suggest that external validity could be improved by the use of field settings (or, at a minimum, realistic laboratory settings) and by the use of true probability samples of respondents. However, if one's goal is to understand generalizability across subpopulations that differ in situational or personal background factors, these remedies do not have the efficacy in increasing external validity that is commonly ascribed to them. If background factor X treatment interactions exist of which the researcher is unaware (as seems likely), these research practices can mask a substantial lack of external validity. Dipboye and Flanagan, writing about industrial and organizational psychology, note that the evidence is that findings from one field setting and from one lab setting are equally unlikely to generalize to a second field setting. Thus, field studies are not by their nature high in external validity and laboratory studies are not by their nature low in external validity. It depends in both cases whether the particular treatment effect studied would change with changes in background factors that are held constant in that study. If one's study is "unrealistic" on the level of some background factor that does not interact with the treatments, it has no effect on external validity. It is only if an experiment holds some background factor constant at an unrealistic level and if varying that background factor would have revealed a strong Treatment x Background factor interaction, that external validity is threatened.
Generalizability across situations
Research in psychology experiments attempted in universities is often criticized for being conducted in artificial situations and that it cannot be generalized to real life. To solve this problem, social psychologists attempt to increase the generalizability of their results by making their studies as realistic as possible. As noted above, this is in the hope of generalizing to some specific population. Realism per se does not help the make statements about whether the results would change if the setting were somehow more realistic, or if study participants were placed in a different realistic setting. If only one setting is tested, it is not possible to make statements about generalizability across settings.
However, many authors conflate external validity and realism. There is more than one way that an experiment can be realistic:
The similarity of an experimental situation to events that occur frequently in everyday life—it is clear that many experiments are decidedly unreal.
In many experiments, people are placed in situations they would rarely encounter in everyday life.
This is referred to the extent to which an experiment is similar to real-life situations as the experiment's mundane realism.
It is more important to ensure that a study is high in psychological realism—how similar the psychological processes triggered in an experiment are to psychological processes that occur in everyday life.
Psychological realism is heightened if people find themselves engrossed in a real event. To accomplish this, researchers sometimes tell the participants a cover story—a false description of the study's purpose. If however, the experimenters were to tell the participants the purpose of the experiment then such a procedure would be low in psychological realism. In everyday life, no one knows when emergencies are going to occur and people do not have time to plan responses to them. This means that the kinds of psychological processes triggered would differ widely from those of a real emergency, reducing the psychological realism of the study.
People don't always know why they do what they do, or what they do until it happens. Therefore, describing an experimental situation to participants and then asking them to respond normally will produce responses that may not match the behavior of people who are actually in the same situation. We cannot depend on people's predictions about what they would do in a hypothetical situation; we can only find out what people will really do when we construct a situation that triggers the same psychological processes as occur in the real world.
Generalizability across people
Social psychologists study the way in which people, in general, are susceptible to social influence. Several experiments have documented an interesting, unexpected example of social influence, whereby the mere knowledge that others were present reduced the likelihood that people helped.
The only way to be certain that the results of an experiment represent the behaviour of a particular population is to ensure that participants are randomly selected from that population. Samples in experiments cannot be randomly selected just as they are in surveys because it is impractical and expensive to select random samples for social psychology experiments. It is difficult enough to convince a random sample of people to agree to answer a few questions over the telephone as part of a political poll, and such polls can cost thousands of dollars to conduct. Moreover, even if one somehow was able to recruit a truly random sample, there can be unobserved heterogeneity in the effects of the experimental treatments... A treatment can have a positive effect on some subgroups but a negative effect on others. The effects shown in the treatment averages may not generalize to any subgroup.
Many researchers address this problem by studying basic psychological processes that make people susceptible to social influence, assuming that these processes are so fundamental that they are universally shared. Some social psychologist processes do vary in different cultures and in those cases, diverse samples of people have to be studied.
Replications
The ultimate test of an experiment's external validity is replication — conducting the study over again, generally with different subject populations or in different settings. Researchers will often use different methods, to see if they still get the same results.
When many studies of one problem are conducted, the results can vary. Several studies might find an effect of the number of bystanders on helping behaviour, whereas a few do not. To make sense out of this, there is a statistical technique called meta-analysis that averages the results of two or more studies to see if the effect of an independent variable is reliable. A meta analysis essentially tells us the probability that the findings across the results of many studies are attributable to chance or to the independent variable. If an independent variable is found to have an effect in only one of 20 studies, the meta-analysis will tell you that that one study was an exception and that, on average, the independent variable is not influencing the dependent variable. If an independent variable is having an effect in most of the studies, the meta-analysis is likely to tell us that, on average, it does influence the dependent variable.
There can be reliable phenomena that are not limited to the laboratory. For example, increasing the number of bystanders has been found to inhibit helping behaviour with many kinds of people, including children, university students, and future ministers; in Israel; in small towns and large cities in the U.S.; in a variety of settings, such as psychology laboratories, city streets, and subway trains; and with a variety of types of emergencies, such as seizures, potential fires, fights, and accidents, as well as with less serious events, such as having a flat tire. Many of these replications have been conducted in real-life settings where people could not possibly have known that an experiment was being conducted.
Basic dilemma of the social psychologist
When conducting experiments in psychology, some believe that there is always a trade-off between internal and external validity—
having enough control over the situation to ensure that no extraneous variables are influencing the results and to randomly assign people to conditions, and
ensuring that the results can be generalized to everyday life.
Some researchers believe that a good way to increase external validity is by conducting field experiments. In a field experiment, people's behavior is studied outside the laboratory, in its natural setting. A field experiment is identical in design to a laboratory experiment, except that it is conducted in a real-life setting. The participants in a field experiment are unaware that the events they experience are in fact an experiment. Some claim that the external validity of such an experiment is high because it is taking place in the real world, with real people who are more diverse than a typical university student sample. However, as real-world settings differ dramatically, findings in one real-world setting may or may not generalize to another real-world setting.
Neither internal nor external validity is captured in a single experiment. Social psychologists opt first for internal validity, conducting laboratory experiments in which people are randomly assigned to different conditions and all extraneous variables are controlled. Other social psychologists prefer external validity to control, conducting most of their research in field studies, and many do both. Taken together, both types of studies meet the requirements of the perfect experiment. Through replication, researchers can study a given research question with maximal internal and external validity.
See also
Construct validity
Content validity
Statistical conclusion validity
Transfer learning
Notes
Causal inference | 0.770202 | 0.984896 | 0.758569 |
Temperament and Character Inventory | The Temperament and Character Inventory (TCI) is an inventory for personality traits devised by Cloninger et al.
It is closely related to and an outgrowth of the Tridimensional Personality Questionnaire (TPQ),
and it has also been related to the dimensions of personality in Zuckerman's alternative five and Eysenck's models and those of the five factor model.
TCI operates with seven dimensions of personality traits: four so-called temperaments
Novelty seeking (NS)
Harm avoidance (HA)
Reward dependence (RD)
Persistence (PS)
and three so-called characters
Self-directedness (SD)
Cooperativeness (CO)
Self-transcendence (ST)
Each of these traits has a varying number of subscales.
The dimensions are determined from a 240-item questionnaire.
The TCI is based on a psychobiological model that attempts to explain the underlying causes of individual differences in personality traits.
Versions
Originally developed in English, TCI has been translated to other languages, e.g., Swedish,
Japanese, Dutch, German, Polish, Korean,
Finnish, Chinese and French.
There is also a revised version TCI-R.
Whereas the original TCI had statements for which the subject should indicate true or false, the TCI-R has a five-point rating for each statement.
The two versions hold 189 of the 240 statements in common.
The revised version has been translated into
Spanish,
French,
Czech,
and Italian.
The number of subscales on the different top level traits differ between TCI and TCI-R.
The subscales of the TCI-R are:
Novelty seeking (NS)
Exploratory excitability (NS1)
Impulsiveness (NS2)
Extravagance (NS3)
Disorderliness (NS4)
Harm avoidance (HA)
Anticipatory worry (HA1)
Fear of uncertainty (HA2)
Shyness (HA3)
Fatigability (HA4)
Reward dependence (RD)
Sentimentality (RD1)
Openness to warm communication (RD2)
Attachment (RD3)
Dependence (RD4)
Persistence (PS)
Eagerness of effort (PS1)
Work hardened (PS2)
Ambitious (PS3)
Perfectionist (PS4)
Self-directedness (SD)
Responsibility (SD1)
Purposeful (SD2)
Resourcefulness (SD3)
Self-acceptance (SD4)
Enlightened second nature (SD5)
Cooperativeness (C)
Social acceptance (C1)
Empathy (C2)
Helpfulness (C3)
Compassion (C4)
Pure-hearted conscience (C5)
Self-transcendence (ST)
Self-forgetful (ST1)
Transpersonal identification (ST2)
Spiritual acceptance (ST3)
Neurobiological foundation
TCI has been used for investigating the neurobiological foundation for personality, together with other research modalities, e.g., with molecular neuroimaging,
structural neuroimaging
and genetics.
Cloninger suggested that the three original temperaments from TPQ, novelty seeking, harm avoidance, and reward dependence, was correlated with low basal dopaminergic activity,
high serotonergic activity, and low basal noradrenergic activity, respectively.
Many studies have used TCI for examining whether genetic variants in individual genes have an association with personality traits. Studies suggest that novelty seeking is associated with dopaminergic pathways.
Dopamine transporter DAT1 and dopamine receptor DRD4 are associated with novelty seeking.
Parkinson's patients, who are intrinsically low in dopamine, are found to have low novelty seeking scores.
Gene variants that have been investigated are, e.g., 5-HTTLPR in the serotonin transporter gene and gene variants in XBP1.
Relationship to other personality models
Cloninger argued that the Five Factor model does not assess domains of personality relevant to personality disorders such as autonomy, moral values, and aspects of maturity and self-actualization considered in humanistic and transpersonal psychology. Cloninger argued that these domains are captured by self-directedness, cooperativeness, and self-transcendence respectively. He also argued that personality factors defined as independent by factor analysis, such as neuroticism and introversion, may actually share underlying etiological factors.
Research has found that all of the TCI dimensions are each related substantially to at least one of the dimensions in the Five Factor Model, Eysenck's model, Zuckerman's alternative five:
Harm avoidance is strongly positively associated with neuroticism and inversely associated with extraversion.
Novelty seeking is most strongly associated with extraversion, although it also has a moderate positive association with openness to experience and a moderate negative association with conscientiousness.
Persistence has a positive association with conscientiousness.
Reward dependence is most strongly associated with extraversion, although it also has a moderate positive association with openness to experience.
Cooperativeness is most strongly associated with agreeableness.
Self-directedness has a strong negative association with neuroticism and a positive association with conscientiousness.
Self-transcendence had a positive association with openness to experience and to a lesser extent extraversion.
Relationships have also been found between the TCI dimensions and traits specific to the models of Zuckerman and Eysenck respectively.
Novelty seeking is related to Impulsive sensation seeking in Zuckerman's alternative five model and to psychoticism in Eysenck's model.
Zuckerman and Cloninger have contended that Harm Avoidance is a composite dimension comprising neurotic introversion at one end and stable extraversion at the other end.
Persistence is related to Zuckerman's Activity scale and inversely to psychoticism.
Cooperativeness is inversely related to Zuckerman's Aggression-hostility scale and to psychoticism.
Self-transcendence has no equivalent in either Zuckerman or Eysenck's model as neither model recognises openness to experience.
Health and well-being
Cloninger has argued that "psychological well-being" depends on the development of facets of the three character dimensions, such as autonomy and life purpose from self-directedness, positive relations with others from cooperativeness, and personal growth and self-actualization from self-transcendence. He has also argued that the temperament dimensions are associated with subjective well-being and to some extent with physical health. A study examining relationships between character dimensions and aspects of health and happiness found that self-directedness was strongly associated with happiness, satisfaction with life, general health, and perceived social support. Cooperativeness was associated most strongly with perceived social support and only weakly with the other well-being measures. Self-transcendence was associated with positive emotions when taking the other character traits into account, but was largely unrelated to negative emotions or the other well-being measures.
See also
Karolinska Scales of Personality
NEO PI-R
References
External links
Personality tests | 0.770316 | 0.984669 | 0.758506 |
Psychomotor agitation | Psychomotor agitation is a symptom in various disorders and health conditions. It is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress and is always an indicative for discharge. Typical manifestations include pacing around, wringing of the hands, uncontrolled tongue movement, pulling off clothing and putting it back on, and other similar actions. In more severe cases, the motions may become harmful to the individual, and may involve things such as ripping, tearing, or chewing at the skin around one's fingernails, lips, or other body parts to the point of bleeding. Psychomotor agitation is typically found in various mental disorders, especially in psychotic and mood disorders. It can be a result of drug intoxication or withdrawal. It can also be caused by severe hyponatremia. The middle-aged and the elderly are more at risk to express it.
Psychomotor agitation overlaps with agitation generally, such as agitation in predementia and dementia; see Agitation (dementia) for details.
Signs and symptoms
People experiencing psychomotor agitation may feel the following emotions or do the following actions. Some of these actions are not inherently bad or maladaptive, but they can have maladaptively excessive versions. For example, self-hugging can be therapeutically advisable, but self-hugging as a component of a set of motor agitation movements is a sign of psychomotor agitation.
unable to sit still
fidgeting
body stiffness
unable to relieve tension
desperate to find a comfortable position
increasingly anxious
exasperated
tearful
extreme irritability, like snapping at friends and family, or being annoyed by small things
anger
agitation
racing thoughts and incessant talking
restlessness
pacing
hand-wringing
self-hugging
nail-biting
outbursts of complaining or shouting
pulling at clothes or hair
picking at skin, as either a sign of PMA or even progressing to a disorder (excoriation disorder)
tapping fingers
tapping feet
starting and stopping tasks abruptly
talking very quickly
moving objects around for no reason
taking off clothes then putting them back on
Causes
Causes include:
Schizophrenia
Bipolar disorder
Post-traumatic stress disorder (PTSD)
Panic attacks
Anxiety disorder
Obsessive-compulsive disorder (OCD)
Nicotine withdrawal
Alcohol withdrawal
Opioid withdrawal
Autism
Asperger syndrome
Claustrophobia
Intellectual disability
Attention deficit hyperactivity disorder
Dementia
Parkinson's disease
Traumatic brain injury
Alzheimer's disease
Acute intermittent porphyria
Hereditary coproporphyria
Variegate porphyria
Side effects of stimulants such as cocaine or methylphenidate
Side effects of antipsychotics like haloperidol
SSRI or SNRI medications
As explained in a 2008 study, in people with mood disorders there is a dynamic link between their mood and the way they move.
People showing signs of psychomotor agitation may be experiencing mental tension and anxiety, which comes out physically as:
fast or repetitive movements
movements that have no purpose
movements that are not intentional
These activities are the subconscious mind's way of trying to relieve tension. Often people experiencing psychomotor agitation feel as if their movements are not deliberate.
Sometimes, however, psychomotor agitation does not relate to mental tension and anxiety.
Recent studies found that nicotine withdrawal induces psychomotor agitation (motor deficit).
In other cases, psychomotor agitation can be caused by antipsychotic medications. For instance, akathisia, a movement disorder sometimes induced by antipsychotics and other psychotropics, is estimated to affect 15-35% of patients with schizophrenia.
Diagnosis
Treatment
A form of self-treatment arises in that many patients develop stimming in a natural, unplanned, and largely nonconscious way, simply because they coincidentally discover behavior that brings some relief to their psychomotor agitation, and develop habits around it. Stimming has many forms, some quite adaptive and others maladaptive (for example, excessive hand-wringing can injure joints, and excessive rubbing or scratching of skin can injure it). Another form of self-treatment that arises not uncommonly is self-medication, which unfortunately can lead to substance use disorders such as alcohol use disorder.
Whereas stimming is a nonpharmacologic but undirected and sometimes harmful amelioration, directed therapy tries to introduce another and generally better nonpharmacologic help in the form of the following lifestyle changes, to help a person to reduce their anxiety levels:
regular exercise
yoga and meditation
deep breathing exercises
Because nonpharmacologic treatment by itself is often not enough, medications are also often used. Intramuscular midazolam, lorazepam, or another benzodiazepine can be used both to sedate agitated patients and to control semi-involuntary muscle movements in cases of suspected akathisia.
Droperidol, haloperidol, or other typical antipsychotics can decrease the duration of agitation caused by acute psychosis, but should be avoided if the agitation is suspected to be akathisia, which can be potentially worsened. Also using promethazine may be useful. Recently, three atypical antipsychotics, olanzapine, aripiprazole and ziprasidone, have become available and FDA approved as an instant release intramuscular injection formulations to control acute agitation. The IM formulations of these three atypical antipsychotics are considered to be at least as effective or even more effective than the IM administration of haloperidol alone or haloperidol with lorazepam (which is the standard treatment of agitation in most hospitals) and the atypicals have a dramatically improved tolerability due to a milder side-effect profile.
In those with psychosis causing agitation, there is a lack of support for the use of benzodiazepines alone, however they are commonly used in combination with antipsychotics since they can prevent side effects associated with dopamine antagonists.
See also
Agitation (dementia)
Akathisia
Body-focused repetitive behavior
Excited delirium
References
External links
Symptoms and signs of mental disorders | 0.761186 | 0.996456 | 0.758489 |
Autism therapies | Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.
Many therapies marketed towards people with autism and/or their parents claim outcomes that have not been supported by Level of Research (LOE) Level 1 (highest level assigned based on the methodological quality of their design, validity, and applicability to patient care). Level 1 research includes evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.
Autism is a neurodevelopmental condition characterized by differences in reciprocal social interaction and communication as well as restricted, repetitive interests, behaviors, or activities. As of 2023, no therapy exists to eliminate autism within someone, let alone to a high degree of viability. Treatment is typically catered to the person's needs. Treatments fall into two major categories: educational interventions and medical management. Training and support are also given to families of those diagnosed with autism spectrum disorders (ASDs).
Studies of interventions have some methodological problems that prevent definitive conclusions about efficacy. Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the systematic reviews have reported that the quality of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options. Intensive, sustained special education programs and behavior therapy early in life can help children with ASD acquire self-care, social, and job skills, and often can improve functioning, and decrease severity of the signs and observed behaviors thought of as maladaptive; Available approaches include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy. Occupational therapists work with autistic children by creating interventions that promote social interaction like sharing and cooperation. They also support the autistic child by helping them work through a dilemma as the OT imitates the child and waiting for a response from the child. Educational interventions have some effectiveness in children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children, and is well established for improving intellectual performance of young children. Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided. The limited research on the effectiveness of adult residential programs shows mixed results.
Historically, "conventional" pharmacotherapy has been used to reduce behaviors and sensitivities associated with ASD. Many such treatments have been prescribed off-label in order to target specific symptoms.
Today, medications are primarily prescribed to adults with autism to avoid any adverse effects in the developing brains of children. Therapy treatments, like behavioural or immersive therapies, are gaining popularity in the treatment plans of autistic children.
Depending on symptomology, one or multiple psychotropic medications may be prescribed. Namely antidepressants, anticonvulsants, and antipsychotics.
As of 2008 the treatments prescribed to children with ASD were expensive; indirect costs are more so. For someone born in 2000, a U.S. study estimated an average discounted lifetime cost of $ ( dollars, inflation-adjusted from 2003 estimate), with about 10% medical care, 30% extra education and other care, and 60% lost economic productivity. A UK study estimated discounted lifetime costs at £ and £ for a person with autism with and without intellectual disability, respectively ( pounds, inflation-adjusted from 2005/06 estimate). Legal rights to treatment are complex, vary with location and age, and require advocacy by caregivers. Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems; one 2008 U.S. study found a 14% average loss of annual income in families of children with ASD, and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment. After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning.
Educational interventions
Educational interventions attempt to help children not only to learn academic subjects and gain traditional readiness skills, but also to improve functional communication and spontaneity, enhance social skills such as joint attention, develop cognitive skills such as symbolic play, reduce disruptive behavior, and generalize learned skills by applying them to new situations. Several program models have been developed, which in practice often overlap and share many features, including:
early intervention that is not dependent upon a definitive diagnosis;
intense intervention, at least 25 hours per week, 12 months per year;
low student/teacher ratio;
family involvement, including training of parents;
interaction with neurotypical peers;
social stories, ABA and other visually based training;
structure that includes predictable routine and clear physical boundaries to lessen distraction; and
ongoing measurement of a systematically planned intervention, resulting in adjustments as needed.
Several educational intervention methods are available, as discussed below. They can take place at home, at school, or at a center devoted to autism treatment; they can be implemented by parents, teachers, speech and language therapists, and occupational therapists. A 2007 study found that augmenting a center-based program with weekly home visits by a special education teacher improved cognitive development and behavior.
Studies of interventions have methodological flaws that prevent definitive conclusions about efficacy. Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic reviews of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options. Concerns about outcome measures, such as their inconsistent use, most greatly affect how the results of scientific studies are interpreted. A 2009 Minnesota study found that parents follow behavioral treatment recommendations significantly less often than they follow medical recommendations, and that they adhere more often to reinforcement than to punishment recommendations. Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors; claims that intervention by around age three years is crucial are not substantiated. Mind-body therapies are frequently utilized by individuals with Autism Spectrum Disorders (ASD). However, there remains a lack of comprehensive examination into the specific types of mind-body therapies used for ASD and their intended outcomes, signifying a need for further research and exploration in this area.
National education policies
U.S.
In the United States, there have been three major policies addressing special education in the United States. These policies were the Education for All Handicapped Children Act in 1975, the Individuals with Disabilities Education Act in 1997, and the No Child Left Behind in 2001. The development of those policies showed increased guidelines for special education and requirements; such as requiring states to fund special education, equality of opportunities, help with transitions after secondary schooling, requiring extra qualifications for special education teachers, and creating a more specific class setting for those with disabilities. The Individuals with Disabilities Education Act, specifically had a large impact on special education as public schools were then required to employ high qualified staff. In 2009, for one to be a Certified Autism Specialist the requirements included: a master's degree, two years of career experience working with the autism population, earn 14 continuing education hours in autism every two years, and register with the International Institute of Education.
Perceived disadvantages of autistic people in the U.S. in the 2010s
Martha Nussbaum discusses how education is one of the fertile functions that is important for the development of a person and their ability to achieve a multitude of other capabilities within society. Autism causes many symptoms that interfere with a child's ability to receive a proper education such as deficits in imitation, observational learning, and receptive and expressive communication. As of 2014, of all disabilities affecting the population, autism ranked third lowest in acceptance into a postsecondary education institution. In a 2012 study funded by the National Institute of Health, Shattuck et al. found that only 35% of autistics are enrolled in a 2 or 4 year college within the first two years after leaving high school compared to 40% of children who have a learning disability. Due to the growing need for a college education to obtain a job, this statistic shows how autistics are at a disadvantage in gaining many of the capabilities that Nussbaum discusses and makes education more than just a type of therapy for those with autism. According to the 2012 study by Shattuck, only 55% of children with autism participated in any paid employment within the first two years after high school. Furthermore, those with autism that come from low income families tend to have lower success in postsecondary schooling.
Oftentimes, schools lacked the resources to create (what at the time was considered) an optimal classroom setting for those 'in need of special education'. In 2014 in the United States, it could cost between $6,595 to $10,421 extra to educate a child with autism. In the 2011–2012 school year, the average cost of education for a public school student was $12,401. In 2015, some cases, the extra cost required to educate a child with autism nearly doubled the average cost to educate the average public school student. As the abilities of autistic people varies highly, it is highly challenging to create a standardized curriculum that will fit all autistic learning needs. In the United States, in 2014 many school districts required schools to meet the needs of disabled students, regardless of the number of children with disabilities there are in the school. This combined with a shortage of licensed special education teachers has created a deficiency in the special education system. in 2011 the shortage caused some states to give temporary special education licenses to teachers with the caveat that they receive a license within a few years.
Mexico
In 1993, Mexico passed an education law that called for the inclusion of those with disabilities. This law was very important for Mexico education, however, there have been issues in implementing it due to a lack of resources.
United Nations and internationally
There have also been multiple international groups that have issued reports addressing issues in special education. The United Nations on "International Norms and Standards relating to Disability" in 1998. This report cites multiple conventions, statements, declarations, and other reports such as: The Universal Declaration of Human Rights, The Salamanca Statement, the Sundberg Declaration, the Copenhagen Declaration and Programme of Action, and many others. One main point that the report emphasizes is the necessity for education to be a human right. The report also states that the "quality of education should be equal to that of persons without disabilities." The other main points brought up by the report discuss integrated education, special education classes as supplementary, teacher training, and equality for vocational education. The United Nations also releases a report by the Special Rapporteur that has a focus on persons with disabilities. In 2015, a report titled "Report of the Special Rapporteur to the 52nd Session of the Commission for Social Development: Note by the Secretary-General on Monitoring of the implementation of the Standard Rules on the Equalization of Opportunities for Persons with Disabilities" was released. This report focused on looking at how the many countries involved, with a focus on Africa, have handled policy regarding persons with disabilities. In this discussion, the author also focuses on the importance of education for persons with disabilities as well as policies that could help improve the education system such as a move towards a more inclusive approach. The World Health Organization has also published a report addressing people with disabilities and within this there is a discussion on education in their "World Report on Disability" in 2011. Other organizations that have issued reports discussing the topic are UNESCO, UNICEF, and the World Bank.
Applied behavior analysis
Applied behavior analysis (ABA) is the applied research field of the science of behavior analysis, and it underpins a wide range of techniques used to treat autism and many other behaviors and diagnoses, including those who are patients in rehab or in whom a behavior change is desired. ABA-based interventions focus on teaching tasks one-on-one using the behaviorist principles of stimulus, response and reward, and on reliable measurement and objective evaluation of observed behavior. There is wide variation in the professional practice of behavior analysis and among the assessments and interventions used in school-based ABA programs. Conversely, various major figures within the autism community have written biographies detailing the harm caused by the provision of ABA, including restraint, sometimes used with mild self stimulatory behaviors such as hand flapping, and verbal abuse. Punishment procedures are very rarely used within the field today; these procedures were once used in the 70s and 80s however now there are ethical guidelines in place to prohibit the use.
The use of technology has begun to be implemented in ABA therapy for the treatment of autism. Robots, gamification, image processing, story boards, augmented reality, and web systems have been shown to be useful in the treatment of autism. These technologies are used to teach children with autism skill acquisition. The web programs were designed to address skills such as attention, social behavior, communication, and/or reading.
ABA has faced a great deal of criticism over the years. Recently, studies have shown that ABA may be abusive and can increase PTSD symptoms in patients. The Autistic Self Advocacy Network campaigns against the use of ABA in autism.
Many of those diagnosed with ASD or similar disorders advocate against behavioural therapies more broadly, like ABA and CBT, often as part of the autism rights movement, on the grounds that these approaches frequently reinforce the demand on autistic people to mask their neurodivergent characteristics or behaviours to favour a more 'neurotypical' and narrow conception of normality. In the case of CBT and talking therapies, the effectiveness varies, with many reporting that they appeared 'too self-aware' to gain significant benefit, as the therapy was designed with neurotypical people in mind. In autistic children, specifically, they also report that it is only mildly beneficial in aiding with their anxieties.
Discrete trial training
Many intensive behavioral interventions rely heavily on discrete trial teaching (DTT) methods, which use stimulus-response-reward techniques to teach foundational skills such as attention, compliance, and imitation. However, children have problems using DTT-taught skills in natural environments. These students are also taught with naturalistic teaching procedures to help generalize these skills. In functional assessment, a common technique, a teacher formulates a clear description of a problem behavior, identifies antecedents, consequences, and other environmental factors that influence and maintain the behavior, develops hypotheses about what occasions and maintains the behavior, and collects observations to support the hypotheses. A few more-comprehensive ABA programs use multiple assessment and intervention methods individually and dynamically.
ABA-based techniques have demonstrated effectiveness in several controlled studies: children have been shown to make sustained gains in academic performance, adaptive behavior, and language, with outcomes significantly better than control groups. A 2009 review of educational interventions for children, whose mean age was six years or less at intake, found that the higher-quality studies all assessed ABA, that ABA is well-established and no other educational treatment is considered probably efficacious, and that intensive ABA treatment, carried out by trained therapists, is demonstrated effective in enhancing global functioning in pre-school children. These gains maybe complicated by initial IQ. A 2008 evidence-based review of comprehensive treatment approaches found that ABA is well established for improving intellectual performance of young children with ASD. A 2009 comprehensive synthesis of early intensive behavioral intervention (EIBI), a form of ABA treatment, found that EIBI produces strong effects, suggesting that it can be effective for some children with autism; it also found that the large effects might be an artifact of comparison groups with treatments that have yet to be empirically validated, and that no comparisons between EIBI and other widely recognized treatment programs have been published. A 2009 systematic review came to the same principal conclusion that EIBI is effective for some but not all children, with wide variability in response to treatment; it also suggested that any gains are likely to be greatest in the first year of intervention. A 2009 meta-analysis concluded that EIBI has a large effect on full-scale intelligence and a moderate effect on adaptive behavior. However, a 2009 systematic review and meta-analysis found that applied behavior intervention (ABI), another name for EIBI, did not significantly improve outcomes compared with standard care of preschool children with ASD in the areas of cognitive outcome, expressive language, receptive language, and adaptive behavior. ABA is cost effective for administrators.
Recently, behavior analysts have built comprehensive models of child development (see Behavior analysis of child development) to generate models for prevention as well as treatment for autism.
Pivotal response training
Pivotal response treatment (PRT) is a naturalistic intervention derived from ABA principles. Instead of individual behaviors, it targets pivotal areas of a child's development, such as motivation, responsivity to multiple cues, self-management, and social initiations; it aims for widespread improvements in areas that are not specifically targeted. The child determines activities and objects that will be used in a PRT exchange. Intended attempts at the target behavior are rewarded with a natural reinforcer: for example, if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer.
Communication interventions
The inability to communicate, verbally or non-verbally, is a core deficit in autism. Children with autism are often engaged in repetitive activity or other behaviors because they cannot convey their intent any other way. They do not know how to communicate their ideas to caregivers or others. Helping a child with autism learn to communicate their needs and ideas is absolutely core to any intervention. Communication can either be verbal or non-verbal. Children with autism require intensive intervention to learn how to communicate their intent.
Communication interventions fall into two major categories. First, many autistic children do not speak, or have little speech, or have difficulties in effective use of language. Social skills have been shown to be effective in treating children with autism. Interventions that attempt to improve communication are commonly conducted by speech and language therapists, and work on joint attention, communicative intent, and alternative or augmentative and alternative communication (AAC) methods such as visual methods, for example visual schedules. AAC methods do not appear to impede speech and may result in modest gains. A 2006 study reported benefits both for joint attention intervention and for symbolic play intervention, and a 2007 study found that joint attention intervention is more likely than symbolic play intervention to cause children to engage later in shared interactions.
Second, social skills treatment attempts to increase social and communicative skills of autistic individuals, addressing a core deficit of autism. A wide range of intervention approaches is available, including modeling and reinforcement, adult and peer mediation strategies, peer tutoring, social games and stories, self-management, pivotal response therapy, video modeling, direct instruction, visual cuing, Circle of Friends and social-skills groups. A 2007 meta-analysis of 55 studies of school-based social skills intervention found that they were minimally effective for children and adolescents with ASD, and a 2007 review found that social skills training has minimal empirical support for children with Asperger syndrome or high-functioning autism.
SCERTS
The SCERTS model is an educational model for working with children with ASD. It was designed to help families, educators and therapists work cooperatively together to maximize progress in supporting the child.
The acronym refers to the focus on:
SC – social communication – the development of functional communication and emotional expression.
ER – emotional regulation – the development of well-regulated emotions and ability to cope with stress.
TS – transactional support – the implementation of supports to help families, educators and therapists respond to children's needs, adapt the environment and provide tools to enhance learning.
Relationship based, developmental models
Relationship based models give importance to the relationships that help children reach and master early developmental milestones. These are often missed or not mastered in children with ASD. Examples of these early milestones are engagement and interest in the world, intimacy with a caregiver, intentionality of action.
Relationship Development Intervention
Relationship development intervention is a family-based treatment program for children with ASD. This program is based on the belief that the development of dynamic intelligence (the ability to think flexibly, take different perspectives, cope with change and process information simultaneously) is key to improving the quality of life of children with autism.
Son-Rise
Son-Rise is a home-based program that emphasizes on implementing a color- and sensory-free playroom. Before implementing the home-based program, an institute trains the parents how to accept their child without judgment through a series of dialogue sessions. Like Floortime, parents join their child's ritualistic behavior for relationship-building. To gain the child's "willing engagement", the facilitator continues to join them only this time through parallel play. Proponents claim that children will become non-autistic after parents accept them for who they are and engage them in play. The program was started by the parents of Raun Kaufman, who is claimed to have gone from being autistic to normal via the treatment in the early 1970s. A stated goal of the program is to increase eye contact. In a 2017 qualitative study it was found that autistic people have reported to find eye contact distressing. No independent study has tested the efficacy of the program, but a 2003 study found that involvement with the program led to more drawbacks than benefits for the involved families over time, and a 2006 study found that the program is not always implemented as it is typically described in the literature, which suggests it will be difficult to evaluate its efficacy.
TEACCH
Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), which has come to be called "structured teaching", emphasises structure by using organized physical environments, predictably sequenced activities, visual schedules and visually structured activities, and structured work/activity systems where each child can practice various tasks. Parents are taught to implement the treatment at home. A 1998 controlled trial found that children treated with a TEACCH-based home program improved significantly more than a control group. A 2013 meta-analysis compiling all the clinical trials of TEACCH indicated that it has small or no effects on perceptual, motor, verbal, cognitive, and motor functioning, communication skills, and activities of daily living. There were positive effects in social and maladaptive behavior, but these required further replication due to the methodological limitations of the pool of studies analysed.
Sensory integration
Unusual responses to sensory stimuli are more common and prominent in children with autism, although there is not good evidence that sensory symptoms differentiate autism from other developmental disorders. Several therapies have been developed to treat sensory processing disorder (SPD). Some of these treatments (for example, sensorimotor handling) have a questionable rationale and have no empirical evidence. Other treatments have been studied, with small positive outcomes, but few conclusions can be drawn due to methodological problems with the studies. These treatments include prism lenses, physical exercise, auditory integration training, and sensory stimulation or inhibition techniques such as "deep pressure"—firm touch pressure applied either manually or via an apparatus such as a hug machine or a pressure garment. Weighted vests, a popular deep-pressure therapy, have only a limited amount of scientific research available, which on balance indicates that the therapy is ineffective. Although replicable treatments have been described and valid outcome measures are known, gaps exist in knowledge related to SPD and therapy. In a 2011 Cochrane review, no evidence was found to support the use of auditory integration training as an ASD treatment method. Because empirical support is limited, systematic evaluation is needed if these interventions are used.
The term multisensory integration in simple terms means the ability to use all of ones senses to accomplish a task. Occupational therapists sometimes prescribe sensory treatments for children with Autism however in general there has been little or no scientific evidence of effectiveness.
Animal-assisted therapy
Old model
Animal-assisted therapy, where an animal such as a dog or a horse becomes a basic part of a person's treatment, was a controversial treatment for some symptoms. A 2007 meta-analysis found that animal-assisted therapy was associated with "a moderate improvement in autism spectrum symptoms". Reviews of published dolphin-assisted therapy (DAT) studies found important methodological flaws and concluded that there is no compelling scientific evidence that DAT is a legitimate therapy or that it affords any more than fleeting improvements in mood.
New model
Modern animal-assisted therapy as relating to autism is not about 'controlling autistic symptoms' but about a natural way to bring about socializing (via bridging the 'double empathy gap') and also for stress reduction. As in a 2020 program: "the remarkable adherence to the therapy program by study participants and the program's clinically relevant effects indicate that AAT with dogs can be used to reduce perceived stress and symptoms of agoraphobia, and to improve social awareness and communication in adults with ASD with normal to high intelligence." In 2021, a study was conducted on this topic, specifically on "autonomic and endocrine activity in adults with autism spectrum disorder" in part for stress reduction, particularly as for autistic people the "downside of social camouflaging is that it is a major source of stress".
Neurofeedback
Neurofeedback attempts to train individuals to regulate their brainwave patterns by letting them observe their brain activity more directly. In its most traditional form, the output of EEG electrodes is fed into a computer that controls a game-like audiovisual display. Neurofeedback has been evaluated 'with positive results for ASD', but studies have lacked random assignment to controls. This research is ongoing as of 2019 though now focused on "improving attention" and "reducing anxiety".
Patterning
Patterning is a set of exercises that attempts to improve the organization of a child's neurologic impairments. It has been used for decades to treat children with several unrelated neurologic disorders, including autism. The method, taught at The Institutes for the Achievement of Human Potential, is based on oversimplified theories and is not supported by carefully designed research studies.
Other methods
There are many simple methods such as priming, prompt delivery, picture schedules, peer tutoring, and cooperative learning, that have been proven to help autistic students to prepare for class and to understand the material better. Priming is done by allowing the students to see the assignment or material before they are shown in class. Prompt delivery consists of giving prompts to the autistic children in order to elicit a response to the academic material. Picture schedules are used to outline the progression of a class and are visual cues to allow autistic children to know when changes in the activity are coming up. This method has proven to be very useful in helping the students follow the activities. Peer tutoring and cooperative learning are ways in which an autistic student and a nondisabled student are paired together in the learning process. This has shown be very effective for "increasing both academic success and social interaction." There are more specific strategies that have been shown to improve an autistic's education, such as LEAP, Treatment and Education of Autistic and Related Communication Handicapped Children, and Non-Model-Specific Special Education Programs for preschoolers. LEAP is "an intensive 12-month program that focuses on providing a highly structured and safe environment that helps students to participate in and derive benefit from educational programming" and focuses on children from 5-21 who have a more severe case of autism. The goal of the program is to develop functional independence through academic instruction, vocational/translational curriculum, speech/language services, and other services personalized for each student. While LEAP, TEACCH, and Non-Model Specific Special Education Programs are all different strategies, there has been no evidence that one is more effective than the other.
Environmental enrichment
Environmental enrichment is concerned with how the brain is affected by the stimulation of its information processing provided by its surroundings (including the opportunity to interact socially). Brains in richer, more-stimulating environments, have increased numbers of synapses, and the dendrite arbors upon which they reside are more complex. This effect happens particularly during neurodevelopment, but also to a lesser degree in adulthood. With extra synapses there is also increased synapse activity and so increased size and number of glial energy-support cells. Capillary vasculation also is greater to provide the neurons and glial cells with extra energy. The neuropil (neurons, glial cells, capillaries, combined) expands making the cortex thicker. There may also exist (at least in rodents) more neurons.
Research on nonhuman animals finds that more-stimulating environments could aid the treatment and recovery of a diverse variety of brain-related dysfunctions, including Alzheimer's disease and those connected to aging, whereas a lack of stimulation might impair cognitive development.
Research on humans suggests that lack of stimulation (deprivation—such as in old-style orphanages) delays and impairs cognitive development. Research also finds that higher levels of education (which is both cognitively stimulating in itself, and associates with people engaging in more challenging cognitive activities) results in greater resilience (cognitive reserve) to the effects of aging and dementia.
Massage therapy
A review of massage therapy as a symptomatic treatment of autism found limited evidence of benefit. There were few high quality studies, and due to the risk of bias found in the studies analyzed, no firm conclusions about the efficacy of massage therapy could be drawn.
Music
Music therapy uses the elements of music to let people express their feelings and communicate. A 2014 review (updated in 2022) found that music therapy may help in social interactions and communication.
Music therapy can involve various techniques depending on where the subject is sitting on the ASD scale. Somebody who may be considered as 'low-functioning' would require vastly different treatment to somebody on the ASD scale who is 'high-functioning'. Examples of these types of therapeutic techniques include:
Free improvisation – No boundaries or skills required
Structured improvisation – Some established parameters within the music
Performing or recreating music – Reproducing a pre-composed piece of music or song with associated activities
Composing music – Creating music that caters to the specific needs of that person using instruments or the voice
Listening – Engaging in specific musical listening base exercises
Improvisational Music Therapy (IMT), is increasing in popularity as a therapeutic technique being applied to children with ASD. The process of IMT occurs when the client and therapist make up music, through the use of various instruments, song and movement. The specific needs of each child or client need to be taken into consideration. Some children with ASD find their different environments chaotic and confusing, therefore, IMT sessions require the presence of a certain routine and be predictable in nature, within their interactions and surroundings. Music can provide all of this, it can be very predictable, it is highly repetitious with its melodies and sounds, but easily varied with phrasing, rhythm and dynamics giving it a controlled flexibility. The allowance of parents or caregivers to sessions can put the child at ease and allow for activities to be incorporated into everyday life.
Sensory enrichment therapy
In all interventions for autistic children, the main strategy is to aim towards the improvement on sensitivity in all senses. Autistic children may lack the ability to name or even feel their own emotions. This can also impact relating to other people's emotions and inferring the moods of others. Many autistic children also live with a Sensory Processing Disorder. In sensory-based interventions, there have been signs of progress in children responding with an appropriate response when given a stimulus after being in sensory-based therapies for a period of time. However, at this time, there is no concrete evidence that these therapies are effective for autistic children. Autism spectrum disorder varies from child to child, which can make it challenging for clinicians to assess and know what therapies to apply.
The purpose of these differentiated interventions are to intervene at the neurological level of the brain in hopes to develop appropriate responses to the different sensations from one's body and also to outside stimuli in one's environment. Scientist have used music therapies, massage therapies, occupational therapies and more. With the Autistic Spectrum being so diverse and widespread, each case or scenario is different.
Mindfulness
Emerging evidence for mindfulness-based interventions for improving mental health in adults with autism has support through a recent systematic review. This includes evidence for decreasing stress, anxiety, ruminating thoughts, anger, and aggression.
Parent-mediated interventions
Parent-mediated interventions offer support and practical advice to parents of autistic children. A 2013 Cochrane Review found that there was no evidence of gains in most of the primary measures of the studies (e.g., the child's adaptive behaviour), however there was strong evidence for a positive pattern of change in parent-child interactions. There was some uncertain evidence of changes in the child's language and communication. A very small number of randomized and controlled studies suggest that parent training can lead to reduced maternal depression, improved maternal knowledge of autism and communication style, and improved child communicative behavior, but due to the design and number of studies available, definitive evidence of effectiveness is not available.
Early detection of ASD in children can often occur before a child reaches the age of three years old. Methods that target early behavior can influence the quality of life for a child with ASD. Parents can learn methods of interaction and behavior management to best assist their child's development. A 2013 Cochrance review concluded that there were some improvements when parent intervention was used.
Medical management
Drugs, supplements, or diets are often used to alter physiology in an attempt to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity that can interfere with education or social adaptation or (more rarely) cause autistic individuals to harm themselves or others. There is plenty of anecdotal evidence to support medical treatment; many parents who try one or more therapies report some progress, and there are a few well-publicized reports of children who are able to return to mainstream education after treatment, with dramatic improvements in health and well-being. However, this evidence may be confounded by improvements seen in autistic children who grow up without treatment, by the difficulty of verifying reports of improvements, and by the lack of reporting of treatments' negative outcomes. Only a very few medical treatments are well supported by scientific evidence using controlled experiments.
Medication
Many medications are used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics. Only the antipsychotics have clearly demonstrated efficacy.
Between the 1950s and 1970s LSD was studied, however, has not been studied in this capacity since.
Research has focused on atypical antipsychotics, especially risperidone, which has the largest amount of evidence that consistently shows improvements in irritability, self-injury, aggression, and tantrums associated with ASD. Risperidone is approved by the Food and Drug Administration (FDA) for treating symptomatic irritability in autistic children and adolescents. In short-term trials (up to six months) most adverse events were mild to moderate, with weight gain, drowsiness, and high blood sugar requiring monitoring; long term efficacy and safety have not been fully determined. It is unclear whether risperidone improves autism's core social and communication deficits. The FDA's decision was based in part on a study of autistic children with severe and enduring problems of tantrums, aggression, and self-injury; risperidone is not recommended for autistic children with mild aggression and explosive behavior without an enduring pattern.
Other drugs are prescribed off-label in the U.S., which means they have not been approved for treating ASD. Large placebo-controlled studies of olanzapine and aripiprazole were underway in early 2008. Aripiprazole may be effective for treating autism in the short term, but is also associated with side effects, such as weight gain and sedation.
Some selective serotonin reuptake inhibitors (SSRIs) and dopamine blockers can reduce some maladaptive behaviors associated with ASD. Although SSRIs reduce levels of repetitive behavior in autistic adults, a 2009 multisite randomized controlled study found no benefit and some adverse effects in children from the SSRI citalopram, raising doubts whether SSRIs are effective for treating repetitive behavior in autistic children. A further study of related medical reviews determined that the prescription of SSRI antidepressants for treating ASDs in children lacked any evidence, and could not be recommended.
Reviews of evidence found that the psychostimulant methylphenidate may be efficacious against hyperactivity and possibly impulsivity associated with ASD, although the findings were limited by low quality evidence. There was no evidence that methylphenidate "has a negative impact on the core symptoms of ASD, or that it improves social interaction, stereotypical behaviours, or overall ASD." Of the many medications studied for treatment of aggressive and self-injurious behavior in children and adolescents with autism, only risperidone and methylphenidate demonstrate results that have been replicated.
A 1998 study of the hormone secretin reported improved symptoms and generated tremendous interest, but several controlled studies since have found no benefit. An experimental drug STX107 has stopped overproduction of metabotropic glutamate receptor 5 in rodents, and it has been hypothesized that this may help in about 5% of autism cases, but this hypothesis has not been tested in humans.
Oxytocin may play a role in autism and may be a possible treatment for repetitive and affiliative behaviors; Two related studies in adults found that oxytocin decreased repetitive behaviors and improved interpretation of emotions, but these preliminary results do not necessarily apply to children. Recent research suggests that oxytocin may decrease the noisiness of the brain's auditory system, increasing perception of social cues and the ability to react in social situations. However, the cues detected may not always be positive: increasing awareness of a trusted adult may be beneficial, but increasing awareness of an aggressor may increase distress. The possibility that oxytocin's effects are context-dependent means that its use as a treatment in ASD should be carefully monitored. According to a 2022 systematic review/network meta-analysis, evidence from large trials didn't show efficacy in children/adolescent for oxytocin and balovaptan (both vasopressin-V1A receptor antagonist), however in adults oxytocin improved repetitive behaviors with small-to-medium effect-sizes and moderate-quality evidence (this result needs to be replicated since participants were mainly high-functioning autistic and age-dependent treatment response isn't excluded). Moreover, according to the same systematic review/network meta-analysis, based on two large studies balovaptan wasn't found efficiacious in adults, but small improvements in quality of life were noted.
Aside from antipsychotics, there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD. Results of the handful of randomized controlled trials that have been performed suggest that risperidone, the SSRI fluvoxamine, and the typical antipsychotic haloperidol may be effective in reducing some behaviors, that haloperidol may be more effective than the tricyclic antidepressant clomipramine, and that the opioid antagonist naltrexone hydrochloride is not effective. In small studies, memantine has been shown to significantly improve language function and social behavior in children with autism. Research is underway on the effects of memantine in adults with ASDs. A person with ASD may respond atypically to medications and the medications can have adverse side effects.
Prosthetics
Unlike conventional neuromotor prostheses, neurocognitive prostheses would sense or modulate neural function in order to physically reconstitute cognitive processes such as executive function and language. No neurocognitive prostheses are currently available but the development of implantable neurocognitive brain-computer interfaces has been proposed to help treat conditions such as autism.
Affective computing devices, typically with image or voice recognition capabilities, have been proposed to help autistic individuals improve their social communication skills. These devices are still under development. Robots have also been proposed as educational aids for autistic children.
Transcranial magnetic stimulation
Transcranial magnetic stimulation, which is a somewhat well established treatment for depression, has been proposed, and used, as a treatment for autism. A review published in 2013 found insufficient evidence to support its widespread use for ASDs. A 2015 review found tentative but insufficient evidence to justify its use outside of clinical studies. New findings show TMS can positively affect gamma brainwave oscillations and help improve performance accuracy.
Alternative medicine
Many alternative therapies and interventions used to be popular in the 1990s and early 2000s, ranging from elimination diets to chelation therapy, though few were supported by scientific studies. Treatment approaches lacked empirical support in quality-of-life contexts, and many programs focused on success measures that lack predictive validity and real-world relevance. Scientific evidence appeared to matter less to service providers than program marketing, training availability, and parent requests. Back then, it was presumed that even if they did not help, conservative treatments such as changes in diet were "expected to be harmless aside from their bother and cost" except that didn't take into account the mental health toll that attitude would have on the children in question who are now adults speaking out against such practices.
Acupuncture
Acupuncture was studied and has not been found to be 'helpful in treating autism'.
Hyperbaric oxygen
In 2007 further studies were needed in order for practitioners and families to make more conclusive and valid decisions concerning HBOT treatments. One small 2009 double-blind study of autistic children found that 40 hourly treatments of 24% oxygen at 1.3 atmospheres provided significant improvement in the children's behavior immediately after treatment sessions but this study has not been independently confirmed. This spawned a relatively large-scale controlled studies since to investigate HBOT. For example, in 2010 using treatments of 24% oxygen at 1.3 atmospheres, though it found less promising results. A 2010 double-blind study compared HBOT to a placebo treatment in children with autistic disorder. Both direct observational measures of behavioral symptoms and standardized psychological assessments were used to evaluate the treatment. No differences were found between the HBOT group and the placebo group on any of the outcome measures. A second 2011 single-subject design study also investigated the effects of 40 HBOT treatments of 24% oxygen at 1.3 atmospheres on directly observed behaviors using multiple baselines across 16 participants. Again, no consistent outcomes were observed across any group and further, no significant improvements were observed within any individual participant. Together, these studies suggest that HBOT at 24% oxygen at 1.3 atmospheric pressure does not result in a clinically significant improvement of the behavioral symptoms of autistic disorder. Nonetheless, news reports and related blogs indicated that HBOT was used for many cases of children with autism in the 2010s.
When considering the financial and time investments required in order to participate in this treatment and the inconsistency of the present findings, HBOT seems to be a riskier and thus, often less favorable. As of May 2011 HBOT could cost up to $150 per hour with individuals using anywhere from 40 to 120 hours as a part of their integrated treatment programs. In addition, purchasing (at $8,495–27,995) and renting ($1,395 per month) of the HBOT chambers is another option some families use.
As of 2017, "Hyperbaric oxygen therapy provides a higher concentration of oxygen delivered in a chamber or tube containing higher than sea level atmospheric pressure. Case series and randomized controlled trials show no evidence to support the benefit of HBOT for children with ASD. Only 1 randomized controlled trial reported effectiveness of this treatment, and those results have yet to be repeated."
Chiropractic
Chiropractic is an alternative medical practice whose main hypothesis is that mechanical disorders of the spine affect general health via the nervous system, and whose main treatment is spinal manipulation. A significant portion of the profession rejects vaccination, as traditional chiropractic philosophy equates vaccines to poison. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous, ineffective, and unnecessary, and in some cases suggesting that vaccination causes autism or that chiropractors should be the primary contact for treatment of autism and other neurodevelopmental disorders. Chiropractic treatment has not been shown to be effective for medical conditions other than back pain, and there is insufficient scientific evidence to make conclusions about chiropractic care for autism.
Craniosacral therapy
Craniosacral therapy is an alternative medical practice whose main hypothesis is that restrictions at cranial sutures of the skull affect rhythmic impulses conveyed via cerebrospinal fluid, and that gentle pressure on external areas can improve the flow and balance of the supply of this fluid to the brain, relieving symptoms of many conditions. There is no scientific support for major elements of the underlying model, there is little scientific evidence to support the therapy, and research methods that could conclusively evaluate the therapy's effectiveness have not been applied. No published studies are available on the use of this therapy for autism.
Chelation therapy
Based on the speculation that heavy metal poisoning may trigger the symptoms of autism, particularly in small subsets of individuals who cannot excrete toxins effectively, some parents have turned to alternative medicine practitioners who provide detoxification treatments via chelation therapy. However, evidence to support this practice has been anecdotal and not rigorous. Strong epidemiological evidence refutes links between environmental triggers, in particular thiomersal-containing vaccines, and the onset of autistic symptoms. In 2002 Thiamine tetrahydrofurfuryl disulfide (TTFD) was hypothesized to act as a chelating agent in children with autism and a 2002 pilot study administered TTFD rectally to ten autism spectrum children, and seemed to find beneficial clinical effect. This study has not been replicated, and a 2006 review of thiamine by the same author did not mention thiamine's possible effect on autism. There is not sufficient evidence to support the use of thiamine (vitamin B1) to treat autism. Dubious invasive treatments are a much more serious matter: for example, in 2005, botched chelation therapy killed a five-year-old boy with autism.
No scientific data supports the claim that the mercury in the vaccine preservative thiomersal causes autism or its symptoms, and there is no scientific support for chelation therapy as a treatment for autism.
Diets and dietary supplements
1990s hypotheses
In the early 1990s, it was hypothesized that autism could be caused or aggravated by opioid peptides like casomorphine that are metabolic products of gluten and casein. Based on that hypothesis, diets that eliminate foods containing either gluten or casein, or both, are widely promoted, and many testimonials can be found describing benefits in autism-related symptoms, notably social engagement and verbal skills. Studies supporting those claims had significant flaws, so those data were inadequate to guide treatment recommendations. Vitamin C decreased stereotyped behavior in a small 1993 study. The study had not been replicated as of 2005, and vitamin C had limited popularity as an autism treatment. High doses might cause kidney stones or gastrointestinal upset such as diarrhea.
2000-2014 hypotheses and research
In the early 2000s, many parents gave their children dietary supplements in an attempt to 'treat autism' or to 'alleviate its symptoms'. The range of supplements given was wide and few are supported by scientific data.
In 2005, it was thought that: although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual; studies report conflicting results, and the relationship between GI problems and ASD is unclear. Atypical eating behavior was thought to occur in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur; at the time it did not appear to result in malnutrition in studies. Other elimination diets were also proposed, targeting salicylates, food dyes, yeast, and simple sugars. No scientific evidence has established the efficacy of such diets in 'treating autism' in children. An elimination diet may create nutritional deficiencies that harm overall health unless care is taken to assure proper nutrition.
In 2006 studies suggested that complementary and alternative medical (CAM) therapy use in children with chronic illnesses is higher than in children in the general population. In a study by Helen H L Wong and Ronald G Smith, they investigated patterns of CAM therapy use in children diagnosed with ASD (n = 50) as compared to a control population of children with no ASD (n = 50). Over half of the parents in the ASD group reported using, or had used at least one CAM therapy for their child (52%) as compared to 28% of the control group (P = 0.024). Seventy percent of therapies used in the ASD group were biologically based therapies consisting of special diets or supplements, and parents felt that 75% of the therapies used were beneficial.
For example, a 2008 study found that autistic boys on casein-free diets had significantly thinner bones than usual, presumably because the diets contribute to calcium and vitamin D deficiencies. A 2009 review found some low-quality evidence to support the use of vitamin B6 in combination with magnesium at high doses, but the evidence was equivocal and the review noted the possible danger of fatal hypermagnesemia. A 2005 Cochrane Review of the evidence for the use of B6 and magnesium found that "[d]ue to the small number of studies, the methodological quality of studies, and small sample sizes, no recommendation can be advanced regarding the use of B6-Mg as a treatment for autism."
Probiotics containing potentially beneficial bacteria were hypothesized to 'relieve some symptoms of autism' by minimizing yeast overgrowth in the colon. The hypothesized yeast overgrowth has not been confirmed by endoscopy, the mechanism connecting yeast overgrowth to autism is only hypothetical, and no clinical trials as of 2005 had been published in the peer-reviewed literature.
Dimethylglycine (DMG) was hypothesized to improve speech and 'reduce autistic behaviors', and was a commonly used supplement. Two double-blind, placebo-controlled studies found no statistically significant effect on 'autistic behaviors', and no peer-reviewed studies have addressed treatment with the related compound trimethylglycine.
Melatonin is sometimes used to manage sleep problems. Adverse effects were generally reported to be mild, including drowsiness, headache, dizziness, and nausea; however, an increase in seizure frequency was reported among susceptible children. Several small RCTs indicated that melatonin was effective in treating insomnia in autistic children, but further large studies are needed. A 2013 literature review found 20 studies that reported improvements in sleep parameters as a result of melatonin supplementation, and concluded that "the administration of exogenous melatonin for abnormal sleep parameters in ASD is evidence-based."
Although omega-3 fatty acids, which are polyunsaturated fatty acids (PUFA), were 'a popular treatment for children with ASD' in the 2000s and 2010s, there is very little high-quality scientific evidence supporting their effectiveness. Several other supplements were hypothesized 'to relieve autism symptoms', including BDTH2, carnosine, cholesterol, cyproheptadine, D-cycloserine, folic acid, glutathione, metallothionein promoters, other PUFA such as omega-6 fatty acids, tryptophan, tyrosine, thiamine (see Chelation therapy), vitamin B12, and zinc. These lack reliable scientific evidence of efficacy or safety in treatment of autism.
2015–Present research
It is now known that "children with ASD are at risk of having alimentary tract disorders – mainly, they are at a greater risk of general gastrointestinal (GI) concerns, constipation, diarrhea, and abdominal pain" and as succinctly summarized the Mayo Clinic website in 2019, "Yes, children with autism spectrum disorder (ASD) tend to have more medical issues, including gastrointestinal (GI) symptoms such as abdominal pain, constipation and diarrhea, compared with their peers." Presently, there is not 'a diet for autism' just advice to not ingest things the individual's body seems to reject, for example: gluten if the person happens to have Celiac disease. As of 2021, "there is no clinical evidence for applying specific (e.g., gluten-free or pro-biotic) diets" to the topic of autism.
Electroconvulsive therapy
In 2009 studies indicated that 12–17% of adolescents and young adults with autism satisfy diagnostic criteria for catatonia, which is loss of or hyperactive motor activity. Electroconvulsive therapy (ECT) have been used to treat cases of catatonia and related conditions in people with autism but as of 2009 no controlled trials had been performed of ECT in autism, and there are serious ethical and legal obstacles to its use.
Stem cell therapy
2007–2012
Mesenchymal stem cells and cord blood CD34+ cells have been proposed to treat autism in 2007 and as of 2012 it was thought they may represent a future treatment. Since immune system deregulation has been implicated in autism, mesenchymal stem cells show the greatest promise as treatment for the disorder. Changes in the innate and adaptive immune system have been observed- those with autism show an imbalance in CD3+, CD4+, and CD8+ T cells, as well as in NK cells. In addition, peripheral blood mononuclear cells (PBMCs) overproduce IL-1β. It was theorized that MSC mediated immune suppressive activity could restore this immune imbalance.
Other
Pseudoscience
A number of naturopathic practitioners claim that CEASE therapy, a mixture of homeopathy, supplements and 'vaccine detoxing', can help people with autism however no robust evidence is available for this.
Packing
In packing, children were wrapped tightly for up to an hour in wet sheets that have been refrigerated, with only their heads left free. The treatment was repeated several times a week, and could continue for years. It was intended as treatment for autistic children who harm themselves and mostly children who could not speak. Similar envelopment techniques had been used for centuries, such as to calm violent patients in Germany in the 19th century; it was re-popularized in France in the 1960s, based on psychoanalytic theories such as the theory of the refrigerator mother. As of 2007, packing was used in hundreds of French clinics. There was no scientific evidence for the effectiveness of packing in 2007, and there was some concern about risk of adverse health effects. As of 2019: "The main French associations of parents with autistic children succeeded in obtaining the prohibition of packing, announced by the French Secretary of State to the Ministry of Health in April 2016."
Exorcism
The Table Talk of Martin Luther contains the story of a twelve-year-old boy who some believe was 'severely autistic'. According to Luther's notetaker Mathesius, Luther thought the boy was a soulless mass of flesh possessed by the devil, and suggested that he be suffocated.
Abuse under the guise of religion
In 2003, an autistic boy in Wisconsin suffocated during an exorcism by an Evangelical minister in which he was wrapped in sheets.
Other religious practices
Ultraorthodox Jewish parents in Israel sometimes used spiritual and mystical interventions such as prayers, blessings, recitations of religious text, amulets, changing the child's name, and exorcism.
Other practices involving spirituality
A 2009 study has suggested that spirituality of mothers with ASDs led to positive outcomes whereas religious activities of mothers were associated with negative outcomes for the child.
Historical outlooks
U.S., U.K., and France
Children in Britain and America would often be put in institutions on the instruction of doctors and the parents told to forget about them, for example, "in Britain, until 1961, almost all doctors regarded these symptoms as part of some general "childhood psychosis" or junior version of schizophrenia". Observer journalist Christopher Stevens, father of an autistic child, reports how a British doctor told him that after a child was admitted to such an institution, usually "nature would take its course" and the child would die due to the prevalence of tuberculosis.
Anti-cure perspective and autism rights movement
The exact cause of autism is unclear, yet some organizations advocate researching a cure. Many self-advocacy autism rights organizations such as the Autistic Self Advocacy Network view autism as a different neurology rather than as a mental disorder, advocate acceptance, and are against ABA as it is seen as trying to force conformity to "neuronormative" society.
Criticisms of most educational, social, and behavioral focused autism therapies as put forth by autistic adults, teachers, and researchers frequently fall into the idea of these programs encouraging or even training behavioral responses directed toward "camouflaging", "passing as non-autistic", or "masking". Recent studies indicate that, among autistic people, burnout and mental health difficulties associated with masking "driven by the stress of masking and living in an unaccommodating neurotypical world" is an issue (which also impacts autistic young people and children). Animal-assisted therapy used to be directed toward symptoms of autism and some studies of the programs are now directed toward burnout.
In 2018 more studies began involving the experiences of autistic adults including their experiences with general practice medicine. Subsequent related studies have focused on communication preferences of autistic adults and the idea of "the 'Autistic Advantage', a strengths-based model".
See also
Autism rights movement
Autism friendly
Equine therapy on autistic people
Ryan's Law
Special education
References
Further reading
Reviewed in:
This describes a special issue of the journal Child and Adolescent Psychiatric Clinics of North America, titled "Treating Autism Spectrum Disorders" (volume 17, issue 4, pages 713–932) and dated October 2008.
External links
"Applied Behavior Analysis (ABA)" at Therapist Neurodiversity Collective.
Treatment of autism | 0.770324 | 0.984586 | 0.75845 |
CBT | CBT most commonly refers to:
Cock and ball torture, a sexual activity
Cognitive behavioral therapy, a psychotherapeutic approach
CBT or cbt may also refer to:
Broadcasting
CBT-FM, a radio station in Grand Falls-Windsor, Canada
Certified Broadcast Technologist, a professional title
Businesses
Cabot Corp (NYSE:CBT), a chemical manufacturer
Cincinnati Bell Telephone, an American telco in Ohio
Connecticut Bank and Trust Company, a regional banking institution that merged into Bank of New England
Computing
.cbt, an extension for tarred comic book archive files
Complete binary tree, a binary tree data structure where all levels are filled
Computer-based testing, electronic administering of examinations
Computer-based training
Core-based trees, a proposal for making IP Multicast scalable by constructing a tree of routers
Closed beta test, a beta version released to a select group for testing
Publishing
cbt (publisher), Munich, Germany
.cbt, a comic book archive file extension
Children's Book Trust, Delhi, India
Committee on Bible Translation, for the New International Version
Science
Center for Biochemical Technology, India
Complete binary tree, in computer science
Coulomb blockade thermometer, in physics
Core body temperature, in biology and medicine
Sport
Commonwealth Bank Trophy, in Australian netball
Competitive Balance Tax, in Major League Baseball
Confederação Brasileira de Tênis (Brazilian Tennis Confederation)
Transport
Campaign for Better Transport (disambiguation), several advocacy groups
Ceneri Base Tunnel, a railway tunnel in Switzerland
Compulsory Basic Training, a British motorcycling certification
Other uses
Cadet Basic Training at the United States Military Academy
Cock and Ball Torture (band), a German grindcore band
See also
Chicago Board of Trade (CBOT) | 0.761826 | 0.995514 | 0.758409 |
Clinic | A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs of populations in local communities, in contrast to larger hospitals which offer more specialized treatments and admit inpatients for overnight stays.
Most commonly, the English word clinic refers to a general practice, run by one or more general practitioners offering small therapeutic treatments, but it can also mean a specialist clinic. Some clinics retain the name "clinic" even while growing into institutions as large as major hospitals or becoming associated with a hospital or medical school.
Etymology
The word clinic derives from Ancient Greek klinein meaning to slope, lean or recline. Hence klinē is a couch or bed and klinikos is a physician who visits his patients in their beds. In Latin, this became clīnicus.
An early use of the word clinic was "one who receives baptism on a sick bed".
Overview
Clinics are often associated with a general medical practice run by one or several general practitioners. Other types of clinics are run by the type of specialist associated with that type: physical therapy clinics by physiotherapists and psychology clinics by clinical psychologists, and so on for each health profession. (This can even hold true for certain services outside the medical field: for example, legal clinics are run by lawyers.)
Some clinics are operated in-house by employers, government organizations, or hospitals, and some clinical services are outsourced to private corporations which specialize in providing health services. In China, for example, owners of such clinics do not have formal medical education. There were 659,596 village clinics in China in 2011.
Health care in India, China, Russia and Africa is provided to those regions' vast rural areas by mobile health clinics or roadside dispensaries, some of which integrate traditional medicine. In India these traditional clinics provide ayurvedic medicine and unani herbal medical practice. In each of these countries, traditional medicine tends to be a hereditary practice.
Function
The function of clinics differs from country to country. For instance, a local general practice run by a single general practitioner provides primary health care and is usually run as a for-profit business by the owner, whereas a government-run specialist clinic may provide subsidized or specialized health care.
Some clinics serve as a place for people with injuries or illnesses to be seen by a triage nurse or other health worker. In these clinics, the injury or illness may not be serious enough to require a visit to an emergency room (ER), but the person can be transferred to one if needed.
Treatment at these clinics is often less expensive than it would be at a casualty department. Also, unlike an ER these clinics are often not open on a 24/7/365 basis. They sometimes have access to diagnostic equipment such as X-ray machines, especially if the clinic is part of a larger facility. Doctors at such clinics can often refer patients to specialists if the need arises.
Large outpatient clinics
Large outpatient clinics vary in size, but can be as large as hospitals.
Function
Typical large outpatient clinics house general medical practitioners (GPs) such as doctors and nurses to provide ambulatory care and some acute care services but lack the major surgical and pre- and post-operative care facilities commonly associated with hospitals.
Besides GPs, if a clinic is a polyclinic, it can house outpatient departments of some medical specialties, such as gynecology, dermatology, ophthalmology, otolaryngology, neurology, pulmonology, cardiology, and endocrinology. In some university cities, polyclinics contain outpatient departments for the entire teaching hospital in one building.
Internationally
Large outpatient clinics are a common type of healthcare facility in many countries, including France, Germany (long tradition), Switzerland, and most of the countries of Central and Eastern Europe (often using a mixed Soviet-German model), as well as in former Soviet republics such as Russia and Ukraine; and in many countries across Asia and Africa.
In Europe, especially in the Central and Eastern Europe, bigger outpatient health centers, commonly in cities and towns, are called policlinics (derived from the word polis, not from poly-).
Recent Russian governments have attempted to replace the policlinic model introduced during Soviet times with a more western model. However, this has failed.
In the Czech Republic, many policlinics were privatized or leasehold and decentralized in the post-communist era: some of them are just lessors and coordinators of a healthcare provided by private doctor's offices in the policlinic building.
India has also set up huge numbers of polyclinics for former defense personnel. The network envisages 426 polyclinics in 343 districts of the country which will benefit about 33 lakh (3.3 million) ex-servicemen residing in remote and far-flung areas.
Policlinics are also the backbone of Cuba's primary care system and have been credited with a role in improving that nation's health indicators.
Mobile clinics
Providing health services through mobile clinics provides accessible healthcare services to these remote areas that have yet to make their way in the politicized space. For example, mobile clinics have proved helpful in dealing with new settlement patterns in Costa Rica. Before foreign aid organizations or the state government became involved in healthcare, Costa Rica's people managed their own health maintenance and protection. People relied on various socio-cultural adaptations and remedies to prevent illnesses, such as personal hygiene and settlement patterns. When new settlements that sprang up along the coast became "artificial" communities, and due to lack of traditional home healing practices here, alternative methods such as mobile clinics had to be implemented in these communities for the protection and prevention of diseases.
A study done in rural Namibia revealed the health changes of orphans, vulnerable children and non-vulnerable children (OVC) visiting a mobile clinic where health facilities are far from the remote villages. Over 6 months, information on immunization status, diagnosis of anemia, skin and intestinal disorders, nutrition, dental disorders was collected and showed that visits to mobile clinics improved the overall health of children that visited regularly. It concluded that specified "planning of these programs in areas with similarly identified barriers may help correct the health disparities among Namibian OVC and could be a first step in improving child morbidity and mortality in difficult-to-reach rural areas."
Food supplementation in the context of routine mobile clinic visits also shows to have improved the nutritional status of children, and it needs further exploration as a way to reduce childhood malnutrition in resource-scarce areas. A cross-sectional study focussed on comparing acute and chronic undernutrition rates prior to and after a food-supplementation program as an adjunct to routine health care for children of migrant workers residing in rural communities in the Dominican Republic. Rates of chronic undernutrition decreased from 33% to 18% after the initiation of the food-supplementation program and shows that the community members attending the mobile clinics are not just passively receiving the information but are incorporating it and helping keep their children nourished.
Types
There are many different types of clinics providing outpatient services. Such clinics may be public (government-funded) or private medical practices.
A CLSC are in Quebec; they are a type of free clinic funded by the provincial government; they provide service not covered by Canada's healthcare plan including social workers
In the United States, a free clinic provides free or low-cost healthcare for those with little or without insurance.
A retail-based clinic is housed in supermarkets and similar retail outlets providing walk-in health care, which may be staffed by nurse practitioners.
A general out-patient clinic offers general diagnoses or treatments without an overnight stay.
A polyclinic or policlinic provides a range of healthcare services (including diagnostics) without need of an overnight stay
A specialist clinic provides advanced diagnostic or treatment services for specific diseases or parts of the body. This type contrasts with general out-patient clinics.
A sexual health clinic deals with sexual health related problems, such as prevention and treatment of sexually transmitted infections.
A gender identity clinic provides services relating to transgender health care.
A fertility clinic aims to help women and couples to become pregnant.
An abortion clinic is a medical facility providing abortion services to women.
An ambulatory surgery clinic offers outpatient or same day surgery services, usually for surgical procedures less complicated than those requiring hospitalization.
An ultrasound clinic offers medical ultrasound investigations for patients. An ultrasound clinic is normally run privately.
See also
Healthcare provider
Health center
Health systems management
Healthcare system
Nurse-led clinic
Polyclinics in England
Walk-in clinic
References
Ambulatory care
Types of health care facilities | 0.76565 | 0.9905 | 0.758377 |
Priory Group | The Priory Group is a provider of mental health care facilities in the United Kingdom. The group operates at more than 500 sites with over 7,000 beds. Its flagship hospital is the Priory Hospital, Roehampton, which is best known for treating celebrities particularly for drug addiction. The Priory Group also manages schools, some for students with autism spectrum disorders through Priory Education and Children’s Services. Some of its facilities are run by its subsidiary Partnerships in Care. In January 2019 it opened its first overseas school in partnership with the Abu Dhabi Department of Education and Knowledge.
Ownership
In 1980 the Priory Hospital in Roehampton was acquired by Community Psychiatric, an American healthcare company, and became the first clinic in what was to become the Priory Group.
The Priory Group was the subject of a management buyout, funded by Mercury Asset Management and several banks, in 1994.
In 2000 Westminster Healthcare Group (a company owned by Dr Chai Patel) acquired Priory Hospitals from the management team and from Mercury Asset Management for £96 million.
In 2002, the company was the subject of another management buyout, this time led by Doughty Hanson & Co, for £289 million. The company was divested to ABN AMRO (later acquired by the Royal Bank of Scotland Group) in July 2005 for £875 million, netting the five company directors over £50 million.
Advent International took control for an aggregate consideration of £925 million in 2011.
In October 2014, former Chief Executive, Tom Riall announced that the group was planning a significant expansion into the mental health community services market and would bid in partnership with “incumbent” NHS providers, an approach that would allow them to come up with new models of care. Anticipating more services to be put out to tender by Clinical commissioning groups, he noted that Priory could contribute "considerable commercial bidding expertise” and become the “overflow provider of choice” for the NHS.
Acadia Healthcare bought the business for £1.3 billion in January 2016 and sold it to Waterland Private Equity for £1.1 billion in January 2021. Waterland plans to join it with MEDIAN of Germany "to create Europe’s leading rehabilitation and mental health services provider", especially in neurology and other post-acute services.
In 2022, The Times reported that the healthcare chain faced "spiralling rental bills" for its hospitals after its new owner Waterland agreed an £800 million sale and leaseback deal of 35 Priory healthcare facilities to Medical Hospitals Trust. The group considered increasing prices for care because it anticipates higher costs, including from rents, which are now subject to annual inflation-based escalators.
In 2023, a British Medical Journal research paper found that healthcare provided by private equity-backed companies like the Priory Group was often more expensive and had "mixed to harmful impacts on quality".
Performance
An investigation by The Times found that the number of reported deaths, including those from natural causes, in Priory facilities rose by 50% between 2017 and 2020. In 2021, NHS England, which contracts the Priory for over £400 million in mental health care contracts annually, criticised the group's chief executive for "repeated service failures" and complained that safety had not improved despite meetings with the Priory Group over the preceding two years. In 2022, the Care Quality Commission identified that Priory hospitals faced criticism over the care related to at least 30 patient fatalities.
The director of the INQUEST charity, Deborah Coles, said the "shocking death toll across Priory services continues" with "repeated systemic failings to protect the lives of people" in its care.
After the suicide of a 14-year old girl, Amy El-Keria, funded by the NHS, at the group’s Ticehurst House hospital in East Sussex in 2012, a prosecution was brought by the Health and Safety Executive. The company pleaded guilty to a charge of being an employer failing to discharge its duty to ensure people were not exposed to risk. It faced a fine of at least £2.4 million. The inquest jury found that the staff had failed to dial 999 quickly enough, had failed to call a doctor promptly and were not trained in CPR.
Its hospital in High Wycombe, a 12-bed low-security unit for young people with learning disabilities or autism, which opened in April 2018 was closed in February 2019 after the Care Quality Commission rated it inadequate and said the staff lacked appropriate experience and skills. The company said that it could not recruit "an experienced, settled team of core nursing and clinical staff.” The CQC rated three units run by Priory Group inadequate.
In 2012, a patient went missing from the Priory Roehampton and shortly afterwards stood in front of a train. The Coroner concluded that "there were gross failures in his care, notably the failure to perform basic observations, followed by a deliberate falsification of the record".
A teenage patient at the Priory Cheadle Royal Hospital took her own life in her room in 2014. The inquest heard that the hospital had "no coherent policy on how or how regularly observations should be conducted". The coroner wrote to the Priory chief executive to express concern at the "deplorable practice" of inadequate record keeping.
A patient at the Chadwick Lodge mental health unit in Milton Keynes took his own life in 2015 when it was operated by the Priory Group. The coroner concluded that a failure to carry out proper observation checks "may have caused or contributed to his death".
A racehorse owner took his own life just days after being discharged from the Priory North London hospital where he had been sectioned for his own safety in 2018. The inquest found risk assessments were poor, discharge planning was inadequate and there was no crisis plan.
In 2018 a coroner at the inquest into the death of a teenage boy at the Priory North London hospital expressed concern at the "really serious failure" of staff to adequately monitor the boy and then falsify logs to appear as though they had. The Care Quality Commission rated safety and leadership on the wards as inadequate and risk management as ineffective.
A retired university lecturer took his own life at the Priory Hospital Altrincham in 2019 and the coroner at his inquest found that staff had written up his observation records to "give the misleading flavour of authenticity". He recommended the standardisation of observations across NHS and private hospitals.
Two Priory hospitals, Kneesworth House in Hertfordshire and Priory Hospital Blandford, were rated “inadequate” by the Care Quality Commission in July 2019. Admissions to Priory Hospital Blandford were suspended “until further notice”. The greatest problems at Kneesworth house were on the forensic wards. Ellingham Hospital, in Attleborough was rated inadequate in November 2019. According to Priory “the fundamental issue . . . was structural: there are simply not enough skilled staff in the region to meet the highly specialised needs of the young people at Ellingham”. 88.2% of its 93 mental healthcare facilities in the UK have received the equivalent of good or better ratings.
In 2020, a detained patient escaped over a garden fence at the Priory Hospital Altrincham and was found dead a few days later. The inquest jury found there was inadequate garden security and risk assessments, and staff failed to follow communication procedures and check essential handover information. The coroner issued a Prevention of Future Deaths Order and noted that the Priory knew that the garden fence was unsafe because previous patients had escaped over it.
A father of three killed himself at the Priory Arnold hospital in September 2020 after hearing voices and becoming fearful of discharge. Before his death, the Priory doctor had dismissed him as "malingering" to get better housing. At the inquest, the Coroner ruled that neglect by the Priory and contributed to his death. He said the case was "one of the worst examples of care provided to a vulnerable, mentally ill patient" and that the care he received was "seriously flawed".
In October 2021, safety problems and the incompetence of hospital staff at the Priory Hospital Kneesworth in Hertfordshire were reported by an undercover journalist in the documentary "Secure Hospital Uncovered (Exposure)" on ITV.
St John’s House near Diss in Suffolk, a 49-bed hospital for adults living with learning disabilities and associated mental health issues was put in special measures in March 2021 after the Care Quality Commission rated it inadequate and accused staff of failing to ensure patients’ safety or dignity.
In 2021, a female patient discharged herself from the Priory Roehampton hospital and was found dead a few days later. The Coroner issued a Prevention of Future Deaths Order and said "matters of concern" were that the Priory made no follow up appointment; did not contact her family after she left and did not try to contact the patient again for 10 days.
In April 2022, one of the UK’s leading forensic psychiatrists found that the Priory was responsible for two fundamental causes and 29 contributory factors of the death of a 23-year old NHS patient at Priory Hospital Woodbourne in Birmingham. At the inquest, the jury found that the death was "contributed to by neglect" by the Priory and a prevention of future death report was issued by the coroner. Priory Healthcare Ltd was criminally convicted in March 2024 of exposing the patient to serious risk of harm at the Priory Hospital Woodbourne and fined £650,000, the biggest penalty in the company’s history. After sentencing, the patient’s father described the Priory as a "calculating, cruel and fundamentally dangerous company".
On Christmas Day 2022, a woman patient walked out of a secure ward at the Priory Arnold, near Nottingham, and was found dead on farmland on Boxing Day. The inquest jury said there had been 2communication failures from all parties, inadequate risk management, missed opportunities to mitigate absconsion risk and insufficient senior oversight". The month after the patient’s death, the CQC carried out an unannounced inspection and found care standards "totally unacceptable".
In 2022, a young mother died at the Priory Hospital Woking and the Coroner issued a Prevention of Future Deaths Order. The jury found risk assessments were not performed in line with policy; incomplete observations; little evidence of staff engagement with the patient; therapy notes were not acted upon and there was a lack of continuity in her care.
In 2022, three young women died within two months of each other at the Priory Cheadle Royal hospital, near Manchester. An inquest jury found the first death was "contributed to by neglect" by the hospital. The jury said "serious inconsistencies existed across all levels of management in relation to her care plan" which resulted in the "inadequate care of a highly vulnerable patient." After the second death, the Coroner issued a Prevention of Future Deaths Order and said that there was "an over-reliance by the NHS on independent providers for mental health beds". After the third death the Coroner found that the hospital had given the patient so much medication that it resulted in profound sedation and the loss of her gag reflex. When the Care Quality Commission rated the Priory Cheadle Royal "inadequate" after the three deaths, Rebekah Cresswell, the Priory Chief Executive, responded saying she "disputed the factual accuracy of many aspects of the report". Less than four months later a fourth young woman died at the same hospital. The jury at her inquest concluded her death was caused by misadventure and the coroner called for urgent changes to mental health provision, warning that "unless something is different, there are going to be more deaths".
In November 2023, Priory Hospital Roehampton was criminally convicted and fined £140,000 for inadequate patient safety measures, which were highlighted following a woman's death under their care. A doctor at the hospital said there had been a "litany of basic errors" in her care and described the ward where she died as an "utter shambles".
Notable patients
The following is alphabetical list of notable people whom The Priory Group has treated:
Craig Charles, actor
Richey Edwards, musician and songwriter
Paul Gascoigne, footballer
Michael Johnson, footballer
Justin Hawkins, singer
Steven Walters, footballer
Ruby Wax, actress and comedian
See also
Private healthcare in the United Kingdom
References
External links
The Priory Group
Addiction organisations in the United Kingdom
Health care companies of the United Kingdom
Private providers of NHS services | 0.777049 | 0.975951 | 0.758362 |
Employee benefits | Employee benefits and benefits in kind (especially in British English), also called fringe benefits, perquisites, or perks, include various types of non-wage compensation provided to employees in addition to their normal wages or salaries. Instances where an employee exchanges (cash) wages for some other form of benefit is generally referred to as a "salary packaging" or "salary exchange" arrangement. In most countries, most kinds of employee benefits are taxable to at least some degree.
Examples of these benefits include: housing (employer-provided or employer-paid) furnished or not, with or without free utilities; group insurance (health, dental, life etc.); disability income protection; retirement benefits; daycare; tuition reimbursement; sick leave; vacation (paid and unpaid); social security; profit sharing; employer student loan contributions; conveyancing; long service leave; domestic help (servants); and other specialized benefits.
The purpose of employee benefits is to increase the economic security of staff members, and in doing so, improve worker retention across the organization. As such, it is one component of reward management. Colloquially, "perks" are those benefits of a more discretionary nature. Often, perks are given to employees who are doing notably well or have seniority. Common perks are take-home vehicles, hotel stays, free refreshments, leisure activities on work time (golf, etc.), stationery, allowances for lunch, and—when multiple choices exist—first choice of such things as job assignments and vacation scheduling. They may also be given first chance at job promotions when vacancies exist.
Managerial perspective
The Bureau of Labor Statistics, like the International Accounting Standards Board, defines employee benefits as forms of indirect expenses. Managers tend to view compensation and benefits in terms of their ability to attract and retain employees, as well as in terms of their ability to motivate them.
Employees – along with potential employees – tend to view benefits that are mandated by regulation differently from benefits that are discretionary, that is, those that are not mandated but are simply designed to make a compensation package more attractive. Benefits that are mandated are thought of as creating employee rights or entitlements, while discretionary benefits are intended to inspire employee loyalty and increase job satisfaction.
Canada
Employee benefits in Canada usually refer to employer sponsored life, disability, health, and dental plans. Such group insurance plans are a top-up to existing provincial coverage. An employer provided group insurance plan is coordinated with the provincial plan in the respective province or territory, therefore an employee covered by such a plan must be covered by the provincial plan first. The life, accidental death and dismemberment and disability insurance component is an employee benefit only. Some plans provide a minimal dependent life insurance benefit as well. The healthcare plan may include any of the following: hospital room upgrades (Semi-Private or Private), medical services/supplies and equipment, travel medical (60 or 90 days per trip), registered therapists and practitioners (i.e. physiotherapists, acupuncturists, chiropractors, etc.), prescription requiring drugs, vision (eye exams, contacts/lenses), and Employee Assistance Programs. The dental plan usually includes Basic Dental (cleanings, fillings, root canals), Major Dental (crowns, bridges, dentures) or Orthodontics (braces).
Other than the employer sponsored health benefits described above, the next most common employee benefits are group savings plans (Group RRSPs and Group Profit Sharing Plans), which have tax and growth advantages to individual saving plans.
United States
Employee benefits in the United States include relocation assistance; medical, prescription, vision and dental plans; health and dependent care flexible spending accounts; retirement benefit plans (pension, 401(k), 403(b)); group term life insurance and accidental death and dismemberment insurance plans; income protection plans (also known as disability protection plans); long-term care insurance plans; legal assistance plans; medical second opinion programs, adoption assistance; child care benefits and transportation benefits; paid time off (PTO) in the form of vacation and sick pay. Benefits may also include formal or informal employee discount programs that grant workers access to specialized offerings from local and regional vendors (like movies and theme park tickets, wellness programs, discounted shopping, hotels and resorts, and so on).
Employers that offer these types of work-life perks seek to raise employee satisfaction, corporate loyalty, and worker retention by providing valuable benefits that go beyond a base salary figure. Fringe benefits are also thought of as the costs of retaining employees other than base salary. The term "fringe benefits" was coined by the War Labor Board during World War II to describe the various indirect benefits which industry had devised to attract and retain labor when direct wage increases were prohibited.
Some fringe benefits (for example, accident and health plans, and group-term life insurance coverage up to $50,000) may be excluded from the employee's gross income and, therefore, are not subject to federal income tax in the United States. Some function as tax shelters (for example, flexible spending, 401(k), or 403(b) accounts). These benefit rates often change from year to year and are typically calculated using fixed percentages that vary depending on the employee’s classification.
Normally, employer-provided benefits are tax-deductible to the employer and non-taxable to the employee. The exception to the general rule includes certain executive benefits (e.g. golden handshake and golden parachute plans) or those that exceed federal or state tax-exemption standards.
American corporations may also offer cafeteria plans to their employees. These plans offer a menu and level of benefits for employees to choose from. In most instances, these plans are funded by both the employees and by the employer(s). The portion paid by employees is deducted from their gross pay before federal and state taxes are applied. Some benefits would still be subject to the Federal Insurance Contributions Act tax (FICA), such as 401(k) and 403(b) contributions; however, health premiums, some life premiums, and contributions to flexible spending accounts are exempt from FICA.
If certain conditions are met, employer provided meals and lodging may be excluded from an employee's gross income. If meals are furnished (1) by the employer; (2) for the employer's convenience; and (3) provided on the business premises of the employer they may be excluded from the employee's gross income per section 119(a). In addition, lodging furnished by the employer for its convenience on the business premise of the employer (which the employee is required to accept as a condition of employment) is also excluded from gross income. Importantly, section 119(a) only applies to meals or lodging furnished "in kind." Therefore, cash allowances for meals or lodging received by an employee are included in gross income.
Qualified disaster relief payments made for an employee during a national disaster are not taxable income to the employee. The payments must be reasonable and necessary personal, family, living, or funeral expenses that have been incurred as a result of a national disaster. Eligible expenses include medical expenses, childcare and tutoring expenses due to school closings, internet, and telephone expenses. Replacement of lost income or lost wages are not eligible.
Employee benefits provided through ERISA (Employee Retirement Income Security Act) are not subject to state-level insurance regulation like most insurance contracts, but employee benefit products provided through insurance contracts are regulated at the state level. However, ERISA does not generally apply to plans by governmental entities, churches for their employees, and some other situations.
Under the Obamacare or ACA's Employer Shared Responsibility provisions, certain employers, known as applicable large employers are required to offer minimum essential coverage that is affordable to their full-time employees or else make the employer shared responsibility payment to the IRS.
Private firms in the US have come up with certain unusual perquisites.
In the United States paid time off, in the form of vacation days or sick days, is not required by federal or state law. Despite that fact, many United States businesses offer some form of paid leave. In the United States, 86% of workers at large businesses and 69% of employees at small business receive paid vacation days.
United Kingdom
In the United Kingdom, employee benefits are categorised by three terms: flexible benefits (flex) and flexible benefits packages, voluntary benefits and core benefits.
"Core benefits" is the term given to benefits which all staff enjoy, such as pension, life insurance, income protection, and holiday. Employees may be unable to remove these benefits, depending on individual employers' preferences.
Flexible benefits, often called a "flex scheme", is where employees are allowed to choose how a proportion of their remuneration is paid or they are given a benefits budget by their employer to spend. Currently around a third of UK employers operate such a scheme. How flexible benefits schemes are structured has remained fairly consistent over the years, although the definition of flex has changed quite a lot since it first arrived in the UK in the 1980s. When flex first emerged, it was run as a formal scheme for a set contract period, through which employees could opt in and out of a selection of employer-paid benefits, select employee-paid benefits, or take the cash. In recent years increasing numbers of UK companies have used the tax and national insurance savings gained through the implementation of salary sacrifice benefits to fund the implementation of flexible benefits. In a salary sacrifice arrangement an employee gives up the right to part of the cash remuneration due under their contract of employment. Usually the sacrifice is made in return for the employer's agreement to provide them with some form of non-cash benefit. The most popular types of salary sacrifice benefits include childcare vouchers and pensions.
A number of external consultancies exist that enable organisations to manage Flex packages centred around the provision of an Intranet or Extranet website where employees can view their current flexible benefit status and make changes to their package. Adoption of flexible benefits has grown considerably, with 62% of employers in a 2012 survey offering a flexible benefit package and a further 21% planning to do so in the future. This has coincided with increased employee access to the internet and studies suggesting that employee engagement can be boosted by their successful adoption.
"Voluntary benefits" is the name given to a collection of benefits that employees choose to opt-in for and pay for personally, although as with flex plans, many employers make use of salary sacrifice schemes where the employee reduces their salary in exchange for the employer paying for the perk. These tend to include benefits such as the government-backed (and therefore tax-efficient) cycle to work, pension contributions and childcare vouchers and also specially arranged discounts on retail and leisure vouchers, gym membership and discounts at local shops and restaurants (providers include Xexec). These can be run in-house or arranged by an external employee benefits consultant.
Fringe benefits tax
In a number of countries (e.g., Australia, New Zealand and Pakistan), the "fringe benefits" are subject to the Fringe Benefits Tax (FBT), which applies to most, although not all, fringe benefits. In India, the fringe benefits tax was abolished in 2009.
In the United States, employer-sponsored health insurance was considered taxable income until 1954.
Disadvantages
In the UK, benefits are often taxed at the individual's normal tax rate, which can prove expensive if there is no financial advantage to the individual from the benefit.
The UK system of state pension provision is dependent upon the payment of National Insurance Contributions. Salary exchange schemes result in reduced payments and so are may reduce the state benefits, most notably the State Second Pension.
See also
Benefit incidence
Novated lease
Income in kind
References
Tax terms | 0.765336 | 0.990849 | 0.758333 |
Patient advocacy | Patient advocacy is a process in health care concerned with advocacy for patients, survivors, and caregivers. The patient advocate may be an individual or an organization, concerned with healthcare standards or with one specific group of disorders. The terms patient advocate and patient advocacy can refer both to individual advocates providing services that organizations also provide, and to organizations whose functions extend to individual patients. Some patient advocates are independent (with no conflict-of-loyalty issues) and some work for the organizations that are directly responsible for the patient's care.
Typical advocacy activities are the following: safeguarding patients from errors, incompetence and misconduct; patient rights, matters of privacy, confidentiality or informed consent, patient representation, awareness-building, support and education of patients, survivors and their carers.
Patient advocates give a voice to patients, survivors and their carers on healthcare-related (public) fora, informing the public, the political and regulatory world, health care providers (hospitals, insurers, pharmaceutical companies etc.), organizations of health care professionals, the educational world, and the medical and pharmaceutical research communities.
Nurses can perform a de facto role of patient advocacy, though this role may be limited due their position in an organization. Patients can advocate for themselves through self-advocacy and the ability for this self-advocacy can be learnt or improved through training.
History
Patient advocacy, as a hospital-based practice, grew out of this patient rights movement: patient advocates (often called patient representatives) were needed to protect and enhance the rights of patients at a time when hospital stays were long and acute conditions—heart disease, stroke and cancer—contributed to the boom in hospital growth. Health care reformers at the time critiqued this growth by quoting Roemer's law: a built hospital bed is a bed likely to be filled. And more radical health analysts coined the term health empires to refer to the increasing power of these large teaching institutions that linked hospital care with medical education, putting one in the service of the other, arguably losing the patient-centered focus in the process. It was not surprising, then, that patient advocacy, like patient care, focused on the hospital stay, while health advocacy took a more critical perspective of a health care system in which power was concentrated on the top in large medical teaching centers and a dominance of the medical profession.
Patient advocacy in the United States emerged in the 1950s in the context of cancer research and treatment. In those early days of cancer treatment, patients and their families raised ethical concerns around the tests, treatment practices, and clinical research being conducted. For instance, they expressed concern to the National Institute of Health (NIH) about the cruelty of the repeated collection of blood samples (for blood marrow examination) and raised questions about whether this was more harmful than beneficial to the patient. Sidney Farber, a Harvard physician and cancer researcher, coined the term total care, to describe the treatment of children with leukemia. Under total care, a physician "treated the family as a whole, factoring in its psychosocial and economic needs", rather than focusing purely on physical health concerns. Previous researchers had dealt with concerns raised by families, because physicians emphasized patient physical health rather than the inclusion of bedside manners with the families. The practice of patient advocacy emerged to support and represent patients in this medico-legal and ethical discussion.
The 1970s were also an important time in the US for patient advocacy as the Patient Rights movement grew. As a major advocacy organization during the time, the National Welfare Rights Organization's (NWRO) materials for a patient's bill of rights influenced many additional organizations and writings, including hospital accreditation standards for the Joint Commission in 1970 and the American Hospital Association's Patient Bill of Rights in 1972. The utilization of advocates by individual patients gained momentum in the early 2000s in the US, and Australia 10 years later, and the profession is now perceived as a mainstream option to optimize outcomes in both hospital- and community-based healthcare.
Self-advocacy
Communication skills, information-seeking skills and problem-solving skills were found to correlate with measures of a patient's ability to advocate for themselves. Conceptualizations of the qualities have defined self-knowledge, communication skills, knowledge of rights, and leadership as components of advocacy.
A number of interventions have been tried to improve patients' effectiveness at advocating for themselves. Studies have found peer-led programs where an individual with a condition is taught interview skills were effective in improving self-advocacy. Writing interventions, where people with conditions received training and practiced writing essays advocating for themselves, were shown to improve self-advocacy.
Patient advocacy processes
At a conceptual level patient advocacy consists of three processes: valuing, apprising and interceding. Valuing consists of understanding the patient's unique attributes and desires. Apprising consists of informing the patient and advising the patient. Interceding consists of interacting with processes to ensure that the patient's unique attributes and desires are represented in these processes, and may include interceding in family interactions as well as healthcare processes.
Examples of patient advocacy include:
Educating and walking patients through the management of their disease or chronic illnesses. The social determinants of health can vary significantly from patient to patient. It is the role of the patient advocate to cater to the patient's needs and assist with these factors, such as where to find treatment to manage their illness, assisting with healthcare access due to socioeconomic barriers, or helping find additional health services. Assistance with the management of their illnesses or disease can also include assisting with cooperative purchases of health care materials.
Establishing a network of contacts. Examples of contacts patient advocates can assist in connecting patients to include: in the public sector (political and regulatory), in public and private health insurance, in the sector of medical service providers, with medical practitioners, and with pharmaceutical and medical research to provide patients with help in the care and management of their diseases.
Providing emotional support in dealing with their health concerns, illnesses, or chronic conditions. According to the National Institute of Mental Health, individuals with chronic illnesses are at a higher risk of depression of than patients with other mental health conditions. When managing their illnesses, patients and survivors experience the direct effect of the consequences their disease has on their quality of life, and may also go through difficult phases of adaptation of their daily routine and lifestyle to accommodate the disease. Part of the role of patient advocates can include providing emotional support for patients or connecting them to mental health resources.
Attending appointments with a patient. Patients can find doctor's appointments intimidating, but also difficult to understand. Issues may stem from differences in language proficiency, educational background, or background in health literacy. A patient advocate's presence can ensure that patient's concerns are highlighted and adequately addressed by physicians. Patient advocates may also be responsible for assisting with scheduling additional appointments as well.
Assisting with health insurance and other financial aspects of healthcare. The Institute of Medicine in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Within the financing system, health insurance plays a significant role. According to a United Health survey, only 9% of Americans surveyed understood health insurance terms, which presents a significant issue for patients, given the importance of health insurance in terms of providing access to healthcare. The patient advocate may help with researching or choosing health insurance plans.
Nurse advocacy
The American Nurses Association (ANA) includes advocacy in its definition of nursing:
Advocacy in nursing finds its theoretical basis in nursing ethics. For instance, the ANA's Code of Ethics for Nurses includes language relating to patient advocacy:
The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
Several factors can lead a patient to use nurses for advocacy, including impairments in their ability to express wishes such as die to speech impairments or limited consciousness, lack of independence due to illiteracy, sociocultural weakness, or separation from friends or family caused by hospitalization. Nurses are more able to advocate if they are independent, professionally committed, and have self-confidence as well as having legal and professional knowledge, as well as knowing a patient's wishes. The act of patient advocacy improved nurses' sense of professional well-being and self-concept, job motivation and job satisfaction, and enhances the public image of nurses; however, advocating for a patient could have social and professional consequences.
Conflict of interests between a nurse's perceived professional responsibilities and their responsibilities to the patient can be a barrier to advocacy. Additionally, a nurse is concerned about all of the patients they care for rather any individual patient. Gadow and Curtis argue that the role of patient advocacy in nursing is to facilitate a patient's informed consent through decision-making, but in mental health nursing there is a conflict between the patient's right to autonomy and nurses' legal and professional duty to protect the patient and the community from harm, since patients may experience delusions or confusion which affect their decision-making. In such instances, the nurse may engage in persuasion and negotiation in order to prevent the risk that they perceive.
Private advocacy
Private advocates (also known as independent patient/health/health care advocates) often work alongside the advocates that work for hospitals. As global healthcare systems started to become more complex, and as the role of the cost of care continues to place more of a burden on patients, a new profession of private professional advocacy began to take root in the mid-2000s. At that time, two organizations were founded to support the work of these new private practitioners, professional patient advocates. The National Association of Healthcare Advocacy Consultants was started to provide broad support for advocacy. The Alliance of Professional Health Advocates was started to support the business of being a private advocate. Some regions require that those detained for the treatment of mental health disorders are given access to independent mental health advocates who are not involved in the patient's treatment.
Proponents of private advocacy, such as Australian advocate Dorothy Kamaker and L. Bradley Schwartz, have noted that the patient advocates employed by healthcare facilities have an inherent conflict of interest in situations where the needs of an individual patient are at odds with the business interests of an advocate's employer. Kamaker argues that hiring a private advocate eliminates this conflict because the private advocate "…has only one master and very clear priorities."
Kamaker founded in 2013 and followed with in 2021 when research revealed that vulnerable groups achieved sub-optimal outcomes and encountered barriers and prejudice in the mainstream health and hospital systems in Australia. "Based on the limited data available, we know that the overall health of people with disabilities is much worse than that of the general population", with "people with disabilities rarely identified as a priority population group in public health policy and practice". Patients supported by advocates have been shown to experience fewer treatment errors and require fewer readmissions post discharge. In Australia there has been some movement by private health insurers to engage private patient advocates to reduce costs, improve outcomes and expedite return to work for employees.
Schwartz is the founder and president of GNANOW.org, where he states, "Everyone employed by a health care company is limited to what they can accomplish for patients and families. Hospital-employed patient advocates, navigators, social workers, and discharge planners are no different. They became health care professionals because they are passionate about helping people. But they have heavy caseloads and many work long hours with limited resources. Independent Patient Advocates work one-on-one with patients and loved ones to explore options, improve communication, and coordinate with overworked hospital staff. In fact, many Independent Patient Advocates used to work for hospitals and health care companies before they decided to work directly for patients."
Patient advocacy organizations
Patient advocacy organizations, PAO, or patient advocacy groups are organizations that exist to represent the interests of people with a particular disease. Patient advocacy organizations may fund research and influence national health policy through lobbying. Examples in the US include the American Cancer Society, American Heart Association, and National Organization for Rare Disorders.
Some patient advocacy groups receive donations from pharmaceutical companies. In the US in 2015, 14 companies donated $116 million to patient advocacy groups. A database identifying more than 1,200 patient groups showed that six pharmaceutical companies contributed $1 million or more in 2015 to individual groups representing patients who use their drugs, and 594 groups in the database received donations from pharmaceutical companies. Fifteen patient groups relied on pharmaceutical companies for at least 20 percent of their revenue in the same year, and some received more than half of their revenue from pharmaceutical companies. Recipients of donations from pharmaceutical companies include the American Diabetes Association, Susan G. Komen, and the Caring Ambassadors Program.
Patient opinion leaders, also sometimes called patient advocates, are individuals who are well versed in a disease, either as patients themselves or as caretakers, and share their knowledge on the particular disease with others. Such POLs can have an influence on health care providers and may help persuade them to use evidence-based therapies or medications in the management of other patients. Identifying such people and persuading them is one goal of market access groups at pharmaceutical and medical device companies.
Organizations
Professional groups
Solace
Solace is an American professional organization where private advocates can list their business and allow consumers to book conversations with advocates directly.
Alliance of Professional Health Advocates
The Alliance of Professional Health Advocates (APHA) is an international membership organization for private, professional patient advocates, and those who are exploring the possibility of becoming private advocates. It provides business support such as legal, insurance and marketing. It also offers a public directory of member advocates called AdvoConnection. Following the 2011 death of Ken Schueler — a charter member of the APHA, described as "the Father of Private Patient Advocacy" — the organization established the H. Kenneth Schueler Patient Advocacy Compass Award. The award recognizes excellence in private practice including the use of best practices, community outreach, support of the profession and professional ethics.
Dialysis Patient Citizens
Dialysis Patient Citizens is an American patient-led, non-profit organization dedicated to improving dialysis citizens' quality of life by advocating for favorable public policy. One of DPC's goals is to provide dialysis patients with the education, access and confidence to be their own advocates. Through their grassroots advocacy campaigns, Patient Ambassador program; Washington, D.C. patient fly-ins; conference calls and briefings, DPC works to train effective advocates for dialysis-related issues. Membership is free.
National Association of Healthcare Advocacy Consultants
National Association of Healthcare Advocacy Consultants (NAHAC) is an American nonprofit organization located in Berkeley, California. Joanna Smith founded NAHAC on July 15, 2009, as a broad-based, grassroots organization for health care and patient advocacy. To that end, it is a multi-stakeholder organization, with membership open to the general public.
National Patient Advocate Foundation
The National Patient Advocate Foundation is a non-profit organization in the United States dedicated to "...improving access to, and reimbursement for, high-quality healthcare through regulatory and legislative reform at the state and federal levels." The National Patient Advocate Foundation was founded simultaneously with the non-profit Patient Advocate Foundation, "...which provides professional case management services to Americans with chronic, life-threatening and debilitating illnesses."
Patient Advocates Australia
Patient Advocates Australia, founded by Dorothy Kamaker, is a support option for consumers of aged, health and disability care in Australia. For the elderly, an emerging need has arisen for patient advocacy in residential aged facilities. The Aged Care Royal Commission Report published in 2021 has made recommendations regarding a need for vigilant advocacy for residents of nursing homes to protect them against rampant abuse and neglect, with one submission calling for the routine provision of independent patient advocates. For the disabled, funding for support to overcome healthcare barriers is available through the National Disability Insurance Scheme.
Greater National Advocates (GNA)
Greater National Advocates is a non-profit organization with the goal of raising Americans' awareness of the lifesaving benefits of independent patient advocacy and to provide patients and loved ones with immediate online access to a trusted network of qualified practitioners. GNA uses fact-based media to spread awareness and steer patients and their loved ones to GNANOW.org where they can learn more and find the professional support they need.
Center for Patient Partnerships
Founded in 2000, the interprofessional Center for Patient Partnerships (CPP) at University of Wisconsin–Madison offers a health advocacy certificate with a focus on either patient advocacy or system-level health policy advocacy. The chapter "Educating for Health Advocacy in Settings of Higher Education" in Patient Advocacy for Health Care Quality: Strategies for Achieving Patient-Centered Care describes CPP's pedagogy and curriculum.
Government agencies
United States
In the United States, state governmental units have established ombudsmen to investigate and respond to patient complaints and to provide other consumer services.
New York
In New York, the Office of Patient Advocacy within the New York State Office of Alcoholism and Substance Abuse Services (OASAS) is responsible for protecting the rights of patients in OASAS-certified programs. The office answers questions from patients and their families; provides guidance for health care professionals on topics related to patient rights, state regulations, and treatment standards, and intervenes to resolve problems that cannot be handled within treatment programs themselves.
California
In California, the Office of the Patient Advocate (OPA), an independent state office established in July 2000 in conjunction with the Department of Managed Health Care, is responsible for the creation and distribution of educational materials for consumers, public outreach, evaluation and ranking of health care service plans, collaboration with patient assistance programs, and policy development for government health regulation.
Such state government offices may also be responsible for intervening in disputes within the legal and insurance systems and in disciplinary actions against health care professionals. Some hospitals, health insurance companies, and other health care organizations also employ people specifically to assume the role of patient advocate. Within hospitals, the person may have the title of ombudsman or patient representative.
See also
Geriatric care management
Ombudsman
Organizational ombudsman
Patient empowerment
References
Medical ethics
Nursing ethics | 0.771776 | 0.982557 | 0.758314 |
Imbecile | The term imbecile was once used by psychiatrists to denote a category of people with moderate to severe intellectual disability, as well as a type of criminal. The word arises from the Latin word imbecillus, meaning weak, or weak-minded. It originally referred to people of the second order in a former and discarded classification of intellectual disability, with a mental age of three to seven years and an IQ of 25–50, above "idiot" (IQ below 25) and below "moron" (IQ of 51–70). In the obsolete medical classification (ICD-9, 1977), these people were said to have "moderate mental retardation" or "moderate mental subnormality" with IQ of 35–49, as they are usually capable of some degree of communication, guarding themselves against danger and performing simple mechanical tasks under supervision.
The meaning was further refined into mental and moral imbecility. The concepts of "moral insanity", "moral idiocy", and "moral imbecility" led to the emerging field of eugenic criminology, which held that crime can be reduced by preventing "feeble-minded" people from reproducing.
"Imbecile" as a concrete classification was popularized by psychologist Henry H. Goddard and was used in 1927 by United States Supreme Court Justice Oliver Wendell Holmes Jr. in his ruling in the forced-sterilization case Buck v. Bell, 274 U.S. 200 (1927).
The concept is closely associated with psychology, psychiatry, criminology, and eugenics. However, the term imbecile quickly passed into vernacular usage as a derogatory term. It fell out of professional use in the 20th century in favor of mental retardation.
Phrases such as "mental retardation", "mentally retarded", and "retarded" are also subject to the euphemism treadmill: initially used in a medical manner, they gradually took on derogatory connotation. This had occurred with the earlier synonyms (for example, moron, imbecile, cretin, and idiot, formerly used as scientific terms in the early 20th century). Professionals searched for connotatively neutral replacements. In the United States, "Rosa's Law" changed references in many federal statutes to "mental retardation" to refer instead to "intellectual disability".
References
Obsolete terms for mental disorders
Pejorative terms for people with disabilities
Intellectual disability
Obsolete medical terms
Slurs related to low intelligence | 0.761274 | 0.996077 | 0.758288 |
Approved mental health professional | The role of approved mental health professional (AMHP) in the United Kingdom was created in the 2007 amendment of the Mental Health Act 1983 to replace the role of approved social worker (ASW). The role is broadly similar to the role of the approved social worker but is distinguished in no longer being the exclusive preserve of social workers. It can be undertaken by other professionals including registered mental health or learning disability nurses, occupational therapists and chartered psychologists after completing appropriate post-qualifying masters level training at level 7 NQF and being approved by a local authority for a period of up to five years, subject to re-warranting. An
AMHP is approved to carry out functions under the Mental Health Act 1983, and as such, they carry with them a warrant card, like police officers. The role of the AMHP is to coordinate the assessment of individuals who are being considered for detention under the Mental Health Act 1983. The reason why some specialist mental health professionals are eligible to undertake this role is broadly to avoid excessive medicalisation of the assessment and treatment for individuals living with a mental disorder, as defined by section 1 of the Mental Health Act 1983. It is the role of the AMHP to decide, founded on the medical recommendations of doctors (or a doctor for the purpose of section 4 of the Act), whether a person should be detained under the Mental Health Act 1983.
Professional role
Approved mental health professionals (AMHPs) are trained to implement elements of the Mental Health Act 1983, as amended by the Mental Health Act 2007, in conjunction with medical practitioners. They have received specific training at least at Level 7 on the National Qualifications Framework, such as a MSc Mental Health (AHMP) or PGDip in Mental Health Studies relating to the application the Mental Health Acts, usually lasting one or two years and perform the role in assessing and deciding whether there are grounds to detain mentally disordered people who meet the statutory criteria. The AMHP is also an important healthcare professional when making decisions under guardianship or community treatment orders.
Assessment and detention under the Act is colloquially known as being 'sectioned', or 'sectioning', in reference to the application of sections of the Mental Health Act relevant to this process. The role to apply for the 'section' remains with the AMHP, not the medical doctor, as many professionals and lay individuals think, thus a doctor may feel a section is needed, although it is actually the AMHP who is the individual who will decide if this is required after detailed assessment and consultations with the medical doctors.
Mental Health Act assessments
AMHPs are responsible for organising, co-ordinating and contributing to Mental Health Act assessments. It is the AMHP's duty, when two medical recommendations have been made, to decide whether or not to make an application to a named hospital for the detention of the person who has been assessed. To be detained under the Mental Health Act individuals need to have a mental disorder, the nature or degree of which warrants detention in hospital on the grounds of their health and/or the risk they present to themselves and/or the risk they present to others. The AMHP's role includes arranging for the assessment of the person concerned by two medical practitioners who must be independent of each other and at least one of whom should be a specialist in mental health, called being 'section 12 approved' under section 12 of the Mental Health Act 1983. Preferably one of the medical assessors should have previous acquaintance with the person being assessed. Efforts should be made to seek less restrictive alternatives to detention if it is safe and appropriate to do so, such as using an individual's own support networks, in line with the principle of care in the least restrictive environment. AMHP's are expected to take account of factors such as gender, culture, ethnicity, age, sexuality and disability in their assessments. Efforts should be also made to overcome any communication barriers, such as deafness or the assessors and the assessed not sharing a language, and an interpreter may be required. It is not good practice for one of the assessors to act as interpreter.
The nearest relative
An important factor in assessments is the role of the Nearest Relative. Which person qualifies as the Nearest Relative is determined according to a hierarchy outlined in the Mental Health Act. If the individual is to be detained under Section 2 (assessment) of the Act, the AMHP is expected to make reasonable efforts to contact the Nearest Relative and invite their views. It is also the AMHP's role to inform them of their right to discharge the person concerned in some circumstances. If the individual is to be detained under Section 3 (treatment) of the Act, the AMHP must ask the Nearest Relative if they object to the individual being detained and if they do then the detention cannot go ahead. There are occasions when the Nearest Relative need not be contacted or might need to be displaced by a court. A Nearest Relative can delegate their role to another appropriate person.
Detention in hospital
The assessors are encouraged by the Code of Practice to discuss the assessment together once the two medical examinations and the AMHP's interview have taken place. For Section 2 and Section 3, assessments by medical practitioners need to take place with no more than five clear days between each other. AMHPs then have up to fourteen days from the time of the second medical assessment to make the decision whether or not to make an application for detention. If proceeding with the application, AMHPs are then responsible for organising the detained individual's safe conveyance to hospital. The best method of conveyance is that which ensures the individual's dignity, comfort and safety. This might be by ambulance or by the police or by some other method. The AMHP will attend at the named hospital and will give the paperwork to nursing staff who check it and receive the application on behalf of the hospital managers. Some errors in the paperwork can be rectified later and the application remains valid. Some other errors invalidate the application and the detention is then no longer lawful.
Community treatment orders
The revised Mental Health Act makes provision for community treatment orders (CTOs). CTOs can be arranged for patients detained under Section 3 (treatment) of the Act, allowing them to return to a place of residence in the community, depending on particular specified conditions, such as to the taking of medication or participating in therapies. If conditions are breached, patients can be formally recalled to hospital for a period of up to 72 hours, during which a decision should be made as to whether their CTO should be revoked. If the CTO is revoked, patients return to being at the beginning of a Section 3 and are automatically referred for a mental health review tribunal. AMHPs work with the responsible clinician and others in the process of assessment and decision making in setting up CTOs and in making decisions on revocation.
References
Further reading
The Mental Health Act Code of Practice is the best guide to the roles and responsibilities of each professional involved in Mental Health Act assessments. Though not statute law it functions as statutory guidance which professionals are expected to follow or give a good reason and rationale for not doing so.
Richard Jones's Mental Health Act Manual (11th edition) has long been a standard reference for approved social workers and now AMHPs. It details statute law and guidance with detailed notes and reference to case law.
The Nearest Relative Handbook by David Hewitt details the complicated legal issues around the definition of, powers, declaration and displacement of the nearest relative and has been updated to include the new amended Mental Health Act 2007.
The Approved Mental Health Professional's Guide to Mental Health Law by Rob Brown (Exeter: Learning Matters) is a concise practitioner guide to how the AMHP role interacts with the Mental Health Act and the Mental Capacity Act.
External links
Wiki Mental Health – Comprehensive information on mental health law in England and Wales, including full text of the Mental Health Act (1983), as amended by the Mental Health Act (2007), and case law.
Social care in the United Kingdom
Mental health occupations
Mental health law in the United Kingdom | 0.78479 | 0.966229 | 0.758287 |
Healing | With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area and replace it with new living tissue. The replacement can happen in two ways: by regeneration in which the necrotic cells are replaced by new cells that form "like" tissue as was originally there; or by repair in which injured tissue is replaced with scar tissue. Most organs will heal using a mixture of both mechanisms.
Within surgery, healing is more often referred to as recovery, and postoperative recovery has historically been viewed simply as restitution of function and readiness for discharge. More recently, it has been described as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities
Healing is also referred to in the context of the grieving process.
In psychiatry and psychology, healing is the process by which neuroses and psychoses are resolved to the degree that the client is able to lead a normal or fulfilling existence without being overwhelmed by psychopathological phenomena. This process may involve psychotherapy, pharmaceutical treatment or alternative approaches such as traditional spiritual healing.
Regeneration
In order for an injury to be healed by regeneration, the cell type that was destroyed must be able to replicate. Cells also need a collagen framework along which to grow. Alongside most cells there is either a basement membrane or a collagenous network made by fibroblasts that will guide the cells' growth. Since ischaemia and most toxins do not destroy collagen, it will continue to exist even when the cells around it are dead.
Example
Acute tubular necrosis (ATN) in the kidney is a case in which cells heal completely by regeneration. ATN occurs when the epithelial cells that line the kidney are destroyed by either a lack of oxygen (such as in hypovolemic shock, when blood supply to the kidneys is dramatically reduced), or by toxins (such as some antibiotics, heavy metals or carbon tetrachloride).
Although many of these epithelial cells are dead, there is typically patchy necrosis, meaning that there are patches of epithelial cells still alive. In addition, the collagen framework of the tubules remains completely intact.
The existing epithelial cells can replicate, and, using the basement membrane as a guide, eventually bring the kidney back to normal. After regeneration is complete, the damage is undetectable, even microscopically.
Healing must happen by repair in the case of injury to cells that are unable to regenerate (e.g. neurons). Also, damage to the collagen network (e.g. by enzymes or physical destruction), or its total collapse (as can happen in an infarct) cause healing to take place by repair.
Genetics
Many genes play a role in healing. For instance, in wound healing, P21 has been found to allow mammals to heal spontaneously. It even allows some mammals (like mice) to heal wounds without scars. The LIN28 gene also plays a role in wound healing. It is dormant in most mammals. Also, the proteins MG53 and TGF beta 1 play important roles in wound healing.
Wound healing
In response to an incision or wound, a wound healing cascade is unleashed. This cascade takes place in four phases: clot formation, inflammation, proliferation, and maturation.
Clotting phase
Healing of a wound begins with clot formation to stop bleeding and to reduce infection by bacteria, viruses and fungi. Clotting is followed by neutrophil invasion three to 24 hours after the wound has been incurred, with mitoses beginning in epithelial cells after 24 to 48 hours.
Inflammation phase
In the inflammatory phase, macrophages and other phagocytic cells kill bacteria, debride damaged tissue and release chemical factors such as growth hormones that encourage fibroblasts, epithelial cells and endothelial cells which make new capillaries to migrate to the area and divide.
Proliferative phase
In the proliferative phase, immature granulation tissue containing plump, active fibroblasts forms. Fibroblasts quickly produce abundant type III collagen, which fills the defect left by an open wound. Granulation tissue moves, as a wave, from the border of the injury towards the center.
As granulation tissue matures, the fibroblasts produce less collagen and become more spindly in appearance. They begin to produce the much stronger type I collagen. Some of the fibroblasts mature into myofibroblasts which contain the same type of actin found in smooth muscle, which enables them to contract and reduce the size of the wound.
Maturation phase
During the maturation phase of wound healing, unnecessary vessels formed in granulation tissue are removed by apoptosis, and type III collagen is largely replaced by type I. Collagen which was originally disorganized is cross-linked and aligned along tension lines. This phase can last a year or longer. Ultimately a scar made of collagen, containing a small number of fibroblasts is left.
Tissue damaged by inflammation
After inflammation has damaged tissue (when combatting bacterial infection for example) and pro-inflammatory eicosanoids have completed their function, healing proceeds in 4 phases.
Recall phase
In the recall phase the adrenal glands increase production of cortisol which shuts down eicosanoid production and inflammation.
Resolution phase
In the Resolution phase, pathogens and damaged tissue are removed by macrophages (white blood cells). Red blood cells are also removed from the damaged tissue by macrophages. Failure to remove all of the damaged cells and pathogens may retrigger inflammation. The two subsets of macrophage M1 & M2 plays a crucial role in this phase, M1 macrophage being a pro inflammatory while as M2 is a regenerative and the plasticity between the two subsets determine the tissue inflammation or repair.
Regeneration phase
In the Regeneration phase, blood vessels are repaired and new cells form in the damaged site similar to the cells that were damaged and removed. Some cells such as neurons and muscle cells (especially in the heart) are slow to recover.
Repair phase
In the Repair phase, new tissue is generated which requires a balance of anti-inflammatory and pro-inflammatory eicosanoids. Anti-inflammatory eicosanoids include lipoxins, epi-lipoxins, and resolvins, which cause release of growth hormones.
See also
Health
References
External links
How wounds heal and tumors form With this simple Flash demonstration, Harvard professor Donald Ingber explains how wounds heal, why scars form, and how tumors develop. Presented by Children's Hospital Boston.
Wound Healing and Repair
Lorenz H.P. and Longaker M.T. Wounds: Biology, Pathology, and Management. Stanford University Medical Center.
Romo T. and McLaughlin L.A. 2003. Wound Healing, Skin. Emedicine.com.
Rosenberg L. and de la Torre J. 2003. Wound Healing, Growth Factors. Emedicine.com.
After the Injury- Children's Hospital Of Philadelphia
Injuries
Medical phenomena
Physiology
Therapy | 0.764774 | 0.991493 | 0.758268 |
Heterogeneous condition | A medical condition is termed heterogeneous, or a heterogeneous disease, if it has several etiologies (root causes); as opposed to homogeneous conditions, which have the same root cause for all patients in a given group. Examples of heterogeneous conditions are hepatitis and diabetes. Heterogeneity is not unusual, as medical conditions are usually defined pathologically (i.e. based on the state of the patient), as in "liver inflammation", or clinically (i.e. based on the apparent symptoms of the patient), as in "excessive urination", rather than etiologically (i.e. based on the underlying cause of the symptoms). Heterogeneous conditions are often divided into endotypes based on etiology.
Where necessary to determine appropriate treatment differential diagnosis procedures are employed.
Endotype
An endotype is a subtype of a condition, which is defined by a distinct functional or pathobiological mechanism. This is distinct from a phenotype, which is any observable characteristic or trait of a disease, such as morphology, development, biochemical or physiological properties, or behavior, without any implication of a mechanism. It is envisaged that patients with a specific endotype present themselves within phenotypic clusters of diseases.
One example is asthma, which is considered to be a syndrome, consisting of a series of endotypes. This is related to the concept of disease entity
Heterogeneity in medical conditions
The term medical condition is a nosological broad term that includes all diseases, disorders, injuries and syndromes, and it is specially suitable in the last case, in which it is not possible to speak about a single disease associated to the clinical course of the patient.
While the term medical condition generally includes mental illnesses, in some contexts the term is used specifically to denote any illness, injury, or disease except for mental illnesses. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the widely used psychiatric manual that defines all mental disorders, uses the term general medical condition to refer to all diseases, illnesses, and injuries except for mental disorders. This usage is also commonly seen in the psychiatric literature. Some health insurance policies also define a medical condition as any illness, injury, or disease except for psychiatric illnesses.
As it is more value-neutral than terms like disease, the term medical condition is sometimes preferred by people with health issues that they do not consider deleterious. It is also preferred when etiology is not unique, because the word disease is normally associated to the cause of the clinical problems. On the other hand, by emphasizing the medical nature of the condition, this term is sometimes rejected, such as by proponents of the autism rights movement.
The term is also used in specialized areas of medicine. A genetic or allelic heterogeneous condition is one where the same disease or condition can be caused, or contributed to, by varying different genes or alleles. In clinical trials and statistics the concepts of homogeneous and heterogeneous populations is important. The same applies for epidemiology
See also
Endotype, each one of the etiological subclasses of a given heterogeneous condition.
References
Diseases and disorders | 0.769313 | 0.985637 | 0.758263 |
Mental illness in ancient Rome | Mental illness in ancient Rome was recognized in law as an issue of mental competence, and was diagnosed and treated in terms of ancient medical knowledge and philosophy, primarily Greek in origin, while at the same time popularly thought to have been caused by divine punishment, demonic spirits, or curses. Physicians and medical writers of the Roman world observed patients with conditions similar to anxiety disorders, mood disorders, dyslexia, schizophrenia, and speech disorders, among others, and assessed symptoms and risk factors for mood disorders as owing to alcohol abuse, aggression, and extreme emotions. It can be difficult to apply modern labels such as schizophrenia accurately to conditions described in ancient medical writings and other literature, which may for instance be referring instead to mania.
Treatments included therapeutic philosophy, intellectual activities, emetics, leeching, bloodletting, venipuncture, sensory manipulation and control of environmental factors, exercise and physical therapy, and medicaments.
Anxiety disorders
Some Romans used magico-medical practices such as chants (carmina) and amulets to cope with anxiety and provide reassurance, but Roman physicians and philosophers classified severe anxiety as a diagnosable medical condition and developed theoretical approaches and therapeutic methods to address it. The Roman orator and sometime philosopher Cicero (1st century BC) distinguished between , worry about future events, and , an outburst of emotion.
Galen, a Greek physician and surgeon who immigrated to Rome in the 2nd century, observed patients with symptoms resembling generalized anxiety disorder or major depressive disorder, such as sweating, indigestion, palpitations, dizziness, fever, weight loss, insomnia, changing skin color, low heartbeat, and an irregular heartbeat. People with this disease are described as having a progression of anxiety and sadness. It was believed that such anxiety could result in death. Galen theorized that this syndrome emerges from an emotion he calls .
Stoicism, as a philosophy centered on using self-control to overcome negative emotions, theorized methods of handling anxiety. Stoic methods have been reinterpreted in light of modern treatments for anxiety disorders, such as cognitive behavioral therapy. The Stoics practiced the technique of negative visualization, which involved considering the worst possible outcome of an action or event in order to prepare oneself for the consequences of it. They would rehearse mentally how they would respond to anticipated problems and try to find a way to change negative situations into positive outcomes. The purpose was to train the practitioner to have little fear and eventually be able to remain calm in difficult situations. The Roman Stoic Seneca believed that to cure anxiety, one must focus on the present moment.
The Imperial-era historian and essayist Plutarch describes a Roman man possibly with scrupulosity, guilt or anxiety over religious subjects commonly associated with obsessive–compulsive disorder and obsessive–compulsive personality disorder (only OCD is recognized as an anxiety disorder). This man is described as "turning pale under his crown of flowers," praying with a "faltering voice," and scattering "incense with trembling hands."
Mood disorders
Mood disorders were frequently described in Greco-Roman medical literature of the Roman Imperial era, including a condition resulting in poor appetite, lethargy, sleeplessness, irritability, agitation, long-lasting fears, and hopelessness, and melancholia, which is now known as depression. Galen believed this disorder also caused delusions, anguish, and cancer, writing that phobias and dysthymia, another depressive disorder, could cause melancholia. Alcohol abuse, hypersexuality, aggression, and extreme emotions were thought to increase the risk of developing this disorder. It is unclear whether ancient doctors thought of depression and mania as separate conditions or one singular condition.
Rufus of Ephesus wrote that melancholiacs experienced episodes of fear, indigestion, doubt, and delusions. Rufus describes melancholiacs who thought that they were pots or that their skin had become parchment. He also observed melancholiacs who experienced changes in appearance and behavior, such as darkened complexion, protruding eyes, more hair, and disfluency. Rufus divided melancholia into three categories: type 1, when the body became completely filled with melancholic blood; type 2, when only the brain was affected; and type 3, primarily affecting the hypochdonrium.
Soranus, also from Ephesus (in present-day Turkey), noticed that the condition of melancholics improved after they drank from certain alkaline springs nearby, which have been shown to contain lithium, a chemical element used to treat bipolar disorder.
The Latin medical writer Celsus recommended bloodletting to treat melancholia, or hellebore to make the patient vomit if bloodletting was not an option. Patients were also to engage in exercise and intellectual activities, and abstain from wine. Other common treatments included applying cool materials to a patient's head.
Aretaeus of Cappadocia, a Greek physician who lived in the Roman province of Cappadocia, describes melancholic patients who experienced episodes of depression and suicidal ideation alongside episodes of "impure dreams" in which they experience "irresistible desires." In this state they are easily angered by criticism and become "wholly mad." Aretaeus also describes people with this disease experiencing hallucinations and delusions. This disorder resembles bipolar disorder, which is defined by episodes of mania and depression. It was thought to be caused by too much black and yellow bile.
Seasonal affective disorder is a medical condition in which the affected person experiences mood changes alongside seasonal changes. One treatment for this disorder is light therapy. The Romans knew that exposure to light could serve as a treatment for those affected by certain conditions. Cicero experienced several depressive episodes over the course of his lifetime. During these periods he kept a journal documenting his days, and his sadness. This technique has been found to alleviate depression and sadness, and it is a form of therapy still used today.
Intellectual disabilities
Treatments for intellectual disabilities included nutritional diets combined with exercise. Because of the importance of eloquent speech among the Roman upper classes and of oratory in politics, speech disorders ( or ) were thought to indicate a lack of intelligence. Stuttering, characterized by involuntary repetition or prolongations of sounds and pauses in speech, was thought to be caused by an excessively moist or an excessively dry tongue. Galen recommended wrapping the tongue with a cloth soaked in lettuce juice to treat a stutter. Another treatment for a speech disorder was tongue massage and gargling. The emperor Claudius had a speech impediment that may have been caused by cerebral palsy or Tourette syndrome. His own mother thought of him as mentally deficient, less of a man, and "unfinished by nature," reflecting a general prejudice in Roman society.
Livy speaks of Roman adults who could not achieve literacy on par with young children. Such people were possibly dyslexic, and it was recognized that they might require alternative pedagogies. The poet Horace mentions schoolboys encouraged to learn by means of cookies, which may have been actually shaped like or stamped with letters and used for teaching. Atticus Bradua, a consul in AD 185, struggled with reading as a child; among any other methods that may have been tried, his father arranged to have him attended by twenty-four slaves, each named with a different letter of the Latin alphabet. Creative teaching methods, in conjunction with the importance of oral expression in Roman society, meant that dyslexia wasn't necessarily a bar to achievement. The emperor Augustus was described by Suetonius as having difficulty in learning to read or write and remembering his speeches despite his intelligence; dyslexia is one possible cause.
Schizophrenia
Ancient Roman doctors described a condition they termed phrenitis or mania. It was theorized that this condition was caused by high amounts of bile due to fever, which would heat the blood, resulting in the onset of an illness. Ancient doctors noticed that this disorder appeared most frequently in young and middle-aged men, and that it appeared rarely in children, women, or older adults. Modern scholars disagree on the nature of this condition. It is possible that it is schizophrenia. However, others believe that there are no mentions of schizophrenia in ancient literature – that schizophrenia, in its modern form, did not exist in ancient times.
The medical writer Celsus described a mental illness which induced episodes of delirium and incoherent speech. Celsus also wrote about a chronic condition which resulted in "entertaining vain images" and caused the mind to be "at the mercy of such imaginings." He distinguished between differing types of this disease. According to Celsus, some were saddened, some became "hilarious," some began to "rave in words," some remained composed, others became "rebellious and violent." Various types of violence are described. Some "do harm by impulse," while others appear to remain sane, yet still commit elaborate acts of violence. Celsus may be describing delusions caused by psychosis, which are false beliefs unable to be changed by evidence to the contrary. He also may be describing a depressive disorder. Celsus mentions certain delusions. He states that one patient believed they could interact with Ajax or Orestes. Arataeus writes about mentally ill people with hallucinations, disorganized speech, delusions, social withdrawal, poor performance at work, and catatonia. He believed that these people had mania, however they may have had schizophrenia.
A variety of treatments were used. For example, doctors would express disapproval of excessive laughter. Cymbals were used to play music, which was thought to reduce melancholic thoughts. Philosophers were used to alleviate the fear and worry the patient experiences. Doctors recommended that patients should be treated through conversation. Servants were supposed to engage in dialogue with the patient. However, they should not agree with everything they say, as this might feed into the delusions. They were also not supposed to disagree with everything the person said, as this might enrage them. The patients were also provided a variety of intellectual activities to keep them engaged. These activities would have been tailored to each patient.
It was common to treat these people by confining them to a dark room. Celsus believed that this form of therapy's usefulness varied from person to person. Some will be frightened by the darkness, other will be calmed. He recommended that "strong" patients should be kept in a bright room, and "weak" ones should be kept in a dim room. Celsus also recommended torture. Violent patients were restrained using chains and flogging. Deprivation of light, immersion into cold water, torturous exercise, food deprivation were all used. Patients were also supposed to only be left with people they were familiar with, and frequently travel and move. They were forced to pay attention and memorize this torture, thus preventing patients from acting out through fear. This treatment was dismissed by two physicians Asclepiades of Bithynia and Soranus of Ephesus as inhumane. They believed that instead, patients should kept in a moderately light room located on the ground floor, eat a simple diet, and have regular exercise. They also recommended that soft fabrics, wool, or servant's hands should be used instead of chains to restrain them.
Bloodletting was another contentious topic. Asclepiades believed it to be equivalent to murder. Celsus disagreed, stating that if a patient was "strong," it must be administered if they are experiencing an extreme episode of the condition. He also recommended that one day after the bloodletting the head should be shaved and cleaned with water. Herbs such as verbena would be boiled in the water. Another procedure consisted of cleaning the head, shaving the head, cleaning it again, then pouring rose oil over it. Concurrent to this, rue pounded with vinegar would be poured over the nose. If the patient is considered "weak" then thyme, or a similar substance, would be applied to rose oil which would then be rubbed over the head. Bitter pellitory herbs would also be applied to the patient's head.
People with this condition also had trouble sleeping and eating. To treat this, they were placed on couches near food. Poppy, Hyoscyamus, saffron ointment, mandrake apples, cardamomum balsam, the sound of falling water, sycamine tears, and mulberry were all thought to aid in sleep. Asclepiades believed these treatments to be ineffective, and that they caused lethargy. Leeches, venesection, and vomiting were also common treatments. An orchid known as white hellebore was used to induce vomit. Doctors would give these patients gruel and mead to eat and drink. Three cups of gruel were given twice a day in winter and three times in summer.
Substance abuse disorders
The Romans generally did not think in terms of "substance abuse", except for alcoholism. Roman writers believed alcoholism would result in decreased sexual potency and damage to the social order, contributing to adultery and promiscuity in women. Despite these concerns, the consumption of wine was widespread amongst all social statuses in Roman society. Pliny believed that "a great part of mankind are of the opinion that there is nothing else in life worth living for" and that alcoholics were "driven to frenzy" and a "thousand crimes." Galen describes a teacher's young slave dying after consuming large amounts of alcohol.
Cannabis was mentioned numerous times in Roman literature. The Romans used the plant to make strong ropes and repel mosquitos. The consumption of cannabis was also believed to decrease sexual activity, cause impotence, and cause nausea. Cannabis was said to cause headaches and a "warm" feeling when consumed in great quantities. Roman doctors were unaware of the plant's psychoactive properties.
Roman doctors used opium to treat illnesses such as insomnia, pain, coughs, hysteria, and conditions involving the digestive system. They were aware of how addictive opium was, and how dangerous an overdose could be.
Paraphiliac and fetishistic disorders
Foot fetishism, klismaphilia, and pedophilia were widespread in ancient Rome. Bestiality, or the sexual attraction to animals is prominent in Roman mythology. The Romans would also have animals rape men and women in the Colosseum or Circus Maximus for entertainment. Ancient Roman brothels were often named after the animal species which they offered for sexual purposes. For example, brothels that offered birds were known as ansenarii, if they offered dogs they were termed belluarii, and caprarii were brothels that offered goats.
Cognitive disorders
The ancient Romans were aware of dementia. It was believed that people with the disease were foolish, and no longer contributed to society. The Romans feared dementia, as they thought that a life without intellectual capabilities was not worth living. Delirium was known as a symptom of Phrenitis and Mania. Roman doctors differentiated between delirium, which is extreme confusion, and psychosis, which confusion between what is and is not real. They believed that black bile and plants such as belladonna, mandragona, opium, and thorn apple caused delirium. Celsus and Galen described brain injuries in their writings. These patients have symptoms such as dizziness. Roman doctors associated brain injury with speech impairments, incontinence, and leg paralysis.
Post-traumatic stress disorder
Post-traumatic stress disorder is a disorder defined by stress caused by traumatic events. Cultural differences and differences in warfare likely resulted in PTSD being less prominent in ancient militaries. Soldiers fought in close formations, with less brutal weaponry that what is used in the modern day, in shorter campaigns. They believed what they were doing was a moral responsibility to their society, and they were exposed to violence more frequently. These factors likely contributed to PTSD being rarer in ancient Rome. Soldiers often chose to fight and remain combat rather than face the disgrace and humiliation that refusing to fight would bring upon them, which from the perspective of modern psychology put many soldiers at risk of developing PTSD and acute stress disorder.
The medical writer Celsus described the condition insania sine febre, "mania without fever." This condition involved hearing and seeing things which were not real, irrationality, depression, loss of appetite, frightfulness, mood swings, eye movements, and hypervigilance, for which Celsus prescribed hypericum. Galen, a practicing physician and surgeon, diagnosed patients with anxiety, anger, depression, and malaise, prescribing massages, lukewarm water, wine and water, bathing, exercise, and food with sweet juices.
Others
The Roman satirist Juvenal complained about the noise of the city making it difficult to sleep, causing insomnia. Pervasive insomnia throughout ancient Rome resulted in numerous deaths. The Roman name for sleep deprivation was , or "waking torture." They used sleep deprivation to torture criminals and prisoners. Sleepwalking was associated with evil spirits.
Roman men could often develop hypochondriasis due to their tendency to discuss and pay attention to medical matters. Eating disorders were considered to be problematic by the Romans. Galen defines two conditions, , which was a craving for sweets, and , which is bulimia nervosa. A possible ancient example of anorexia nervosa, an eating disorder characterized by extremely limited consumption of food, involved a Roman saint named Blaesilla. She was a disciple of Jerome. She practiced fasting, eventually succumbing to her hunger and dying at the age of 20.
Ancient writers mention people who faked mental illnesses to escape responsibilities. In the modern day, deliberately feigning a mental illness for attention is known as factitious disorder imposed on self. If done for financial or personal gain, it is known as malingering. If done with a motive on others, it is known as Factitious disorder imposed on another.
Ancient writers, such as Homer, Hippocrates, and Aretaeus, noticed an individual with intense emotions, impulsive behavior, extreme anger, depression, and mania. These symptoms are reminiscent of Borderline personality disorder, a Cluster B personality disorder characterized by unstable relationships, strong emotions, and impulsive behavior.
Supernatural causes and magic
Belief in magic was strong enough that it was an issue in some court cases and certain practices were banned by law. The Apologia of Apuleius is a speech in which he defends himself against charges that he quite literally bewitched his very wealthy older wife, Pudentilla, rendering her mentally incompetent for the purpose of defrauding her. The proof that he had not practiced magic against her, Apuleius argues, is the fact that she retained her high intelligence—the efficacy of magic in debilitating the mind was not in doubt.
Disabilities were popularly thought to have resulted from divine punishment. Demons and evil spirits were supposed to be the source of some mental illnesses. Magical objects were used to treat anger. Users would offload their feelings onto these objects. Popular medications included not only beaver testicles, weasels, and smoked camel brains, but apotropaic practices such as tickling patients with their head near a fire.
Early science
Among medical practitioners, philosophers, and scientists, mental illnesses were also attributed to natural or biological causes. The dominant theory in ancient Rome was humorism, which is the idea that each person had a group of four humors. If they were balanced then the individual would develop illnesses, including mental ones. The pulse and heartbeat of the affected person were also used to diagnose. Galen believed that negative emotions imbalanced the mind, causing disease. He believed that these emotions caused blood to retreat to "the depths of the body." Resulting in many negative symptoms and diseases such as melancholia and depression. It was believed that seasons could affect the illnesses. Changes in weather were thought to stir up the humors.
The Romans noticed that diseases and conditions, such as epilepsy, could be inherited. Roman doctors also distinguished between people with mental illness, and those at risk of mental illness. Ancient doctors categorized some people into a "half-mad" category, which meant symptoms only emerged while drunk or stressed.
In Roman law
Roman law recognized that a person's ability to make legal decisions might be compromised by a mental disorder. The word for a person thus incapacitated was furiosus, from the abstract noun furor. Other terms in juristic texts include demens (out of one's mind), mente captus (a captive of the mind, in a state of mental seizure), insanus (unwell, mentally ill), non suae sanae mentis (not of right mind), and non compos mentis, which has endured in modern legal language. The terms used in legal texts for insanity have general meanings as well—the poet Ovid describes a mythological woman as not compos mentis when she loses the self-possession of her healthy mind in a highly charged sexual situation—and the criteria used by medical consultants to distinguish mental incompetence under the law have not survived in the written record.
However, many if not most people with serious neurodevelopmental issues would not have made it to adulthood. Disabilities detected in infancy usually led to the child being "exposed," abandoned under conditions likely to cause death. If the intellectually disabled survived to adulthood, they could not exercise their rights as adult Roman citizens and were treated like children who were still minors. But because they could not be held accountable for their actions, they were also exempt under the law from any crimes they committed.
The ability to act under one's own will was a prerequisite for taking legal actions, such as entering into contracts, and since the furiosus was regarded as not acting under his own will, any legal transactions he conducted were invalid. Juristic texts give marriage and the manumission of slaves as examples of actions the furiosus was not legally competent to carry out. However, it was also recognized that the furiosus might have periods of lucidity (intervalla) during which he could exercise his will in carrying out legal actions.
A legal curator (caretaker) would be appointed for a person judged mentally incompetent to manage his own affairs. When an adult of limited mental capacity was named as an heir to an estate, the bequest likewise would include the appointment of a curator or guardian, just as a guardian would be arranged for underage children. The practice of assuring caretaking (cura) was as old as the Twelve Tables (mid-5th century BC), when it was assumed to be a responsibility of the family. During the early Imperial period, a person who thought they might be dealing with a furiosus could ask a praetor or provincial governor to investigate, affirm the diagnosis, and appoint a curator.
Because Roman society was patriarchal, a head of household (paterfamilias) who was furiosus put the family at particular risk of destabilization, calling for the urgent appointment of a curator. A father might be immoral or irresponsible without losing his patria potestas (legal power as a father to govern his household), but a curator would be appointed to take over his affairs only if he was deemed furiosus, intellectually incapable of adult reasoning as equated with a child under age seven.
Augustus, the first and longest-reigning Roman emperor, even appointed a special procurator for Archelaus, client king of Cappadocia, during a time when he was struggling with physical and mental illness. Archelaus outlived Augustus, whose successor Tiberius accused the king of "rebellious conduct" and of feigning insanity to avoid execution; when the king's mental incompetence was demonstrated, he was spared the death penalty.
Military law
In military law, early discharge (missio causaria), as distinguished from either a dishonorable or honorable discharge, could be granted to a soldier for a physical or mental disability. Two or three physicians (medici) each conducted an independent examination, and the decision was made by a judge with competence in this area. Extant documents for early discharge happen to cite only physical infirmities, though Roman jurists discuss cases of mental illness.
Suicide to avoid captivity or enslavement by the enemy was regarded as honorable, but a suicide attempt in the normal course of service was considered a form of treason, punishable—with "somewhat peculiar logic"—by death. Legal texts list six extenuating circumstances for suicide attempts that could result in a dishonorable discharge rather than execution: inpatientia doloris (unbearable pain), morbus (physical or mental illness), luctus (sorrow or grief), taedium vitae (weariness of life), furor (madness), and pudor (shame). Similar extenuating circumstances could be taken into account in a charge of treason arising from self-mutilation for the purpose of evading or escaping military service, for instance cutting off a thumb.
References
Depression (mood)
Anorexia nervosa
Mood disorders
Schizophrenia
Stoicism
History of mental disorders
Bipolar disorder
Ancient Roman medicine | 0.781772 | 0.969917 | 0.758255 |
Human condition | The human condition can be defined as the characteristics and key events of human life, including birth, learning, emotion, aspiration, reason, morality, conflict, and death. This is a very broad topic that has been and continues to be pondered and analyzed from many perspectives, including those of art, biology, literature, philosophy, psychology, and religion.
As a literary term, "human condition" is typically used in the context of ambiguous subjects, such as the meaning of life or moral concerns.
Some perspectives
Each major religion has definitive beliefs regarding the human condition. For example, Buddhism teaches that existence is a perpetual cycle of suffering, death, and rebirth from which humans can be liberated via the Noble Eightfold Path. Meanwhile, many Christians believe that humans are born in a sinful condition and are doomed in the afterlife unless they receive salvation through Jesus Christ.
Philosophers have provided many perspectives. An influential ancient view was that of the Republic in which Plato explored the question "what is justice?" and postulated that it is not primarily a matter among individuals but of society as a whole, prompting him to devise a utopia. Two thousand years later René Descartes declared "I think, therefore I am" because he believed the human mind, particularly its faculty of reason, to be the primary determiner of truth; for this he is often credited as the father of modern philosophy. One such modern school, existentialism, attempts to reconcile an individual's sense of disorientation and confusion in a universe believed to be absurd.
Many works of literature provide a perspective on the human condition. One famous example is Shakespeare's monologue "All the world's a stage" which pensively summarizes seven phases of human life.
Psychology has many theories, including Maslow's hierarchy of needs and the notions of identity crisis and terror management. It also has various methods, e.g. the logotherapy developed by Holocaust survivor Viktor Frankl to discover and affirm a sense of meaning. Another method, cognitive behavioral therapy, has become a widespread treatment for clinical depression.
Charles Darwin established the biological theory of evolution, which posits that the human species is related to all others, living and extinct, and that natural selection is the primary survival factor. This led to subsequent beliefs, such as social Darwinism, which eventually lost its connection to natural selection, and theistic evolution of a creator deity acting through laws of nature, including evolution.
See also
Human nature
Know thyself
References
Concepts in philosophical anthropology
Concepts in social philosophy
Concepts in the philosophy of mind
Existentialist concepts
Humans
Personal life
Philosophy of life
Psychological concepts | 0.760028 | 0.997638 | 0.758233 |
SBAR | SBAR is an acronym for Situation, Background, Assessment, Recommendation; a technique that can be used to facilitate prompt and appropriate communication. This communication model has gained popularity in healthcare settings, especially amongst professions such as physicians and nurses. It is a way for health care professionals to communicate effectively with one another, and also allows for important information to be transferred accurately. The format of SBAR allows for short, organized and predictable flow of information between professionals.
History
SBAR was first developed by the military, specifically for nuclear submarines. It was then used in the aviation industry, which adopted a similar model before it was put into use in health care. It was introduced to rapid response teams (RRT) at Kaiser Permanente in Colorado in 2002, to investigate patient safety. The main purpose was to alleviate communication problems traced from the differences in communication styles between healthcare professionals. SBAR was later adopted by many other health care organizations. It is among the most popular handover mnemonic systems in use.
It is now widely recommended in healthcare communication. For instance, the Royal College of Physicians of London, United Kingdom, recommends the use of SBAR during the handover of care between medical teams when treating patients who are seriously ill or at risk of deteriorating. SBAR is an included tool in the Interventions to Reduce Acute Care Transfers (INTERACT II) project, a US measure to reduce rehospitalization among residents of long-term care (LTC) facilities.
Elements
Pre-SBAR
A few things are necessary for a health care professional to know before beginning an SBAR conversation. A thorough assessment of the patient should be done. The patient’s chart should be on hand with a list of current medications, allergies, IV fluids, and labs. Vital signs should be completed before making the call, and the patient's code status should be known and reported.
Situation
This part of SBAR determines what is going on and why health care professionals are needed. Health care professionals become familiar with the environment and the patient. Identify the problem and concern and provide a brief description of it. Be able to describe what is going on with the patient and why they are experiencing what is going on. During this stage of the communication the main goal is to communicate what is happening. It is recommended that this element be brief and last no more than 10 seconds.
It is recommended that health care professionals identify the person with whom they are speaking, to introduce oneself (including title or role) and where one is calling from. Providing information about the patient such as name, age, sex, and reason for admission is also important. Lastly, the health care professional is to communicate the patient's status (such as chest pain or nausea).
Background
The goal of background is to be able to identify and provide the diagnosis or reason for the patient’s admission, their medical status, and history. The background is also the place to determine the reason or context of the patient's visit. During this stage the patient's chart is ready and as much important medical-based information is provided to set up the assessment of data. Examples of medical-based information include date and reason for admission, most recent vital signs and vital signs outside of normal parameters, current medications, allergies, and labs, code status, and other clinically important information.
Assessment
At this stage, the situation is surveyed to determine the most appropriate course of action. Here the medical professional states what they believe the problem is based on current assessments and medical findings. The assessment should include a focused assessment of problem areas, all lines coming in and out of the patient's body, input and output, bowel and bladder, nutrition, and pain status. Any impertinent information is avoided unless asked for.
Recommendation
Health care professionals give very precise and descriptive explanations on exactly what they need during that time frame. Possible solutions that could correct the situation at hand are discussed between health care professionals. Notably, suggesting ideas to physicians can be a weak point of nurses. Therefore, an explicit statement of what is required, how urgent, and what action needs to be taken is paramount.
Preparation is an integral part of SBAR and health care professionals are suggested to prepare to be able to answer any question the physician may ask. Discussion with another colleague may help. It is highly recommended that information about medical records, medication, administration records, and patient flow sheet be studied before contacting a physician.
Example of use in clinical setting
This is a direct example that shows how SBAR communication is used in a hospital setting involving communication between two nurses to effectively assess and diagnose the patient and correct the problem. This example is between an preoperative nurse to operating room nurse.
Situation:
"Mary, I'm going to be sending Mr. Porter over to you in a few minutes for repair of his fractured ankle. I want you to know what's going on with him. I'm concerned about his emotional status. I've also alerted Dr Anesthesiologist and Dr Surgeon about my concern, but they have agreed to go ahead with the surgery because he needs this procedure to salvage his foot."
Background:
"He was in an auto accident last Friday, and his wife was killed. His children are all at the funeral home making arrangements for her burial. He's made some comments about not wanting to live. His vital signs are stable; the foot is cool and slightly mottled. We've just given him some Versed."
Assessment:
"I think his emotional status is such that this will be a very difficult period of time for him, especially during induction and awakening from anesthesia."
Recommendation:
"I suggest that you meet him as soon as possible and stay with him during induction and emergence from anesthesia."
Effects of use
In a 2013 review of studies addressing communication errors during handover, the greatest problem reported was the omission of detailed patient information. SBAR has been suggested as a means to overcome this problem by applying a system and structure to the presentation of information.
Using the SBAR communication model provides for more effective and enhanced family and patient outcomes on pediatric units. Using SBAR when producing bedside reports increases patient and family satisfaction and also increases their level of comfort when dealing with outlying situations. SBAR also allows nurses to be more effective when giving reports outside of the patients room. SBAR is a model used in communication that standardizes information to be given and lessons on communication variability, making report concise, objective and relevant.
Another benefit of using SBAR is that it allows patients to have the time to ask any questions that they might have, and allows patients to gain exact knowledge of information related to their plan of care. SBAR allows patients to be fully aware of whom their nurse is on every shift and this adds to the patients sense of comfort knowing that there will always be someone around looking after them during shift change.
SBAR use has not only improved the relationship between the doctors and the nurses but has also had a dramatic increase of overall health of patients. This led to a decrease in hospitalizations and deaths which efficiently improved communication between the nurse and doctor, which also led to a reduction of unexpected deaths. The problem between the communication between nurses and doctors is that the levels of teamwork and interaction are different therefore causing ineffective communication.
SBAR has been used in quality improvement projects that have looked at ways of avoiding hospitalizations.
Limitations
SBAR communication encounters difficulties in certain situations which are:
If the recipient is unfamiliar with the concept of SBAR.
SBAR is a difficult concept to learn and practice and as such requires thorough education about the subject matter complete with necessary follow-up. A supportive environment, role-playing, and a skills assessment may help with the process.
Further emphasis must also be given on recommendation since it has been seen that the R in SBAR has been the weak point of nurses. Giving advice to physicians on what to do is found to be intimidating for some nurses.
A disadvantage to using the SBAR communication model within bedside reporting can be the issue of having to wake up patients and families when the practice of bedside charting occurs. Health care professionals and units must find an alternative way to deal with the patients and their families decisions if they choose not to be awakened and involved in bedside charting.
Another disadvantage to using SBAR when bedside charting is the issue of disclosing sensitive topics or new information that has not been shared with the patient or family before or after the bedside charting takes place. An alternative to this can be for nurses to makes plans to share new or sensitive information before or after bedside report.
Using SBAR communication when bedside charting causes a disadvantage for itself through the sharing of confidential information with the patient where it could be overheard by other patients. The effective communication that SBAR promotes leaves room for confidential information to be disclosed when nurses and doctors have discussions with patients causing patients and their families having negative opinion about participating in bedside charting, ultimately interfering with the use of the SBAR communication model.
References
Further reading
External links
No Delays Achiever SBAR
SBAR Technique for Communication: A Situational Briefing Model
SBAR for UK-based Health Care Professionals
Medical mnemonics
Mnemonic acronyms
Nursing | 0.768292 | 0.9869 | 0.758228 |
Infantilization | Infantilization is the prolonged treatment of one who is not a child, as though they are a child. Studies have shown that an individual, when infantilized, is overwhelmingly likely to feel disrespected. Such individuals may report a sense of transgression akin to dehumanization.
Racism
Infantilization is an important concept that was pivotal to maintaining slavery - children of enslaved women would also be enslaved because both belonged to the master. Africans were considered ‘child races’, resulting in subsequent infantilization. When black men respond negatively to “boy,” this is caused by infantilization. Infantilization plays a role in implicit bias, which is a modern effect caused by subjugation, primarily economically, by failing to honor the work and creativity of subjugated populations. Infantilization can be used by propaganda to remove factual contributions from subjugated communities. This is done by individuals who would rather believe something that fits within their belief system than truly hear information as it comes.
Ableism
Disabled individuals can be infantilized in their interactions with able-bodied people. That can occur alongside other paternalistic behaviours and denies individuals their autonomy. Infantilization is more commonly experienced by people with visible disabilities (e.g. people who have visual impairments). Another specific disability often infantilized is autism, which is viewed as a children’s disorder, with many autism organizations being run by neurotypical parents of autistic children and most charities dedicated to autism focused on children. The extreme focus on children essentially denies the existence of autistic adults within public consciousness, leading to many people unknowingly discriminating against autistic adults.
Ageism
Older adults
Infantilization can happen to older adults which leads to denying them autonomy in their care, such as through being excessively controlled or being addressed with baby talk, as if they were a child incapable of understanding complex topics. This leads to a reduced quality of care. From a patient's perspective, this is seen as disrespectful and patronizing. Infantilization can also occur as an aspect of intimate partner violence, as some abusive partners substitute physical violence for psychological abuse to maintain their power.
Youth
When used in reference to teenagers or adolescents, the term typically suggests that teenagers and their potential are underestimated in modern society. It can also be used to describe adolescents being regarded as though they are younger than their actual age. Infantilization may also refer to a process when a child is being treated in a manner appropriate only for younger children. Robert Epstein is a notable critic of the treatment of youth and adolescents, suggesting that many public policymakers and neuroscientists utilize myths about the teenage brain in order to disenfranchise and ultimately infantilize them.
Property law
In property law, infantilization is defined as "the restriction of an individual’s or group’s autonomy based on the failure to recognize and respect their full capacity to reason." When infantilization is coupled with property takeover, the result is a dignity taking. There are several examples of dignity takings, including wage theft from undocumented workers in which the power imbalance allows employers to rob workers of their agency and avenues for redress; the dispossession of property from African Americans in the South Carolina sea islands by predatory tax buyers, who routinely infantilized their victims by overwhelming them with paperwork and timelines to accelerate foreclosures; and the unequal division of matrimonial property in southern Nigeria after divorce that assumes women are less capable of managing property and thus infantilizes them.
Sexism
Adult women are frequently referred to as girls, a term that is inherently infantilizing. Infantilization is such a common feature of sexism that it is one of five dimensions of sexual harassment in a Gender Experiences Questionnaire.
Humanitarian aid can infantilize women who are displaced from their homes by depicting them simply as innocent victims, not as capable individuals with agency. Women refugees may also be depicted as helpless and unwanted.
Fictional female characters have been depicted as "overtly girly" and criticized as contributing to the infantilization of women.
See also
Condescension
Dumbing down
Transgenerational trauma
Family honor
References
Psychological attitude
Ableism
Ageism
Misogyny | 0.765231 | 0.990847 | 0.758226 |
Regulation | Regulation is the management of complex systems according to a set of rules and trends. In systems theory, these types of rules exist in various fields of biology and society, but the term has slightly different meanings according to context. For example:
in government, typically regulation (or its plural) refers to the delegated legislation which is adopted to enforce primary legislation; including land-use regulation
in economy: regulatory economics
in finance: Financial regulation
in business, industry self-regulation occurs through self-regulatory organizations and trade associations which allow industries to set and enforce rules with less government involvement; and,
in biology, gene regulation and metabolic regulation allow living organisms to adapt to their environment and maintain homeostasis;
in psychology, self-regulation theory is the study of how individuals regulate their thoughts and behaviors to reach goals.
Forms
Regulation in the social, political, psychological, and economic domains can take many forms: legal restrictions promulgated by a government authority, contractual obligations (for example, contracts between insurers and their insureds), self-regulation in psychology, social regulation (e.g. norms), co-regulation, third-party regulation, certification, accreditation or market regulation.
State-mandated regulation is government intervention in the private market in an attempt to implement policy and produce outcomes which might not otherwise occur, ranging from consumer protection to faster growth or technological advancement.
The regulations may prescribe or proscribe conduct ("command-and-control" regulation), calibrate incentives ("incentive" regulation), or change preferences ("preferences shaping" regulation). Common examples of regulation include limits on environmental pollution, laws against child labor or other employment regulations, minimum wages laws, regulations requiring truthful labelling of the ingredients in food and drugs, and food and drug safety regulations establishing minimum standards of testing and quality for what can be sold, and zoning and development approvals regulation. Much less common are controls on market entry, or price regulation.
One critical question in regulation is whether the regulator or government has sufficient information to make ex-ante regulation more efficient than ex-post liability for harm and whether industry self-regulation might be preferable. The economics of imposing or removing regulations relating to markets is analysed in empirical legal studies, law and economics, political science, environmental science, health economics, and regulatory economics.
Power to regulate should include the power to enforce regulatory decisions. Monitoring is an important tool used by national regulatory authorities in carrying out the regulated activities.
In some countries (in particular the Scandinavian countries) industrial relations are to a very high degree regulated by the labour market parties themselves (self-regulation) in contrast to state regulation of minimum wages etc.
Measurement
Regulation can be assessed for different countries through various quantitative measures. The Global Indicators of Regulatory Governance by World Bank's Global Indicators Group scores 186 countries on transparency around proposed regulations, consultation on their content, the use of regulatory impact assessments and the access to enacted laws on a scale from 0 to 5. The V-Dem Democracy indices include the regulatory quality indicator. The QuantGov project at the Mercatus Center tracks the count of regulations by topic for United States, Canada, and Australia.
History
Regulation of businesses existed in the ancient early Egyptian, Indian, Greek, and Roman civilizations. Standardized weights and measures existed to an extent in the ancient world, and gold may have operated to some degree as an international currency. In China, a national currency system existed and paper currency was invented. Sophisticated law existed in Ancient Rome. In the European Early Middle Ages, law and standardization declined with the Roman Empire, but regulation existed in the form of norms, customs, and privileges; this regulation was aided by the unified Christian identity and a sense of honor regarding contracts.
Modern industrial regulation can be traced to the Railway Regulation Act 1844 in the United Kingdom, and succeeding Acts. Beginning in the late 19th and 20th centuries, much of regulation in the United States was administered and enforced by regulatory agencies which produced their own administrative law and procedures under the authority of statutes. Legislators created these agencies to require experts in the industry to focus their attention on the issue. At the federal level, one of the earliest institutions was the Interstate Commerce Commission which had its roots in earlier state-based regulatory commissions and agencies. Later agencies include the Federal Trade Commission, Securities and Exchange Commission, Civil Aeronautics Board, and various other institutions. These institutions vary from industry to industry and at the federal and state level. Individual agencies do not necessarily have clear life-cycles or patterns of behavior, and they are influenced heavily by their leadership and staff as well as the organic law creating the agency. In the 1930s, lawmakers believed that unregulated business often led to injustice and inefficiency; in the 1960s and 1970s, concern shifted to regulatory capture, which led to extremely detailed laws creating the United States Environmental Protection Agency and Occupational Safety and Health Administration.
Regulatory economics
Regulatory state
Regulatory capture
Deregulation
See also
References
External links
Centre on Regulation in Europe (CERRE)
New Perspectives on Regulation (2009) and Government and Markets: Toward a New Theory of Regulation (2009)
US/Canadian Regulatory Cooperation: Schmitz on Lessons from the European Union, Canadian Privy Council Office Commissioned Study
A Comparative Bibliography: Regulatory Competition on Corporate Law
Wikibooks
Legal and Regulatory Issues in the Information Economy
Lawrence A. Cunningham, A Prescription to Retire the Rhetoric of 'Principles-Based Systems' in Corporate Law, Securities Regulation and Accounting (2007)
Economics of regulation
Public policy | 0.762799 | 0.993999 | 0.758222 |
Problematization | Problematization is a process of stripping away common or conventional understandings of a subject matter in order to gain new insights. This method can be applied to a term, writing, opinion, ideology, identity, or person. Practitioners consider the concrete or existential elements of these subjects. Analyzed as challenges (problems), practitioners may seek to transform the situations under study. It is a method of defamiliarization of common sense.
Problematization is a critical thinking and pedagogical dialogue or process and may be considered demythicisation. Rather than taking the common knowledge (myth) of a situation for granted, problematization poses that knowledge as a problem, allowing new viewpoints, consciousness, reflection, hope, and action to emerge.
What may make problematization different from other forms of criticism is its target, the context and details, rather than the pro or con of an argument. More importantly, this criticism does not take place within the original context or argument, but draws back from it, re-evaluates it, leading to action which changes the situation. Rather than accepting the situation, one emerges from it, abandoning a focalised viewpoint.
To problematize a statement, for example, one asks simple questions:
Who is making this statement?
For whom is it intended?
Why is this statement being made here, now?
Whom does this statement benefit?
Whom does it harm?
Problematization (Foucault)
For Michel Foucault, problematization serves as the overarching concept of his work in "History of Madness".
He treats it both as an object of inquiry and a specific form of critical analysis. As an object of inquiry, problematization is described as a process of objects becoming problems by being “characterized, analyzed, and treated” as such.
As a form of analysis, problematization seeks to answer the questions of “how and why certain things (behavior; phenomena, processes) became a problem”. Foucault does not distinguish clearly problematization as an object of inquiry from problematization as a way of inquiry. Problematization as a specific form of critical analysis is a form of “re-problematization”.
History of Thought
Problematization is the core of his “history of thought” which stands in sharp contrast to "history of ideas" ("the analysis of attitudes and types of action") as well as "history of mentalities" ("the analysis of systems of representation"). The history of thought refers to an inquiry of what it is, in a given society and epoch, “what allows one to take a step back from his way of acting or reacting, to present it to oneself as an object of thought and question it as to its meaning, its conditions and its goals”. Therefore, thought is described as a form of self-detachment from one's own action that allows “to present it to oneself as an object of thought [and] to question it as to its meaning, its conditions, and its goals". Thought is the reflection of one's own action “as a problem”. According to Foucault, the notions of thought and problematization are closely linked: to problematize is to engage in “work of thought”. Crucially, then, Foucault implies that our way of reflecting upon ourselves as individuals, as political bodies, as scientific disciplines or other, has a history and, consequently, imposes specific (rather than universal or a priori) structures upon thought.
Responses To Problems
A central element in the problematization analysis are responses to problems. The analysis of a specific problematization is “the history of an answer (…) to a certain situation”. However, Foucault stresses that "most of the time different responses [...] are proposed". His analytical interest focuses on finding at the root of those diverse and possibly contrasting answers, the conditions of possibility of their simultaneous appearance, i.e. “the general form of problematization”. This sets Foucauldian problematization apart from many other approaches in that it invites researchers to view opposing scientific theories or political views, and indeed contradictory enunciations in general as responses to the same problematization rather than as the manifestations of mutually excluding discourses. It is this level of problematizations and discourses that Foucault refers to when establishing that Foucault's “history of thought” seeks to answer the question of "how [...] a particular body of knowledge [is] able to be constituted?".
Engaging in Problematization
Engaging in problematization entails questioning beliefs held to be true by society. Ultimately, this intellectual practice is “to participate in the formation of a political will”. It also carves out elements that “pose problems for politics”. At the same time, it also requires self-reflection on behalf of the intellectual, since problematization is to investigate into the ontological question of the present and to determine a distinguishing “element of the present". This element is decisive for the “process that concerns thought, knowledge, and philosophy” in which the intellectual is part of as “element and actor". By questioning the present, or “contemporaneity”, “as an event”, the analyst constitutes the event's “meaning, value, philosophical particularity” but relies at the same time on it, for he/she “find[s] both [his/her] own raison d’être and the grounds for what [he/she] says” in the event itself.
Actor-Network Theory
The term also had a different meaning when used in association with actor–network theory (ANT), and especially the "sociology of translation" to describe the initial phase of a translation process and the creation of a network. According to Michel Callon, problematization involves two elements:
Interdefinition of actors in the network
Definition of the problem/topic/action program, referred to as an obligatory passage point (OPP)
Criticism
In Literary Criticism, An Autopsy Mark Bauerlein writes: The act of problematizing has obvious rhetorical uses. It sounds rigorous and powerful as a weapon in the fight against lax and dishonest inquiry. Also, for trained critics, problematizing x is one of the easiest interpretative gestures to make. In the most basic instance, all one has to do is add quotation marks to x, to say "Walden is a 'classic'" instead of "Walden is a classic." The scarequotes cause a hesitation over the term and imply a set of other problematizing questions: what is a "classic"? what does it presuppose? in what contexts is it used? what does it do? what educational and political purposes does it serve? Instead of being a familiar predicate in scholarship, one readers casually assimilate without much notice, "classic" now stands out from the flow of discourse. The questions hover around its use and, until they are resolved, the use of "classic" is impaired. Usually, such questions yield ready answers, but their readiness does not cut into the apparent savviness of the critics asking them. This is another advantage of the term "problematize": it is a simple procedure, but it sounds like an incisive investigative pursuit.
References
External links
Postmodern theory | 0.776604 | 0.976267 | 0.758172 |
Asociality | Asociality refers to the lack of motivation to engage in social interaction, or a preference for solitary activities. Asociality may be associated with avolition, but it can, moreover, be a manifestation of limited opportunities for social relationships. Developmental psychologists use the synonyms nonsocial, unsocial, and social uninterest. Asociality is distinct from, but not mutually exclusive to, anti-social behavior. A degree of asociality is routinely observed in introverts, while extreme asociality is observed in people with a variety of clinical conditions.
Asociality is not necessarily perceived as a totally negative trait by society, since asociality has been used as a way to express dissent from prevailing ideas. It is seen as a desirable trait in several mystical and monastic traditions, notably in Hinduism, Jainism, Roman Catholicism, Eastern Orthodoxy, Buddhism and Sufism.
Introversion
Introversion is "the state of or tendency toward being wholly or predominantly concerned with and interested in one's own mental life." Introverted persons are considered the opposite of extraverts, who seem to thrive in social settings rather than being alone. An introvert may present as an individual preferring being alone or interacting with smaller groups over interaction with larger groups, writing over speaking, having fewer but more fulfilling friendships, and needing time for reflection. While not a measurable personality trait, some popular writers have characterized introverts as people whose energy tends to expand through reflection and dwindle during interaction.
In matters of the brain, researchers have found differences in anatomy between introverted and extraverted persons. Introverted people are found to experience a higher flow of blood to the frontal lobe than extraverts, which is the part of the brain that contributes to problem-solving, memory, and preemptive thought.
Social anhedonia
Social anhedonia is found in both typical and extreme cases of asociality or personality disorders that feature social withdrawal. Social anhedonia is distinct from introversion and is frequently accompanied with alexithymia.
Many cases of social anhedonia are marked by extreme social withdrawal and the complete avoidance of social interaction. One research article studying the individual differences in social anhedonia discusses the negative aspects of this form of extreme or aberrant asociality. Some individuals with social anhedonia are at higher risk of developing schizophrenia and may have mental functioning that becomes poorer than the average.
In human evolution and anthropology
Scientific research suggests that asocial traits in human behavior, personality, and cognition may have several useful evolutionary benefits. Traits of introversion and aloofness can protect an individual from impulsive and dangerous social situations because of reduced impulsivity and reward. Frequent voluntary seclusion stimulates creativity and can give the individual time to think, work, reflect, and see useful patterns more easily.
Research indicates the social and analytical functions of the brain function in a mutually exclusive way. With this in mind, researchers posit that people who devoted less time or interest to socialization used the analytical part of the brain more frequently and thereby were often responsible for devising hunting strategies, creating tools, and spotting useful patterns in the environment in general for both their own safety and the safety of the group.
Imitation and social learning have been confirmed to be potentially limiting and maladaptive in animal and human populations. When social learning overrides personal experience (asocial learning), negative effects can be observed such as the inability to seek or pick the most efficient way to accomplish a task and a resulting inflexibility to changing environments. Individuals who are less receptible, motivated, and interested in sociability are likely less affected by or sensible to socially imitated information and faster to notice and react to changes in the environment, essentially holding onto their own observations in a rigid manner and, consequently, not imitating a maladaptive behavior through social learning. These behaviors, including deficits in imitative behavior, have been observed in individuals with autism spectrum disorders and introverts, and are correlated with the personality traits of neuroticism and disagreeableness.
The benefits of this behavior for the individual and their kin caused it to be preserved in part of the human population. The usefulness for acute senses, novel discoveries, and critical analytical thought may have culminated in the preservation of the suspected genetic factors of autism and introversion itself due to their increased cognitive, sensorial, and analytical awareness.
In psychopathology
Schizophrenia
In schizophrenia, asociality is one of the main five "negative symptoms", with the others being avolition, anhedonia, reduced affect, and alogia. Due to a lack of desire to form relationships, social withdrawal is common in people with schizophrenia. People with schizophrenia may experience social deficits or dysfunction as a result of the disorder, leading to asocial behavior. Frequent or ongoing delusions and hallucinations can deteriorate relationships and other social ties, isolating individuals with schizophrenia from reality and in some cases leading to homelessness. Even when treated with medication for the disorder, they may be unable to engage in social behaviors. These behaviors include things like maintaining conversations, accurately perceiving emotions in others, or functioning in crowded settings. There has been extensive research on the effective use of social skills training (SST) for the treatment of schizophrenia, in outpatient clinics as well as inpatient units. SST can be used to help patients with schizophrenia make better eye contact with other people, increase assertiveness, and improve their general conversational skills.
Personality disorders
Avoidant personality disorder
Asociality is common amongst people with avoidant personality disorder (AvPD). They experience discomfort and feel inhibited in social situations, being overwhelmed by feelings of inadequacy. Such people remain consistently fearful of social rejection, choosing to avoid social engagements as they do not want to give people the opportunity to reject (or possibly, accept) them. Though they inherently crave a sense of belonging, their fear of criticism and rejection leads people with AvPD to actively avoid occasions that require social interaction, leading to extremely asocial tendencies; as a result, these individuals often have difficulty cultivating and preserving close relationships.
People with AvPD may also display social phobia, the difference being that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.
Schizoid personality disorder
Schizoid personality disorder (SzPD) is characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may simultaneously demonstrate a rich and elaborate but exclusively internal fantasy world.
It is not the same as schizophrenia, although they share such similar characteristics as detachment and blunted affect. There is, moreover, increased prevalence of the disorder in families with schizophrenia.
Schizotypal personality disorder
Schizotypal personality disorder is characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs. People with this disorder feel extreme discomfort with maintaining close relationships with people, and therefore they often do not. People who have this disorder may display peculiar manners of talking and dressing and often have difficulty in forming relationships. In some cases, they may react oddly in conversations, not respond, or talk to themselves.
Autism
Autistic people may display profoundly asocial tendencies, due to differences in how autistic and allistic (non-autistic) people communicate. These different communication styles can cause mutual friction between the two neurotypes, known as the double empathy problem. Autistic people tend to express emotions differently and less intensely than allistic people, and often do not pick up on allistic social cues or linguistic pragmatics (including eye contact, facial expressions, tone of voice, body language, and implicatures) used to convey emotions and hints.
Connecting with others is important to overall health. An increased difficulty in accurately reading social cues by others can affect this desire for people with autism. The risk of adverse social experiences is high for those with autism, and so they may prefer to be avoidant in social situations rather than experience anxiety over social performance. Social deficits in people with autism is directly correlated with the increased prevalence of social anxiety in this community. As they are in a steep minority, there is risk of not having access to like-minded peers in their community, which can lead them to withdrawal and social isolation.
Mood disorders
Depression
Asociality can be observed in individuals with major depressive disorder or dysthymia, as individuals lose interest in everyday activities and hobbies they used to enjoy, this may include social activities, resulting in social withdrawal and withdrawal tendencies.
SST can be adapted to the treatment of depression with a focus on assertiveness training. Depressed patients often benefit from learning to set limits with others, to obtain satisfaction for their own needs, and to feel more self-confident in social interactions. Research suggests that patients who are depressed because they tend to withdraw from others can benefit from SST by learning to increase positive social interactions with others instead of withdrawing from social interactions.
Social anxiety disorder
Asocial behavior is observed in people with social anxiety disorder (SAD), who experience perpetual and irrational fears of humiliating themselves in social situations. They often have panic attacks and severe anxiety as a result, which can occasionally lead to agoraphobia. The disorder is common in children and young adults, diagnosed on average between the ages of 8 and 15. If left untreated, people with SAD exhibit asocial behavior into adulthood, avoiding social interactions and career choices that require interpersonal skills. SST can help people with social phobia or shyness to improve their communication and social skills so that they will be able to mingle with others or go to job interviews with greater ease and self-confidence.
Traumatic brain injury
Traumatic brain injuries (TBI) can also lead to asociality and social withdrawal.
Management
Treatments
Social skills training
Social skills training (SST) is an effective technique aimed towards anyone with "difficulty relating to others," a common symptom of shyness, marital and family conflicts, or developmental disabilities; as well as of many mental and neurological disorders including adjustment disorders, anxiety disorders, attention-deficit/hyperactivity disorder, social phobia, alcohol dependence, depression, bipolar disorder, schizophrenia, avoidant personality disorder, paranoid personality disorder, obsessive-compulsive disorder, and schizotypal personality disorder.
Fortunately for people who display difficulty relating to others, social skills can be learned, as they are not simply inherent to an individual's personality or disposition. Therefore, there is hope for anyone who wishes to improve their social skills, including those with psychosocial or neurological disorders. Nonetheless, it is important to note that asociality may still be considered neither a character flaw nor an inherently negative trait.
SST includes improving eye contact, speech duration, frequency of requests, and the use of gestures, as well as decreasing automatic compliance to the requests of others. SST has been shown to improve levels of assertiveness (positive and negative) in both men and women.
Additionally, SST can focus on receiving skills (e.g. accurately perceiving problem situations), processing skills (e.g. considering several response alternatives), and sending skills (delivering appropriate verbal and non-verbal responses).
Metacognitive interpersonal therapy
Metacognitive interpersonal therapy is a method of treating and improving the social skills of people with personality disorders that are associated with asociality. Through metacognitive interpersonal therapy, clinicians seek to improve their patients' metacognition, meaning the ability to recognize and read the mental states of themselves. The therapy differs from SST in that the patient is trained to identify their own thoughts and feelings as a means of recognizing similar emotions in others. Metacognitive interpersonal therapy has been shown to improve interpersonal and decision-making skills by encouraging awareness of suppressed inner states, which enables patients to better relate to other people in social environments.
The therapy is often used to treat patients with two or more co-occurring personality disorders, commonly including obsessive-compulsive and avoidant behaviors.
Coping mechanisms
In order to cope with asocial behavior, many individuals, especially those with avoidant personality disorder, develop an inner world of fantasy and imagination to entertain themselves when feeling rejected by peers. Asocial people may frequently imagine themselves in situations where they are accepted by others or have succeeded at an activity. Additionally, they may have fantasies relating to memories of early childhood and close family members.
See also
Anti-social behaviour
Conformity
Disorders of diminished motivation
Dissent
Hermit
Hikikomori
Introspection
Recluse
Seclusion
Silent treatment
Social isolation
Solitude
References
Further reading
Interpersonal relationships | 0.760067 | 0.997499 | 0.758166 |
Open Dialogue | Open Dialogue is an alternative approach for treating psychosis as well as other mental health disorders developed in the 1980s in Finland by Yrjö Alanen and his collaborators. Open dialogue interventions are currently being trialed in several other countries including Australia, Belgium, Denmark, Germany, Italy, Norway, Poland, the United Kingdom, and the United States. In Israel there is a non-governmental organization called Open Dialogue Israel.
Open Dialogue (OD) developed from Need-Adapted Treatment as described by Alanen and colleagues in the early 1990s. This approach took shape within the mental health services of Finnish Western Lapland in the 1980s and 1990s. During its initial research and training in psychotherapy, seven key principles were identified:
providing immediate help
considering clients' social network during the treatment
being flexible and mobile during the treatment
assigning the responsibility of organizing treatments to one professional
ensuring psychological continuity
accepting uncertainty
engaging in dialogism
The first five principles focus on the organizational aspects of delivering mental health services; the last two principles are about the conversational methods mental health professionals use in network meetings with clients. The participation of friends and family, responding to the client's utterances, trying to make meaning of what a client has to say, and "tolerating uncertainty".
A recently published global survey on the worldwide implementation of Open Dialogue in mental health services gathered data from 142 Open Dialogue teams in 24 countries, mainly in Europe. Key factors enhancing Open Dialogue implementation included well-trained staff, regular supervisions, research capabilities, diverse professional teams, self-referrals, outpatient services, younger clients, and the involvement of experts by experience. The study underscores the importance of more Open Dialogue training, supervision, and research.
Theoretical basis
In a paper illustrating the Open dialogue method Seikkula, Alakar and Aaltonen postulate that "from the social constructionist point of view, psychosis can be seen as one way of dealing with terrifying experience in one's life that do not have language other than the one of hallucinations and delusions" and that "psychotic reactions should be seen [as] attempts to make sense of one's experiences that are so heavy that they have made it impossible to construct a rational spoken narrative" arguing that people may talk about such experiences in metaphor.
They offer a model that "psychotic reactions greatly resemble traumatic experiences" with experiences of victimization "not being stored in the part of the memory system that promotes sense-making". Postulating that "an open dialogue, without any preplanned themes or forms seems to be important in enabling the construction of a new language in which to express difficult events in one's life."
This understanding differs radically from common psychiatric models of psychosis that view it as being caused by a biological process in the brain, such as the dopamine hypothesis of schizophrenia.
Effectiveness
Although pilot treatments since the 1980s show improved reintegration and a reduction in the need for medication, a systematic review of academic publications on the topic in 2018 concluded that "further studies are needed in a real-world setting to explore how and why [open dialogue] works", remarking that "most studies were highly biased and of low quality".
"Open Dialogue for Psychosis: Organising Mental Health Services to Prioritise Dialogue, Relationship and Meaning", edited by Putman and Martindale was published in 2021. It includes chapters on long term randomised, controlled research projects currently underway in the UK, Italy and Denmark to establish an evidence base for Open Dialogue in those national health services, funded by grants from the NIH in the UK and the Ministry of Health in Italy. In the UK, five NHS trusts are involved with a common training regime for both clinic and peer worker participant staff and have enrolled participant service users. In Italy, eight regional mental health services are involved in that trial.
In Denmark, a trial was conducted across five municipalities, and in 2019, Buus et al. published a retrospective register study, where they compared the level of contact with emergency and general practice services by young people who had been assisted by Open Dialogue services compared with those assisted by treatment-as-usual services in Denmark, and found that in the first year those in the Open dialogue cohort had more contacts but in the following years fewer, concluding that "Open Dialogue was significantly associated with some reduced risks of utilising health care services. These mixed results should be tested in a randomized design."
References
Treatment of mental disorders
Treatment of psychosis
External links
https://developingopendialogue.com/resources/
https://open-dialogue.net | 0.783761 | 0.967299 | 0.758132 |
Troubled teen industry | The troubled teen industry (also known as TTI) is a broad range of youth residential programs aimed at struggling teenagers. The term encompasses various facilities and programs, including youth residential treatment centers, wilderness programs, boot camps, and therapeutic boarding schools.
These programs claim to rehabilitate and teach troubled teenagers through various practices. Troubled teen facilities are privately run, and the troubled teen industry constitutes a multi-billion dollar industry. They accept young people who are considered to have struggles with learning disabilities, emotional regulation, mental illness, and substance abuse. Young people may be labeled as "troubled teens", delinquents, or other language on their websites and other advertising materials. Sometimes, these therapies are used as a punishment for contravening family expectations. For example, one person was placed in a troubled teen program because her mother found her choice in boyfriends unacceptable.
The troubled teen industry has encountered many scandals due to child abuse, institutional corruption, and deaths, and is highly controversial. Many critics of these facilities point to a lack of local, state, and federal laws in the United States and elsewhere governing them. Some countries, such as Bermuda, have been known to send teenagers to programs located in the United States. In addition to their controversial therapeutic practices, many former residents report being forcibly transported to troubled teen facilities by teen escort companies, a practice dubbed "gooning".
History
The troubled teen industry has a precursor in the drug rehabilitation program called Synanon, founded in 1958 by Charles Dederich. By the late 1970s, Synanon had developed into a cult and adopted a resolution proclaiming the Synanon Religion, with Dederich as the highest spiritual authority, allowing the organization to qualify as tax-exempt under US law. Synanon rejected the use of medication for drug rehabilitation, and instead relied on the "Synanon Game", group sessions of attack therapy where members were encouraged to criticize and humiliate each other. Synanon popularized "tough love" attack therapy as a treatment for addiction, and the idea that confrontation and verbal condemnation could cure adolescent misbehavior. Synanon disbanded in 1991, after its tax-exempt status was revoked by the IRS and it was bankrupted by having to pay US$17 million in back taxes.
Synanon's techniques were highly influential and inspired human potential self-help organizations such as Erhard Seminars Training (est) and Lifespring.
Synanon-style therapy was also used in Straight, Incorporated and The Seed, two drug rehabilitation programs for youth.
Former Synanon member Mel Wasserman founded CEDU Educational Services in 1967, a company which operated within the troubled teens industry. CEDU owned several for-profit therapeutic boarding schools, group homes, and behavior modification programs. The techniques used by CEDU schools were derived from Synanon's; for example, long, confrontational large-group sessions called "Propheets" took cues from the Synanon Game. CEDU went out of business in 2005, amid lawsuits and state regulatory crackdowns.
Joseph "Joe" Ricci, a dropout from a direct Synanon-descendent program, founded a therapeutic boarding school called Élan School in 1970. Élan closed down in 2011 amid persistent allegations of abuse.
Synanon's techniques also inspired the World Wide Association of Specialty Programs (WWASP), an umbrella organization of facilities meant for rehabilitating troubled teenagers. WWASP is no longer in business, due to widespread allegations of physical and psychological abuse. Many WWASP programs were shut down by the Costa Rican, Jamaican, and Mexican governments after investigations into allegations of abuse.
Practices
Troubled teen programs have been criticized for failing to offer evidence-based therapies such as cognitive behavioral therapy or trauma- and violence-informed care. Many or most troubled teen programs share a common lineage descending from Synanon, and use some form of "the game," a group attack therapy session. Additionally, some TTI programs use a form of primal therapy, a discredited form of therapy which involves reenacting traumatic and painful moments such as rape.
Many practices used in troubled teen programs, especially punishments, have been singled out as constituting child abuse or neglect. These include but are not limited to: restricting communication with family and peers; use of physical and chemical restraint (i.e., in the form of sedative drugs); use of seclusion as punishment; gay conversion therapy; excessive use of strip search and cavity search; denial of sleep and nutrition; aversion therapy; etc.
In 2007, the Government Accountability Office published a study verifying thousands of reports of abuse and death in TTI facilities dating back to 1990. The National Disability Rights Network published a report in 2021 reporting common issues at troubled teen facilities including the aforementioned forms of abuse as well as chronic staffing shortages, deprivation of education, and unhygienic and unsafe facility conditions.
Transportation
Many troubled teen institutions offer youth transportation through teen escort companies, in which minors are transported to their facilities against their will. Parents who sign their children up for troubled teen camps will sign over temporary custody to the teen escort company. This transportation is a service offered in the United States and elsewhere, and is a practice that has been criticized on ethical and legal grounds as being akin to kidnapping. Some of the subjects report not realizing they were transported with permission of their parents until days afterward. Clients have reported being ambushed in their own beds at home, or tricked into believing they are going elsewhere. Those who have been in the troubled teen industry call this process "gooning". There have been incidents where transportation staff have impersonated government officials. Former clients of troubled teen programs have made efforts to pursue legal recourse through civil lawsuits targeting both parents and the companies associated with these programs.
Controversies
False imprisonment
19-year-old Fred Collins Jr. found himself falsely imprisoned by Straight Inc., after initially visiting a family member who was enrolled in the program by his parents. Upon arrival, he was kept in a windowless room for six-and-a-half hours, and the staff refused to let him leave until he agreed to enroll into the program. At one New Mexico program, Tierra Blanca Ranch, the authorities found that the adolescent clients had been shackled and handcuffed.
Forced labor
Numerous troubled teen programs have been reported to engage in the practice of compelled labor, wherein program participants are required to perform physically demanding tasks such as wood chopping and horse manure shoveling.
Kidnapping
Elizabeth Zasso was an emancipated minor living in the state of New York who was illegally kidnapped by a teen escort company hired by her parents and taken to the state Utah where she was enrolled in a wilderness therapy program called the Challenger Foundation. It was ruled that the Challenger Foundation had violated her constitutional rights.
Stress positions
In certain instances, troubled teen programs have employed a torture technique known as "stress positions" as a form of discipline against their clients.
Strip searches
Many troubled teen programs conduct forced strip searches against the will of adolescent clients.
Solitary confinement
Numerous troubled teen programs, including the well-known Provo Canyon School, have faced allegations of employing solitary confinement as a disciplinary measure. Solitary confinement is a controversial practice that involves isolating individuals from social contact and is the subject of extensive debate regarding its ethical and psychological implications. Additionally, the now-defunct program known as Tranquility Bay, located in Jamaica, has also been reported to have utilized solitary confinement as part of its disciplinary methods. This practice has garnered considerable attention and criticism from various quarters.
Psychological abuse
Numerous reports have surfaced, documenting instances of psychological abuse inflicted upon clients within troubled teen programs. One particularly disturbing example of such abuse involves mock executions, wherein students were coerced into digging their own graves as part of a psychologically distressing exercise. These allegations highlight the gravity of ethical concerns within these programs and have sparked significant scrutiny and criticism from various outlets.
Regulatory laws
Utah, California, Oregon, Montana, and Missouri have all enacted laws aimed at increasing oversight of troubled teen facilities. Utah's law was proposed in 2021 after noted celebrity Paris Hilton came out with her story about her experience at Provo Canyon School. Hilton's testimony triggered a state investigation into the facility, and she later advocated for the law when it was in the process of being passed.
In the United States Congress, bills were proposed to regulate troubled teen facilities every year from 2007 to 2018. In 2021, the Stronger Child Abuse Prevention and Treatment Act was passed by the House of Representatives. , it has not been passed by the Senate.
Legal history
On June 27, 1990, Kristen Chase died from heatstroke whilst enrolled at the Challenger Foundation, a Wilderness Therapy program located in Kane County, Utah. The county's district attorney charged the owner of the program, Steve Cartisano, with nine counts of child abuse and one count of negligent homicide. Lance Jagger was also charged with negligent homicide and child abuse, but the charges were dropped after he agreed to testify against Cartisano. A jury acquitted Steve Cartisano on all charges.
On January 15, 1995, Aaron Bacon died from acute peritonitis while attending the North Star Wilderness Program in Utah. Nine staff members, including company co-founder Lance Jagger, were charged with abuse and neglect. Lance Jagger, William Henry, and Georgette Costigan pled guilty to negligent homicide. Craig Fisher was found guilty of third-degree felony abuse or neglect of a disabled child.
On March 2, 1998, Nicholaus Contreraz died from complications due to an infection. Among his symptoms were chronic urinary and fecal incontinence, for which staff would force him to eat meals on the toilet and sleep in his soiled underwear as punishment. The autopsy revealed Contreraz had died from empyema with a partial collapse of his left lung. He had also contracted strep and staph infections with pneumonia and chronic bronchitis, and the coroner also discovered 71 cuts and bruises. During the investigation by the Pinal County Sheriff's Office, it was found that Nicholaus had been cleared for physical training activities by staff. The Federal Bureau of Investigation opened an investigation into civil rights violations at the location on a broader scale. The California Social Services Department investigation found widespread excessive use of physical restraint and hands-on confrontations by staff members.
Timeline
1967: CEDU High School is founded by Mel Wasserman, a former Synanon member, in Running Springs, California.
May 30, 1970: The Élan School is founded by Joe Ricci, a former resident of Daytop Village, in Naples, Maine.
February 16, 1982: Nancy Reagan visits Straight, Inc. in Florida.
December 27, 1982: Philip Williams Jr. dies in Elan School boxing ring.
May 26, 1983: A federal jury awards a Straight, Inc. patient $220,000 after finding said patient to have been falsely imprisoned by the foundation.
November 11, 1985: Princess Diana and Nancy Reagan visit Straight, Inc.
1987: Scientology's troubled teen program Mace-Kingsley Ranch School opens in California.
January 15, 1995: Aaron Bacon dies from acute peritonitis while attending the North Star Wilderness Program in Utah.
December 21, 1996: Craig Fisher is sentenced over his role in Aaron Bacon's death.
1998: Robert Lichfield creates the World Wide Association of Specialty Programs and Schools.
1999: National Association of Therapeutic Schools and Programs is founded.
February 2001: 14-year-old Ryan Lewis dies by suicide while enrolled at Alldredge Academy in West Virginia.
July 2001: 14-year-old Tony Haynes is forced to eat dirt and dies at a desert boot camp for teenagers.
July 15, 2002: Ian August dies from heat exhaustion while attending the Skyline Journey Wilderness Program in Utah. The Utah Department of Human Service revoked Skyline Journey's state license on the 25 October 2002.
December 25, 2002: 17-year-old Kiley Jaquays falls to her death while visiting the Bloomington Caves in Utah with her residential treatment center, Integrity House.
May 23, 2003: Costa Rican government officials shut down the Academy at Dundee Ranch, a behavior modification program run by the US-based company World Wide Association of Specialty Programs and Schools.
February 8, 2004: 16-year-old Daniel Yuen goes missing from CEDU High School in California.
October 2004: Karlye Newman dies by suicide at Spring Creek Lodge Academy.
2006: Yang Yongxin establishes an "Internet-addiction camp" inside the Fourth Hospital of Linyi in China and begins practicing electroconvulsive therapy.
August 28, 2009: Sergey Blashchishen dies from heat exhaustion during a hike whilst attending Sage Walk, a wilderness therapy program operated by Aspen Education Group.
February 8, 2013: The hacking collective group Anonymous launches #OpTTIabuse, a campaign against the troubled teen industry.
November 2015: Ten teenagers are arrested after a riot at Copper Hills Youth Center in Utah.
February 2017: 16-year-old Ben Jackson dies by suicide at Montana Academy.
July 10, 2019: Red Rock Canyon School in Utah closes after a riot breaks out in April 2019.
April 2020: 16-year-old Cornelius Fredericks dies while being restrained at youth program in Michigan.
October 9, 2020: American socialite Paris Hilton and other former residents of Provo Canyon School lead a silent protest against the school in Provo, Utah.
January 16, 2022: A 14-year-old girl dies from medical neglect at Maple Lake Academy, a residential treatment center in Utah.
August 31, 2022: Agape Baptist Academy is served an indictment for transporting a California teenager and violating a protection order.
January 11, 2023: Agape Baptist Academy announces plans for permanent closure.
February 3, 2024: A 12-year-old boy dies after one night at Trails Carolina wilderness program.
February 2024: All children are removed from Trails Carolina pending manslaughter investigation.
February 15, 2024: Open Sky Wilderness closes after years of controversy surrounding the effectiveness of wilderness therapy programs.
June 24, 2024: The autopsy report for the boy who died at Trails Carolina is released. The cause of death is determined to have been asphyxia caused by smothering, and the manner of death is determined to have been homicide.
August 22, 2024: Evoke Therapy, a wilderness program located out of Santa Clara, UT, announces their intention to close down after over 20 years of operations.
Media
Children of Darkness, a 1983 documentary on the Élan School
Not My Kid, a 1985 TV movie based on the Straight, Inc. program
Locked in Paradise, a television program on the troubled teen program called Tranquility Bay, aired in December 2004.
Boot Camp, a 2008 film based on the WWASP program Paradise Cove, located in Samoa.
Kidnapped for Christ, a documentary released in 2014 about a Christian behavior modification program.
The Last Stop, a documentary on the Élan School released in 2017.
This Is Paris, a documentary on Paris Hilton's experience in various troubled-teen programs, released in 2020.
Hell Camp: Teen Nightmare, a documentary released in December 2023. It is about a wilderness therapy program called the Challenger Foundation in Utah, and covers the controversial conditions of the program as well as the death of Kristen Chase.
Joe versus Elan School, an autobiographical, web-based graphic novel.
The Program: Cons, Cults, and Kidnapping is a 2024 American true crime documentary series, directed by Katherine Kubler. It follows Kubler and former classmates of hers from the Academy at Ivy Ridge, a behavior modification facility that was marketed as a boarding school, as they reflect on the abusive conditions they experienced in the program and the lasting trauma.
References
Further reading
Strangeways, Sam. (11 December 2019) "Sending troubled children to US cost $33m"
Juvenile delinquency
Human rights abuses
Conversion therapy
Religion and mental health
Youth rights
Behavior modification | 0.760749 | 0.996533 | 0.758112 |
Transdisciplinarity | Transdisciplinarity connotes a research strategy that crosses disciplinary boundaries to create a holistic approach. It applies to research efforts focused on problems that cross the boundaries of two or more disciplines, such as research on effective information systems for biomedical research (see bioinformatics), and can refer to concepts or methods that were originally developed by one discipline, but are now used by several others, such as ethnography, a field research method originally developed in anthropology but now widely used by other disciplines.
The Belmont Forum elaborated that a transdisciplinary approach is enabling inputs and scoping across scientific and non-scientific stakeholder communities and facilitating a systemic way of addressing a challenge. This includes initiatives that support the capacity building required for the successful transdisciplinary formulation and implementation of research actions.
Usage
Transdisciplinarity has two common meanings:
German usage
In German-speaking countries, Transdisziplinarität refers to the integration of diverse forms of research, and includes specific methods for relating knowledge in problem-solving. A 2003 conference held at the University of Göttingen showcased the diverse meanings of multi-, inter- and transdisciplinarity and made suggestions for converging them without eliminating present usages.
When the very nature of a problem is under dispute, transdisciplinarity can help determine the most relevant problems and research questions involved. A first type of question concerns the cause of the present problems and their future development (system knowledge). Another concerns which values and norms can be used to form goals of the problem-solving process (target knowledge). A third relates to how a problematic situation can be transformed and improved (transformation knowledge). Transdisciplinarity requires adequate addressing of the complexity of problems and the diversity of perceptions of them, that abstract and case-specific knowledge are linked, and that practices promote the common good.
Transdisciplinarity arises when participating experts interact in an open discussion and dialogue, giving equal weight to each perspective and relating them to each other. This is difficult because of the overwhelming amount of information involved, and because of incommensurability of specialized languages in each field of expertise. To excel under these conditions, researchers need not only in-depth knowledge and know-how of the disciplines involved, but skills in moderation, mediation, association and transfer.
Wider usage
Transdisciplinarity is also used to signify a unity of knowledge beyond disciplines.
Jean Piaget introduced this usage of the term in 1970, and in 1987, the International Center for Transdisciplinary Research (CIRET) adopted the Charter of Transdisciplinarity at the 1st World Congress of Transdisciplinarity, Convento da Arrabida, Portugal, November 1994.
In the CIRET approach, transdisciplinarity is radically distinct from interdisciplinarity. Interdisciplinarity, like pluridisciplinarity, concerns the transfer of methods from one discipline to another, allowing research to spill over disciplinary boundaries, but staying within the framework of disciplinary research.
As the prefix "trans" indicates, transdisciplinarity concerns that which is at once between the disciplines, across the different disciplines, and beyond each individual discipline. Its goal is the understanding of the present world, of which one of the imperatives is the overarching unity of knowledge.
Another critical defining characteristic of transdisciplinary research is the inclusion of stakeholders in defining research objectives and strategies in order to better incorporate the diffusion of learning produced by the research. Collaboration between stakeholders is deemed essential – not merely at an academic or disciplinary collaboration level, but through active collaboration with people affected by the research and community-based stakeholders. In such a way, transdisciplinary collaboration becomes uniquely capable of engaging with different ways of knowing the world, generating new knowledge, and helping stakeholders understand and incorporate the results or lessons learned by the research.
Transdisciplinarity is defined by Basarab Nicolescu through three methodological postulates: the existence of levels of Reality, the logic of the included middle, and complexity. In the presence of several levels of Reality the space between disciplines and beyond disciplines is full of information. Disciplinary research concerns, at most, one and the same level of Reality; moreover, in most cases, it only concerns fragments of one level of Reality. On the contrary, transdisciplinarity concerns the dynamics engendered by the action of several levels of Reality at once. The discovery of these dynamics necessarily passes through disciplinary knowledge. While not a new discipline or a new superdiscipline, transdisciplinarity is nourished by disciplinary research; in turn, disciplinary research is clarified by transdisciplinary knowledge in a new, fertile way. In this sense, disciplinary and transdisciplinary research are not antagonistic but complementary. As in the case of disciplinarity, transdisciplinary research is not antagonistic but complementary to multidisciplinarity and interdisciplinarity research.
According to Nicolescu, transdisciplinarity is nevertheless radically distinct from multidisciplinarity and interdisciplinarity because of its goal, the understanding of the present world, which cannot be accomplished in the framework of disciplinary research. The goal of multidisciplinarity and interdisciplinarity always remains within the framework of disciplinary research. If transdisciplinarity is often confused with interdisciplinarity or multidisciplinarity (and by the same token, we note that interdisciplinarity is often confused with multidisciplinarity) this is explained in large part by the fact that all three overflow disciplinary boundaries. Advocates maintain this confusion hides the huge potential of transdisciplinarity. One of the best known professionals of transdisciplinarity in Argentina is Pablo Tigani, and his concept about transdisciplinarity is:
Currently, transdisciplinarity is a consolidated academic field that is giving rise to new applied researches, especially in Latin America and the Caribbean. In this sense, the transdisciplinary and biomimetics research of Javier Collado on Big History represents an ecology of knowledge between scientific knowledge and the ancestral wisdom of native peoples, such as Indigenous peoples in Ecuador. According to Collado, the transdisciplinary methodology applied in the field of Big History seeks to understand the interconnections of the human race with the different levels of reality that co-exist in nature and in the cosmos, and this includes mystical and spiritual experiences, very present in the rituals of shamanism with ayahuasca and other sacred plants. In abstract, the teaching of Big History in universities of Brazil, Ecuador, Colombia, and Argentina implies a transdisciplinary vision that integrates and unifies diverse epistemes that are in, between, and beyond the scientific disciplines, that is, including ancestral wisdom, spirituality, art, emotions, mystical experiences and other dimensions forgotten in the history of science, specially by the positivist approach.
Transdisciplinary education
Transdisciplinary education is education that brings integration of different disciplines in a harmonious manner to construct new knowledge and uplift the learner to higher domains of cognitive abilities and sustained knowledge and skills. It involves better neural networking for lifelong learning.
Transdisciplinarity has been flagged internationally as an important aim of education. For example, Global Education Magazine, an international journal supported by UNESCO and UNHCR:
"transdisciplinarity represents the capable germ to promote an endogenous development of the evolutionary spirit of internal critical consciousness, where religion and science are complementary. Respect, solidarity and cooperation should be global standards for the entire human development with no boundaries. This requires a radical change in the ontological models of sustainable development, global education and world-society. We must rely on the recognition of a plurality of models, cultures and socio-economical diversification. As well as biodiversity is the way for the emergence of new species, cultural diversity represents the creative potential of world-society."
Influence in disciplines and fields
Arts and humanities
Transdisciplinarity can be found in the arts and humanities. For example, the Planetary Collegium seeks "the development of transdisciplinary discourse in the convergence of art, science, technology and consciousness research." The Plasticities Sciences Arts (PSA) research group also develops transdisciplinary approaches regarding humanities and fundamental sciences relationships as well as the Art & Science field. An example of transdisciplinary research in the arts and humanities can be seen in Lucy Jeffery's study on the work of Samuel Beckett, entitled Transdisciplinary Beckett: Visual Arts, Music, and the Creative Process.
Human sciences
The range of transdisciplinarity becomes clear when the four central questions of biological research ((1) causation, (2) ontogeny, (3) adaptation, (4) phylogeny [after Niko Tinbergen 1963, see also Tinbergen's four questions, cf. Aristotle: Causality / Four Major Causes]) are graphed against distinct levels of analysis (e.g. cell, organ, individual, group; [cf. "Laws about the Levels of Complexity" of Nicolai Hartmann 1940/1964, see also Rupert Riedl 1984]):
In this "scheme of transdisciplinarity", all anthropological disciplines (paragraph C in the table of the pdf-file below), their questions (paragraph A: see pdf-file) and results (paragraph B: see pdf-file) can be intertwined and allocated with each other for examples how these aspects go into those little boxes in the matrix. This chart includes all realms of anthropological research (no one is excluded). It is the starting point for a systematical order for all human sciences, and also a source for a consistent networking and structuring of their results. This "bio-psycho-social" orientation framework is the basis for the development of the "Fundamental Theory of Human Sciences" and for a transdisciplinary consensus. (In this tabulated orientation matrix the questions and reference levels in italics are also the subject of the humanities.). Niko Tinbergen was familiar with both conceptual categories (i.e. the four central questions of biological research and the levels of analysis), the tabulation was made by Gerhard Medicus. Certainly, a humanist perspective always involves a transdisciplinary focus. A good and classic example of mixing very different sciences was the work developed by Leibniz in seventeenth-eighteenth centuries in order to create a universal system of justice.
Health science
The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. Transdisciplinary within public health emphasizes integrating diverse individuals, skills, perspectives, and expertise across disciplines to dissolve traditional boundaries and develop holistic approaches linking ecosystem and human health boundaries.
See also
International Association of Transdisciplinary Psychology
Science of team science
References
Citations
Works cited
Further reading
External links
Ulli Vilsmaier: What Is Transdisciplinarity? Explainer Video, TU Berlin, 2024
transdisciplinary-net, Swiss Academies of Arts and Sciences
Transdisciplinary Case Studies at ETH Zurich
International Center for Transdisciplinary Research The site of the International Center for Transdisciplinary Research (CIRET). E-zine "Transdisciplinary Encounters".
Transdisciplinary Studies The book series dedicated to transdisciplinary research.
World Knowledge Dialogue Foundation
Transdisciplinary Studies at Claremont Graduate University
PLASTIR : The Transdisciplinary Review of human plasticity
Journal of the International Association of Transdisciplinary Psychology
Academic discipline interactions
Holism | 0.768876 | 0.985995 | 0.758108 |
Auditory processing disorder | Auditory processing disorder (APD), rarely known as King-Kopetzky syndrome or auditory disability with normal hearing (ADN), is a neurodevelopmental disorder affecting the way the brain processes sounds. Individuals with APD usually have normal structure and function of the ear, but cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech. It is thought that these difficulties arise from dysfunction in the central nervous system.
The American Academy of Audiology notes that APD is diagnosed by difficulties in one or more auditory processes known to reflect the function of the central auditory nervous system. It can affect both children and adults, and may continue to affect children into adulthood. Although the actual prevalence is currently unknown, it has been estimated to impact 2–7% of children in US and UK populations. Males are twice as likely to be affected by the disorder as females.
Neurodevelopmental forms of APD are different than aphasia because aphasia is by definition caused by acquired brain injury. However, acquired epileptic aphasia has been viewed as a form of APD.
Signs and symptoms
Individuals with this disorder may experience the following signs and symptoms:
speaking louder or softer than is situationally appropriate;
difficulty remembering lists or sequences;
needing words or sentences to be repeated;
impaired ability to memorize information learned by listening;
interpreting words too literally;
needing assistance to hear clearly in noisy environments;
relying on accommodation and modification strategies;
finding or requesting a quiet work space away from others;
requesting written material when attending oral presentations; and
asking for directions to be given one step at a time.
Relation to attention deficit hyperactivity disorder
APD and attention deficit hyperactivity disorder (ADHD) can present with overlapping symptoms. Below is a ranked order of behavioral symptoms that are most frequently observed in each disorder. Professionals evaluated the overlap of symptoms between the two disorders; the order below is of symptoms that are almost always observed. Although the symptoms listed have differences, there are many similarities in how they may present in an individual, which can make it difficult to differentiate between the two conditions.
There is a co-occurrence between ADHD and APD. A systematic review published in 2018 detailed one study that showed 10% of children with APD have confirmed or suspected ADHD. It also stated that it is sometimes difficult to distinguish the two, since characteristics and symptoms between APD and ADHD tend to overlap. The systematic review also described this overlap between APD and other behavioral disorders and whether or not it was easy to distinguish those children that solely had auditory processing disorder.
Relation to specific language impairment and developmental dyslexia
There has been considerable debate over the relationship between APD and specific language impairment (SLI).
SLI is diagnosed when a child has difficulties with understanding or producing spoken language, and the cause of these difficulties is not obvious (and specifically cannot be explained by peripheral hearing loss). The child is typically late in their language development and may struggle to produce clear speech sounds and produce or understand complex sentences. Some theorize that SLI is the result of auditory processing problems. However, this theory is not universally accepted; others theorize that the main difficulties associated with SLI stem from problems with the higher-level aspects of language processing. Where a child has both auditory and language problems, it can be difficult to sort out the causality at play.
Similarly with developmental dyslexia, researchers continue to explore the hypothesis that reading problems emerge as a downstream consequence of difficulties in rapid auditory processing. Again, cause and effect can be hard to unravel. This is one reason why some experts have recommended using non-verbal auditory tests to diagnose APD. Specifically regarding neurological factors, dyslexia has been linked to polymicrogyria which causes cell migrational problems. Children that have polymicrogyri almost always present with deficits on APD testing. It has also been suggested that APD may be related to cluttering, a fluency disorder marked by word and phrase repetitions.
Some studies found that a higher than expected proportion of individuals diagnosed with SLI and dyslexia on the basis of language and reading tests also perform poorly on tests in which auditory processing skills are tested. APD can be assessed using tests that involve identifying, repeating, or discriminating speech, and a child may perform poorly because of primary language problems. In a study comparing children with a diagnosis of dyslexia and those with a diagnosis of APD, they found the two groups could not be distinguished. Analogous results were observed in studies comparing children diagnosed with SLI or APD, the two groups presenting with similar diagnostic criteria. As such, the diagnosis a child receives may depend on which specialist they consult: the same child who might be diagnosed with APD by an audiologist may instead be diagnosed with SLI by a speech-language therapist, or with dyslexia by a psychologist.
Causes
Acquired
Acquired APD can be caused by any damage to, or dysfunction of, the central auditory nervous system and can cause auditory processing problems. For an overview of neurological aspects of APD, see T. D. Griffiths's 2002 article "Central Auditory Pathologies".
Genetics
Some studies have indicated an increased prevalence of a family history of hearing impairment in these patients. The pattern of results is suggestive that auditory processing disorder may be related to conditions of autosomal dominant inheritance. In other words, the ability to listen to and comprehend multiple messages at the same time is a trait that is heavily influenced by genes. These "short circuits in the wiring" sometimes run in families or result from a difficult birth, just like any learning disability. Inheritance of auditory processing disorder refers to whether an individual inherits the condition from their parents, or whether it runs in families. Central auditory processing disorder may be hereditary neurological traits from the mother or the father.
Developmental
In the majority of cases of developmental APD, the cause is unknown. An exception is acquired epileptic aphasia or Landau–Kleffner syndrome, where a child's development regresses, with language comprehension severely affected. The child is often thought to be deaf, but testing reveals normal peripheral hearing. In other cases, suspected or known causes of APD in children include delay in myelin maturation, ectopic (misplaced) cells in the auditory cortical areas, or genetic predisposition. In one family with autosomal dominant epilepsy, seizures which affected the left temporal lobe seemed to cause problems with auditory processing. In another extended family with a high rate of APD, genetic analysis showed a haplotype in chromosome 12 that fully co-segregated with language impairment.
Hearing begins in utero, but the central auditory system continues to develop for at least the first decade after birth. There is considerable interest in the idea that disruption to hearing during a sensitive period may have long-term consequences for auditory development. One study showed thalamocortical connectivity in vitro was associated with a time sensitive developmental window and required a specific cell adhesion molecule (lcam5) for proper brain plasticity to occur. This points to connectivity between the thalamus and cortex shortly after being able to hear (in vitro) as at least one critical period for auditory processing. Another study showed that rats reared in a single tone environment during critical periods of development had permanently impaired auditory processing. In rats, "bad" auditory experiences, such as temporary deafness by cochlear removal, leads to neuron shrinkage. In a study looking at attention in APD patients, children with one ear blocked developed a strong right-ear advantage but were not able to modulate that advantage during directed-attention tasks.
In the 1980s and 1990s, there was considerable interest in the role of chronic otitis media (also called middle ear disease or "glue ear") in causing APD and related language and literacy problems. Otitis media with effusion is a very common childhood disease that causes a fluctuating conductive hearing loss, and there was concern this may disrupt auditory development if it occurred during a sensitive period. Consistent with this, in a sample of young children with chronic ear infections recruited from a hospital otorhinolaryngology department, increased rates of auditory difficulties were found later in childhood. However, this kind of study will have sampling bias because children with otitis media will be more likely to be referred to hospital departments if they are experiencing developmental difficulties. Compared with hospital studies, epidemiological studies, which assesses a whole population for otitis media and then evaluate outcomes, found much weaker evidence for long-term impacts of otitis media on language outcomes.
Somatic
It seems that somatic anxiety (that is, physical symptoms of anxiety such as butterflies in the stomach or cotton mouth) and situations of stress may be determinants of speech-hearing disability.
Diagnosis
Questionnaires which address common listening problems can be used to identify individuals who may have auditory processing disorder, and can help in the decision to pursue clinical evaluation.
One of the most common listening problems is speech recognition in the presence of background noise.
According to the respondents who participated in a study by Neijenhuis, de Wit, and Luinge (2017), symptoms of APD which are characteristic in children with listening difficulties, and are typically problematic with adolescents and adults, include:
Difficulty hearing in noisy environments
Auditory attention problems
Understanding speech more easily in one-on-one situations
Difficulties in noise localization
Difficulties in remembering oral information
According to the New Zealand Guidelines on Auditory Processing Disorders (2017), the following checklist of key symptoms of APD or comorbidities can be used to identify individuals who should be referred for audiological and APD assessment:
Difficulty following spoken directions unless they are brief and simple
Difficulty attending to and remembering spoken information
Slowness in processing spoken information
Difficulty understanding in the presence of other sounds
Overwhelmed by complex or "busy" auditory environments e.g. classrooms, shopping malls
Poor listening skills
Insensitivity to tone of voice or other nuances of speech
Acquired brain injury
History of frequent or persistent middle ear disease (otitis media, "glue ear").
Difficulty with language, reading, or spelling
Suspicion or diagnosis of dyslexia
Suspicion or diagnosis of language disorder or delay
Finally, the New Zealand guidelines state that behavioral checklists and questionnaires should only be used to provide guidance for referrals, for information gathering (for example, prior to assessment or as outcome measures for interventions), and as measures to describe the functional impact of auditory processing disorder. They are not designed for the purpose of diagnosing auditory processing disorders. The New Zealand guidelines indicate that a number of questionnaires have been developed to identify children who might benefit from evaluation of their problems in listening. Examples of available questionnaires include the Fisher's Auditory Problems Checklist, the Children's Auditory Performance Scale, the Screening Instrument for Targeting Educational Risk, and the Auditory Processing Domains Questionnaire among others. All of the previous questionnaires were designed for children and none are useful for adolescents and adults.
The University of Cincinnati Auditory Processing Inventory (UCAPI) was designed for use with adolescents and adults seeking testing for evaluation of problems with listening and/or to be used following diagnosis of an auditory processing disorder to determine the subject's status. Following a model described by Zoppo et al. (2015), a 34-item questionnaire was developed that investigates auditory processing abilities in each of the six common areas of complaint in APD (listening and concentration, understanding speech, following spoken instructions, attention, and other.) The final questionnaire was standardized on normally-achieving young adults ranging from 18 to 27 years of age. Validation data was acquired from subjects with language-learning or auditory processing disorders who were either self-reported or confirmed by diagnostic testing. A UCAPI total score is calculated by combining the totals from the six listening conditions and provides an overall value to categorize listening abilities. Additionally, analysis of the scores from the six listening conditions provides an auditory profile for the subject. Each listening condition can then be utilized by the professional in making recommendation for diagnosing problem of learning through listening and treatment decisions. The UCAPI provides information on listening problems in various populations that can aid examiners in making recommendations for assessment and management.
APD has been defined anatomically in terms of the integrity of the auditory areas of the nervous system. However, children with symptoms of APD typically have no evidence of neurological disease, so the diagnosis is made based on how the child performs behavioral auditory tests. Auditory processing is "what we do with what we hear", and in APD there is a mismatch between peripheral hearing ability (which is typically normal) and ability to interpret or discriminate sounds. Thus in those with no signs of neurological impairment, APD is diagnosed on the basis of auditory tests. There is, however, no consensus as to which tests should be used for diagnosis, as evidenced by the succession of task force reports that have appeared in recent years.
The first of these occurred in 1996. This was followed by a conference organized by the American Academy of Audiology.
Experts attempting to define diagnostic criteria have to grapple with the problem that a child may do poorly on an auditory test for reasons other than poor auditory perception: for instance, failure could be due to inattention, difficulty in coping with task demands, or limited language ability. In an attempt to rule out at least some of these factors, the American Academy of Audiology conference explicitly advocated that for APD to be diagnosed, the child must have a modality-specific problem, i.e. affecting auditory but not visual processing. However, a committee of the American Speech-Language-Hearing Association subsequently rejected modality-specificity as a defining characteristic of auditory processing disorders.
Definitions
in 2005 the American Speech–Language–Hearing Association published "Central Auditory Processing Disorders" as an update to the 1996 publication, "Central Auditory Processing: Current Status of Research and Implications for Clinical Practice". The American Academy of Audiology has released more current practice guidelines related to the disorder. ASHA formally defines APD as "a difficulty in the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information."
In 2018, the British Society of Audiology published a "position statement and practice guidance" on auditory processing disorder and updated its definition of APD. According to the Society, APD refers to the inability to process speech and on-speech sounds.
Auditory processing disorder can be developmental or acquired. It may result from ear infections, head injuries, or neurodevelopmental delays that affect processing of auditory information. This can include problems with: "...sound localization and lateralization (see also binaural fusion); auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals".
The Committee of UK Medical Professionals Steering the UK Auditory Processing Disorder Research Program have developed the following working definition of auditory processing disorder: "APD results from impaired neural function and is characterized by poor recognition, discrimination, separation, grouping, localization, or ordering of speech sounds. It does not solely result from a deficit in general attention, language or other cognitive processes."
Types of testing
The SCAN-C for children and SCAN-A for adolescents and adults are the most common tools for screening and diagnosing APD in the USA. Both tests are standardized on a large number of subjects and include validation data on subjects with auditory processing disorders. The SCAN test batteries include screening tests: norm-based criterion-referenced scores; diagnostic tests: scaled scores, percentile ranks and ear advantage scores for all tests except the Gap Detection test. The four tests include four subsets on which the subject scores are derived include: discrimination of monaurally presented single words against background noise (speech in noise), acoustically degraded single words (filtered words), dichotically presented single words and sentences.
Random Gap Detection Test (RGDT) is also a standardized test. It assesses an individual's gap detection threshold of tones and white noise. The exam includes stimuli at four different frequencies (500, 1000, 2000, and 4000 Hz) and white noise clicks of 50 ms duration. This test provides an index of auditory temporal resolution. In children, an overall gap detection threshold greater than 20 ms means they have failed and may have an auditory processing disorder based on abnormal perception of sound in the time domain.
Gaps in Noise Test (GIN) also measures temporal resolution by testing the patient's gap detection threshold in white noise.
Pitch Patterns Sequence Test (PPT) and Duration Patterns Sequence Test (DPT) measure auditory pattern identification. The PPS has s series of three tones presented at either of two pitches (high or low). Meanwhile, the DPS has a series of three tones that vary in duration rather than pitch (long or short). Patients are then asked to describe the pattern of pitches presented.
Masking Level Difference (MLD) at 500 Hz measures overlapping temporal processing, binaural processing, and low-redundancy by measuring the difference in threshold of an auditory stimulus when a masking noise is presented in and out of phase.
The Staggered Spondaic Word Test (SSW) is one of the oldest tests for APD developed by Jack Katz. Although it has fallen into some disuse by audiologists as it is complicated to score, it is one of the quickest and most sensitive tests to determine APD.
Modality-specificity and controversies
The issue of modality-specificity has led to considerable debate among experts in this field. Cacace and McFarland have argued that APD should be defined as a modality-specific perceptual dysfunction that is not due to peripheral hearing loss. They criticize more inclusive conceptualizations of APD as lacking diagnostic specificity. A requirement for modality-specificity could potentially avoid including children whose poor auditory performance is due to general factors such as poor attention or memory. Others, however, have argued that a modality-specific approach is too narrow, and that it would miss children who had genuine perceptual problems affecting both visual and auditory processing. It is also impractical, as audiologists do not have access to standardized tests that are visual analogs of auditory tests. The debate over this issue remains unresolved between modality-specific researchers such as Cacace, and associations such as the American Speech-Language-Hearing Association (among others). It is clear, however, that a modality-specific approach will diagnose fewer children with APD than a modality-general one, and that the latter approach runs a risk of including children who fail auditory tests for reasons other than poor auditory processing. Although modality-specific testing has been advocated for well over a decade, the visual analog of APD testing has met with sustained resistance from the fields of optometry and ophthalmology.
Another controversy concerns the fact that most traditional tests of APD use verbal materials. The British Society of Audiology has embraced Moore's (2006) recommendation that tests for APD should assess processing of non-speech sounds. The concern is that if verbal materials are used to test for APD, then children may fail because of limited language ability. An analogy may be drawn with trying to listen to sounds in a foreign language. It is much harder to distinguish between sounds or to remember a sequence of words in a language you do not know well: the problem is not an auditory one, but rather due to lack of expertise in the language.
In recent years there have been additional criticisms of some popular tests for diagnosis of APD. Tests that use tape-recorded American English have been shown to over-identify APD in speakers of other forms of English. Performance on a battery of non-verbal auditory tests devised by the Medical Research Council's Institute of Hearing Research was found to be heavily influenced by non-sensory task demands, and indices of APD had low reliability when this was controlled for. This research undermines the validity of APD as a distinct entity in its own right and suggests that the use of the term "disorder" itself is unwarranted. In a recent review of such diagnostic issues, it was recommended that children with suspected auditory processing impairments receive a holistic psychometric assessment including general intellectual ability, auditory memory, and attention, phonological processing, language, and literacy. The authors state that "a clearer understanding of the relative contributions of perceptual and non-sensory, unimodal and supramodal factors to performance on psychoacoustic tests may well be the key to unraveling the clinical presentation of these individuals."
Depending on how it is defined, APD may share common symptoms with ADD/ADHD, specific language impairment, and autism spectrum disorders. A review showed substantial evidence for atypical processing of auditory information in children with autism. Dawes and Bishop noted how specialists in audiology and speech-language pathology often adopted different approaches to child assessment, and they concluded their review as follows: "We regard it as crucial that these different professional groups work together in carrying out assessment, treatment and management of children and undertaking cross-disciplinary research." In practice, this seems rare.
To ensure that APD is correctly diagnosed, the examiners must differentiate APD from other disorders with similar symptoms. Factors that should be taken into account during the diagnosis are: attention, auditory neuropathy, fatigue, hearing and sensitivity, intellectual and developmental age, medications, motivation, motor skills, native language and language experience, response strategies and decision-making style, and visual acuity.
It should also be noted that children under the age of seven cannot be evaluated correctly because their language and auditory processes are still developing. In addition, the presence of APD cannot be evaluated when a child's primary language is not English.
Characteristics
The American Speech-Language-Hearing Association state that children with (central) auditory processing disorder often:
have trouble paying attention to and remembering information presented orally, and may cope better with visually acquired information
have problems carrying out multi-step directions given orally; need to hear only one direction at a time
have poor listening skills
need more time to process information
have difficulty learning a new language
have difficulty understanding jokes, sarcasm, and learning songs or nursery rhymes
have language difficulties (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
have difficulty with reading, comprehension, spelling, and vocabulary
APD can manifest as problems determining the direction of sounds, difficulty perceiving differences between speech sounds and the sequencing of these sounds into meaningful words, confusing similar sounds such as "hat" with "bat", "there" with "where", etc. Fewer words may be perceived than were actually said, as there can be problems detecting the gaps between words, creating the sense that someone is speaking unfamiliar or nonsense words. In addition, it is common for APD to cause speech errors involving the distortion and substitution of consonant sounds. Those with APD may have problems relating what has been said with its meaning, despite obvious recognition that a word has been said, as well as repetition of the word. Background noise, such as the sound of a radio, television or a noisy bar can make it difficult to impossible to understand speech, since spoken words may sound distorted either into irrelevant words or words that do not exist, depending on the severity of the auditory processing disorder. Using a telephone can be problematic for someone with auditory processing disorder, in comparison with someone with normal auditory processing, due to low quality audio, poor signal, intermittent sounds, and the chopping of words. Many who have auditory processing disorder subconsciously develop visual coping strategies, such as lip reading, reading body language, and eye contact, to compensate for their auditory deficit, and these coping strategies are not available when using a telephone.
As noted above, the status of APD as a distinct disorder has been queried, especially by speech-language pathologists and psychologists, who note the overlap between clinical profiles of children diagnosed with APD and those with other forms of specific learning disability. Many audiologists, however, would dispute that APD is just an alternative label for dyslexia, SLI, or ADHD, noting that although it often co-occurs with these conditions, it can be found in isolation.
Subcategories
Based on sensitized measures of auditory dysfunction and on psychological assessment, patients can be subdivided into seven subcategories:
middle ear dysfunction
mild cochlear pathology
central/medial olivocochlear efferent system (MOCS) auditory dysfunction
purely psychological problems
multiple auditory pathologies
combined auditory dysfunction and psychological problems
unknown
Different subgroups may represent different pathogenic and etiological factors. Thus, subcategorization provides further understanding of the basis of auditory processing disorder, and hence may guide the rehabilitative management of these patients. This was suggested by Professor Dafydd Stephens and F Zhao at the Welsh Hearing Institute, Cardiff University.
Treatment
Treatment of APD typically focuses on three primary areas: changing learning environment, developing higher-order skills to compensate for the disorder, and remediation of the auditory deficit itself. However, there is a lack of well-conducted evaluations of intervention using randomized controlled trial methodology. Most evidence for effectiveness adopts weaker standards of evidence, such as showing that performance improves after training. This does not control for possible influences of practice, maturation, or placebo effects. Recent research has shown that practice with basic auditory processing tasks (i.e. auditory training) may improve performance on auditory processing measures and phonemic awareness measures. Changes after auditory training have also been recorded at the physiological level. Many of these tasks are incorporated into computer-based auditory training programs such as Earobics and Fast ForWord, an adaptive software available at home and in clinics worldwide, but overall, evidence for effectiveness of these computerized interventions in improving language and literacy is not impressive. One small-scale uncontrolled study reported successful outcomes for children with APD using auditory training software.
Treating additional issues related to APD can result in success. For example, treatment for phonological disorders (difficulty in speech) can result in success in terms of both the phonological disorder as well as APD. In one study, speech therapy improved auditory evoked potentials (a measure of brain activity in the auditory portions of the brain).
While there is evidence that language training is effective for improving APD, there is no current research supporting the following APD treatments:
Auditory Integration Training typically involves a child attending two 30-minute sessions per day for ten days.
Lindamood-Bell Learning Processes (particularly, the Visualizing and Verbalizing program)
Physical activities that require frequent crossing of the midline (e.g., occupational therapy)
Sound Field Amplification
Neuro-Sensory Educational Therapy
Neurofeedback
The use of an individual FM transmitter/receiver system by teachers and students has nevertheless been shown to produce significant improvements with children over time.
History
Samuel J. Kopetzky first described the condition in 1948. P. F. King, first discussed the etiological factors behind it in 1954. Helmer Rudolph Myklebust's 1954 study, "Auditory Disorders in Children". suggested auditory processing disorder was separate from language learning difficulties. His work sparked interest in auditory deficits after acquired brain lesions affecting the temporal lobes and led to additional work looking at the physiological basis of auditory processing, but it was not until the late seventies and early eighties that research began on APD in depth.
In 1977, the first conference on the topic of APD was organized by Robert W. Keith, Ph.D. at the University of Cincinnati. The proceedings of that conference was published by Grune and Stratton under the title "Central Auditory Dysfunction" (Keith RW Ed.) That conference started a new series of studies focusing on APD in children. Virtually all tests currently used to diagnose APD originate from this work. These early researchers also invented many of the auditory training approaches, including interhemispheric transfer training and interaural intensity difference training. This period gave us a rough understanding of the causes and possible treatment options for APD.
Much of the work in the late nineties and 2000s has been looking to refining testing, developing more sophisticated treatment options, and looking for genetic risk factors for APD. Scientists have worked on improving behavioral tests of auditory function, neuroimaging, electroacoustic, and electrophysiologic testing. Working with new technology has led to a number of software programs for auditory training. With global awareness of mental disorders and increasing understanding of neuroscience, auditory processing is more in the public and academic consciousness than in years past.
See also
Amblyaudia
Auditory verbal agnosia
Cocktail party effect
Cortical deafness
Dafydd Stephens
Echoic memory
Hearing loss
Language processing
List of eponymous diseases
Music-specific disorders
Selective auditory attention
Selective mutism
Sensory processing disorders
Spatial hearing loss
References
External links
Auditory processing disorder: An overview for the clinician
American Speech-Language-Hearing Association (ASHA)
Neurological disorders
Audiology
Psychoacoustics
Hearing
Learning disabilities
Oral communication
Phonology
Speech processing
Special education
Communication disorders
Syndromes | 0.760295 | 0.99711 | 0.758098 |
Mobbing | Mobbing, as a sociological term, refers either to bullying in any context, or specifically to that within the workplace, especially when perpetrated by a group rather than an individual.
Psychological and health effects
Victims of workplace mobbing frequently suffer from: adjustment disorders, somatic symptoms, psychological trauma (e.g., trauma tremors or sudden onset selective mutism), post-traumatic stress disorder (PTSD), or major depression.
In mobbing targets with PTSD, Leymann notes that the "mental effects were fully comparable with PTSD from war or prison camp experiences." Some patients may develop alcoholism or other substance abuse disorders. Family relationships routinely suffer and victims sometimes display acts of aggression towards strangers in the street. Workplace targets and witnesses may even develop brief psychotic episodes , generally with paranoid symptoms. Leymann estimated that 15% of suicides in Sweden could be directly attributed to workplace mobbing.
Development of the concept
Konrad Lorenz, in his book entitled On Aggression (1966), first described mobbing among birds and other animals, attributing it to instincts rooted in the Darwinian struggle to thrive (see animal mobbing behavior). In his view, most humans are subject to similar innate impulses but capable of bringing them under rational control. Lorenz's explanation for his choice of the English word "mobbing" was omitted in the English translation by Marjorie Kerr Wilson. According to Kenneth Westhues, Lorenz chose the word "mobbing" because he remembered in the collective attack by birds, the old German term hassen auf, which means "to hate after" or "to put a hate on" was applied and this emphasised "the depth of antipathy with which the attack is made" rather than the English word 'mobbing' which emphasised the collective aspect of the attack. Westhues also noted that the application of the term for human bullying behaviour has been criticised by several academics.
In the 1970s, the Swedish physician applied Lorenz's conceptualization to the collective aggression of children against a targeted child. In the 1980s, professor and practising psychologist Heinz Leymann applied the term to ganging up in the workplace. In 2011, anthropologist Janice Harper suggested that some anti-bullying approaches effectively constitute a form of mobbing by using the label "bully" to dehumanize, encouraging people to shun and avoid people labeled bullies, and in some cases sabotage their work or refuse to work with them, while almost always calling for their exclusion and termination from employment.
Cause
Janice Harper followed her Huffington Post essay with a series of essays in both The Huffington Post and in her column "Beyond Bullying: Peacebuilding at Work, School and Home" in Psychology Today that argued that mobbing is a form of group aggression innate to primates, and that those who engage in mobbing are not necessarily "evil" or "psychopathic", but responding in a predictable and patterned manner when someone in a position of leadership or influence communicates to the group that someone must go. For that reason, she indicated that anyone can and will engage in mobbing, and that once mobbing gets underway, just as in the animal kingdom it will almost always continue and intensify as long as the target remains with the group. She subsequently published a book on the topic in which she explored animal behavior, organizational cultures and historical forms of group aggression, suggesting that mobbing is a form of group aggression on a continuum of structural violence with genocide as the most extreme form of mob aggression.
Online
Social networking sites and blogs have enabled anonymous groups to coordinate and attack other people. The victims of these groups can be targeted by various attacks and threats, sometimes causing the victims to use pseudonyms or go offline to avoid them.
In the workplace
British anti-bullying researchers Andrea Adams and Tim Field have used the expression "workplace bullying" instead of what Leymann called "mobbing" in a workplace context. They identify mobbing as a particular type of bullying that is not as apparent as most, defining it as "an emotional assault. It begins when an individual becomes the target of disrespectful and harmful behavior. Through innuendo, rumors, and public discrediting, a hostile environment is created in which one individual gathers others to willingly, or unwillingly, participate in continuous malevolent actions to force a person out of the workplace."
Adams and Field believe that mobbing is typically found in work environments that have poorly organised production or working methods and incapable or inattentive management and that mobbing victims are usually "exceptional individuals who demonstrated intelligence, competence, creativity, integrity, accomplishment and dedication".
In contrast, Janice Harper suggests that workplace mobbing is typically found in organizations where there is limited opportunity for employees to exit, whether through tenure systems or contracts that make it difficult to terminate an employee (such as universities or unionized organizations), and/or where finding comparable work in the same community makes it difficult for the employee to voluntarily leave (such as academic positions, religious institutions, or military). In these employments, efforts to eliminate the worker will intensify to push the worker out against his or her will through shunning, sabotage, false accusations and a series of investigations and poor reviews. Another form of employment where workers are mobbed are those that require the use of uniforms or other markers of group inclusion (law enforcement, fire fighting, military), organizations where a single gender has predominated, but another gender is beginning to enter (STEM fields, fire fighting, military, nursing, teaching, and construction). Finally, she suggests that organizations where there are limited opportunities for advancement can be prone to mobbing because those who do advance are more likely to view challenges to their leadership as threats to their precarious positions. Harper further challenges the idea that workers are targeted for their exceptional competence. In some cases, she suggests, exceptional workers are mobbed because they are viewed as threatening to someone, but some workers who are mobbed are not necessarily good workers. Rather, Harper contends, some mobbing targets are outcasts or unproductive workers who cannot easily be terminated, and are thus treated inhumanely to push them out. While Harper emphasizes the cruelty and damaging consequences of mobbing, her organizational analysis focuses on the structural, rather than moral, nature of the organization. Moreover, she views the behavior itself, which she terms workplace aggression, as grounded in group psychology, rather than individual psychosis—even when the mobbing is initiated due to a leader's personal psychosis, the dynamics of group aggression will transform the leader's bullying into group mobbing—two vastly distinct psychological and social phenomena.
Shallcross, Ramsay and Barker consider workplace "mobbing" to be a generally unfamiliar term in some English speaking countries. Some researchers claim that mobbing is simply another name for bullying. Workplace mobbing can be considered as a "virus" or a "cancer" that spreads throughout the workplace via gossip, rumour and unfounded accusations. It is a deliberate attempt to force a person out of their workplace by humiliation, general harassment, emotional abuse and/or terror. Mobbing can be described as being "ganged up on." Mobbing is executed by a leader (who can be a manager, a co-worker, or a subordinate). The leader then rallies others into a systematic and frequent "mob-like" behaviour toward the victim.
Mobbing as "downward bullying" by superiors is also known as "bossing", and "upward bullying" by colleagues as "staffing", in some European countries, for instance, in German-speaking regions.
At school
Following on from the work of Heinemann, Elliot identifies mobbing as a common phenomenon in the form of group bullying at school. It involves "ganging up" on someone using tactics of rumor, innuendo, discrediting, isolating, intimidating, and above all, making it look as if the targeted person is responsible (victim blaming). It is to be distinguished from normal conflicts (between pupils of similar standing and power), which are an integral part of everyday school life.
In academia
Kenneth Westhues' study of mobbing in academia found that vulnerability was increased by personal differences such as being a foreigner or of a different sex; by working in fields such as music or literature which have recently come under the sway of less objective and more post-modern scholarship; financial pressure; or having an aggressive superior. Other factors included envy, heresy and campus politics.
Checklists
Sociologists and authors have created checklists and other tools to identify mobbing behaviour. Common approaches to assessing mobbing behavior is through quantifying frequency of mobbing behavior based on a given definition of the behavior or through quantifying what respondents believe encompasses mobbing behavior. These are referred to as "self-labeling" and "behavior experience" methods respectively.
Limitations of some mobbing examination tools are:
Participant exhaustion due to examination length
Limited sample exposure resulting in limited result generalizability
Confounding with constructs that result in the same affect as mobbing but are not purposely harmful
Common Tools used to measure mobbing behavior are:
Leyman Inventory of Psychological Terror (LIPT)
Negative Acts Questionnaire-Revised (NAQ-R)
Luxembourg Workplace Mobbing Scale (LWMS)
Counteracting
From an organizational perspective, it has been suggested that mobbing behavior can be curtailed by acknowledging behaviors as mobbing behaviors and that such behaviors result in harm and/or negative consequences. Precise definitions of such traits are critical due to ambiguity of unacceptable and acceptable behaviors potentially leading to unintentional mobbing behavior. Attenuation of mobbing behavior can further be enhanced by developing policies that explicitly address specific behaviors that are culturally accepted to result in harm or negative affect. This provides a framework from which mobbing victims can respond to mobbing. Lack of such a framework may result in a situation where each instance of mobbing is treated on an individual basis with no recourse of prevention. It may also indicate that such behaviors are warranted and within the realm of acceptable behavior within an organization. Direct responses to grievances related to mobbing that are handled outside of a courtroom and training programs outlining antibully-countermeasures also demonstrate a reduction in mobbing behavior.
Persecutory delusions
See also
References
Further reading
Davenport NZ, Schwartz RD & Elliott GP Mobbing, Emotional Abuse in the American Workplace, 3rd Edition 2005, Civil Society Publishing. Ames, IA,
Shallcross L., Ramsay S. & Barker M. "Workplace Mobbing: Expulsion, Exclusion, and Transformation (2008) (blind peer reviewed) Australia and New Zealand Academy of Management Conference (ANZAM)
Westhues. Eliminating Professors: A Guide to the Dismissal Process. Lewiston, New York: Edwin Mellen Press.Westhues K The Envy of Excellence: Administrative Mobbing of High-Achieving Professors Lewiston, New York: Edwin Mellen Press.Westhues K "At the Mercy of the Mob" OHS Canada, Canada's Occupational Health & Safety Magazine (18:8), pp. 30–36.
Institute for education of works councils Germany – Information about Mobbing, Mediation and conflict resolution (German)
Zapf D. & Einarsen S. 2005 "Mobbing at Work: Escalated Conflicts in Organizations." Counterproductive Work Behavior: Investigations of Actors and Targets. Fox, Suzy & Spector, Paul E. Washington, DC: American Psychological Association. p. vii
Abuse
Aggression
Harassment and bullying
Interpersonal conflict
Injustice
Persecution
Group processes
Occupational health psychology
Stalking
1960s neologisms
Majority–minority relations | 0.761135 | 0.995962 | 0.758061 |
Atlas personality | The Atlas personality, named after the story of the Titan Atlas from Greek mythology who is forced to hold up the sky, is someone obliged to take on adult responsibilities prematurely. They are as a result liable to develop a pattern of compulsive caregiving in later life.
Origins and nature
The Atlas personality is typically found in a person who felt obliged during childhood to take on responsibilities such as providing psychological support to parents, often in a chaotic family situation. This experience often involves parentification.
The result in adult life can be a personality devoid of fun, and feeling the weight of the world on their shoulders. Depression and anxiety, as well as oversensitivity to others and an inability to assert their own needs, are further identifiable characteristics. In addition, there may also be an underlying rage against the parents for not having provided love, and for exploiting the child for their own needs.<ref>Alice Miller, 'The Drama of Being a Child (London 1990) p. 38</ref>
While Atlas personalities may appear to function adequately as adults, they may be pervaded with a sense of emptiness and be lacking in vitality.
Treatment
Persons suffering from Atlas personality may benefit from psychotherapy. In such cases, a therapist talks with the patient about the patient's childhood and helps identify behavioral patterns that may have arisen from being given too many responsibilities too early in life.
See also
References
Further reading
L. J. Cozolino, The Making of a Therapist'' (New York 2004)
Behavioural syndromes associated with physiological disturbances and physical factors
Interpersonal relationships
Narcissism
Borderline personality disorder
Atlas (mythology) | 0.768218 | 0.986779 | 0.758061 |
Mental disorders in fiction | Works of fiction dealing with mental illness include:
In children's books
The Tale of Samuel Whiskers or The Roly-Poly Pudding, 1908 children's book by Beatrix Potter. Tom Kitten comes out of his ordeal with a crippling phobia of rats, and possible posttraumatic stress disorder as well.
In young adult novels
Lisa, Bright and Dark, 1968 novel by John Neufeld. A story about a teenager's descent into madness.
Thirteen Reasons Why, 2007 novel by Jay Asher. About a teenage girl who is suffering from depression which results in suicide. Many other characters are also suffering from mental illnesses including bipolar, anxiety, PTSD, and also depression.
Saint Jude, 2011 novel by Dawn Wilson. Suffering from manic-depressive illness, Taylor spends her senior year of high school at a place called Saint Jude's—essentially a group home for teenagers with mental illnesses.
Freaks Like Us, 2012 young adult novel by Susan Vaught. The reader is taken on a suspenseful adventure through the mind of a schizophrenic teenage boy.
Forgive Me, Leonard Peacock, 2013 novel by Matthew Quick.
In mainstream literature
Ajax, – 430 BC; tragedy by Sophocles
Heracles, 416 BC tragedy by Euripides and Hercules Furens, c. AD 40–60 tragedy by Seneca the Younger, both of which cover Hera filling Hercules with a homicidal madness.
Orlando Furioso, 1516–1532; epic poem by Ludovico Ariosto, tells the story of Orlando, Charlemagne's most famous paladin, who goes mad upon learning that Angelica, the woman he is in love with, has run away with a Saracen knight. Filled with despair, Orlando travels through Europe and Africa destroying everything in his path. The English knight Astolfo flies up in a flaming chariot to the Moon, where everything lost on Earth is to be found, including Orlando's wits. He brings them back in a bottle and makes Orlando sniff them, thus restoring him to sanity. (At the same time Orlando falls out of love with Angelica, as the author explains that love is itself a form of insanity.)
Hamlet, circa 1600; tragedy by William Shakespeare
Don Quixote, 1605/1615 two-volume novel by Miguel de Cervantes, involves a man whose worldview is influenced by fictional works, especially of chivalric exploits. Because of his refusal to conform to social conventions, he is perceived as mad by his contemporaries, without further evidence of a mental defect or illness.
The Sorrows of Young Werther, 1774 epistolary novel by Johann Wolfgang von Goethe.
Faust I, 1808 tragedy by Goethe. The collision of a natural love-desire with her conscience and with the norms of the society around her evokes radical inner conflicts for the female hero Margarete.
Mandeville, 1817 novel by William Godwin. A tale of madness that takes place during the English Civil War.
The Bride of Lammermoor, 1819 historical novel by Sir Walter Scott. Lucy's mind snaps when she's made to jilt the man she loves and marry someone else.
Diary of a Madman, 1835 farcical short story by Nikolai Gogol.
Lenz, 1836 novella fragment by Georg Büchner depicting the unfolding of mental disorder with the German poet Jakob Michael Reinhold Lenz.
The Count of Monte Cristo: 1844 novel by Alexandre Dumas. One of the people who wronged Dantès goes mad from the latter's vengeance.
Jane Eyre, an 1847 novel by Charlotte Brontë.
Villette, an 1853 novel by Charlotte Brontë.
Aurelia (Aurélia ou le rêve et la vie), an 1855 autobiography (posthumously published) of insanity by Gérald de Nerval.
Madame Bovary, 1856 novel by Gustave Flaubert.
Hard Cash, 1863 novel by Charles Reade about the injustice and poor treatment of the insane and allegedly insane.
Crime and Punishment, 1866 novel by Fyodor Dostoevsky.
Strangers and Pilgrims, 1873 novel by Mary Elizabeth Braddon.
Strange Case of Dr Jekyll and Mr Hyde, 1886 novella by Robert Louis Stevenson.
Hunger (Sult in the original Norwegian), 1890 novel by Knut Hamsun depicting a man whose mind slowly turns to ruin through hunger.
The Picture of Dorian Gray, 1891 novel by Oscar Wilde, centering on a handsome, narcissistic young man enthralled by the "new" hedonism of the times.
Ward Number Six, 1892 short story by Anton Chekhov.
The Yellow Wallpaper, 1892 short story by Charlotte Perkins Gilman.
The Adventure of the Devil's Foot, 1910 mystery short story by Sir Arthur Conan Doyle. The fumes from burning the powder of a toxic plant with extreme fear-inducing properties destroy the minds of those who survive its effects—unless one gets away fast.
Remembrance of Things Past, 1913–1927 seven-volume novel by Marcel Proust.
Swann's Way, 1913 work by Marcel Proust.
Zeno's Conscience, 1923 novel by Italo Svevo. The main character is Zeno Cosini, and the book is the fictional character's memoirs that he keeps at the insistence of his psychiatrist. Zeno's Conscience is most notably influential for being one of the first modernist novels with a non-linear structure and told by an unreliable narrator.
Christina Alberta's Father, 1925 novel by H.G. Wells. The story tells how a retired laundryman suffered from delusions that he was the reincarnation of Sargon, King of Kings, returned to earth as Lord of the World.
The Shutter of Snow, 1930 novel by Emily Holmes Coleman. Portrays the post-partum psychosis of Marthe Gail, who after giving birth to her son, is committed to an insane asylum.
Flight into Darkness (German original: Flucht in die Finsternis), 1931 novella by Arthur Schnitzler.
Tender is the Night, 1934 novel by F. Scott Fitzgerald.
Private Worlds, 1934 novel by Phyllis Bottome. Tells the story of the staff and patients at a mental hospital in which a caring female psychiatrist and her colleague face discrimination by a conservative new supervisor.
The A.B.C. Murders, 1936 detective fiction novel by Agatha Christie that revolves around the nature of homicidal lunatics, to a surprising twist reveal.
The Outward Room, 1937 novel by Millen Brand. Details a young woman's recovery in a mental hospital during the Great Depression after she suffers a nervous breakdown following her brother's sudden death.
Appointment with Death, 1938 detective fiction novel by Agatha Christie. One of Mrs. Boynton's daughters has paranoid schizophrenia from her mother's tormenting of her.
And Then There Were None, 1939 detective fiction/psychological horror novel by Agatha Christie. As the ordeal drags on, the fewer and fewer who survive go insane under the prolonged strain.
The Royal Game (or Chess Story; Schachnovelle in the original German), 1942 novella by Stefan Zweig, depicting a monarchist who develops, and then cannot again shed, the custom to separate his psyche into two personas, having been urged to maintain his sanity by playing chess against himself in solitary confinement.
Earth Abides, 1949 post-apocalyptic science-fiction novel by George Stewart, deals with the human reactions to living when nearly everyone else died.
The Catcher in the Rye, 1951 novel by J. D. Salinger.
Lover, When You're Near Me, 1952 science fiction short story by Richard Matheson on a man being traumatically steered in his will by a woman of a dull extraterrestrial race who covets him sexually.
Dear Diary, 1954 science fiction short story by Richard Matheson. Diary entries from the years AD 1964, AD 3964, and LXIV (=64) all show the same dissatisfaction with the current situation and the same desire to live either some thousand years later or earlier, that from 3964 also due to the unpleasant inventions of another inhabitant of the writer's plastic skyscraper, which enable him to see her through the walls.
The Hobbit, The Two Towers, and The Return of the King; 1937, 1954, and 1955 high fantasy novels by J. R. R. Tolkien. The creature Gollum, a hobbit with Dissociative Identity Disorder, plays a major role. Also, a magical effect of treasure recently held by a dragon is that individuals susceptible to greed develop a form of greedy paranoia called the Dragon Sickness.
The Mind Thing, incomplete 1960 science fiction serialization, later published as a novel, by Fredric Brown. An extraterrestrial being has been sent to Earth as a punishment and tries to influence people's and animal's minds so that they would help it creating the technical means it needs to return home.
To Kill A Mockingbird, 1960 novel by Harper Lee.
Unearthly Neighbors, 1960 science fiction novel by Chad Oliver. The anthropology professor Monte Stewart and the linguist Charlie Jenike get angry at each other on a hot day, after having killed a member of a race between apes and men on a planet of Sirius together, in revenge for a deadly attack of the man's tribe onto their wives and a colleague. Jenike loses his mind and drowns himself in a nearby river shortly after.
One Flew Over the Cuckoo's Nest, 1962 novel by Ken Kesey about the treatment of mental illness.
Nilo, mi hijo, a 1963 play by Antonio González Caballero.
The Bell Jar, 1963 novel by Sylvia Plath, a fictionalised account of Plath's own struggles with depression.
Wide Sargasso Sea, a 1966 retelling of Jane Eyre by Jean Rhys.
Clans of the Alphane Moon, 1964 science-fiction novel by Philip K. Dick. Largely set on a world in which a lost group of former psychiatric patients have organised themselves into caste-like groups along psychiatric diagnostic lines, forming an unusual but functional society.
I Never Promised You a Rose Garden, 1964 autobiographical novel by Joanne Greenberg.
A Wrinkle in the Skin, 1965 post-apocalyptic science fiction novel by John Christopher. The hero and a boy meet a captain who has lost his mind, in his ship on the bottom of the English Channel that has fallen dry through an earthquake. They are welcomed heartily, but forbidden to take any food with them, when they leave.
The Bird of Paradise, 1967 work by R. D. Laing, often available with his non-fiction essay The Politics of Experience about schizophrenia and hallucinogenic drugs.
The Ethics of Madness, 1967 science fiction short story by Larry Niven.
Bedlam Planet, 1968 science fiction novel by John Brunner. A crew of astronauts tries to live on the animal and vegetable food growing on a planet of Sigma Draconis, which evokes mental disorder, but also sets free survival instincts that have so far been hidden.
The Sword, 1968 fantasy short story by Lloyd Alexander. A king yields to anger, with lethal results, in a moment of weakness. As he grows worse and worse, he also develops a severe case of paranoia, fearing assassination and other revenge plots around every corner.
Knots, 1970 work by R.D. Laing.
Diving into the Wreck, 1973 collection of poetry by Adrienne Rich.
Sybil, 1973 novel by Flora Rheta Schreiber.
Breakfast of Champions, 1973 novel by Kurt Vonnegut.
The Eden Express, 1975 memoir by Mark Vonnegut .
Ordinary People, 1976 novel by Judith Guest.
Woman on the Edge of Time, 1976 novel by Marge Piercy.
The Silmarillion, 1977 collection of myths by J. R. R. Tolkien. The account of the rise and fall of Númenor states that one of the kings, Tar-Atanamir, was "witless and unmanned" in his final years.
The Language of Goldfish, 1980 young adult novel by Zibby Oneal
Norwegian Wood, 1987 novel by Haruki Murakami
The Cat Who Went Underground, 1989 detective fiction novel by Lillian Jackson Braun
Doom Patrol, a comic book series originating in 1963. During Grant Morrison's 1989 – 1993 run it included the multiple personality affected Crazy Jane and several other characters either insane or in possession of greater truths.
American Psycho. 1991 novel by Bret Easton Ellis.
Heir to the Empire, Dark Force Rising, and The Last Command, 1991 trilogy of novels by Timothy Zahn. Joruus C'baoth, the clone of a tragic Jedi Master from the final years of the Old Republic, is insane due to his hyper-accelerated physical and mental development.
Mariel of Redwall, 1991 fantasy novel by Brian Jacques. Pirate warlord Gabool grows increasingly paranoid about possible threats to his power and develops delusions about a stolen bell.
Regeneration, 1991 novel by Pat Barker, based on the historical experiences of the poet Siegfried Sassoon, explores shell-shock and other traumatic illnesses following World War I.
Amnesia, 1992 novel by Douglas Anthony Cooper.
She's Come Undone, 1992 novel by Wally Lamb.
Girl, Interrupted, 1993 memoir by Susanna Kaysen.
Prozac Nation, 1994 memoir by Elizabeth Wurtzel.
Effie's Burning, 1995 play by Valerie Windsor.
Maskerade, 1995 comic fantasy/detective fiction novel by Sir Terry Pratchett.
Myst: The Book of Atrus, 1995 novel (re-released in a 2004 omnibus) by Rand and Robyn Miller with Dave Wingrove. Atrus comes to realize that his father is a megalomaniac.
Fight Club, 1996 novel by Chuck Palahniuk.
The Green Mile, 1996 serial novel by Stephen King.
Enduring Love, 1997 novel Ian McEwan.
Glimmer, 1997 novel by Annie Waters.
Glamorama. 1998 novel by Bret Easton Ellis.
I Know This Much Is True, 1998 novel by Wally Lamb.
Willow Weep for Me: A Black Woman's Journey Through Depression, 1998 memoir by Meri Nana-Ama Danquah.
Cut, 2000 novel by Patricia McCormick.
Borderline, 2000 novel by Marie-Sissi Labrèche.
La, 2002 novel by Marie-Sissi Labrèche.
Oxygen and The Fifth Man, 2001 and 2002 science fiction duology by Randall S. Ingermanson and John B. Olson. One of the astronauts on a Mars mission grows increasingly paranoid.
Harry Potter and the Order of the Phoenix, 2003 fantasy novel by J. K. Rowling, includes a scene with a couple who both have profound dementia resulting from prolonged magical torture.
The Unifying Force, 2003 science fiction novel by James Luceno.
The Curious Incident of the Dog in the Nighttime, 2003 novel by Mark Haddon.
The Good Patient: A Novel, 2004 novel by Kristin Waterfield Duisberg.
Set This House in Order, a 2004 novel by Matt Ruff. Revolving around a romance between two characters with multiple personalities.
Hello, Serotonin, 2004 work by Jon Paul Fiorentino.
High Rhulain, 2005 fantasy novel by Brian Jacques. Between his battle injuries and a traumatic bereavement, Long Patrol Major Cuthbert Blanedaale Frunk has developed Dissociative Identity Disorder.
Human Traces, 2005 novel by Sebastian Faulks. Two psychiatrists set in the late 19th and early 20th century.
Love Creeps, 2005 novel by Amanda Filipacchi. A comedic book about a love triangle who are stalking each other.
A Spot of Bother, 2006 novel by Mark Haddon, written from the point of view of a 57-year-old hypochondriac man who suffers from extreme panic attacks and also develops dementia
Darkness Descending, 2007 novel by Bethann Korsmit about a man who suffers a mental breakdown and various other mental problems, and the people who help him to overcome the obstacles in his life.
The Vegetarian, 2007 novel by Han Kang.
All in the Mind, 2008 novel by Alastair Campbell which draws on the author's experiences of depression and alcoholism
Atmospheric Disturbances, 2009 novel by Rivka Galchen. About a psychiatrist and one of his patients with a mental illness.
The Wilderness, 2009 novel by Samantha Harvey about Alzheimer's.
Radiant Daughter, 2010 novel by Patricia Grossman. A story that is about a Czech family with a daughter who is suffering from bipolar disorder.
Blepharospasm, 2011 novel by Harutyun Mackoushian. A story that focuses on a boy suffering from anxiety.
A Better Place, 2011 novel by Mark A. Roeder.
The Heart of Darkness, 2014 novel by Dominic Lyne. Through conversations with his therapist, he tries to make sense of the world around him and his inability to do so pulls him deeper into the depths of his delusions.
Challenger Deep, 2015 young adult novel by Neal Shusterman. The first half of the book leaves the audience questioning if the plot is real, but it ends up being about mental illnesses. From the point of view of somebody with a mental illness.
The Suicide of Claire Bishop, 2015 novel by Carmiel Banasky. Schizophrenia, Alzheimer's, and suicide are main topics.
Turtles All The Way Down, 2018 novel by John Green, which features a young woman navigating daily existence within the ever-tightening spiral of her own thoughts.
Everything Here Is Beautiful, 2018 novel by Mira T. Lee. An immigrant story, and a young woman's quest to find fulfillment and a life unconstrained by her illness.
Cleopatra in Space 2014-2020 graphic novel series by Mike Maihack. The protagonist, Cleopatra "Cleo" has a bit of ADHD and was written from the beginning as having "depressive disorder."
The Drowning Girl, 2012 novel by Caitlin R. Kiernan. The protagonist, a young woman afflicted with hereditary schizophrenia, becomes infatuated with the lone survivor of a suicide cult.
My Half-Sister's Half-Sister, 2021 novel by Samantha Henthorn. The protagonist accuses her family of practising witchcraft until it is revealed that she is psychotic and is admitted to a mental health ward.
Motion pictures
Many motion pictures portray mental illness in inaccurate ways, leading to misunderstanding and heightened stigmatization of the mentally ill. However, some movies are lauded for dispelling stereotypes and providing insight into mental illness. In a study by George Gerbner, it was determined that 5 percent of 'normal' television characters are murderers, while 20% of 'mentally-ill' characters are murderers. 40% of normal characters are violent, while 70% of mentally-ill characters are violent. Contrary to what is portrayed in films and television, Henry J. Steadman, Ph.D., and his colleagues at Policy Research Associates found that, overall, formal mental patients did not have a higher rate of violence than the control group of people who were not formal mental patients. In both groups, however, substance abuse was linked to a higher rate of violence. (Hockenbury and Hockenbury, 2004)
Psycho, a 1960 American film which features a man who exhibits multiple personality-disorder (includes several prequels or sequels or remakes)
Marnie, a 1964 American film which features a woman with obsessive fear and distrust
Oil Lamps, a 1971 film by Juraj Herz, based on the same named novel by Jaroslav Havlíček, describing the life of a vivacious girl and her matrimony with a sardonic man, who suffers from emerging paralytic dementia
Benny & Joon, a 1993 American film which features a woman with schizophrenia.
Memento, a 2000 psychological thriller film about a man with anterograde amnesia which renders his brain unable to store new memories.
A Beautiful Mind, a 2001 film which is a fictionalised account of a mathematician with schizophrenia, John Nash.
The Soloist, a 2009 film depicting the true story of Nathaniel Ayers, a musical prodigy who develops schizophrenia during his second year at Juilliard School, becomes homeless and plays a two stringed violin in the streets of Downtown Los Angeles.
Silver Linings Playbook, a 2012 film about a bipolar man and his relationship with a depressed young widow.
Television
Many popular television shows feature characters with a mental health condition. Often these portrayals are inaccurate and reinforce existing stereotypes, thereby increasing stigma associated with having a mental health condition. Common ways that television shows can generate misunderstanding and fear are by depicting people with these conditions as medically noncompliant, violent, and/or intellectually challenged. However, in recent years certain organizations have begun to advocate for accurate portrayals of mental health conditions in the media, and certain television shows have been applauded by mental health organizations for helping to dispel myths of these conditions.
One show, Wonderland, went on the air in 2000 and only lasted several episodes. It was largely critically acclaimed, but pressure from mental health advocates and people with mental health conditions, who felt that the show perpetuated stereotypes and contributed to the stigma attached to them, led to the show's cancellation.
The Scandinavian crime drama The Bridge features multiple examples of mental illness, most prominently including Münchausen syndrome by proxy.
In 2005, the shows Huff; Monk; Scrubs; and ER all won Voice Awards from the Substance Abuse and Mental Health Services Administration for their positive portrayal of people who manage mental health conditions. Neal Baer, executive producer of ER and Law & Order: Special Victims Unit also won a lifetime achievement award for his work in incorporating mental health issues into these two shows.
United States of Tara is a television show about dissociative identity disorder.
The Steven Universe franchise features characters with psychological trauma.
The animated Netflix series, Bojack Horseman dives into themes about depression, generalized anxiety, self-destructive behavior, post-traumatic stress disorder, narcissism and substance abuse
The Animated Netflix series, Arcane (TV series) presents the story of two sisters suffering from extreme trauma. Fans trust Jinx suffers from borderline personality disorder, PTSD and Schizophrenia, while Vi has extreme childhood trauma.
Video games
The game Silent Hill 2 of the same genres contains three major characters struggling with mental illness. Though their conditions are never named, two of these characters exhibit symptoms which, together with their backstories, may suggest acute dissociative amnesia; while the third character most definitively approximates body dysmorphic disorder. (The topic of dissociative amnesia is revisited in later installments of the series.) In addition, both this game and Silent Hill 3 mention various former patients of the now-abandoned town's local psychiatric hospital, with one said patient making an appearance in the latter game.
Life is Strange deals with depression, suicide most notably, as the main character Max tries to prevent the suicide of one of her friends. One of the characters exhibits concerning behaviors and is prescribed medicines most often associated with bipolar and schizophrenia. It is implied he is seeing a psychiatrist.
Danganronpa: Trigger Happy Havoc deals with a side character named Toko Fukawa who suffers from DID. Her first identity being a well-known writer. Her second identity was a serial killer. The next character who has a canon mental illness is Nagito Komaeda, a loved character from Danganronpa 2: Goodbye Despair who suffers from lymphoma in stage 3 and has Frontotemporal dementia.
Final Fantasy VII implies numerous times that the main character, Cloud Strife, has some form of schizophrenia or schizoaffective disorder as well as post-traumatic stress disorder.
In Pokémon Sword and Shield, Chairman Rose is shown to have a severe idée fixe about a far-off energy crisis.
Myst III: Exile features a character named Saavedro, full of despair and a justified grievance, who has been trapped alone for twenty years, certain that all his people are dead. In his journal he writes of a mental fog that he can lose himself in from time to time (he suspects for months sometimes), when he "can barely remember what I've done". He describes this fog as eating his mind and writes that he sometimes struggles to bring memories back to the surface.
See also
List of mental disorders in film
Notes
Literary motifs | 0.775317 | 0.977711 | 0.758036 |
Mentalization-based treatment | Mentalization-based treatment (MBT) is an integrative form of psychotherapy, bringing together aspects of psychodynamic, cognitive-behavioral, systemic and ecological approaches. MBT was developed and manualised by Peter Fonagy and Anthony Bateman, designed for individuals with borderline personality disorder (BPD). Some of these individuals suffer from disorganized attachment and failed to develop a robust mentalization capacity. Fonagy and Bateman define mentalization as the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. An alternative and simpler definition is "Seeing others from the inside and ourselves from the outside." The object of treatment is that patients with BPD increase their mentalization capacity, which should improve affect regulation, thereby reducing suicidality and self-harm, as well as strengthening interpersonal relationships.
More recently, a range of mentalization-based treatments, using the "mentalizing stance" defined in MBT but directed at children (MBT-C), families (MBT-F) and adolescents (MBT-A), and for chaotic multi-problem youth, AMBIT (adaptive mentalization-based integrative treatment) has been under development by groups mainly gravitating around the Anna Freud National Centre for Children and Families. Moreover, the MBT model has been used in treating patients with eating disorders (MBT-ED)
The treatment should be distinguished from and has no connection with mindfulness-based stress reduction (MBSR) therapy developed by Jon Kabat-Zinn.
Goals
The major goals of MBT are:
better behavioral control
increased affect regulation
more intimate and gratifying relationships
the ability to pursue life goals
This is believed to be accomplished through increasing the patient's capacity for mentalization in order to stabilize the client's sense of self and to enhance stability in emotions and relationships.
Focus of treatment
A distinctive feature of MBT is placing the enhancement of mentalizing itself as focus of treatment. The aim of therapy is not developing insight, but the recovery of mentalizing. Therapy examines mainly the present moment, attending to events of the past only insofar as they affect the individual in the present. Other core aspects of treatment include a stance of curiosity, partnership with the patient rather than an 'expert' type role, monitoring and regulating emotional arousal, and identifying the affect focus. Transference is not included in the MBT model. MBT does encourage consideration of the patient-therapist relationship, but without necessarily generalizing to other relationships, past or present.
Treatment procedure
MBT should be offered to patients twice per week with sessions alternating between group therapy and individual treatment. During sessions the therapist works to stimulate or nurture mentalizing. Particular techniques are employed to lower or raise emotional arousal as needed, to interrupt non-mentalizing and to foster flexibility in perspective-taking. Activation occurs through the elaboration of current attachment relationships, the therapist's encouragement and regulation of the patient's attachment bond with the therapist and the therapist's attempts to create attachment bonds between members of the therapy group.
Mechanisms of change
The safe attachment relationship with the therapist provides a relational context in which it is safe for the patient to explore the mind of the other. Fonagy and Bateman have recently proposed that MBT (and other evidence-based therapies) works by providing ostensive cues that stimulate epistemic trust. The increase in epistemic trust, together with a persistent focus on mentalizing in therapy, appear to facilitate change by leaving people more open to learning outside of therapy, in the social interactions of their day-to-day lives.
Efficacy
Fonagy, Bateman, and colleagues have done extensive outcome research on MBT for borderline personality disorder. The first randomized, controlled trial was published in 1999, concerning MBT delivered in a partial hospital setting. The results showed real-world clinical effectiveness that compared favorably with existing treatments for BPD. A follow-up study published in 2003 demonstrated that MBT is cost-effective. Encouraging results were also found in an 18-month study, in which subjects were randomly assigned to an outpatient MBT treatment condition versus a structured clinical management (SCM) treatment. The lasting efficacy of MBT was demonstrated in an 8-year follow-up of patients from the original trial, comparing MBT versus treatment as usual. In that research, patients who had received MBT had less medication use, fewer hospitalizations and longer periods of employment compared to patients who received standard care. Replication studies have been published by other European investigators. Researchers have also demonstrated the effectiveness of MBT for adolescents as well as that of a group-only format of MBT.
References
Further reading
Allen, J.G., Fonagy, P. (2006). Handbook of mentalization-based treatment. Chichester, UK: John Wiley. .
Allen, J.G., Fonagy, P., Bateman, A.W. (2008) Mentalizing in clinical practice. Arlington, USA: American Psychiatric Publishing. .
Psychodynamics
Psychotherapy by type
Mindfulness (psychology)
Borderline personality disorder | 0.770729 | 0.983509 | 0.758019 |
Ego psychology | Ego psychology is a school of psychoanalysis rooted in Sigmund Freud's structural id-ego-superego model of the mind.
An individual interacts with the external world as well as responds to internal forces. Many psychoanalysts use a theoretical construct called the ego to explain how that is done through various ego functions. Adherents of ego psychology focus on the ego's normal and pathological development, its management of libidinal and aggressive impulses, and its adaptation to reality.
History
Early conceptions of the ego
Sigmund Freud initially considered the ego to be a sense organ for perception of both external and internal stimuli. He thought of the ego as synonymous with consciousness and contrasted it with the repressed unconscious. In 1910, Freud emphasized the attention to detail when referencing psychoanalytical matters, while predicting his theory to become essential in regards to everyday tasks with the Swiss psychoanalyst, Oscar Pfister. By 1911, he referenced ego instincts for the first time in Formulations on the Two Principles of Mental Functioning and contrasted them with sexual instincts: ego instincts responded to the reality principle while sexual instincts obeyed the pleasure principle. He also introduced attention and memory as ego functions.
Freud's ego psychology
Freud later argued that not all unconscious phenomena can be attributed to the id, and that the ego has unconscious aspects as well. This posed a significant problem for his topographic theory, which he resolved in The Ego and the Id (1923).
In what came to be called the structural theory, the ego was now a formal component of a three-way system that also included the id and superego. The ego was still organized around conscious perceptual capacities, yet it now had unconscious features responsible for repression and other defensive operations. Freud's ego at this stage was relatively passive and weak; he described it as the helpless rider on the id's horse, more or less obliged to go where the id wished to go.
In Inhibitions, Symptoms, and Anxiety (1926), Freud revised his theory of anxiety as well as delineated a more robust ego. Freud argued that instinctual drives (id), moral and value judgments (superego), and requirements of external reality all make demands upon an individual. The ego mediates among conflicting pressures and creates the best compromise. Instead of being passive and reactive to the id, the ego was now a formidable counterweight to it, responsible for regulating id impulses, as well as integrating an individual's functioning into a coherent whole. The modifications made by Freud in Inhibitions, Symptoms, and Anxiety formed the basis of a psychoanalytic psychology interested in the nature and functions of the ego. This marked the transition of psychoanalysis from being primarily an id psychology, focused on the vicissitudes of the libidinal and aggressive drives as the determinants of both normal and psychopathological functioning, to a period in which the ego was accorded equal importance and was regarded as the prime shaper and modulator of behavior.
Systematization
Following Sigmund Freud, the psychoanalysts most responsible for the development of ego psychology, and its systematization as a formal school of psychoanalytic thought, were Anna Freud, Heinz Hartmann, and David Rapaport. Other important contributors included Ernst Kris, Rudolph Loewenstein, René Spitz, Margaret Mahler, Edith Jacobson, Paul Federn, and Erik Erikson.
Anna Freud
Anna Freud focused her attention on the ego's unconscious, defensive operations and introduced many important theoretical and clinical considerations. In The Ego and the Mechanisms of Defense (1936), Anna Freud argued the ego was predisposed to supervise, regulate, and oppose the id through a variety of defenses. She described the defenses available to the ego, linked them to the stages of psychosexual development during which they originated, and identified various psychopathological compromise formations in which they were prominent. Clinically, Anna Freud emphasized that the psychoanalyst's attention should always be on the defensive functions of the ego, which could be observed in the manifest presentation of the patient's associations. The analyst needed to be attuned to the moment-by-moment process of what the patient talked about in order to identify, label, and explore defenses as they appeared. For Anna Freud, direct interpretation of repressed content was less important than understanding the ego's methods by which it kept things out of consciousness. Her work provided a bridge between Freud's structural theory and ego psychology.
Heinz Hartmann
Heinz Hartmann (1939/1958) believed the ego included innate capacities that facilitated an individual's ability to adapt to his or her environment. These included perception, attention, memory, concentration, motor coordination, and language. Under normal conditions, which Hartmann called "an average expectable environment," these capacities developed into ego functions with autonomy from the libidinal and aggressive drives; that is, they were not products of frustration and conflict as Freud (1911) believed. Hartmann recognized, however, that conflicts were part of the human condition and that certain ego functions may become conflicted by aggressive and libidinal impulses, as witnessed by conversion disorders (e.g., glove paralysis), speech impediments, eating disorders, and attention-deficit disorder.
A focus on ego functions and how an individual adapts to his or her environment led Hartmann to create both a general psychology and a clinical instrument with which an analyst could evaluate an individual's functioning and formulate appropriate therapeutic interventions. Hartmann's propositions imply that the task of the ego psychologist was to neutralize conflicted impulses and expand the conflict-free spheres of ego functions. Through such effects, Hartmann believed, psychoanalysis facilitated an individual's adaptation to his or her environment. He claimed, however, that his aim was to understand the mutual regulation of the ego and environment rather than to promote adjustment of the ego to the environment; additionally, he proposed that diminishing conflict in an individual's ego would help him or her to respond actively to, and shape rather than passively react to, the environment.
Mitchell and Black (1995) wrote: "Hartmann powerfully affected the course of psychoanalysis, opening up a crucial investigation of the key processes and vicissitudes of normal development. Hartmann's contributions broadened the scope of psychoanalytic concerns, from psychopathology to general human development, and from an isolated, self-contained treatment method to a sweeping intellectual discipline among other disciplines" (p. 35).
David Rapaport
David Rapaport played a prominent role in the development of ego psychology, and his work likely represented its apex.
In the influential monograph The Structure of Psychoanalytic Theory (1960), Rappaport organized ego psychology into an integrated, systematic, and hierarchical theory capable of generating empirically testable hypotheses. He proposed that psychoanalytic theory—as expressed through the principles of ego psychology—was a biologically based general psychology that could explain the entire range of human behavior. For Rapaport, this endeavor was fully consistent with Freud's attempts to do the same (e.g., Freud's studies of dreams, jokes, and the "psychopathology of everyday life".)
Other contributors
While Hartmann was the principal architect of ego psychology, he collaborated closely with Ernst Kris and Rudolph Loewenstein.
Subsequent psychoanalysts interested in ego psychology emphasized the importance of early-childhood experiences and socio-cultural influences on ego development. René Spitz (1965), Margaret Mahler (1968), Edith Jacobson (1964), and Erik Erikson studied infant and child behavior, and their observations were integrated into ego psychology. Their observational and empirical research described and explained early attachment issues, successful and faulty ego development, and psychological development through interpersonal interactions.
Spitz identified the importance of mother-infant nonverbal emotional reciprocity; Mahler refined the traditional psychosexual developmental phases by adding the separation-individuation process; and Jacobson emphasized how libidinal and aggressive impulses unfolded within the context of early relationships and environmental factors. Finally, Erik Erikson provided a bold reformulation of Freud's biologic, epigenetic psychosexual theory through his explorations of socio-cultural influences on ego development. For Erikson, an individual was pushed by his or her own biological urges and pulled by socio-cultural forces.
Decline
In the United States, ego psychology was the predominant psychoanalytic approach from the 1940s through the 1960s. Initially, this was due to the influx of European psychoanalysts, including prominent ego psychologists like Hartmann, Kris, and Loewenstein, during and after World War II. These European analysts settled throughout the United States and trained the next generation of American psychoanalysts.
By the 1970s, several challenges to the philosophical, theoretical, and clinical tenets of ego psychology emerged. The most prominent of which were: a "rebellion" led by Rapaport's protégés (George Klein, Robert Holt, Roy Schafer, and Merton Gill); object relations theory; and self psychology.
Contemporary
Modern conflict theory
Charles Brenner (1982) attempted to revive ego psychology with a concise and incisive articulation of the fundamental focus of psychoanalysis: intrapsychic conflict and the resulting compromise formations. Over time, Brenner (2002) tried to develop a more clinically based theory, what came to be called “modern conflict theory.” He distanced himself from the formal components of the structural theory and its metapsychological assumptions, and focused entirely on compromise formations.
Heinz Kohut developed self psychology, a theoretical and therapeutic model related to ego psychology, in the late 1960s. Self psychology focuses on the mental model of the self as important in pathologies.
Ego functions
Reality testing: The ego's capacity to distinguish what is occurring in one's own mind from what is occurring in the external world. It is perhaps the single most important ego function because negotiating with the outside world requires accurately perceiving and understanding stimuli. Reality testing is often subject to temporary, mild distortion or deterioration under stressful conditions. Such impairment can result in temporary delusions and hallucination and is generally selective, clustering along specific, psychodynamic lines. Chronic deficiencies suggest either psychotic or organic interference.
Impulse control: The ability to manage aggressive and/or libidinal wishes without immediate discharge through behavior or symptoms. Problems with impulse control are common; for example: road rage; sexual promiscuity; excessive drug and alcohol use; and binge eating.
Affect regulation: The ability to modulate feelings without being overwhelmed.
Judgment: The capacity to act responsibly. This process includes identifying possible courses of action, anticipating and evaluating likely consequences, and making decisions as to what is appropriate in certain circumstances.
Object relations: The capacity for mutually satisfying relationship. The individual can perceive himself and others as whole objects with three dimensional qualities.
Thought processes: The ability to have logical, coherent, and abstract thoughts. In stressful situations, thought processes can become disorganized. The presence of chronic or severe problems in conceptual thinking is frequently associated with schizophrenia and manic episodes.
Defensive functioning: A defense is an unconscious attempt to protect the individual from some powerful, identity-threatening feeling. Initial defenses develop in infancy and involve the boundary between the self and the outer world; they are considered primitive defenses and include projection, denial, and splitting. As the child grows up, more sophisticated defenses that deal with internal boundaries such as those between ego and super ego or the id develop; these defenses include repression, regression, displacement, and reaction formation. All adults have, and use, primitive defenses, but most people also have more mature ways of coping with reality and anxiety.
Synthesis: The synthetic function is the ego's capacity to organize and unify other functions within the personality. It enables the individual to think, feel, and act in a coherent manner. It includes the capacity to integrate potentially contradictory experiences, ideas, and feelings; for example, a child loves his or her mother yet also has angry feelings toward her at times. The ability to synthesize these feelings is a pivotal developmental achievement.
Reality testing involves the individual's capacity to understand and accept both physical and social reality as it is consensually defined within a given culture or cultural subgroup. In large measure, the function hinges on the individual's capacity to distinguish between her own wishes or fears (internal reality) and events that occur in the real world (external reality). The ability to make distinctions that are consensually validated determines the ego's capacity to distinguish and mediate between personal expectations, on the one hand, and social expectations or laws of nature on the other. Individuals vary considerably in how they manage this function. When the function is seriously compromised, individuals may withdraw from contact with reality for extended periods of time. This degree of withdrawal is most frequently seen in psychotic conditions. Most times, however, the function is mildly or moderately compromised for a limited period of time, with far less drastic consequences' (Berzoff, 2011).
Judgment involves the capacity to reach “reasonable” conclusions about what is and what is not “appropriate” behavior. Typically, arriving at a “reasonable” conclusion involves the following steps: (1) correlating wishes, feeling states, and memories about prior life experiences with current circumstances; (2) evaluating current circumstances in the context of social expectations and laws of nature (e.g., it is not possible to transport oneself instantly out of an embarrassing situation, no matter how much one wishes to do so); and (3) drawing realistic conclusions about the likely consequences of different possible courses of action. As the definition suggests, judgment is closely related to reality testing, and the two functions are usually evaluated in tandem (Berzoff, 2011).
Modulating and controlling impulses is based on the capacity to hold sexual and aggressive feelings in check without acting on them until the ego has evaluated whether they meet the individual's own moral standards and are acceptable in terms of social norms. Adequate functioning in this area depends on the individual's capacity to tolerate frustration, to delay gratification, and to tolerate anxiety without immediately acting to ameliorate it. Impulse control also depends on the ability to exercise appropriate judgment in situations where the individual is strongly motivated to seek relief from psychological tension and/or to pursue some pleasurable activity (sex, power, fame, money, etc.). Problems in modulation may involve either too little or too much control over impulses (Berzoff, 2011).
Modulation of affect The ego performs this function by preventing painful or unacceptable emotional reactions from entering conscious awareness, or by managing the expression of such feelings in ways that do not disrupt either emotional equilibrium or social relationships. To adequately perform this function, the ego constantly monitors the source, intensity, and direction of feeling states, as well as the people toward whom feelings will be directed. Monitoring determines whether such states will be acknowledged or expressed and, if so, in what form. The basic principle to remember in evaluating how well the ego manages this function is that affect modulation may be problematic because of too much or too little expression.
As an integral part of the monitoring process, the ego evaluates the type of expression that is most congruent with established social norms. For example, in white American culture it is assumed that individuals will contain themselves and maintain a high level of personal/vocational functioning except in extremely traumatic situations such as death of a family member, very serious illness or terrible accident. This standard is not necessarily the norm in other cultures (Berzhoff, Flanagan, & Hertz, 2011).
Object relations involves the ability to form and maintain coherent representations of others and of the self. The concept refers not only to the people one interacts with in the external world but also to significant others who are remembered and represented within the mind. Adequate functioning implies the ability to maintain a basically positive view of the other, even when one feels disappointed, frustrated, or angered by the other's behavior. Disturbances in object relations may manifest themselves through an inability to fall in love, emotional coldness, lack of interest in or withdrawal from interactions with others, intense dependency, and/or an excessive need to control relationships (Berzhoff, Flanagan, & Hertz, 2011).
Self-esteem regulation involves the capacity to maintain a steady and reasonable level of positive self-regard in the face of distressing or frustrating external events. Painful affective states, including anxiety, depression, shame, and guilt, as well as exhilarating emotions such as triumph, glee, and ecstasy may also undermine self-esteem. Generally speaking, in dominant American culture a measured expression of both pain and pleasure is expressed; excess in either direction is a cause for concern. White Western culture tends to assume that individuals will maintain a consistent and steadily level of self-esteem, regardless of external events or internally generated feeling states (Berzhoff, Flanagan, & Hertz, 2011).
Mastery when conceptualized as an ego function, mastery reflects the epigenetic view that individuals achieve more advanced levels of ego organization by mastering successive developmental challenges. Each stage of psychosexual development (oral, anal, phallic, genital) presents a particular challenge that must be adequately addressed before the individual can move on to the next higher stage. By mastering stage-specific challenges, the ego gains strength in relations to the other structures of the mind and thereby becomes more effective in organizing and synthesizing mental processes. Freud expressed this principle in his statement, “Where id was, shall ego be.” An undeveloped capacity for mastery can be seen, for example, in infants who have not been adequately nourished, stimulated, and protected during the first year of life, in the oral stage of development. When they enter the anal stage, such infants are not well prepared to learn socially acceptable behavior or to control the pleasure they derive from defecating at will. As a result, some of them will experience delays in achieving bowel control and will have difficulty in controlling temper tantrums, while others will sink into a passive, joyless compliance with parental demands that compromises their ability to explore, learn, and become physically competent. Conversely, infants who have been well gratified and adequately stimulated during the oral stage enter the anal stage feeling relatively secure and confident. For the most part, they cooperate in curbing their anal desires, and are eager to win parental approval for doing so. In addition, they are physically active, free to learn and eager to explore. As they gain confidence in their increasingly autonomous physical and mental abilities, they also learn to follow the rules their parents establish and, in doing so, with parental approval. As they master the specific tasks related to the anal stage, they are well prepared to move on to the next stage of development and the next set of challenges. When adults have problems with mastery, they usually enact them in derivative or symbolic ways (Berzhoff, Flanagan, & Hertz, 2011).
Conflict, defense and resistance analysis
According to Freud's structural theory, an individual's libidinal and aggressive impulses are continuously in conflict with his or her own conscience as well as with the limits imposed by reality. In certain circumstances, these conflicts may lead to neurotic symptoms. Thus, the goal of psychoanalytic treatment is to establish a balance between bodily needs, psychological wants, one's own conscience, and social constraints. Ego psychologists argue that the conflict is best addressed by the psychological agency that has the closest relationship to consciousness, unconsciousness, and reality: the ego.
The clinical technique most commonly associated with ego psychology is defense analysis. Through clarifying, confronting, and interpreting the typical defense mechanisms a patient uses, ego psychologists hope to help the patient gain control over these mechanisms.
Cultural influences
The classical scholar E. R. Dodds used ego psychology as the framework for his influential study The Greeks and the Irrational (1951).
The Sterbas relied on Hartmann's conflict-free sphere to help explain the contradictions they found in Beethoven's character in Beethoven and His Nephew (1954).
Criticisms
Many authors have criticized Hartmann's conception of a conflict-free sphere of ego functioning as both incoherent and inconsistent with Freud's vision of psychoanalysis as a science of mental conflict. Freud believed that the ego itself takes shape as a result of the conflict between the id and the external world. The ego, therefore, is inherently a conflicting formation in the mind. To state, as Hartmann did, that the ego contains a conflict-free sphere may not be consistent with key propositions of Freud's structural theory.
Ego psychology, and 'Anna-Freudianism', were together seen by Kleinians as maintaining a conformist, adaptative version of psychoanalysis inconsistent with Freud's own views. Hartmann claimed, however, that his aim was to understand the mutual regulation of the ego and environment rather than to promote adjustment of the ego to the environment. Furthermore, an individual with a less-conflicted ego would be better able to actively respond and shape, rather than passively react to, his or her environment.
Jacques Lacan was if anything still more opposed to ego psychology, using his concept of the Imaginary to stress the role of identifications in building up the ego in the first place. Lacan saw in the "non-conflictual sphere...a down-at-heel mirage that had already been rejected as untenable by the most academic psychology of introspection'.
See also
Notes
References
Further reading
Brenner, C. (1982). The mind in conflict. New York: International Universities Press, Inc.
Freud, A. (1966). The ego and the mechanisms of defense. Revised edition. New York: International Universities Press, Inc. (First edition published in 1936.)
Freud, S. (1911). Formulations on the two principles of mental functioning. Standard Edition, vol. 12, pp. 213–226.
Freud, S. (1923). The ego and the id. Standard Edition, vol. 19, pp. 1–59.
Freud, S. (1926). Inhibitions, symptoms, and anxieties. Standard Edition, vol. 20, pp. 75–174.
Hartmann, H. (1939/1958). Ego psychology and the problem of adaptation. Trans., David Rapaport. New York: International Universities Press, Inc. (First edition published in 1939.)
Jacobson, E. (1964). The self and the object world. New York: International Universities Press, Inc.
Mahler, M. (1968). On human symbiosis and the vicissitudes of individuation. New York: International Universities Press, Inc.
Mitchell, S.A. & Black, M.J. (1995). Freud and beyond: A history of modern psychoanalytic thought. New York: Basic Books.
Spitz, R. (1965). The first year of life. New York: International Universities Press.
Personality theories
Neopsychoanalytic schools | 0.764034 | 0.992124 | 0.758017 |
Caffeine-induced psychosis | Caffeine-induced psychosis is a relatively rare phenomenon that can occur in otherwise healthy people. Overuse of caffeine may also worsen psychosis in people suffering from schizophrenia. It is characterized by psychotic symptoms such as delusions, paranoia, and hallucinations. This can happen with ingestion of high doses of caffeine, or when caffeine is chronically abused, but the actual evidence is currently limited.
Understanding psychosis
Psychosis is a symptom of psychotic disorders like schizophrenia and severe mood disorders like depression or bipolar disorder. Simply put, psychosis affects the human brain in ways that alter the person's ability to perceive reality. During a psychotic episode, a person may misinterpret and struggle to understand their own thoughts, and additionally "they may have difficulty recognizing what is real and what is not." In order to spot an individual who could be experiencing Psychosis, look for these symptoms:
Schizophrenia: A type of psychotic disorder that impacts how a person experiences reality. Schizophrenia interferes with a person's abilities of cognition, behavior, and emotions. Symptoms of schizophrenia include:
Hallucinations- The ability to see or hear something that is not occurring in reality, though to someone with schizophrenia these experiences feel real because it has the "full force and impact of a normal experience." Most hallucinations that come from schizophrenia consist of hearing things that aren't said, or imagining voices.
Delusions- Imagining an event that has falsely occurred or believing something that has not occurred/ is not based in reality.
Disorganized thinking and speech- The incapacity to form coherent thoughts, leading to disorganized speech. Disorganized speech is recognized as words put together that do not relate to each other or combine to make any sense logically. Speech in which words are put together meaninglessly in a way that is not able to be understood is commonly referred to as word salad. Disorganized thinking is a common symptom of schizophrenia.
Negative Symptoms- The inability to function normally which may include a lack of interest in activities the person has once enjoyed before, experiencing emotions, or participating in normal human routines such as personal hygiene.
Bipolar disorder: A type of mood disorder that is typically known for its extreme mood swings and inconsistent behavior patterns. Symptoms of bipolar disorder include:
Mania- A main characteristic of bipolar disorder that occurs after a period of severe depression. During this time the person will likely experience: high amounts of energy and happiness, as well as a deep sense of self importance, feeling extremely impulsive/indecisive, making decisions that are potentially risky/harmful, becoming distracted easily, falling into delusions, or thinking illogically.
Depression- Another main characteristic of bipolar disorder that occurs before a period of mania. Symptoms of depression include: feeling amounts of deep sadness or irritability, lacking enough energy to function in routine activities, losing interest in activities one has previously enjoyed, suicidal thoughts, an overwhelming sense of worthlessness, difficulty remembering events or focusing, lack of appetite, and illogical thinking.
Patterns of mania and depression- Episodes of depression that follow mania or vice versa. During periods of mania and depression, one may actually experience a "normal" mood. Some people can experience:
Rapid Cycling: "where a person with bipolar disorder repeatedly swings from a high to a low phase quickly."
Mixed State: "where a person with bipolar disorder experiences symptoms of depression and mania together; for example, overactivity with a depressed mood."
General Depression: Also known as major depressive disorder, is a type of mood disorder that negatively impacts a person's mood and ability to function in daily activities.
If a person has any one of these symptoms, they are most likely prone to experience Psychosis.
Caffeine use & its risks
Consuming excessive amounts of caffeine and combining this with psychotic and mood disorders can impact the severity of the disorders, but excessive consumption can severely affect people who are schizophrenic. 85% of the population of the United States ingests caffeine in some form every day. The most common ways people ingest caffeine is through freshly brewed coffee, instant coffee, tea, soda, and chocolate.
Average caffeine levels are:
Brewed coffee- 100 mg/6 oz serving
Instant coffee- 65 mg
Tea- 40 mg
Soda- 35 mg
Chocolate- 5 mg
A majority of the population ingests roughly 210 mg of caffeine every day, while people who have higher tolerances/consume more excessive amounts ingest more than 500 mg of caffeine daily.
80% of people with schizophrenia smoke daily and are heavy smokers. Smoking tends to deplete much of ingested caffeine, so the majority of users with schizophrenia have to consume much more caffeine than others to regulate their caffeine levels.
Many people with schizophrenia use caffeine to combat boredom or to fight the sedating effects of antipsychotic medications. Additionally people with schizophrenia may have polydipsia (causes someone to feel an immense amount of thirst, despite already drinking plenty of hydrating fluids), so people with this disorder may try to consume more caffeine than normal. A lot of antipsychotic medications contain ingredients that make the mouth more prone to dryness, which would also increase the amount of coffee (containing caffeine) one may uptake.
"Caffeine use can cause restlessness, nervousness, insomnia, rambling speech, and agitation" worsening the symptoms of schizophrenia. "Caffeine is metabolized by the CYP1A2 enzyme and also acts as a competitive inhibitor of this enzyme. Thus, caffeine can interact with a wide range of psychiatric medications, including antidepressant agents, antipsychotic agents, antimanic agents, antianxiety agents, and sedative agents." So when caffeine interacts with these specific medications, it can complicate the side effects of the disorder and possibly the medication. To lessen the side effects, people with schizophrenia should consume lower amounts of caffeine.
A consumption of less than 250 mg of caffeine a day has been seen to give better results in better performances on cognitive tasks in people with schizophrenia. Although, more research still needs to be done to determine if the same amount of caffeine that is safe to consume by schizophrenics (> 250 mg/a day) matches up with the general population of people without schizophrenia.
Treatment & prevention
Chronic caffeine-induced psychosis has been reported in a 47-year-old man with high caffeine intake. The psychosis resolved within seven weeks after lowering caffeine intake, without the use of anti-psychotic medication.
For schizophrenic people that have an addiction to caffeine, the best way to treat caffeine-induced psychosis is to gradually consume smaller amounts of it over a period of time. Withdrawal to certain drugs may worsen side effects of any psychotic or mood disorders, so it is best for people that have an addiction to slowly drop their levels of caffeine over time instead of completely restricting their consumption of caffeine.
For people who consume excessive amounts of caffeine and don't already have a psychotic disorder, a doctor may prescribe antipsychotics to help stop the effects of psychosis. For people with a psychotic disorder, it is best to slowly limit caffeine intake and continue taking antipsychotics.
References
Caffeine
Psychosis
Schizophrenia | 0.77149 | 0.98249 | 0.757982 |
Introjection | In psychology, introjection (also known as identification or internalization) is the unconscious adoption of the thoughts or personality traits of others. It occurs as a normal part of development, such as a child taking on parental values and attitudes. It can also be a defense mechanism in situations that arouse anxiety.
It has been associated with both normal and pathological development.
Theory
Introjection is a concept rooted in the psychoanalytic theories of unconscious motivations. Unconscious motivation refers to processes in the mind which occur automatically and bypass conscious examination and considerations.
Introjection is the learning process or in some cases a defense mechanism where a person unconsciously absorbs experiences and makes them part of their psyche.
In learning
In psychoanalysis, introjection refers to an unconscious process wherein one takes components of another person's identity, such as feelings, experiences and cognitive functioning, and transfers them inside themselves, making such experiences part of their new psychic structure. These components are obliterated from consciousness (splitting), perceived in someone else (projection), and then experienced and performed (i.e., introjected) by that other person. Cognate concepts are identification, incorporation and internalization.
As a defense mechanism
It is considered a self-stabilizing defense mechanism used when there is a lack of full psychological contact between a child and the adults providing that child's psychological needs. In other words, it provides the illusion of maintaining relationship but at the expense of a loss of self. To use a simple example, a person who picks up traits from their friends is introjecting.
Another straightforward illustration could be a youngster who is being bullied at school. Unknowingly adopting the bully's behavior, the victim youngster may do so to stop being picked on in the future.
Projection has been described as an early phase of introjection.
Historic precursors
Freud and Klein
In Freudian terms, introjection is the aspect of the ego's system of relational mechanisms which handles checks and balances from a perspective external to what one normally considers 'oneself', infolding these inputs into the internal world of the self-definitions, where they can be weighed and balanced against one's various senses of externality. For example:
"When a child envelops representational images of his absent parents into himself, simultaneously fusing them with his own personality."
"Individuals with weak ego boundaries are more prone to use introjection as a defense mechanism."
According to D. W. Winnicott, "projection and introjection mechanisms... let the other person be the manager sometimes, and to hand over omnipotence."
According to Freud, the ego and the superego are constructed by introjecting external behavioural patterns into the subject's own person. Specifically, he maintained that the critical agency or the superego could be accounted for in terms of introjection and that the superego derives from the parents or other figures of authority. The derived behavioural patterns are not necessarily reproductions as they actually are but incorporated or introjected versions of them.
Torok and Ferenczi
However, the aforementioned description of introjection has been challenged by Maria Torok as she favours using the term as it is employed by Sándor Ferenczi in his essay "The Meaning of Introjection" (1912). In this context, introjection is an extension of autoerotic interests that broadens the ego by a lifting of repression so that it includes external objects in its make-up. Torok defends this meaning in her 1968 essay "The Illness of Mourning and the Fantasy of the Exquisite Corpse", where she argues that Sigmund Freud and Melanie Klein confuse introjection with incorporation and that Ferenczi's definition remains crucial to analysis. She emphasized that in failed mourning "the impotence of the process of introjection (gradual, slow, laborious, mediated, effective)" means that "incorporation is the only choice: fantasmatic, unmediated, instantaneous, magical, sometimes hallucinatory...'crypt' effects (of incorporation)".
Fritz and Laura Perls
In Gestalt therapy, the concept of "introjection" is not identical with the psychoanalytical concept. Central to Fritz and Laura Perls' modifications was the concept of "dental or oral aggression", when the infant develops teeth and is able to chew. They set "introjection" against "assimilation". In Ego, Hunger and Aggression, Fritz and Laura Perls suggested that when the infant develops teeth, he or she has the capacity to chew, to break apart food, and assimilate it, in contrast to swallowing before; and by analogy to experience, to taste, accept, reject or assimilate.
Laura Perls explains: "I think Freud said that development takes place through introjection, but if it remains introjection and goes no further, then it becomes a block; it becomes identification."
Thus Fritz and Laura Perls made "assimilation", as opposed to "introjection", a focal theme in Gestalt therapy and in their work, and the prime means by which growth occurs in therapy. In contrast to the psychoanalytic stance, in which the "patient" introjects the (presumably more healthy) interpretations of the analyst, in Gestalt therapy the client must "taste" with awareness their experience, and either accept or reject it, but not introject or "swallow whole". Hence, the emphasis is on avoiding interpretation, and instead encouraging discovery. This is the key point in the divergence of Gestalt therapy from traditional psychoanalysis: growth occurs through gradual assimilation of experience in a natural way, rather than by accepting the interpretations of the analyst.
See also
Internalization (sociology)
Internalized oppression
Internalizing disorder
Labeling theory
References
Defence mechanisms
Psychoanalytic terminology
Freudian psychology | 0.763433 | 0.992784 | 0.757924 |
General semantics | General semantics is a school of thought that incorporates philosophic and scientific aspects. Although it does not stand on its own as a separate school of philosophy, a separate science, or an academic discipline, it describes itself as a scientifically empirical approach to cognition and problem solving. It has been described by nonproponents as a self-help system, and it has been criticized as having pseudoscientific aspects, but it has also been favorably viewed by various scientists as a useful set of analytical tools albeit not its own science.
General semantics is concerned with how phenomena (observable events) translate to perceptions, how they are further modified by the names and labels we apply to them, and how we might gain a measure of control over our own cognitive, emotional, and behavioral responses. Proponents characterize general semantics as an antidote to certain kinds of delusional thought patterns in which incomplete and possibly warped mental constructs are projected onto the world and treated as reality itself. Accurate map–territory relations are a central theme.
After partial launches under the names human engineering and humanology, Polish-American originator Alfred Korzybski (1879–1950) fully launched the program as general semantics in 1933 with the publication of Science and Sanity: An Introduction to Non-Aristotelian Systems and General Semantics.
In Science and Sanity, general semantics is presented as both a theoretical and a practical system whose adoption can reliably alter human behavior in the direction of greater sanity. In the 1947 preface to the third edition of Science and Sanity, Korzybski wrote: "We need not blind ourselves with the old dogma that 'human nature cannot be changed', for we find that it can be changed." While Korzybski considered his program to be empirically based and to strictly follow the scientific method, general semantics has been described as veering into the domain of pseudoscience.
Starting around 1940, university English professor S. I. Hayakawa (1906–1992), speech professor Wendell Johnson, speech professor Irving J. Lee, and others assembled elements of general semantics into a package suitable for incorporation into mainstream communications curricula. The Institute of General Semantics, which Korzybski and co-workers founded in 1938, continues today. General semantics as a movement has waned considerably since the 1950s, although many of its ideas live on in other movements, such as media literacy, neuro-linguistic programming and rational emotive behavior therapy.
Overview
"Identification" and "the silent level"
In the 1946 "Silent and Verbal Levels" diagram, the arrows and boxes denote ordered stages in human neuro-evaluative processing that happens in an instant. Although newer knowledge in biology has more sharply defined what the text in these 1946 boxes labels "electro-colloidal", the diagram remains, as Korzybski wrote in his last published paper in 1950, "satisfactory for our purpose of explaining briefly the most general and important points". General semantics postulates that most people "identify," or fail to differentiate the serial stages or "levels" within their own neuro-evaluative processing. "Most people," Korzybski wrote, "identify in value levels I, II, III, and IV and react as if our verbalizations about the first three levels were 'it.' Whatever we may say something 'is' obviously is not the 'something' on the silent levels."
By making it a 'mental' habit to find and keep one's bearings among the ordered stages, general semantics training seeks to sharpen internal orientation much as a GPS device may sharpen external orientation. Once trained, general semanticists affirm, a person will act, respond, and make decisions more appropriate to any given set of happenings. Although producing saliva constitutes an appropriate response when lemon juice drips onto the tongue, a person has inappropriately identified when an imagined lemon or the word "l–e–m–o–n" triggers a salivation response.
"Once we differentiate, differentiation becomes the denial of identity," Korzybski wrote in Science and Sanity. "Once we discriminate among the objective and verbal levels, we learn 'silence' on the unspeakable objective levels, and so introduce a most beneficial neurological 'delay'—engage the cortex to perform its natural function." British-American philosopher Max Black, an influential critic of general semantics, called this neurological delay the "central aim" of general semantics training, "so that in responding to verbal or nonverbal stimuli, we are aware of what it is that we are doing".
Abstracting and consciousness of abstracting
Identification prevents what general semantics seeks to promote: the additional cortical processing experienced as a delay. Korzybski called his remedy for identification "consciousness of abstracting." The term "abstracting" occurs ubiquitously in Science and Sanity. Korzybski's use of the term is somewhat unusual and requires study to understand his meaning. He discussed the problem of identification in terms of "confusions of orders of abstractions" and "lack of consciousness of abstracting". To be conscious of abstracting is to differentiate among the "levels" described above; levels II–IV being abstractions of level I (whatever level I "is"—all we really get are abstractions). The techniques Korzybski prescribed to help a person develop consciousness of abstracting he called "extensional devices".
Extensional devices
Satisfactory accounts of general semantics extensional devices can be found easily. This article seeks to explain briefly only the "indexing" devices. Suppose you teach in a school or university. Students enter your classroom on the first day of a new term, and, if you identify these new students to a memory association retrieved by your brain, you under-engage your powers of observation and your cortex. Indexing makes explicit a differentiating of studentsthis term from studentsprior terms. You survey the new students, and indexing explicitly differentiates student1 from student2 from student3, etc. Suppose you recognize one student—call her Anna—from a prior course in which Anna either excelled or did poorly. Again, you escape identification by your indexed awareness that Annathis term, this course is different from Annathat term, that course. Not identifying, you both expand and sharpen your apprehension of "students" with an awareness rooted in fresh silent-level observations.
Language as a core concern
Autoassociative memory in the memory-prediction model describes neural operations in mammalian brains generally. A special circumstance for humans arises with the introduction of language components, both as fresh stimuli and as stored representations. Language considerations figure prominently in general semantics, and three language and communications specialists who embraced general semantics, university professors and authors Hayakawa, Wendell Johnson and Neil Postman, played major roles in framing general semantics, especially for non-readers of Science and Sanity.
Criticism
Korzybski wrote in the preface to the third edition of Science and Sanity (1947) that general semantics "turned out to be an empirical natural science". But the type of existence, if any, of universals and abstract objects is an issue of serious debate within metaphysical philosophy. So Black summed up general semantics as "some hypothetical neurology fortified with dogmatic metaphysics". And in 1952, two years after Korzybski died, American skeptic Martin Gardner wrote, "[Korzybski's] work moves into the realm of cultism and pseudo-science."
Former Institute of General Semantics executive director Steve Stockdale has compared GS to yoga. "First, I'd say that there is little if any benefit to be gained by just knowing something about general semantics. The benefits come from maintaining an awareness of the principles and attitudes that are derived from GS and applying them as they are needed. You can sort of compare general semantics to yoga in that respect... knowing about yoga is okay, but to benefit from yoga you have to do yoga." Similarly, Kenneth Burke explains Korzybski's kind of semantics contrasting it, in A Grammar of Motives, with a kind of Burkean poetry by saying "Semantics is essentially scientist, an approach to language in terms of knowledge, whereas poetic forms are kinds of action".
History
Early attempts at validation
The First American Congress for General Semantics convened in March 1935 at the Central Washington College of Education in Ellensburg, Washington. In introductory remarks to the participants, Korzybski said: General semantics formulates a new experimental branch of natural science, underlying an empirical theory of human evaluations and orientations and involving a definite neurological mechanism, present in all humans. It discovers direct neurological methods for the stimulation of the activities of the human cerebral cortex and the direct introduction of beneficial neurological 'inhibition'.... He added that general semantics "will be judged by experimentation". One paper presented at the congress reported dramatic score improvements for college sophomores on standardized intelligence tests after six weeks of training by methods prescribed in Chapter 29 of Science and Sanity.
Interpretation as semantics
General semantics accumulated only a few early experimental validations. In 1938, economist and writer Stuart Chase praised and popularized Korzybski in The Tyranny of Words. Chase called Korzybski "a pioneer" and described Science and Sanity as "formulating a genuine science of communication. The term which is coming into use to cover such studies is 'semantics,' matters having to do with signification or meaning." Because Korzybski, in Science and Sanity, had articulated his program using "semantic" as a standalone qualifier on hundreds of pages in constructions like "semantic factors," "semantic disturbances," and especially "semantic reactions," to label the general semantics program "semantics" amounted to only a convenient shorthand.
Hayakawa read The Tyranny of Words, then Science and Sanity, and in 1939 he attended a Korzybski-led workshop conducted at the newly organized Institute of General Semantics in Chicago. In the introduction to his own Language in Action, a 1941 Book of the Month Club selection, Hayakawa wrote, "[Korzybski's] principles have in one way or another influenced almost every page of this book...." But, Hayakawa followed Chase's lead in interpreting general semantics as making communication its defining concern. When Hayakawa co-founded the Society for General Semantics and its publication ETC: A Review of General Semantics in 1943—he would continue to edit ETC. until 1970—Korzybski and his followers at the Institute of General Semantics began to complain that Hayakawa had wrongly coopted general semantics. In 1985, Hayakawa gave this defense to an interviewer: "I wanted to treat general semantics as a subject, in the same sense that there's a scientific concept known as gravitation, which is independent of Isaac Newton. So after a while, you don't talk about Newton anymore; you talk about gravitation. You talk about semantics and not Korzybskian semantics."
Lowered sights
The regimen in the Institute's seminars, greatly expanded as team-taught seminar-workshops starting in 1944, continued to develop following the prescriptions laid down in Chapter XXIX of Science and Sanity. The structural differential, patented by Korzybski in the 1920s, remained among the chief training aids to help students reach "the silent level," a prerequisite for achieving "neurological delay". Innovations in the seminar-workshops included a new "neuro-relaxation" component, led by dancer and Institute editorial secretary Charlotte Schuchardt (1909–2002).
But although many people were introduced to general semantics—perhaps the majority through Hayakawa's more limited 'semantics'—superficial lip service seemed more common than the deep internalization that Korzybski and his co-workers at the Institute aimed for. Marjorie Kendig (1892–1981), probably Korzybski's closest co-worker, director of the Institute after his death, and editor of his posthumously published Collected Writings: 1920–1950, wrote in 1968:I would guess that I have known about 30 individuals who have in some degree adequately, by my standards, mastered this highly general, very simple, very difficult system of orientation and method of evaluating—reversing as it must all our cultural conditioning, neurological canalization, etc....
To me the great error Korzybski made—and I carried on, financial necessity—and for which we pay the price today in many criticisms, consisted in not restricting ourselves to training very thoroughly a very few people who would be competent to utilize the discipline in various fields and to train others. We should have done this before encouraging anyone to popularize or spread the word (horrid phrase) in societies for general semantics, by talking about general semantics instead of learning, using, etc. the methodology to change our essential epistemological assumptions, premises, etc. (unconscious or conscious), i.e. the un-learning basic to learning to learn.
Yes, large numbers of people do enjoy making a philosophy of general semantics. This saves them the pain of rigorous training so simple and general and limited that it seems obvious when said, yet so difficult.
Successors at the Institute of General Semantics continued for many years along the founders' path. Stuart Mayper (1916–1997), who studied under Karl Popper, introduced Popper's principle of falsifiability into the seminar-workshops he led at the Institute starting in 1977. More modest pronouncements gradually replaced Korzybski's claims that general semantics can change human nature and introduce an era of universal human agreement. In 2000, Robert Pula (1928–2004), whose roles at the Institute over three decades included Institute director, editor-in-chief of the Institute's General Semantics Bulletin, and leader of the seminar-workshops, characterized Korzybski's legacy as a "contribution toward the improvement of human evaluating, to the amelioration of human woe...."
Hayakawa died in 1992. The Society for General Semantics merged into the Institute of General Semantics in 2003. In 2007, Martin Levinson, president of the Institute's Board of Trustees, teamed with Paul D. Johnston, executive director of the Society at the date of the merger, to teach general semantics with a light-hearted Practical Fairy Tales for Everyday Living.
Other institutions supporting or promoting general semantics in the 21st century include the New York Society for General Semantics, the European Society for General Semantics, the Australian General Semantics Society, and the Balvant Parekh Centre for General Semantics and Other Human Sciences (Baroda, India).
The major premises
Non-Aristotelianism: While Aristotle wrote that a true definition gives the essence of the thing (defined in Greek to ti ên einai, literally "the what it was to be"), general semantics denies the existence of such an 'essence'. In this, general semantics purports to represent an evolution in human evaluative orientation. In general semantics, it is always possible to give a description of empirical facts, but such descriptions remain just that—descriptions—which necessarily leave out many aspects of the objective, microscopic, and submicroscopic events they describe. According to general semantics, language, natural or otherwise (including the language called 'mathematics') can be used to describe the taste of an orange, but one cannot give the taste of the orange using language alone. According to general semantics, the content of all knowledge is structure, so that language (in general) and science and mathematics (in particular) can provide people with a structural 'map' of empirical facts, but there can be no 'identity', only structural similarity, between the language (map) and the empirical facts as lived through and observed by people as humans-in-environments (including doctrinal and linguistic environments).
Time binding: The human ability to pass information and knowledge from one generation to the next. Korzybski claimed this to be a unique capacity, separating people from animals. This distinctly human ability for one generation to start where a previous generation left off, is a consequence of the uniquely human ability to move to higher and higher levels of abstraction without limit. Animals may have multiple levels of abstraction, but their abstractions must stop at some finite upper limit; this is not so for humans: humans can have 'knowledge about knowledge', 'knowledge about knowledge about knowledge', etc., without any upper limit. Animals possess knowledge, but each generation of animals does things pretty much in the same way as the previous generation, limited by their neurology and genetic makeup. By contrast, at one time most human societies were hunter-gatherers, but now more advanced means of food production (growing, raising, or buying) predominate. Except for some insects (for example, ants), all animals are still hunter-gatherer species, even though many have existed longer than the human species. For this reason, animals are regarded in general semantics as space-binders (doing space-binding), and plants, which are usually stationary, as energy-binders (doing energy-binding).
Non-elementalism and non-additivity: The refusal to separate verbally what cannot be separated empirically, and the refusal to regard such verbal splits as evidence that the 'things' that are verbally split bear an additive relation to one another. For example, space-time cannot empirically be split into 'space' + 'time', a conscious organism (including humans) cannot be split into 'body' + 'mind', etc., therefore, people should never speak of 'space' and 'time' or 'mind' and 'body' in isolation, but always use the terms space-time or mind-body (or other organism-as-a-whole terms).
Infinite-valued determinism: General semantics regards the problem of 'indeterminism vs. determinism' as the failure of pre-modern epistemologies to formulate the issue properly, as the failure to consider or include all factors relevant to a particular prediction, and failure to adjust our languages and linguistic structures to empirical facts. General semantics resolves the issue in favor of determinism of a special kind called 'infinite-valued' determinism which always allows for the possibility that relevant 'causal' factors may be 'left out' at any given date, resulting in, if the issue is not understood at that date, 'indeterminism', which simply indicates that our ability to predict events has broken down, not that the world is 'indeterministic'. General semantics considers all human behavior (including all human decisions) as, in principle, fully determined once all relevant doctrinal and linguistic factors are included in the analysis, regarding theories of 'free will' as failing to include the doctrinal and linguistic environments as environments in the analysis of human behavior.
Connections to other disciplines
The influence of Ludwig Wittgenstein and the Vienna Circle, and of early operationalists and pragmatists such as Charles Sanders Peirce, is particularly clear in the foundational ideas of general semantics. Korzybski himself acknowledged many of these influences.
The concept of "silence on the objective level"—attributed to Korzybski and his insistence on consciousness of abstracting—are parallel to some of the central ideas in Zen Buddhism. Although Korzybski never acknowledged any influence from this quarter, he formulated general semantics during the same years that the first popularizations of Zen were becoming part of the intellectual currency of educated speakers of English. On the other hand, later Zen-popularizer Alan Watts was influenced by ideas from general semantics.
General semantics has survived most profoundly in the cognitive therapies that emerged in the 1950s and 1960s. Albert Ellis (1913–2007), who developed rational emotive behavior therapy, acknowledged influence from general semantics and delivered the Alfred Korzybski Memorial Lecture in 1991. The Bruges (Belgium) center for solution-focused brief therapy operates under the name Korzybski Institute Training and Research Center. George Kelly, creator of personal construct psychology, was influenced by general semantics. Fritz Perls and Paul Goodman, founders of Gestalt therapy are said to have been influenced by Korzybski Wendell Johnson wrote "People in Quandaries: The Semantics of Personal Adjustment" in 1946, which stands as the first attempt to form a therapy from general semantics.
Ray Solomonoff (1926–2009) was influenced by Korzybski. Solomonoff was the inventor of algorithmic probability, and founder of algorithmic information theory ( Kolmogorov complexity).
Another scientist influenced by Korzybski (verbal testimony) is Paul Vitanyi (born 1944), a scientist in the theory of computation.
During the 1940s, 1950s, and 1960s, general semantics entered the idiom of science fiction. Notable examples include the works of A. E. van Vogt, The World of Null-A and its sequels. General semantics appear also in Robert A. Heinlein's work, especially Gulf. Bernard Wolfe drew on general semantics in his 1952 science fiction novel Limbo. Frank Herbert's novels Dune and Whipping Star <ref>O'Reilly, 1981 (p. 180), "The influence of General Semantics is particularly obvious in Whipping Star"...</ref> are also indebted to general semantics. The ideas of general semantics became a sufficiently important part of the shared intellectual toolkit of genre science fiction to merit parody by Damon Knight and others; they have since shown a tendency to reappear in the work of more recent writers such as Samuel R. Delany, Suzette Haden Elgin and Robert Anton Wilson. In 2008, John Wright extended van Vogt's Null-A series with Null-A Continuum. William Burroughs references Korzybski's time binding principle in his essay The Electronic Revolution, and elsewhere. Henry Beam Piper explicitly mentioned general semantics in Murder in the Gunroom, and its principles, such as awareness of the limitations of knowledge, are apparent in his later work. A fictional rendition of the Institute of General Semantics appears in the 1965 French science fiction film, Alphaville, directed by Jean-Luc Godard.
Neil Postman, founder of New York University's media ecology program in 1971, edited ETC: A Review of General Semantics from 1976 to 1986. Postman's student Lance Strate, a co-founder of the Media Ecology Association, served as executive director of the Institute of General Semantics from 2007 to 2010.
With Charles Weingartner, Neil Postman included General Semantics within the introductory background analysis in Teaching as a Subversive Activity (Delacorte, 1969). In particular, they argued that General Semantics fitted with what Postman and Weingartner referred to as the "Whorf-Sapir hypothesis", the claim that the particular language used to describe experience shapes how we perceive and understand that experience; that is, language shapes the way people think. (The "Whorf-Sapir hypothesis" is also known as Linguistic relativity.)
See also
Related fields
Cognitive science
Cognitive therapy
E-Prime
Gestalt therapy
Language and thought
Linguistic relativity
Perceptual control theory
Rational emotive behavior therapy
Related subjects
Cratylus (dialogue)
Harold Innis's communications theories
Institute of General Semantics
Ladder of inference
Map–territory relation
Neuro-linguistic programming
Propaganda
Related persons
Aristotle
Gregory Bateson
Sanford I. Berman
Albert Ellis
Elwood Murray
Allen Walker Read
Wilhelm Reich
Ida Rolf
William Vogt
Robert Anton Wilson
Related books
Levels of Knowing and Existence: Studies in General Semantics, by Harry L. Weinberg
Language in Thought and Action, by Professor S.I. Hayakawa (later a U.S. Senator), popularizing the tenets of General Semantics
The World of Null-A, a science fiction novel by A. E. van Vogt, which envisions a world run by General Semanticists
Gulf, a science fiction novella by Robert A. Heinlein (published in Assignment in Eternity), in which a secret society trained in General Semantics and the techniques of Samuel Renshaw act to protect humanity
Notes
Further reading
Dare to Inquire: Sanity and Survival for the 21st Century and Beyond. by , (2003). Robert Anton Wilson wrote: "This seems to me a revolutionary book on how to transcend prejudices, evade the currently fashionable lunacies, open yourself to new perceptions, new empathy and even new ideas, free your living total brain from the limits of your dogmatic verbal 'mind', and generally wake up and smell the bodies of dead children and other innocents piling up everywhere. In a time of rising rage and terror, we need this as badly as a city with plague needs vaccines and antibiotics. If I had the money I'd send a copy to every delegate at the UN."Trance-Formations: Neuro-Linguistic Programming and the Structure of Hypnosis by Richard Bandler and John Grinder, (1981). One of the important principles—also widely used in political propaganda—discussed in this book is that trance induction uses a language of pure process and lets the listener fill in all the specific content from their own personal experience. E.g. the hypnotist might say "imagine you are sitting in a very comfortable chair in a room painted your favorite color" but not "imagine you are sitting in a very comfortable chair in a room painted red, your favorite color" because then the listener might think "wait a second, red is not my favorite color".
The work of the scholar of political communication Murray Edelman (1919–2001), starting with his seminal book The Symbolic Uses of Politics (1964), continuing with Politics as symbolic action: mass arousal and quiescience (1971), Political Language: Words that succeed and policies that fail (1977), Constructing the Political Spectacle (1988) and ending with his last book The Politics of Misinformation (2001) can be viewed as an exploration of the deliberate manipulation and obfuscation of the map-territory distinction for political purposes.Logic and contemporary rhetoric: the use of reason in everyday life by Howard Kahane (d. 2001). (Wadsworth: First edition 1971, sixth edition 1992, tenth edition 2005 with Nancy Cavender.) Highly readable guide to the rhetoric of clear thinking, frequently updated with examples of the opposite drawn from contemporary U.S. media sources.Doing Physics : how physicists take hold of the world by Martin H. Krieger, Bloomington: Indiana University Press, 1992. A "cultural phenomenology of doing physics". The General Semantics connection is the relation to Korzybski's original motivation of trying to identify key features of the successes of mathematics and the physical sciences that could be extended into everyday thinking and social organization.Metaphors We Live By by George Lakoff and Mark Johnson, (1980).Philosophy in the flesh: the embodied mind and its challenge to Western thought by George Lakoff and Mark Johnson, (1997).The Art of Asking Questions by Stanley L. Payne, (1951) This book is a short handbook-style discussion of how the honest pollster should ask questions to find out what people actually think without leading them, but the same information could be used to slant a poll to get a predetermined answer. Payne notes that the effect of asking a question in different ways or in different contexts can be much larger than the effect of sampling bias, which is the error estimate usually given for a poll. E.g. (from the book) if you ask people "should government go into debt?" the majority will answer "No", but if you ask "Corporations have the right to issue bonds. Should governments also have the right to issue bonds?" the majority will answer "Yes".
Related booksThe art of awareness; a textbook on general semantics by , Dubuque, Iowa: W.C. Brown Co., 1966, 1973, 1978; , 1996.Crazy talk, stupid talk: how we defeat ourselves by the way we talk and what to do about it by Neil Postman, Delacorte Press, 1976. All of Postman's books are informed by his study of General Semantics (Postman was editor of ETC. from 1976 to 1986) but this book is his most explicit and detailed commentary on the use and misuse of language as a tool for thought.
Developing sanity in human affairs edited by Susan Presby Kodish and Robert P. Holston, Greenwood Press, Westport Connecticut, copyright 1998, Hofstra University. A collection of papers on the subject of general semantics.
Drive Yourself Sane: Using the Uncommon Sense of General Semantics, Third Edition. by Bruce I. Kodish and Susan Presby Kodish. Pasadena, CA: Extensional Publishing, 2011.General Semantics in Psychotherapy: Selected Writings on Methods Aiding Therapy, edited by Isabel Caro and Charlotte Schuchardt Read, Institute of General Semantics, 2002.Language habits in human affairs; an introduction to General Semantics by Irving J. Lee, Harper and Brothers, 1941. Still in print from the Institute of General Semantics. On a similar level to Hayakawa.The language of wisdom and folly; background readings in semantics edited by Irving J. Lee, Harper and Row, 1949. Was in print (ca. 2000) from the International Society of General Semantics—now merged with the Institute of General Semantics. A selection of essays and short excerpts from different authors on linguistic themes emphasized by General Semantics—without reference to Korzybski, except for an essay by him.
"Language Revision by Deletion of Absolutisms," by Allen Walker Read. Paper presented at the ninth annual meeting of the Semiotic Society of America, Bloomington, IN, 13 October 1984. Published in ETC: A Review of General Semantics. V42n1, Spring 1985, pp. 7–12.
Living With Change, Wendell Johnson, Harper Collins, 1972.Mathsemantics: making numbers talk sense by Edward MacNeal, HarperCollins, 1994. Penguin paperback 1995. Explicit General Semantics combined with numeracy education (along the lines of John Allen Paulos's books) and simple statistical and mathematical modelling, influenced by MacNeal's work as an airline transportation consultant. Discusses the fallacy of Single Instance thinking in statistical situations.Operational philosophy: integrating knowledge and action by Anatol Rapoport, New York: Wiley (1953, 1965).People in Quandaries: the semantics of personal adjustment by Wendell Johnson, 1946—still in print from the Institute of General Semantics. Insightful book about the application of General Semantics to psychotherapy; was an acknowledged influence on Richard Bandler and John Grinder in their formulation of Neuro-Linguistic Programming.Semantics by Anatol Rapoport, Crowell, 1975. Includes both general semantics along the lines of Hayakawa, Lee, and Postman and more technical (mathematical and philosophical) material. A valuable survey. Rapoport's autobiography Certainties and Doubts : A Philosophy of Life (Black Rose Books, 2000) gives some of the history of the General Semantics movement as he saw it.Your Most Enchanted Listener by Wendell Johnson, Harper, 1956. Your most enchanted listener is yourself, of course. Similar material as in People in Quandaries but considerably briefer.
Related academic articles
Bramwell, R. D. (1981). The semantics of multiculturalism: a new element in curriculum. Canadian Journal of Education, Vol. 6, No. 2 (1981), pp. 92–101.
Clarke, R. A. (1948). General semantics in art education. The School Review, Vol. 56, No. 10 (Dec., 1948), pp. 600–605.
Chisholm, F. P. (1943). Some misconceptions about general semantics. College English, Vol. 4, No. 7 (Apr., 1943), p. 412–416.
Glicksberg, C. I. (1946) General semantics and the science of man. Scientific Monthly, Vol. 62, No. 5 (May, 1946), pp. 440–446.
Hallie, P. P. (1952). A criticism of general semantics. College English, Vol. 14, No. 1 (Oct., 1952), pp. 17–23.
Hasselris, P. (1991). From Pearl Harbor to Watergate to Kuwait: "Language in Thought and Action". The English Journal, Vol. 80, No. 2 (Feb., 1991), pp. 28–35.
Hayakawa, S. I. (1939). General semantics and propaganda. Public Opinion Quarterly, Vol. 3 No. 2 (Apr., 1939), pp. 197–208.
Kenyon, R. E. (1988). The Impossibility of Non-identity Languages. General Semantics Bulletin, No. 55, (1990), pp. 43–52.
Kenyon, R. E. (1993). E-prime: The Spirit and the Letter. ETC: A Review of General Semantics. Vol. 49 No. 2, (Summer 1992). pp. 185–188
Krohn, F. B. (1985). A general semantics approach to teaching business ethics. Journal of Business Communication, Vol. 22, Issue 3 (Summer, 1985), pp 59–66.
Maymi, P. (1956). General concepts or laws in translation. The Modern Language Journal, Vol. 40, No. 1 (Jan., 1956), pp. 13–21.
O'Brien, P. M. (1972). The sesame land of general semantics. The English Journal, Vol. 61, No. 2 (Feb., 1972), pp. 281–301.
Rapaport, W. J. (1995). Understanding understanding: syntactic semantics and computational cognition. Philosophical Perspectives, Vol. 9, AI, Connectionism and Philosophical Psychology (1995), pp. 49–88.
Thorndike, E. L. (1946). The psychology of semantics. American Journal of Psychology, Vol. 59, No. 4 (Oct., 1946), pp. 613–632.
Whitworth, R. (1991). A book for all occasions: activities for teaching general semantics. The English Journal, Vol. 80, No. 2 (Feb., 1991), pp. 50–54.
Youngren, W. H. (1968). General semantics and the science of meaning. College English'', Vol. 29, No. 4 (Jan., 1968), pp. 253–285.
External links
Institute of General Semantics
Institute of General Semantics in Europe
New York Society for General Semantics
European Society For General Semantics
Australian General Semantics Society
ETC A Review of General Semantics Index
1933 introductions | 0.76693 | 0.988227 | 0.757901 |
Peer support | Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters (although it can be provided by peers without training), and can take a number of forms such as peer mentoring, reflective listening (reflecting content and/or feelings), or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.
Peer support is distinct from other forms of social support in that the source of support is a peer, a person who is similar in fundamental ways to the recipient of the support; their relationship is one of equality. A peer is in a position to offer support by virtue of relevant experience: he or she has "been there, done that" and can relate to others who are now in a similar situation. Trained peer support workers such as peer support specialists and peer counselors receive special training and are required to obtain Continuing Education Units, like clinical staff. Some other trained peer support workers may also be law-enforcement personnel and firefighters as well as emergency medical responders The social peer support also offers an online system
of distributed expertise, interactivity, social distance and control, which may promote
disclosure of personal problems (Paterson, Brewer, & Leeseberg, 2013).
Underlying theory
Peer support has been shown to be effective in substance use and related behaviour, treatment engagement, and ameliorating risk behaviours associated with HIV and hepatitis C, and empowering people with mental illness and improving their quality of life. Its effectiveness is believed to derive from a variety of psychosocial processes first described by Mark Salzer and colleagues in 2002: social support, experiential knowledge, social learning theory, social comparison theory, the helper-therapy principle, and self-determination theory.
Social support is the existence of positive psychosocial interactions with others with whom there is mutual trust and concern. Positive relationships contribute to positive adjustment and buffer against stressors and adversities by offering (a) emotional support (esteem, attachment, and reassurance), (b) instrumental support (material goods and services), (c) companionship and (d) information support (advice, guidance, and feedback).
Experiential knowledge is specialized information and perspectives that people obtain from living through a particular experience such as substance abuse, a physical disability, chronic physical or mental illness, or a traumatic event such as combat, a natural disaster, domestic violence or a violent crime, sexual abuse, or imprisonment. Experiential knowledge tends to be unique and pragmatic and when shared contributes to solving problems and improving quality of life.
Social learning theory postulates that peers, because they have undergone and survived relevant experiences, are more credible role models for others. Interactions with peers who are successfully coping with their experiences or illness are more likely to result in positive behavior change.
Social comparison means that individuals are more comfortable interacting with others who share common characteristics with themselves, such as a psychiatric illness, in order to establish a sense of normalcy. By interacting with others who are perceived to be better than them, peers are given a sense of optimism and something to strive toward.
The helper-therapy principle proposes that there are four significant benefits to those who provide peer support: (a) increased sense of interpersonal competence as a result of making an impact on another person's life; (b) development of a sense of equality in giving and taking between himself or herself and others; (c) helper gains new personally-relevant knowledge while helping; and (d) the helper receives social approval from the person they help, and others.
Self-determination means that individuals have the right to determine their own future—people are more likely to act on their own decisions rather than decisions made by others for them.
In schools and education
Peer mentoring
Peer mentoring takes place in learning environments such as schools, usually between an older more experienced student and a new student. Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling into the whole new schedule and lifestyle of secondary school life. Peer mentoring is also used in the workplace as a means of orienting new employees. New employees who are paired with a peer mentor are twice as likely to remain in their job than those who do not receive mentorship.
Peer listening
This form of peer support is widely used within schools. Peer supporters are trained, normally from within schools or universities, or sometimes by outside organizations, such as Childline's CHIPS (Childline In Partnership With Schools) program, to be "active listeners". Within schools, peer supporters are normally available at break or lunch times.
Peer mediation
Peer mediation is a means of handling incidents of bullying by bringing the victim and the bully together under mediation by one of their peers.
Peer helper in sports
A peer helper in sports works with young adults in sports such as football, soccer, track, volleyball, baseball, cheerleading, swimming, and basketball. They may provide help with game tactics (e.g. keeping your eye on the ball), emotional support, training support, and social support.
In health
In mental health
Peer support can occur within, outside or around traditional mental health services and programs, between two people or in groups. Peer support is increasingly being offered through digital health like text messaging and smartphone apps. Peer support is a key concept in the recovery approach and in consumer-operated services programs. Consumers/clients of mental health programs have also formed non-profit self-help organizations, and serve to support each other and to challenge associated stigma and discrimination. The role of peer workers in mental health services was the subject of a conference in London in April 2012, jointly organized by the Centre for Mental Health and the NHS Confederation. Research has shown that peer-run self-help groups yield improvement in psychiatric symptoms resulting in decreased hospitalization, larger social support networks and enhanced self-esteem and social functioning. There is considerable variety in the ways that peer support is defined and conceptualized as it relates to mental health services. In some cases, clinicians, psychiatrists, and other staff who do not necessarily have their own experiences of receiving psychiatric treatment are being trained, often by psychiatric survivors, in peer support as an approach to building relationships that are genuine, mutual, and non-coercive.
For anxiety and depression
In Canada, the LEAF (Living Effectively with Anxiety and Fear) Program is a peer-led support group for cognitive-behavioral therapy of persons with mild to moderate panic disorders.
In a 2011 meta-analysis of seven randomized trials that compared a peer support intervention to group cognitive-behavioral therapy in patients with depression, peer support interventions were found to improve depression symptoms more than usual care alone and results may be comparable to those of group cognitive behavioral therapy. These findings suggest that peer support interventions have the potential to be effective components of depression care, and they support the inclusion of peer support in recovery-oriented mental health treatment.
Several studies have shown that peer support reduces fear during stressful situations such as combat and domestic violence and may mitigate post-traumatic stress disorder. The 1982 Vietnam-Era Veterans Adjustment Survey showed that PTSD was highest in those men and women who lacked positive social support from family, friends, and society in general.
For first responders
Peer support programs have also been implemented to address stress and psychological trauma among law-enforcement personnel and firefighters as well as emergency medical responders. Peer support is an important component of the critical incident stress management program used to alleviate stress and trauma among disaster first responders.
For survivors of trauma
Peer support has been used to help survivors of trauma, such as refugees, cope with stress and deal with difficult living conditions. Peer support is integral to the services provided by the National Center for Trauma-Informed Care. Other programs have been designed for female survivors of domestic violence and for women in prison.
Survivor Corps defines peer support for trauma survivors as "Encouragement and assistance provided by a colleague who has overcome similar difficulties to engender self-confidence and autonomy and to enable the survivor to make his or her own decisions and implement them." Peer support is a fundamental strategy in the rehabilitation of landmine survivors in Afghanistan, Bosnia, El Salvador and Vietnam. A study of 470 amputee survivors of war-related violence in six countries showed that nearly one hundred percent said they had benefited from peer support.
A peer support program operated by the Centre d’Encadrement et de Développement des Anciens Combattants in Burundi with support from the Center for International Stabilization and Recovery and Action on Armed Violence has assisted survivors of war-related violence, including women with disabilities, and female ex-combatants since 2010. A similar program in Rwanda works with survivors of the Rwandan genocide. Peer support has been recommended as a fundamental part of victim assistance programs for survivors of war-related violence.
A 1984 study on the impact of peer support and support groups for victims of domestic violence showed that 146 battered women found women's peer support groups the most helpful source of a range of available treatments. The women in these groups appeared to give direct advice and to act as role models. A 1986 study on 70 adolescent mothers considered to be at risk for domestic violence showed that peer support improved cognitive problem-solving skills, self-reinforcement, and parenting competence.
Pandora's Aquarium, an online support group operating as part of Pandora's Project, offers peer support to survivors of rape and sexual abuse and their friends and family.
In addiction
Twelve-step programs for overcoming substance misuse and other addiction recovery groups are often based on peer support. Since the 1930s Alcoholics Anonymous has promoted peer support between new members and their sponsors: "The process of sponsorship is this: an alcoholic who has made some progress in the recovery program shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA." Other addiction recovery programs rely on peer support without following the twelve-step model.
In chronic illness
Peer support has been beneficial for many people living with diabetes. Diabetes encompasses all aspects of people's lives, often for decades. Support from peers can offer emotional, social, and practical assistance that helps people do the things they need to do to stay healthy. Peer support groups for diabetics complement and enhance other health care services. J.F. Caro is the co-founder and Chief Scientific Officer of one of such groups named Peer for Progress.
Peer support has also been provided for people with cancer and HIV. The Breast Cancer Network of Strength trains peer counselors to work with breast cancer survivors.
For people with disabilities
Peer support is considered to be a key component of the independent living movement and has been widely used by organizations that work with people with disabilities, including the Amputee Coalition of America (ACA) and Survivor Corps. Since 1998 the ACA has operated a National Peer Network for survivors of limb loss. The Blinded Veterans Association has recently launched Operation Peer Support (OPS), a program designed to support men and women returning to the US blinded or experiencing significant visual impairment in connection with their military service. Peer support has also benefited survivors of traumatic brain injury and their families. There is also FacingDisability for Families Facing Spinal Cord Injuries , which has a peer counseling program in addition to 1,000 videos drawn from interviews of people with spinal cord injuries, their families, caregivers and experts.
For veterans and their families
Several programs exist that provide peer support for military veterans in the US and Canada. In 2010 the Military Women to Women Peer Support Group was established in Helena, Montana.
The Tragedy Assistance Program for Survivors (TAPS) provides peer support, crisis care, casualty casework assistance, and grief and trauma resources for families of members of the US military. Operation Peer Support (OPS) is a program for US military veterans who were blinded or have significant visual impairment.
In January 2013 Senator Patty Murray, Chairman of the United States Senate Committee on Veterans' Affairs, sponsored an amendment of the National Defense Authorization Act (S.3254) that would require peer counseling as part of a comprehensive suicide prevention program for US veterans.
For veterans with PTSD
Peer support outreach for those exposed to traumatic events refers to programs that seek to identify and reach out to those with or at risk for mental health problems following a traumatic event as a means of connecting those people to mental health services. Paraprofessional peers are defined as having a shared background as the target population and work closely with and supplement the services of the mental healthcare team. These peers are trained in certain interventions (such as Psychological First Aid) and are closely supervised by professional mental healthcare personnel. Peer support for recovery from PTSD refers to programs in which someone with lived experience of PTSD, who experienced a significant reduction in symptoms, provides formal services to those who have not yet made significant steps in recovery from his or her condition. The peer support for recovery model focuses on improvement in overall health and wellness, and has long been successful in the treatment of SMI (serious mental illness) but is relatively new for PTSD.
A further review of existing literature found that carefully recruited, trained, supervised, and supported paraprofessionals can deliver mental health interventions effectively, and may be valuable in communities with fewer resources for mental healthcare.
Researchers at the Palo Alto VA National Center for PTSD also conducted focus groups at the VA Palo Alto Health Care System Trauma Recovery Programs, a PTSD Residential Rehabilitation Program, and a Women's Trauma Recovery Program to determine veteran and staff perceptions of informal peer support interventions already in place. Four themes were identified, including "peer support contributing to a feeling of social connectedness", "positive role modeling by the peer support provider", "peer support augmenting care offered by professional providers", and "peer supporter acting as a 'culture broker' and orienting recipients to mental health treatment."
These findings have been put into practice through a peer support program for veterans in the Sonora, Stockton, and Modesto VA outpatient clinics. The clinics are part of the Palo Alto Veterans Affairs Healthcare System that extend to more rural parts of northern California. The program is funded through grants in support of new treatment approaches to serve veterans in rural, traditionally underserved areas. Leadership for the program comes from the Menlo Park division of the Palo Alto VA system.
The peer support program has been operational since 2012 with over 268 unique veterans seen between 2012 and 2015. The two peer support providers involved in the program are veterans of the Vietnam and Iraq wars, respectively, and after having recovered from their own mental health disorders utilize their experiences to help their fellow veterans. The two providers have been responsible for leading between 5 and 7 groups each week as well as conducting telephone outreach and one-on-one engagement visits. These services have successfully helped to augment the often overburdened mental health treatment teams at the central valley outpatient VA clinics.
The peer support program has been described in several publications. A personal story of success was featured in Stanford Medicine magazine and the collaborative nature of the program was described in the book, Partnerships for Mental Health.
For people at work
Trauma risk management (TRiM) is a work-place based peer support for use in helping to protect the mental health of employees who have been exposed to traumatic stress. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM peer support training provides TRiM Practitioners with a background understanding of psychological trauma and its effects. TRiM was developed in the UK by military mental health professionals including Professor Neil Greenberg. There have been numerous scientific publications on the use of TRiM which have demonstrated it to be an acceptable and effective method of peer support. Similar to TRiM, the sustaining resilience at work (StRaW) peer support could increase recognition among coworkers and managers about the significance of supporting fellow workers in applying their recently acquired knowledge and abilities on the job.. StRaW was developed by March on Stress Ltd and early research again shows it to be a credible and effective way of supporting staff at work.
Sex workers
Several peer-based organizations exist for sex workers. The aim of these organizations is to support the health, rights, and well-being of sex workers and advocate on their behalf for law reform in order to make work safer. Sex work is work and there are many people who willingly choose it as a job/career. While sex trafficking does exist, not everyone who does sex work is doing so under duress. Social stigma is a major hurdle sex workers encounter, with many people trying to 'save' them. Peer support workers and peer educators are seen as best practices by the Sex Industry Network (SIN) when engaging with community members because peers can understand that someone could willingly choose to do sex work.
References
External links
International Federation of the Red Cross/Red Crescent Reference Centre for Psychosocial Support
American Self-Help Group Clearinghouse
LEAF (Living Effectively with Anxiety and Fear) Program
Counseling
Mental health support groups
Drug rehabilitation
Educational psychology
Anxiety
Personal development
Support groups
Peer learning
Peer-to-peer | 0.769493 | 0.984902 | 0.757876 |
Path dependence | Path dependence is a concept in the social sciences, referring to processes where past events or decisions constrain later events or decisions. It can be used to refer to outcomes at a single point in time or to long-run equilibria of a process. Path dependence has been used to describe institutions, technical standards, patterns of economic or social development, organizational behavior, and more.
In common usage, the phrase can imply two types of claims. The first is the broad concept that "history matters," often articulated to challenge explanations that pay insufficient attention to historical factors. This claim can be formulated simply as "the future development of an economic system is affected by the path it has traced out in the past" or "particular events in the past can have crucial effects in the future." The second is a more specific claim about how past events or decisions affect future events or decisions in significant or disproportionate ways, through mechanisms such as increasing returns, positive feedback effects, or other mechanisms.
Commercial examples
Videocassette recording systems
The videotape format war is a key example of path dependence. Three mechanisms independent of product quality could explain how VHS achieved dominance over Betamax from a negligible early adoption lead:
A network effect: videocassette rental stores observed more VHS rentals and stocked up on VHS tapes, leading renters to buy VHS players and rent more VHS tapes, until there was complete vendor lock-in.
A VCR manufacturer bandwagon effect of switching to VHS-production because they expected it to win the standards battle.
Sony, the original developer of Betamax, did not let pornography companies license their technology for mass production, which meant that nearly all pornographic motion pictures released on video used VHS format.
An alternative analysis is that VHS was better-adapted to market demands (e.g. having a longer recording time). In this interpretation, path dependence had little to do with VHS's success, which would have occurred even if Betamax had established an early lead.
QWERTY keyboard
The QWERTY keyboard is a prominent example of path dependence due to the widespread emergence and persistence of the QWERTY keyboard. QWERTY has persisted over time despite more efficient keyboard arrangements being developed – QWERTY vs. Dvorak is an example of this. However, there is still debate about the validity of this being a true example of path dependence.
Railway track gauges
The standard gauge of railway tracks is another example of path dependence which explains how a seemingly insignificant event or circumstance can change the choice of technology over the long run despite contemporary knowhow showing such a choice to be inefficient.
More than half the world's railway gauges are , known as standard gauge, despite the consensus among engineers being that wider gauges have increased performance and speed. The path to the adoption of the standard gauge began in the late 1820s when George Stephenson, a British engineer, began work on the Liverpool and Manchester Railway. His experience with primitive coal tramways resulted in this gauge width being copied by the Liverpool and Manchester Railway, then the rest of Great Britain, and finally by railroads in Europe and North America.
There are tradeoffs involved in the choice of rail gauge between the cost of constructing a line (which rises with wider gauges) and various performance metrics, including maximum speed, low center of gravity (desirable, especially in double-stack rail transport). While the attempts with Brunel gauge, a significantly broader gauge failed, the widespread use of Iberian gauge, Russian gauge and Indian gauge, all of which are broader than Stephenson's choice, show that there is nothing inherent to the 1435 mm gauge that led to its global success.
Economics
Path dependence theory was originally developed by economists to explain technology adoption processes and industry evolution. The theoretical ideas have had a strong influence on evolutionary economics. A common expression of the concept is the claim that predictable amplifications of small differences are a disproportionate cause of later circumstances, and, in the "strong" form, that this historical hang-over is inefficient.
There are many models and empirical cases where economic processes do not progress steadily toward some pre-determined and unique equilibrium, but rather the nature of any equilibrium achieved depends partly on the process of getting there. Therefore, the outcome of a path-dependent process will often not converge towards a unique equilibrium, but will instead reach one of several equilibria (sometimes known as absorbing states).
This dynamic vision of economic evolution is very different from the tradition of neo-classical economics, which in its simplest form assumed that only a single outcome could possibly be reached, regardless of initial conditions or transitory events. With path dependence, both the starting point and 'accidental' events (noise) can have significant effects on the ultimate outcome. In each of the following examples it is possible to identify some random events that disrupted the ongoing course, with irreversible consequences.
Economic development
In economic development, it is said (initially by Paul David in 1985) that a standard that is first-to-market can become entrenched (like the QWERTY layout in typewriters still used in computer keyboards). He called this "path dependence", and said that inferior standards can persist simply because of the legacy they have built up. That QWERTY vs. Dvorak is an example of this phenomenon, has been re-asserted, questioned, and continues to be argued. Economic debate continues on the significance of path dependence in determining how standards form.
Economists from Alfred Marshall to Paul Krugman have noted that similar businesses tend to congregate geographically ("agglomerate"); opening near similar companies attracts workers with skills in that business, which draws in more businesses seeking experienced employees. There may have been no reason to prefer one place to another before the industry developed, but as it concentrates geographically, participants elsewhere are at a disadvantage, and will tend to move into the hub, further increasing its relative efficiency. This network effect follows a statistical power law in the idealized case, though negative feedback can occur (through rising local costs).
Buyers often cluster around sellers, and related businesses frequently form business clusters, so a concentration of producers (initially formed by accident and agglomeration) can trigger the emergence of many dependent businesses in the same region.
In the 1980s, the US dollar exchange rate appreciated, lowering the world price of tradable goods below the cost of production in many (previously successful) U.S. manufacturers. Some of the factories that closed as a result, could later have been operated at a (cash-flow) profit after dollar depreciation, but reopening would have been too expensive. This is an example of hysteresis, switching barriers, and irreversibility.
If the economy follows adaptive expectations, future inflation is partly determined by past experience with inflation, since experience determines expected inflation and this is a major determinant of realized inflation.
A transitory high rate of unemployment during a recession can lead to a permanently higher unemployment rate because of the skills loss (or skill obsolescence) by the unemployed, along with a deterioration of work attitudes. In other words, cyclical unemployment may generate structural unemployment. This structural hysteresis model of the labour market differs from the prediction of a "natural" unemployment rate or NAIRU, around which 'cyclical' unemployment is said to move without influencing the "natural" rate itself.
Types of path dependence
Liebowitz and Margolis distinguish types of path dependence; some do not imply inefficiencies and do not challenge the policy implications of neoclassical economics. Only "third-degree" path dependence—where switching gains are high, but transition is impractical—involves such a challenge. They argue that such situations should be rare for theoretical reasons, and that no real-world cases of private locked-in inefficiencies exist. Vergne and Durand qualify this critique by specifying the conditions under which path dependence theory can be tested empirically.
Technically, a path-dependent stochastic process has an asymptotic distribution that "evolves as a consequence (function of) the process's own history". This is also known as a non-ergodic stochastic process.
In The Theory of the Growth of the Firm (1959), Edith Penrose analyzed how the growth of a firm both organically and through acquisition is strongly influenced by the experience of its managers and the history of the firm's development.
Conditions which give rise to path dependence
Path dependence may arise or be hindered by a number of important factors, these may include
Durability of capital equipment
Technical interrelatedness
Increasing returns
Dynamic increasing returns to adoption
Social sciences
Institutions
Recent methodological work in comparative politics and sociology has adapted the concept of path dependence into analyses of political and social phenomena. Path dependence has primarily been used in comparative-historical analyses of the development and persistence of institutions, whether they be social, political, or cultural. There are arguably two types of path-dependent processes:
One is the critical juncture framework, most notably utilized by Ruth and David Collier in political science. In the critical juncture, antecedent conditions allow contingent choices that set a specific trajectory of institutional development and consolidation that is difficult to reverse. As in economics, the generic drivers are: lock-in, positive feedback, increasing returns (the more a choice is made, the bigger its benefits), and self-reinforcement (which creates forces sustaining the decision).
The other path-dependent process deals with reactive sequences where a primary event sets off a temporally-linked and causally-tight deterministic chain of events that is nearly uninterruptible. These reactive sequences have been used to link such things as the assassination of Martin Luther King Jr. with welfare expansion, or the Industrial Revolution in England with the development of the steam engine.
The critical juncture framework has been used to explain the development and persistence of welfare states, labor incorporation in Latin America, and the variations in economic development between countries, among other things. Scholars such as Kathleen Thelen caution that the historical determinism in path-dependent frameworks is subject to constant disruption from institutional evolution.
Kathleen Thelen has criticized the application of QWERTY keyboard-style mechanisms to politics. She argues that such applications to politics are both too contingent and too deterministic. Too contingent in the sense that the initial choice is open and flukey, and too deterministic in the sense that once the initial choice is made, an unavoidable path inevitably forms from which there is no return.
Organizations
Paul Pierson's influential attempt to rigorously formalize path dependence within political science, draws partly on ideas from economics. Herman Schwartz has questioned those efforts, arguing that forces analogous to those identified in the economic literature are not pervasive in the political realm, where the strategic exercise of power gives rise to, and transforms, institutions.
Especially sociology and organizational theory, a distinct yet closely related concept to path dependence is the concept of imprinting which captures how initial environmental conditions leave a persistent mark (or imprint) on organizations and organizational collectives (such as industries and communities), thus continuing to shape organizational behaviours and outcomes in the long run, even as external environmental conditions change.
Individuals and groups
The path dependence of emergent strategy has been observed in behavioral experiments with individuals and groups.
Other examples
A general type of path dependence is a typological vestige.
In typography, for example, some customs persist, although the reason for their existence no longer applies; for example, the placement of the period inside a quotation in U.S. spelling. In metal type, pieces of terminal punctuation, such as the comma and period, are comparatively small and delicate (as they must be x-height for proper kerning.) Placing the full-height quotation mark on the outside protected the smaller cast metal sort from damage if the word needed to be moved around within or between lines. This would be done even if the period did not belong to the text being quoted.
Evolution is considered by some to be path-dependent and historically contingent: mutations occurring in the past have had long-term effects on current life forms, some of which may no longer be adaptive to current conditions. For instance, there is a controversy about whether the panda's thumb is a leftover trait or not.
In the computer and software markets, legacy systems indicate path dependence: customers' needs in the present market often include the ability to read data or run programs from past generations of products. Thus, for instance, a customer may need not merely the best available word processor, but rather the best available word processor that can read Microsoft Word files. Such limitations in compatibility contribute to lock-in, and more subtly, to design compromises for independently developed products, if they attempt to be compatible. Also see embrace, extend and extinguish.
In socioeconomic systems, commercial fisheries' harvest rates and conservation consequences are found to be path dependent as predicted by the interaction between slow institutional adaptation, fast ecological dynamics, and diminishing returns.
In physics and mathematics, a non-holonomic system is a physical system in which the states depend on the physical paths taken.
See also
Critical juncture theory
Imprinting (organizational theory)
Innovation butterfly
Historicism
Network effect
Opportunity cost
Ratchet effect
Tyranny of small decisions
Notes
References
Arrow, Kenneth J. (1963), 2nd ed. Social Choice and Individual Values. Yale University Press, New Haven, pp. 119–120 (constitutional transitivity as alternative to path dependence on the status quo).
Arthur, W. Brian (1994), Increasing Returns and Path Dependence in the Economy. University of Michigan Press.
, in P. Garrouste and S. Ioannides (eds), Evolution and Path Dependence in Economic Ideas: Past and Present, Edward Elgar Publishing, Cheltenham, England.
Hargreaves Heap, Shawn (1980), "Choosing the Wrong 'Natural' Rate: Accelerating Inflation or Decelerating Employment and Growth?" Economic Journal 90(359) (Sept): 611–20 (ISSN 0013-0133)
Stephen E. Margolis and S.J. Liebowitz (2000), "Path Dependence, Lock-In, and History"
Nelson, R. and S. Winter (1982), An evolutionary theory of economic change, Harvard University Press.
Pdf.
Penrose, E. T., (1959), The Theory of the Growth of the Firm, New York: Wiley.
Pierson, Paul (2000). "Increasing Returns, Path Dependence, and the Study of Politics". American Political Science Review, June.
_ (2004), Politics in Time: Politics in Time: History, Institutions, and Social Analysis, Princeton University Press.
Puffert, Douglas J. (1999), "Path Dependence in Economic History" (based on the entry "Pfadabhängigkeit in der Wirtschaftsgeschichte", in the Handbuch zur evolutorischen Ökonomik)
_ (2001), "Path Dependence in Spatial Networks: The Standardization of Railway Track Gauge"
_ (2009), Tracks across continents, paths through history: the economic dynamics of standardization in railway gauge, University of Chicago Press.
Schwartz, Herman. "Down the Wrong Path: Path Dependence, Increasing Returns, and Historical Institutionalism"., undated mimeo
Shalizi, Cosma (2001), "QWERTY, Lock-in, and Path Dependence", unpublished website, with extensive references
Vergne, J. P. and R. Durand (2010), "The missing link between the theory and empirics of path dependence", Journal of Management Studies, 47(4):736–59, with extensive references
Competition (economics)
Market failure
Markov models
Decision theory
Memory | 0.76359 | 0.992513 | 0.757873 |
Disorders of diminished motivation | Disorders of diminished motivation (DDM) are a group of disorders involving diminished motivation and associated emotions. Many different terms have been used to refer to diminished motivation. Often however, a spectrum is defined encompassing apathy, abulia, and akinetic mutism, with apathy the least severe and akinetic mutism the most extreme.
DDM can be caused by psychiatric disorders like depression and schizophrenia, brain injuries, strokes, and neurodegenerative diseases. Damage to the anterior cingulate cortex and to the striatum, which includes the nucleus accumbens and caudate nucleus and is part of the mesolimbic dopamine reward pathway, have been especially associated with DDM. Diminished motivation can also be induced by certain drugs, including antidopaminergic agents like antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and cannabis, among others.
DDM can be treated with dopaminergic and other activating medications, such as dopamine reuptake inhibitors, dopamine releasing agents, and dopamine receptor agonists, among others. These kinds of drugs have also been used by healthy people to improve motivation. A limitation of some medications used to increase motivation is development of tolerance to their effects.
Definition
Disorders of diminished motivation (DDM) is an umbrella term referring to a group of psychiatric and neurological disorders involving diminished capacity for motivation, will, and affect.
A multitude of terms have been used to refer to DDM of varying severities and varieties, including apathy, abulia, akinetic mutism, athymhormia, avolition, amotivation, anhedonia, psychomotor retardation, affective flattening, akrasia, and psychic akinesia (auto-activation deficit or loss of psychic self-activation), among others. Other constructs, like fatigue, lethargy, and anergia, also overlap with the concept of DDM. Alogia (poverty of speech) and asociality (lack of social interest) are associated with DDM as well.
Often however, a spectrum of DDM is defined encompassing apathy, abulia, and akinetic mutism, with apathy being the mildest form and akinetic mutism being the most severe or extreme form. Akinetic mutism involves alertness but absence of movement and speech due to profound lack of will. People with the condition are indifferent even to biologically relevant stimuli such as pain, hunger, and thirst.
Causes
Less extreme forms of DDM, for instance apathy or anhedonia, can be a symptom of psychiatric disorders and related conditions, like depression, schizophrenia, or drug withdrawal. More extreme forms of DDM, for instance severe apathy, abulia, or akinetic mutism, can be a result of traumatic brain injury (TBI), stroke, or neurodegenerative diseases like dementia or Parkinson's disease.
Reduction in motivation and affect can also be induced by certain drugs, such as dopamine receptor antagonists including D2 receptor receptor antagonists like antipsychotics (e.g., haloperidol) and metoclopramide and D1 receptor antagonists like ecopipam, dopamine-depleting agents like tetrabenazine and reserpine, dopaminergic neurotoxins like 6-hydroxydopamine (6-OHDA) and methamphetamine, serotonergic antidepressants like the selective serotonin reuptake inhibitors (SSRIs) and MAO-A-inhibiting monoamine oxidase inhibitors (MAOIs), and cannabis or cannabinoids (CB1 receptor agonists).
Damage to a variety of brain areas have been implicated in DDM. However, damage to or reduced functioning of the anterior cingulate cortex (ACC) and striatum have been especially implicated in DDM. The striatum is part of the dopaminergic mesolimbic pathway, which connects the ventral tegmental area (VTA) of the midbrain to the nucleus accumbens (NAc) of the ventral striatum and basal ganglia. Strokes affecting other striatal and basal ganglia structures, like the caudate nucleus of the dorsal striatum, have also been associated with DDM.
Treatment
DDM, like abulia and akinetic mutism, can be treated with dopaminergic and other activating medications. These include psychostimulants and releasers or reuptake inhibitors of dopamine and/or norepinephrine like amphetamine, methylphenidate, bupropion, modafinil, and atomoxetine; D2-like dopamine receptor agonists like pramipexole, ropinirole, rotigotine, piribedil, bromocriptine, cabergoline, and pergolide; the dopamine precursor levodopa; and MAO-B-selective monoamine oxidase inhibitors (MAOIs) like selegiline and rasagiline, among others. Selegiline is also a catecholaminergic activity enhancer (CAE), and this may additionally or alternatively be involved in its pro-motivational effects.
The dopamine D1 receptor appears to have an important role in motivation and reward. Centrally acting dopamine D1-like receptor agonists like tavapadon and razpipadon and D1 receptor positive modulators like mevidalen and glovadalen are under development for medical use, including treatment of Parkinson's disease and notably of dementia-related apathy. Centrally active catechol-O-methyltransferase inhibitors (COMTIs) like tolcapone, which are likewise dopaminergic agents, have been studied in the treatment of psychiatric disorders but not in the treatment of DDM. Genetic variants in catechol-O-methyltransferase (COMT) have been associated with motivation and apathy susceptibility, as well as with reward, mood, and other neuropsychological variables.
Besides in people with DDM, psychostimulants and related agents have been used non-medically to enhance motivation in healthy people, for instance in academic contexts. This has provoked discussions on the ethics of such uses.
A limitation of certain medications used to improve motivation, like psychostimulants, is development of tolerance to their effects. Rapid acute tolerance to amphetamines is believed to be responsible for the dissociation between their relatively short durations of action (~4hours for main desired effects) and their much longer elimination half-lives (~10hours) and durations in the body (~2days). It appears that continually increasing or ascending concentration–time curves are beneficial for prolonging effects, which has resulted in administration multiple times per day and development of delayed- and extended-release formulations. Medication holidays and breaks can be helpful in resetting tolerance.
Another possible limitation of amphetamine specifically is dopaminergic neurotoxicity, which might occur even at therapeutic doses.
Besides medications, various psychological and physiological processes, including arousal, mood, expectancy effects (e.g., placebo), novelty, psychological stress or urgency, rewarding and aversive stimuli, availability of rewards, addiction, and sleep amount, among others, can also context- and/or stimulus-dependently modulate or enhance brain dopamine signaling and motivation to varying degrees. Relatedly, the psychostimulant effects of amphetamine are greatly potentiated by environmental novelty in animals.
Related concepts
Attention deficit hyperactivity disorder (ADHD) often involves motivational deficits, and the ADHD academic Russell Barkley has referred to the condition as a "motivational deficit disorder" in various publications and presentations. However, ADHD has perhaps more accurately been conceptualized as a disorder of executive function and of directing or allocating attention and motivation rather than a global deficiency in these processes. People with ADHD are often highly motivated towards stimuli that interest them, not uncommonly experiencing a flow-like state called hyperfocus while engaging such stimuli. In any case, as with management of DDM, psychostimulants and other catecholaminergic agents are used in people with ADHD to treat their symptoms, including difficulties with attention, executive control, and motivation. Amphetamines in the treatment of ADHD appear to have among the largest effect sizes in terms of effectiveness of any interventions (medications or forms of psychotherapy) used in the management of psychiatric disorders generally.
DDM (and ADHD) should not be confused with "motivational deficiency disorder" ("MoDeD"; "extreme laziness"), a fake or spoof disease created for humorous purposes in 2006 to raise awareness about disease mongering, overdiagnosis, and medicalization.
References
Emotions
Motivation
Neuropsychology
Pro-motivational agents
Psychopathological syndromes
Symptoms and signs of mental disorders
Symptoms and signs: Nervous system | 0.764042 | 0.991925 | 0.757872 |
Springer Publishing | Springer Publishing Company is an American publishing company of academic journals and books, focusing on the fields of nursing, gerontology, psychology, social work, counseling, public health, and rehabilitation (neuropsychology). It was established in 1951 by Bernhard Springer, a great-grandson of Julius Springer, and is based in Midtown Manhattan, New York City.
History
Springer Publishing Company was founded in 1950 by Bernhard Springer, the Berlin-born great-grandson of Julius Springer, who founded Springer-Verlag (now Springer Science+Business Media). Springer Publishing's first landmark publications included Livestock Health Encyclopedia by R. Seiden and the 1952 Handbook of Cardiology for Nurses. The company's books soon branched into other fields, including medicine and psychology. Nursing publications grew rapidly in number, as Modell's Drugs in Current Use, a small annual paperback, sold over 150,000 copies over several editions. Solomon Garb's Laboratory Tests for Nurses, first published in 1954, sold nearly 240,000 copies over six editions in 25 years. In its second decade, the firm expanded into new publishing areas to reflect the rapidly expanding health care industry. Gerontology was a growing topic of interest, and in the 1960s Bernhard Springer published six titles on aging. Meanwhile, publications in psychiatry and psychology continued to grow.
After Bernhard Springer's death in 1970, his wife Ursula assumed responsibility for the company, and the firm continued to expand, adding titles in social work, counseling, rehabilitation, and public health, in addition to publishing journals, and annual reviews. In 2004, Ursula Springer sold Springer Publishing Company to Mannheim Holdings, LLC, a subsidiary of the Mannheim Trust. In 2008 they established a division to focus on nursing, and "signs to look for" when abuse is suspected. In 2015, Demos Medical Publishing merged into Springer Publishing.
Journals
Springer Publishing publishes the following academic journals:
Footnotes
Further reading
External links
Academic publishing companies
Publishing companies of the United States
Publishing companies established in 1950
1950 establishments in New York City
Companies based in New York City | 0.765049 | 0.990609 | 0.757865 |
Gerontology | Gerontology is the study of the social, cultural, psychological, cognitive, and biological aspects of aging. The word was coined by Ilya Ilyich Mechnikov in 1903, from the Greek , meaning "old man", and , meaning "study of". The field is distinguished from geriatrics, which is the branch of medicine that specializes in the treatment of existing disease in older adults. Gerontologists include researchers and practitioners in the fields of biology, nursing, medicine, criminology, dentistry, social work, physical and occupational therapy, psychology, psychiatry, sociology, economics, political science, architecture, geography, pharmacy, public health, housing, and anthropology.
The multidisciplinary nature of gerontology means that there are a number of sub-fields which overlap with gerontology. There are policy issues, for example, involved in government planning and the operation of nursing homes, investigating the effects of an aging population on society, and the design of residential spaces for older people that facilitate the development of a sense of place or home. Dr. Lawton, a behavioral psychologist at the Philadelphia Geriatric Center, was among the first to recognize the need for living spaces designed to accommodate the elderly, especially those with Alzheimer's disease. As an academic discipline the field is relatively new. The USC Leonard Davis School of Gerontology created the first PhD, master's and bachelor's degree programs in gerontology in 1975.
History
In the Islamic Golden Age, several physicians wrote on issues related to Gerontology. Avicenna's The Canon of Medicine (1025) offered instruction for the care of the aged, including diet and remedies for problems including constipation. Arabic physician Ibn Al-Jazzar Al-Qayrawani (Algizar, c. 898–980) wrote on the aches and conditions of the elderly. His scholarly work covers sleep disorders, forgetfulness, how to strengthen memory, and causes of mortality. Ishaq ibn Hunayn (died 910) also wrote works on the treatments for forgetfulness.
While the number of aged humans, and the life expectancy, tended to increase in every century since the 14th, society tended to consider caring for an elderly relative as a family issue. It was not until the coming of the Industrial Revolution that ideas shifted in favor of a societal care-system. Some early pioneers, such as Michel Eugène Chevreul, who himself lived to be 102, believed that aging itself should be a science to be studied. Élie Metchnikoff coined the term "gerontology" in 1903.
Modern pioneers like James Birren began organizing gerontology as its own field in the 1940s, later being involved in starting a US government agency on aging—the National Institute on Aging—programs in gerontology at the University of Southern California and University of California, Los Angeles, and as past president of the Gerontological Society of America (founded in 1945).
With the population of people over 60 years old expected to be some 22% of the world's population by 2050, assessment and treatment methods for age-related disease burden—the term geroscience emerged in the early 21st century.
Aging demographics
The world is forecast to undergo rapid population aging in the next several decades. In 1900, there were 3.1 million people aged 65 years and older living in the United States. However, this population continued to grow throughout the 20th century and reached 31.2, 35, and 40.3 million people in 1990, 2000, and 2010, respectively. Notably, in the United States and across the world, the "baby boomer" generation began to turn 65 in 2011. Recently, the population aged 65 years and older has grown at a faster rate than the total population in the United States. The total population increased by 9.7%, from 281.4 million to 308.7 million, between 2000 and 2010. However, the population aged 65 years and older increased by 15.1% during the same period. It has been estimated that 25% of the population in the United States and Canada will be aged 65 years and older by 2025. Moreover, by 2050, it is predicted that, for the first time in United States history, the number of individuals aged 60 years and older will be greater than the number of children aged 0 to 14 years. Those aged 85 years and older (oldest-old) are projected to increase from 5.3 million to 21 million by 2050. Adults aged 85–89 years constituted the greatest segment of the oldest-old in 1990, 2000, and 2010. However, the largest percentage point increase among the oldest-old occurred in the 90- to 94-year-old age group, which increased from 25.0% in 1990 to 26.4% in 2010.
With the rapid growth of the aging population, social work education and training specialized in older adults and practitioners interested in working with older adults are increasingly in demand.
Gender differences with age
There has been a considerable disparity between the number of men and women in the older population in the United States. In both 2000 and 2010, women outnumbered men in the older population at every single year of age (e.g., 65 to 100 years and over). The sex ratio, which is a measure used to indicate the balance of males to females in a population, is calculated by taking the number of males divided by the number of females, and multiplying by 100. Therefore, the sex ratio is the number of males per 100 females. In 2010, there were 90.5 males per 100 females in the 65-year-old population. However, this represented an increase from 1990 when there were 82.7 males per 100 females, and from 2000 when the sex ratio was 88.1. Although the gender gap between men and women has narrowed, women continue to have a greater life expectancy and lower mortality rates at older ages relative to men. For example, the Census 2010 reported that there were approximately twice as many women as men living in the United States at 89 years of age (361,309 versus 176,689, respectively).
Geographic distribution of older adults in the United States
The number and percentage of older adults living in the United States vary across the four different regions (Northeast, Midwest, West, and South) defined by the United States census. In 2010, the South contained the greatest number of people aged 65 years and older and 85 years and older. However, proportionately, the Northeast contains the largest percentage of adults aged 65 years and older (14.1%), followed by the Midwest (13.5%), the South (13.0%), and the West (11.9%). Relative to the Census 2000, all geographic regions demonstrated positive growth in the population of adults aged 65 years and older and 85 years and older. The most rapid growth in the population of adults aged 65 years and older was evident in the West (23.5%), which showed an increase from 6.9 million in 2000 to 8.5 million in 2010. Likewise, in the population aged 85 years and older, the West (42.8%) also showed the fastest growth and increased from 806,000 in 2000 to 1.2 million in 2010. It is worth highlighting that Rhode Island was the only state that experienced a reduction in the number of people aged 65 years and older, and declined from 152,402 in 2000 to 151,881 in 2010. Conversely, all states exhibited an increase in the population of adults aged 85 years and older from 2000 to 2010.
Sub-fields
As with many disciplines, over the course of the 20th and 21st centuries the field of gerontology has sub-divided into multiple specific disciplines focused on increasingly narrow aspects of the aging process.
Biogerontology
Biogerontology is the special sub-field of gerontology concerned with the biological aging process, its evolutionary origins, and potential means to intervene in the process. Aim of biogerontology is to prevent age-related disease by intervening in aging processes or even eliminate aging per se. Some argue that aging fits the criteria of disease, therefore aging is disease and should be treated as disease. In 2008 Aubrey de Grey said that in case of suitable funding and involvement of specialists there is a 50% chance, that in 25–30 years humans will have technology saving people from dying of old age, regardless of the age at which they will be at that time. His idea is to repair inside cells and between them all that can be repaired using modern technology, allowing people to live until time when technology progress will allow to cure deeper damage. This concept got the name "longevity escape velocity".
A meta analysis of 36 studies concluded that there is an association between age and DNA damage in humans, a finding consistent with the DNA damage theory of aging.
Social gerontology
Social gerontology is a multi-disciplinary sub-field that specializes in studying or working with older adults. Social gerontologists may have degrees or training in social work, nursing, psychology, sociology, demography, public health, or other social science disciplines. Social gerontologists are responsible for educating, researching, and advancing the broader causes of older people.
Because issues of life span and life extension need numbers to quantify them, there is an overlap with demography. Those who study the demography of the human life span differ from those who study the social demographics of aging.
Social theories of aging
Several theories of aging are developed to observe the aging process of older adults in society as well as how these processes are interpreted by men and women as they age.
Activity theory
Activity theory was developed and elaborated by Cavan, Havighurst, and Albrecht. According to this theory, older adults' self-concept depends on social interactions. In order for older adults to maintain morale in old age, substitutions must be made for lost roles. Examples of lost roles include retirement from a job or loss of a spouse.
Activity is preferable to inactivity because it facilitates well-being on multiple levels. Because of improved general health and prosperity in the older population, remaining active is more feasible now than when this theory was first proposed by Havighurst nearly six decades ago. The activity theory is applicable for a stable, post-industrial society, which offers its older members many opportunities for meaningful participation. Weakness: Some aging persons cannot maintain a middle-aged lifestyle, due to functional limitations, lack of income, or lack of a desire to do so. Many older adults lack the resources to maintain active roles in society. On the flip side, some elders may insist on continuing activities in late life that pose a danger to themselves and others, such as driving at night with low visual acuity or doing maintenance work to the house while climbing with severely arthritic knees. In doing so, they are denying their limitations and engaging in unsafe behaviors.
Disengagement theory
Disengagement theory was developed by Cumming and Henry. According to this theory, older adults and society engage in a mutual separation from each other. An example of mutual separation is retirement from the workforce. A key assumption of this theory is that older adults lose "ego-energy" and become increasingly self-absorbed. Additionally, disengagement leads to higher morale maintenance than if older adults try to maintain social involvement. This theory is heavily criticized for having an escape clause—namely, that older adults who remain engaged in society are unsuccessful adjusters to old age.
Gradual withdrawal from society and relationships preserves social equilibrium and promotes self-reflection for elders who are freed from societal roles. It furnishes an orderly means for the transfer of knowledge, capital, and power from the older generation to the young. It makes it possible for society to continue functioning after valuable older members die.
Age stratification theory
According to this theory, older adults born during different time periods form cohorts that define "age strata". There are two differences among strata: chronological age and historical experience. This theory makes two arguments. 1. Age is a mechanism for regulating behavior and as a result determines access to positions of power. 2. Birth cohorts play an influential role in the process of social change.
Life course theory
According to this theory, which stems from the life course perspective aging occurs from birth to death. Aging involves social, psychological, and biological processes. Additionally, aging experiences are shaped by cohort and period effects.
Also reflecting the life course focus, consider the implications for how societies might function when age-based norms vanish—a consequence of the deinstitutionalization of the life course—and suggest that these implications pose new challenges for theorizing aging and the life course in postindustrial societies. Dramatic reductions in mortality, morbidity, and fertility over the past several decades have so shaken up the organization of the life course and the nature of educational, work, family, and leisure experiences that it is now possible for individuals to become old in new ways. The configurations and content of other life stages are being altered as well, especially for women. In consequence, theories of age and aging will need to be reconceptualized.
Cumulative advantage/disadvantage theory
According to this theory, which was developed beginning in the 1960s by Derek Price and Robert Merton and elaborated on by several researchers such as Dale Dannefer, inequalities have a tendency to become more pronounced throughout the aging process. A paradigm of this theory can be expressed in the adage "the rich get richer and the poor get poorer". Advantages and disadvantages in early life stages have a profound effect throughout the life span. However, advantages and disadvantages in middle adulthood have a direct influence on economic and health status in later life.
Environmental gerontology
Environmental gerontology is a specialization within gerontology that seeks an understanding and interventions to optimize the relationship between aging persons and their physical and social environments.
The field emerged in the 1930s during the first studies on behavioral and social gerontology. In the 1970s and 1980s, research confirmed the importance of the physical and social environment in understanding the aging population and improved the quality of life in old age. Studies of environmental gerontology indicate that older people prefer to age in their immediate environment, whereas spatial experience and place attachment are important for understanding the process.
Some research indicates that the physical-social environment is related to the longevity and quality of life of the elderly. Precisely, the natural environment (such as natural therapeutic landscapes, therapeutic garden) contributes to active and healthy aging in the place.
Jurisprudential gerontology
Jurisprudential gerontology (sometimes referred to as "geriatric jurisprudence") is a specialization within gerontology that looks into the ways laws and legal structures interact with the aging experience. The field started from legal scholars in the field of elder law, which found that looking into legal issues of older persons without a broader inter-disciplinary perspective does not provide the ideal legal outcome. Using theories such as therapeutic jurisprudence, jurisprudential scholars critically examined existing legal institutions (e.g. adult guardianship, end of life care, or nursing homes regulations) and showed how law should look more closely to the social and psychological aspects of its real-life operation. Other streams within jurisprudential gerontology also encouraged physicians and lawyers to try to improve their cooperation and better understand how laws and regulatory institutions affect health and well-being of older persons.
See also
Academic journals on gerontology
Aging and memory
Aging Portfolio
Biological clock
Bionics
Clinical geropsychology
Elderly care
Financial gerontology
Gerontotechnology
Life extension
List of life extension topics
Old age
Oldest people
Silver Alert
Timeline of senescence research
References
External links
Ageing
Branches of biology
Interdisciplinary subfields of sociology
1900s neologisms | 0.760548 | 0.996468 | 0.757861 |
Play (BDSM) | Play, within BDSM circles, is any of the wide variety of "kinky" activities. This includes both physical and mental activities, covering a wide range of intensities and levels of social acceptability. The term originated in the BDSM club and party communities, indicating the activities taking place within a scene. It has since extended to the full range of BDSM activities.
Play can take many forms. It ranges from light "getting to know you" sessions where participants discover each other's likes and dislikes to extreme, extended play between committed individuals that know each other's limits and are willing to push or be pushed at their boundaries. While physical activities are better known and more infamous, it also includes 'mental play' such as erotic hypnosis and mind games.
BDSM play is usually the primary topic of negotiation, especially for casual players and limited scenes. Most BDSM clubs and local communities offer classes and materials about negotiating play scenes. Play safety is a major topic of discussion and debate within BDSM communities.
Categories of play
Play is broken down into two broad categories, physical and mental. Physical play is better known and consists of the typical activities the average person thinks of as BDSM. As the BDSM scene matures and gains greater mainstream tolerance, mental play is becoming an increasingly noteworthy part of the community.
Physical BDSM
Physical BDSM encompasses all "kinky" activities that are carried out physically. Two of the best known examples are flogging and bondage. Extensive classes and workshops teach technical skills to carry out these activities competently, as well as safety considerations and protocols. This is the type of play most often seen in BDSM clubs and in media representations of kink. While often associated with sadism and masochism, many activities are not focused on or even involve pain. Non-painful sensation play and elaborate bondage done mainly for aesthetic purposes are prominent examples.
Mental BDSM
Mental BDSM is the collection of activities intended to create a psychological impact, often without a physical component. Recreational hypnosis is the most prominent example, with a well-developed international community. Another noteworthy but controversial example is the 'mind fuck', wherein a state of confusion and/or psychological conflict is intentionally created. While mental 'players' have considerably less documented material to study, an active Internet community and classes offered through local groups and conventions provide many learning opportunities.
Types of play
Participants in BDSM typically recognise different types of play, based on their intensity and social acceptability. These distinctions can be rather arbitrary and variant. What is considered edge play for a particular couple or local community may be merely heavy play, or even light play, for others.
Light play
Light play consists of activities that are considered mild and/or carry little social stigma. This especially includes BDSM elements commonly practiced by "vanilla" couples. Light bondage, slapping, and casual spanking are examples of light play.
Heavy play
Heavy play indicates elements that are intense and/or carry substantial social stigma. The bulk of activities undertaken by BDSM participants would be considered as heavy play or bordering on heavy play. Examples of heavy play include caning, suspension bondage, and erotic hypnosis.
Edge play
Edgeplay is a term used for types of play that "push the edge." They usually involve a risk of physical or emotional harm. Breath play, knife play, gun play and blood play are all types of edge play. In males, restriction of flow of urine and semen may contribute to the development of benign prostatic hyperplasia and erectile dysfunction.
Edge play can also literally refer to playing with an edge, for example knives, swords and other implements. It is sometimes used to describe activities that challenge the boundaries of the participants.
This type of play generally falls under the umbrella of RACK (Risk Aware Consensual Kink).
Safety and consent
Deadly outcomes arising from BDSM play are rare. A recent case collection reported three cases of deaths related to consensual BDSM activities. According to a study that examined 17 cases of deaths related to such activities, the most prominent cause of death was strangulation (which occurred in 88% of the cases in the sample).
Some deaths related to play, including erotic asphyxia, have resulted in criminal prosecutions, with some defendants arguing in court that their partners had died accidentally. Such defenses have been deemed as problematic by some scholars, who believe that male defendants have disguised misogynistic conduct as a strategy to manipulate trial and sentencing results.
See also
Glossary of BDSM
References
BDSM terminology | 0.767098 | 0.987956 | 0.757859 |
World Mental Health Day | World Mental Health Day (10 October) is an international day for global mental health education, awareness and advocacy against social stigma. It was first celebrated in 1992 at the initiative of the World Federation for Mental Health, a global mental health organization with members and contacts in more than 150 countries. This day, each October, thousands of supporters come to celebrate this annual awareness program to bring attention to mental illness and its major effects on people's lives worldwide. In addition, this day provides an opportunity for mental health professionals to discuss and shed light on their work, making mental health a priority worldwide. In some countries this day is part of an awareness week, such as Mental Health Week in Australia.
History
World Mental Health Day was celebrated for the first time on October 10, 1992, at the initiative of Deputy Secretary General Richard Hunter. Up until 1994, the day had no specific theme other than general promoting mental health advocacy and educating the public.
In 1994 World Mental Health Day was celebrated with a theme for the first time at the suggestion of then Secretary General Eugene Brody. The theme was "Improving the Quality of Mental Health Services throughout the World".
World Mental Health Day is supported by WHO through raising awareness on mental health issues using its strong relationships with the Ministries of health and civil society organizations across the globe. WHO also supports with developing technical and communication material.
On World Mental Health Day 2018, Prime Minister Theresa May appointed Jackie Doyle-Price as the UK's first suicide prevention minister. This occurred while as the government hosted the first ever global mental health summit.
World Mental Health Day themes
See also
Global Mental Health
Mental Illness Awareness Week (US, first week of October)
National Alliance on Mental Illness (NAMI)
National Institute of Mental Health (NIMH)
World Health Day
World Federation for Mental Health
References
External links
World Federation for Mental Health
World Mental Health Day (WHO)
World Mental Health Day 2020
World Mental Health Day 2021 (WHO)
World Mental Health Day 2021 (PAHO)
Mental health
Health awareness days
Disability observances
October observances
Recurring events established in 1992 | 0.761509 | 0.99516 | 0.757823 |
Psychosynthesis | Psychosynthesis is an approach to psychology that expands the boundaries of the field by identifying a deeper center of identity, which is the postulate of the Self. It considers each individual unique in terms of purpose in life, and places value on the exploration of human potential. The approach combines spiritual development with psychological healing by including the life journey of an individual or their unique path to self-realization.
The integrative framework of psychosynthesis is based on Sigmund Freud's theory of the unconscious and addresses psychological distress and intra-psychic and interpersonal conflicts.
Development
Psychosynthesis was developed by Italian psychiatrist, Roberto Assagioli, who was a colleague of Freud and Bleuler. He compared psychosynthesis to the prevailing thinking of the day, contrasting psychosynthesis for example with existential psychology, but unlike the latter considered loneliness not to be "either ultimate or essential".
Assagioli asserted that "the direct experience of the self, of pure self-awareness...—is true." Spiritual goals of "self-realization" and the "interindividual psychosynthesis"—of "social integration...the harmonious integration of the individual into ever larger groups up to the 'one humanity'"—were central to Assagioli's theory. Psychosynthesis was not intended to be a school of thought or an exclusive method. However, many conferences and publications had it as a central theme, and centers were formed in Italy and the United States in the 1960s.
Psychosynthesis departed from the empirical foundations of psychology because it studied a person as a personality and a soul, but Assagioli continued to insist that it was scientific. He developed therapeutic methods beyond those in psychoanalysis. Although the unconscious is an important part of his theory, Assagioli was careful to maintain a balance with rational, conscious therapeutical work.
Assagioli was not the first to use the term "psychosynthesis". The earliest use was by James Jackson Putnam, who used it as the name of his electroconvulsive therapy. The term was also used by C. G. Jung and A. R. Orage, who were both more aligned with Assagioli's use of the term than Putnam's use. C. G. Jung, in comparing his goals to those of Sigmund Freud, wrote, "If there is a 'psychoanalysis' there must also be a 'psychosynthesis which creates future events according to the same laws'." A. R. Orage, who was the publisher of the influential journal, The New Age, used the term as well, but hyphenated it (psycho-synthesis). Orage formed an early psychology study group (which included Maurice Nicoll who later studied with Carl Jung) and concluded that what humanity needed was not psychoanalysis, but psycho-synthesis. The term was also used by Bezzoli. Freud, however, was opposed to what he saw as the directive element in Jung's approach to psychosynthesis, and Freud argued for a spontaneous synthesis on the patient's part: "As we analyse...the great unity which we call his ego fits into itself all the instinctual impulses which before had been split off and held apart from it. The psycho-synthesis is thus achieved in analytic treatment without our intervention, automatically and inevitably."
Origins
In 1909, C.G. Jung wrote to Sigmund Freud of "a very pleasant and perhaps valuable acquaintance, our first Italian, a Dr. Assagioli from the psychiatric clinic in Florence". Later however, this same Roberto Assagioli (1888 – 1974) wrote a doctoral dissertation, "La Psicosintesi," in which he began to move away from Freud's psychoanalysis toward what he called psychosynthesis:
A beginning of my conception of psychosynthesis was contained in my doctoral thesis on Psychoanalysis (1910), in which I pointed out what I considered to be some of the limitations of Freud's views.
In developing psychosynthesis, Assagioli agreed with Freud that healing childhood trauma and developing a healthy ego were necessary aims of psychotherapy, but Assagioli believed that human growth could not be limited to this alone. A student of philosophical and spiritual traditions of both East and West, Assagioli sought to address human growth as it proceeded beyond the norm of the well-functioning ego; he wished to support the fruition of human potential—what Abraham Maslow later termed self-actualization—into the spiritual or transpersonal dimensions of human experience as well.
Assagioli envisioned an approach to the human being that could address both the process of personal growth—of personality integration and self-actualization—as well as transpersonal development—that dimension glimpsed for example in peak experiences (Maslow) of inspired creativity, spiritual insight, and unitive states of consciousness. Psychosynthesis recognizes the process of self-realization, of contact and response with one's deepest callings and directions in life, which can involve either or both personal and transpersonal development.
Psychosynthesis is therefore one of the earliest forerunners of both humanistic psychology and transpersonal psychology, even preceding Jung's break with Freud by several years. Assagioli's conception has an affinity with existential-humanistic psychology and other approaches that attempt to understand the nature of the healthy personality, personal responsibility, and choice, and the actualization of the personal self. Similarly, his conception is related to the field of transpersonal psychology (with its focus on higher states of consciousness), spirituality, and human experience beyond the individual self. Assagioli served on the board of editors for both the Journal of Humanistic Psychology and the Journal of Transpersonal Psychology.
Assagioli presents two major theoretical models in his seminal book, Psychosynthesis, models that have remained fundamental to psychosynthesis theory and practice:
A diagram and description of the human person
A stage theory of the process of psychosynthesis (see below).
Aims
In Psychosomatic Medicine and Bio-psychosynthesis, Assagioli states that the principal aims and tasks of psychosynthesis are:
the elimination of the conflicts and obstacles, conscious and unconscious, that block [the complete and harmonious development of the human personality]
the use of active techniques to stimulate the psychic functions still weak and immature.
In his major book, Psychosynthesis: A Collection of Basic Writings (1965), Assagioli writes of three aims of psychosynthesis:
Let us examine whether and how it is possible to solve this central problem of human life, to heal this fundamental infirmity of man. Let us see how he may free himself from this enslavement and achieve an harmonious inner integration, true Self-realization, and right relationships with others. (p. 21)
Model of the person
At the core of psychosynthesis theory is the Egg Diagram, which maps the human psyche into different distinct and interconnected levels.
Lower unconscious
For Assagioli, 'the lower unconscious, which contains one's personal psychological past in the form of repressed complexes, long-forgotten memories and dreams and imaginations', stood at the base of the diagram of the mind.
The lower unconscious is that realm of the person to which is relegated the experiences of shame, fear, pain, despair, and rage associated with primal wounding suffered in life. One way to think of the lower unconscious is that it is a particular bandwidth of one's experiential range that has been broken away from consciousness. It comprises that range of experience related to the threat of personal annihilation, of destruction of self, of nonbeing, and more generally, of the painful side of the human condition. As long as this range of experience remains unconscious, the person will have a limited ability to be empathic with self or others in the more painful aspects of human life.
At the same time, 'the lower unconscious merely represents the most primitive part of ourselves...It is not bad, it is just earlier '. Indeed, 'the "lower" side has many attractions and great vitality', and – as with Freud's id, or Jung's shadow – the conscious goal must be to 'achieve a creative tension' with the lower unconscious.
Middle unconscious
The middle unconscious is a sector of the person whose contents, although unconscious, nevertheless support normal conscious functioning in an ongoing way (thus it is illustrated as most immediate to "I"). It is the capacity to form patterns of skills, behaviors, feelings, attitudes, and abilities that can function without conscious attention, thereby forming the infrastructure of one's conscious life.
The function of the middle unconscious can be seen in all spheres of human development, from learning to walk and talk, to acquiring languages, to mastering a trade or profession, to developing social roles. Anticipating today's neuroscience, Assagioli even referred to "developing new neuromuscular patterns". All such elaborate syntheses of thought, feeling, and behavior are built upon learnings and abilities that must eventually operate unconsciously.
For Assagioli, 'Human healing and growth that involves work with either the middle or the lower unconscious is known as personal psychosynthesis '.
Higher unconscious
Assagioli termed 'the sphere of aesthetic experience, creative inspiration, and higher states of consciousness...the higher unconscious '. The higher unconscious (or superconscious) denotes "our higher potentialities which seek to express themselves, but which we often repel and repress" (Assagioli). As with the lower unconscious, this area is by definition not available to consciousness, so its existence is inferred from moments in which contents from that level affect consciousness. Contact with the higher unconscious can be seen in those moments, termed peak experiences by Maslow, which are often difficult to put into words, experiences in which one senses deeper meaning in life, a profound serenity and peace, a universality within the particulars of existence, or perhaps a unity between oneself and the cosmos. This level of the unconscious represents an area of the personality that contains the "heights" overarching the "depths" of the lower unconscious. As long as this range of experience remains unconscious – in what Desoille termed '"repression of the sublime"' – the person will have a limited ability to be empathic with self or other in the more sublime aspects of human life.
The higher unconscious thus represents 'an autonomous realm, from where we receive our higher intuitions and inspirations – altruistic love and will, humanitarian action, artistic and scientific inspiration, philosophic and spiritual insight, and the drive towards purpose and meaning in life'. It may be compared to Freud's superego, seen as 'the higher, moral, supra-personal side of human nature...a higher nature in man', incorporating 'Religion, morality, and a social sense – the chief elements in the higher side of man...putting science and art to one side'.
Subpersonalities
Subpersonalities based in the personal unconscious form a central strand in psychosynthesis thinking. 'One of the first people to have started really making use of subpersonalities for therapy and personal growth was Roberto Assagioli', psychosynthesis reckoning that 'subpersonalities exist at various levels of organization, complexity, and refinement' throughout the mind. A five-fold process of recognition, acceptance, co-ordination, integration, and synthesis 'leads to the discovery of the Transpersonal Self, and the realization that that is the final truth of the person, not the subpersonalities'.
Some subpersonalities may be seen 'as psychological contents striving to emulate an archetype...degraded expressions of the archetypes of higher qualities '. Others will resist the process of integration; will 'take the line that it is difficult being alive, and it is far easier – and safer – to stay in an undifferentiated state'.
"I"
"I" is the direct "reflection" or "projection" of Self (Assagioli) and the essential being of the person, distinct but not separate from all contents of experience. "I" possesses the two functions of consciousness, or awareness, and will, whose field of operation is represented by the concentric circle around "I" in the oval diagram – Personal Will.
Psychosynthesis suggests that "we can experience the will as having four stages. The first stage could be described as 'having no will, and might perhaps be linked with the hegemony of the lower unconscious. "The next stage of the will is understanding that 'will exists'. We might still feel that we cannot actually do it, but we know...it is possible". "Once we have developed our will, at least to some degree, we pass to the next stage which is called 'having a will, and thereafter "in psychosynthesis we call the fourth and final stage of the evolution of the will in the individual 'being will – which then "relates to the 'I' or self...draws energy from the transpersonal self".
The "I" is placed at the center of the field of awareness and will in order to indicate that "I" is the one who has consciousness and will. It is "I" who is aware of the psyche-soma contents as they pass in and out of awareness; the contents come and go, while "I" may remain present to each experience as it arises. But "I" is dynamic as well as receptive: "I" has the ability to affect awareness, in addition to the contents of awareness, by choosing to focus awareness (as in many types of meditation), expand it, or contract it.
Since "I" is distinct from any and all contents and structures of experience, "I" can be thought of as not a "self" at all but as "noself". That is, "I" is never the object of experience. "I" is who can experience, for example, the ego disintegrating and reforming, who can encounter emptiness and fullness, who can experience utter isolation or cosmic unity, who can engage any and all arising experiences. "I" is not any particular experience but the experiencer, not object but subject, and thus cannot be seen or grasped as an object of consciousness. This "noself" view of "I" can be seen in Assagioli's discussion of "I" as a reflection of Self: "The reflection appears to be self-existent but has, in reality, no autonomous substantiality. It is, in other words, not a new and different light but a projection of its luminous source". The next section describes this "luminous source", Self.
Self
Pervading all the areas mapped by the oval diagram, distinct but not separate from all of them, is Self (which has also been called Higher Self or Transpersonal Self). The concept of Self points towards a source of wisdom and guidance within the person, a source which can operate quite beyond the control of the conscious personality. Since Self pervades all levels, an ongoing lived relationship with Self—Self-realization—may lead anywhere on the diagram as one's direction unfolds (this is one reason for not illustrating Self at the top of the diagram, a representation that tends to give the impression that Self-realization leads only into the higher unconscious). Relating to Self may lead for example to engagement with addictions and compulsions, to the heights of creative and religious experience, to the mysteries of unitive experience, to issues of meaning and mortality, to grappling with early childhood wounding, to discerning a sense of purpose and meaning in life.
The relationship of "I" and Self is paradoxical. Assagioli was clear that "I" and Self were from one point of view, one. He wrote, "There are not really two selves, two independent and separate entities. The Self is one". Such a nondual unity is a fundamental aspect of this level of experience. But Assagioli also understood that there could be a meaningful relationship between the person and Self as well:
Accounts of religious experiences often speak of a "call" from God, or a "pull" from some Higher Power; this sometimes starts a "dialogue" between the man [or woman] and this "higher Source"...
Assagioli did not of course limit this relationship and dialogue to those dramatic experiences of "call" seen in the lives of great men and women throughout history. Rather, the potential for a conscious relationship with Self exists for every person at all times and may be assumed to be implicit in every moment of every day and in every phase of life, even when one does not recognize this. Whether within one's private inner world of feelings, thoughts, and dreams, or within one's relationships with other people and the natural world, a meaningful ongoing relationship with Self may be lived.
Stages
Writing about the model of the person presented above, Assagioli states that it is a "structural, static, almost 'anatomical' representation of our inner constitution, while it leaves out its dynamic aspect, which is the most important and essential one". Thus he follows this model immediately with a stage theory outlining the process of psychosynthesis. This scheme can be called the "stages of psychosynthesis", and is presented here.
It is important to note that although the linear progression of the following stages does make logical sense, these stages may not in fact be experienced in this sequence; they are not a ladder up which one climbs, but aspects of a single process. Further, one never outgrows these stages; any stage can be present at any moment throughout the process of Psychosynthesis, Assaglioli acknowledging 'persisting traits belonging to preceding psychological ages' and the perennial possibility of 'retrogression to primitive stages'.
The stages of Psychosynthesis may be tabulated as follows:
Thorough knowledge of one's personality.
Control of its various elements.
Realization of one's true Self—the discovery or creation of a unifying center.
Psychosynthesis: the formation or reconstruction of the personality around a new center.
Methods
Psychosynthesis was regarded by Assagioli as more of an orientation and a general approach to the whole human being, and as existing apart from any of its particular concrete applications. This approach allows for a wide variety of techniques and methods to be used within the psychosynthesis context. 'Dialogue, Gestalt techniques, dream work, guided imagery, affirmations, and meditation are all powerful tools for integration', but 'the attitude and presence of the guide are of far greater importance than the particular methods used'. Sand tray, art therapy, journaling, drama therapy, and body work; cognitive-behavioral techniques; object relations, self psychology, and family systems approaches, may all be used in different contexts, from individual and group psychotherapy, to meditation and self-help groups. Psychosynthesis offers an overall view which can help orient oneself within the vast array of different modalities available today, and be applied either for therapy or for self-actualization.
Recently, two psychosynthesis techniques were shown to help student sojourners in their acculturation process. First, the self-identification exercise eased anxiety, an aspect of culture shock. Secondly, the subpersonality model aided students in their ability to integrate a new social identity. In another recent study, the subpersonality model was shown to be an effective intervention for aiding creative expression, helping people connect to different levels of their unconscious creativity. Most recently, psychosynthesis psychotherapy has proven to activate personal and spiritual growth in self-identified atheists.
One broad classification of the techniques used involves the following headings: ' Analytical: To help identify blocks and enable the exploration of the unconscious'. Psychosynthesis stresses 'the importance of using obstacles as steps to growth' – 'blessing the obstacle...blocks are our helpers'.
' Mastery...the eight psychological functions need to be gradually retrained to produce permanent positive change'.
' Transformation...the refashioning of the personality around a new centre'.
' Grounding...into the concrete terms of daily life.
' Relational...to cultivate qualities such as love, openness and empathy'.
Psychosynthesis allows practitioners the recognition and validation of an extensive range of human experience: the vicissitudes of developmental difficulties and early trauma; the struggle with compulsions, addictions, and the trance of daily life; the confrontation with existential identity, choice, and responsibility; levels of creativity, peak performance, and spiritual experience; and the search for meaning and direction in life. None of these important spheres of human existence need be reduced to the other, and each can find its right place in the whole. This means that no matter what type of experience is engaged, and no matter what phase of growth is negotiated, the complexity and uniqueness of the person may be respected—a fundamental principle in any application of psychosynthesis.
Criticism
In the December 1974 issue of Psychology Today, Assagioli was interviewed by Sam Keen and was asked to comment on the limits of psychosynthesis. He answered paradoxically: "The limit of psychosynthesis is that it has no limits. It is too extensive, too comprehensive. Its weakness is that it accepts too much. It sees too many sides at the same time and that is a drawback."
Psychosynthesis "has always been on the fringes of the 'official' therapy world" and it "is only recently that the concepts and methods of psychoanalysis and group analysis have been introduced into the training and practice of psychosynthesis psychotherapy".
As a result, the movement has been at times exposed to the dangers of fossilisation and cultism, so that on occasion, having "started out reflecting the high-minded spiritual philosophy of its founder, [it] became more and more authoritarian, more and more strident in its conviction that psychosynthesis was the One Truth".
A more technical danger is that premature concern with the transpersonal may hamper dealing with personal psychosynthesis: for example, "evoking serenity ... might produce a false sense of well-being and security". Practitioners have noted how "inability to ... integrate the superconscious contact with everyday experience easily leads to inflation", and have spoken of "an 'Icarus complex', the tendency whereby spiritual ambition fails to take personality limitations into account and causes all sorts of psychological difficulties".
Fictional analogies
Stephen Potter's "Lifemanship Psycho-Synthesis Clinic", where one may "find the psycho-synthesist lying relaxed on the couch while the patient will be encouraged to walk up and down" would seem a genuine case of "parallel evolution", since its clear targets, as "the natural antagonists...of the lifeplay, are the psychoanalysts".
Notes
References
Psychosynthesis: A Collection of Basic Writings by Roberto Assagioli
The Act of Will by Roberto Assagioli
What We May Be: Techniques for Psychological and Spiritual Growth Through Psychosynthesis by Piero Ferrucci
Unfolding Self: The Practice Of Psychosynthesis by Molly Young Brown
Psychosynthesis: A Psychology of the Spirit by John Firman and Ann Gila
The Primal Wound: A Transpersonal View of Trauma, Addiction, and Growth by John Firman and Ann Gila
"Psychosynthesis: The Elements and Beyond" by Will Parfitt
A Psychology with a Soul: Psychosynthesis in Evolutionary Context by Jean Hardy
Phenomenological, Existential, and Humanistic Psychologies: a Historical Survey by Henryk Misiak and Virginia Staudt Sexton
Lombard, C.A. (2014).Coping with anxiety and rebuilding identity: A psychosynthesis approach to culture shock. Counseling Psychology Quarterly, 27:2. http://www.tandfonline.com/eprint/KmPD4Cfz6NhcyXEsdraS/full
Lombard, C.A. & Müller, B.C.M. (2016) Opening the Door to Creativity: A Psychosynthesis Approach Journal of Humanistic Psychology, June 30, 2016, doi: 10.1177/0022167816653224. http://jhp.sagepub.com/content/early/2016/06/24/0022167816653224.abstract
Bibliography
Assagioli, R. (1965). Psychosynthesis. New York: The Viking Press.
_. (1967). Jung and Psychosynthesis. New York: Psychosynthesis Research Foundation.
_. (1973). The Act of Will. New York: Penguin Books.
Firman, J., & Gila, A. (1997). The primal wound: A transpersonal view of trauma, addiction, and growth. Albany, NY: State University of New York Press.
___. (2002). Psychosynthesis: A psychology of the spirit. Albany, NY: State University of New York Press.
Jung, C. G. 1954. The Development of Personality, Bollingen Series XX. Princeton, NJ: Princeton University Press.
Maslow, Abraham. (1962). Toward a Psychology of Being. Princeton, N.J.: D. Van Nostrand Company, Inc.
McGuire, William, ed. (1974). The Freud/Jung Letters. Vol. XCIV, Bollingen Series. Princeton, N.J.: Princeton University Press.
Whitmore, D. (2013) Psychosynthesis Counselling in Action (Counselling in Action series) 4th Edition. Sage.
Sørensen, Kenneth, (2016). The Soul of Psychosynthesis - The Seven Core Concepts. Kentaur Forlag
External links
The Institute of Psychosynthesis The Institute of Psychosynthesis London, founded under the guidance of Roberto Assagioli
The Psychosynthesis Trust founded by Roberto Assagioli
Re-Vision Centre for Integrative Psychosynthesis
Istituto di Psicosintesi The Institute of Psychosynthesis founded by Roberto Assagioli
Association for the Advancement of Psychosynthesis Psychosynthesis resources
Integral Psychosynthesis MA thesis on Integral Psychosynthesis
65 articles on Psychosynthesis Webpage featuring psychosynthesis
Training Schools:
The Institute of Psychosynthesis
Psychosynthesis Trust
Re-Vision
Istituto di Psicosintesi
The Synthesis Center
Humanistic psychology
Human Potential Movement
Spiritual evolution
Systems psychology
Transpersonal psychology | 0.764745 | 0.990939 | 0.757815 |
Social history (medicine) | In medicine, a social history (abbreviated "SocHx") is a portion of the medical history (and thus the admission note) addressing familial, occupational, and recreational aspects of the patient's personal life that have the potential to be clinically significant.
Components
Components can include inquiries about:
Substances
Alcohol
Tobacco (pack years)
illicit drugs
occupation
sexual behavior (increased risk of various infections among prostitutes, people who have sex with people for money, and males engaging in anal-receptive intercourse)
prison (especially if tuberculosis needs to be ruled out)
travel
exercise
diet
Firearms in household (especially if children or persons with cognitive impairment are present)
Relation to history
References
Medical terminology | 0.787631 | 0.962107 | 0.757785 |
Brain training | Brain training (also called cognitive training) is a program of regular activities purported to maintain or improve one's cognitive abilities. The phrase “cognitive ability” usually refers to components of fluid intelligence such as executive function and working memory. Cognitive training reflects a hypothesis that cognitive abilities can be maintained or improved by exercising the brain, analogous to the way physical fitness is improved by exercising the body. Cognitive training activities can take place in numerous modalities such as cardiovascular fitness training, playing online games or completing cognitive tasks in alignment with a training regimen, playing video games that require visuospatial reasoning, and engaging in novel activities such as dance, art, and music.
Numerous studies have indicated that aspects of brain structure remain "plastic" throughout life. Brain plasticity reflects the ability for the brain to change and grow in response to the environment. There is ample debate within the scientific community on the efficacy of brain training programs and controversy on the ethics of promoting brain training software to potentially vulnerable subjects.
Studies and interventions
Cognitive training has been studied by scientists for the past 100 years.
Cognitive training includes interventions targeted at improving cognitive abilities such as problem-solving, reasoning, attention, executive functions, and working memory. These kinds of abilities are targeted because they are correlated with individual differences such as academic achievement and life outcomes and it is thought that training general cognitive functions will lead to transfer of improvement across a variety of domains. Cognitive reserve is the capacity of a person to meet the various cognitive demands of life and is evident in an ability to assimilate information, comprehend relationships, and develop reasonable conclusions and plans. Cognitive training includes interventions targeted at improving cognitive abilities. One hypothesis to support cognitive training is that certain activities, done regularly, might help maintain or improve cognitive reserve.
Cognitive training studies often target clinical groups such as people with neurodegenerative disorders such as Alzheimer's and children with ADHD that experience general cognitive deficits. More broadly, it is thought that cognitive training may especially benefit older adults as there is a general decline in fluid intelligence with age as there are decreases in speed of processing, working memory, longterm memory, and reasoning skills. Some researchers argue that the lower performance of older adults on cognitive tasks may not always reflect actual ability as older adults may show performance decrements due to strategy choice, such as avoiding using memory retrieval in memory tasks.
Conceptual basis
Cognitive training is grounded in the idea that the brain is plastic. Brain plasticity refers to the ability for the brain to change and develop based on life experiences. Evidence for neuroplasticity includes studies on musical expertise and London taxicab drivers that have demonstrated that expertise leads to increased volume in specific brain areas. A 2008 study that trained older adults in juggling showed an increase in gray matter volume as a result of the training. A study attempting to train the updating component of executive function in young and older adults showed that cognitive training could lead to improvements in task performance across both of the groups, however, general transfer of ability to new tasks was only shown in young adults and not older adults. It has been hypothesized that transfer effects are dependent on an overlap in neural activation during the trained and transfer tasks. Cognitive training has been shown to lead to neural changes such as increased blood flow to the prefrontal cortex in attention training and decreased bilateral compensatory recruitment in older adults.
Mental exercises
Mind games for self-improvement fall into two main categories. There are mental exercises and puzzles to maintain or improve the actual working of the brain.
Mental exercises can be done through simple socializing. Social interaction engages in many facets of cognitive thinking and can facilitate cognitive functioning. Cartwright and Zander noted that if an alien was visiting Earth for the first time, they would be surprised by the amount of social contact humans make. Caring for one another and growing up in a group setting (family) shows a certain degree of interdependence that shows deep phylogenetic roots. However, this social contact is declining in the United States. Face-to-face interaction is getting more and more sparse. Family and friend visits, including dinners, are not as common. The amount of social contact a person receives can greatly affect their mental health. A preference for being with others has a high correlation with well-being and with mental long-term and short-term effects on performance.
There are many things involved in a simple interaction between two people: paying attention, maintaining in memory the conversation, adjusting to a different perspective than your own, assessing situational constraints, and self-monitoring appropriate behavior. It is true that some of these are automatic processes, but attention, working memory, and cognitive control are definitely executive functions. Doing all these things in a simple social interaction helps train the working memory in influencing social inference.
Social cognitive neuroscience also supports social interaction as a mental exercise. The prefrontal cortex function involves the ability to understand a person's beliefs and desires. The ability to control one's own beliefs and desires is served by the parietal and prefrontal regions of the brain, which is the same region emphasizing cognitive control.
The other category of mental exercises falls into the world of puzzles. Neurocognitive disorders such as dementia and impairment in cognitive functioning have risen as a healthcare concern, especially among the older generation. Solving jigsaw puzzles is an effective way to develop visuospatial functioning and keeping the mind sharp. Anyone can do it, as it is low-cost and can be intrinsically motivating. The important part about jigsaw puzzles is that it is challenging, especially compared to other activities, such as watching television. Engagement in such an intellectual activity predicts a lower risk in developing a cognition disorder later on in life.
There is also the category of the self-empowering mind game, as in psychodrama, or mental and fantasy workshops – elements which might be seen as an ultimate outgrowth of yoga as a set of mental (and physical) disciplines.
The ability to imagine and walk oneself through various scenarios is a mental exercise in itself. Self-reflection in this way taps into many different cognitive capabilities, including questioning rigid viewpoints, elaborating on experience, and knowing oneself through their relational context.
Commercial programs
By 2016, companies offering products and services for cognitive training were marketing them as improving educational outcomes for children, and for adults as improving memory, processing speed, and problem-solving, and even as preventing dementia or Alzheimers. They often have supported their marketing with discussion about the educational or professional background of their founders, some discuss neuroscience that supports their approach—especially concepts of neuroplasticity and transfer of learning, and some cite evidence from clinical trials. The key claim made by these companies is that the specific training that they offer generalizes to other fields—academic or professional performance generally or everyday life.
CogniFit was founded in 1999, Cogmed in 2001, Posit Science in 2002, and Brain Age was first released in 2005, all capitalizing on the growing interest within the public in neuroscience, along with heightened worries by parents about ADHD and other learning disabilities in their children, and concern about their own cognitive health as they aged.
The launch of Brain Age in 2005 marked a change in the field, as prior to this products or services were marketed to fairly narrow populations (for example, students with learning problems), but Brain Age was marketed to everyone, with a significant media budget. In 2005, consumers in the US spent $2 million on cognitive training products; in 2007 they spent about $80 million.
By 2012, "brain training" was a $1 billion industry. In 2013 the market was $1.3 billion, and software products made up about 55% of those sales. By that time neuroscientists and others had a growing concern about the general trend toward what they called "neurofication", "neurohype", "neuromania", and neuromyths.
Regulation and lawsuits
Starting in January 2015, the United States Federal Trade Commission (FTC) sued companies selling "brain training" programs or other products marketed as improving cognitive function, including WordSmart Corporation, the company that makes Lumosity, and Brain Research Labs (which sold dietary supplements) for deceptive advertising; later that year the FTC also sued LearningRx.
The FTC found that Lumosity's marketing "preyed on consumers' fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer's disease", without providing any scientific evidence to back its claims. The company was ordered not to make any claims that its products can "[improve] performance in school, at work, or in athletics" or "[delay or protect] against age-related decline in memory or other cognitive function, including mild cognitive impairment, dementia, or Alzheimer's disease", or "[reduce] cognitive impairment caused by health conditions, including Turner syndrome, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), traumatic brain injury (TBI), stroke, or side effects of chemotherapy", without "competent and reliable scientific evidence", and agreed to pay a $50 million settlement (reduced to $2 million).
In its lawsuit against LearningRx, the FTC said LearningRx had been "deceptively claim[ing] their programs were clinically proven to permanently improve serious health conditions like ADHD (attention deficit hyperactivity disorder), autism, dementia, Alzheimer's disease, strokes, and concussions". In 2016, LearningRx settled with the FTC by agreeing not to make the disputed assertions unless they had "competent and reliable scientific evidence" which was defined as randomized controlled trials done by competent scientists." For the judgment's monetary component, LearningRx agreed to pay $200,000 of a $4 million settlement.
Effectiveness
Studies that try to train specific cognitive abilities often only show task-specific improvements, and participants are unable to generalize their strategies to new tasks or problems. In 2016, there was some evidence that some of these programs improved performance on tasks in which users were trained, less evidence that improvements in performance generalize to related tasks, and almost no evidence that "brain training" generalizes to everyday cognitive performance. In addition, most clinical studies were flawed. But in 2017, the National Academies of Sciences, Engineering, and Medicine found moderate strength evidence for cognitive training as an intervention to prevent cognitive decline and dementia, and in 2018, the American Academy of Neurology guidelines for treatment of mild cognitive impairment included cognitive training.
To address growing public concerns with regard to aggressive online marketing of brain games to older population, a group of scientists published a letter in 2008 warning the general public that there is a lack of research showing effectiveness of brain games in older adults.
In 2010, the Agency for Healthcare Research and Quality found that there was insufficient evidence to recommend any method of preventing age-related memory deficits or Alzheimer's.
In 2014 another group of scientists published a similar warning. Later that year, another group of scientists made a counter statement, organized and maintained by the Chief Scientific Officer of Posit. They compiled a list of published studies on efficacy of cognitive training across populations and disciplines.
In 2014, one group of over 70 scientists stated that brain games cannot be scientifically proven as being cognitively advantageous, whether that be in preventing cognitive decline or improving cognitive functioning. Another group argued the opposite, with over 130 scientists saying that there is valid evidence in the benefits of brain training. The question is how these two groups reached different conclusions in reading the same literature. Different standards on both sides can answer that question. In a more specific manner, there is indeed a great deal of evidence that brain training does indeed improve performance on trained tasks, but less evidence in closely related tasks. There is even less evidence on distantly related tasks.
In 2017, a committee of the National Academies of Sciences, Engineering, and Medicine released a report about the evidence on interventions for preventing cognitive decline and dementia.
In 2017, a group of Australian scientists undertook a systematic review of what studies have been published of commercially available brain training programs in an attempt to give consumers and doctors credible information on which brain training programs are actually scientifically proved to work. After reviewing close to 8,000 studies about brain training programs marketed to healthy older adults, most programs had no peer reviewed published evidence of their efficacy. Of the seven brain training programs that did, only two of those had multiple studies, including at least one study of high quality: BrainHQ and CogniFit.
In 2019, a group of researchers showed that claims of enhancement following brain training and other training programs have been exaggerated, based on a number of meta-analyses. Other factors, e.g., genetics, seem to play a bigger role.
Cognitive training for Parkinson's disease
A 2020 Cochrane review found no certain evidence that cognitive training is beneficial for people with Parkinson's disease dementia (PDD) or Parkinson's disease-related mild cognitive impairment (PD-MCI), however the authors also note that their conclusion was based on a small number of studies with few participants, limitations of study design and execution, and imprecise results, and that there is still an overall need for more robust studies involving cognitive training as it pertains to PDD and PD-MCI.
See also
Apensar, a "brain trainer" mobile game
Brain training programs
Cognitive intervention
Environmental enrichment
Neurocognition
Neuroplasticity
Sudoku
Logic puzzle
References
Further reading
Applied psychology
Cognitive neuroscience
Neuropsychology | 0.770175 | 0.983891 | 0.757768 |
Medical malpractice | Medical malpractice is a legal cause of action that occurs when a medical or health care professional, through a negligent act or omission, deviates from standards in their profession, thereby causing injury or death to a patient. The negligence might arise from errors in diagnosis, treatment, aftercare or health management.
An act of medical malpractice usually has three characteristics. Firstly, it must be proven that the treatment has not been consistent with the standard of care, which is the standard medical treatment accepted and recognized by the profession. Secondly, it must be proven that the patient has suffered some kind of injury due to the negligence. In other words, an injury without negligence or an act of negligence without causing any injury cannot be considered malpractice. Thirdly, it must be proven that the injury resulted in significant damages such as disability, unusual pain, suffering, hardship, loss of income or a significant burden of medical bills.
Medical malpractice law
In common law jurisdictions, medical malpractice liability is normally based on the tort of negligence.
Although the law of medical malpractice differs significantly between nations, as a broad general rule liability follows when a health care practitioner does not show a fair, reasonable and competent degree of skill when providing medical care to a patient. If a practitioner holds himself out as a specialist a higher degree of skill is required. Jurisdictions have also been increasingly receptive to claims based on informed consent, raised by patients who allege that they were not adequately informed of the risks of medical procedures before agreeing to treatment.
As law varies by jurisdiction, the specific professionals who may be targeted by a medical malpractice action will vary depending upon where the action is filed. Among professionals that may be potentially liable under medical malpractice laws are:
Physicians, surgeons, psychiatrists and dentists.
Nurses, midwives, nurse practitioners, and physician assistants.
Allied health professionals - including physiotherapists, osteopaths, chiropractors, podiatrists, occupational therapists, social workers, psychologists, pharmacists, optometrists and medical radiation practitioners.
Among the acts or omissions that may potentially support a medical malpractice claim are the failure to properly diagnose a disease or medical condition, the failure to provide appropriate treatment for a medical condition, and unreasonable delay in treating a diagnosed medical condition. In some jurisdictions a medical malpractice action may be allowed even without a mistake from the doctor, based upon principles of informed consent, where a patient was not informed of possible consequences of a course of treatment and would have declined the medical treatment had proper information been provided in advance.
United Kingdom
The Supreme Court of the United Kingdom decided in 2018 that the duty of care extended to information given to patients by clerical staff of a healthcare provider, such that a medical negligence case might be predicated upon an administrative mistake. A patient at Croydon Health Services NHS Trust's emergency department had severe brain damage having been given misleading information by staff at reception. He was told that he would be seen by a doctor in four or five hours and left the hospital, when actually he would be seen inside 30 minutes by a triage nurse.
£1.7 billion was spent on clinical negligence claims by the NHS in 2016/17. 36% of that was legal costs. In January 2018, NHS England announced that NHS hospitals in England would no longer provide office or advertising space for lawyers who encourage people to take the NHS to court.
In 2019/20 11,682 medical negligence claims and reported incidents were received by the NHS – an increase of 9.3% on 2018/19. In the same time, the total value of clinical negligence claims under the CNST scheme reduced from £8.8 billion, to £8.3 billion.
Litigation
In many jurisdictions, a medical malpractice lawsuit is initiated officially by the filing and service of a summons and complaint. The parties subsequently engage in discovery," a process through which documents such as medical records are exchanged, and depositions are taken by parties involved in the lawsuit. A deposition involves the taking of statements made under oath about the case. Certain conversations are not discoverable due to issues of privilege, a legal protection against discovery, but most conversations between the parties and witnesses are discoverable.
Consequences
Consequences for patients and doctors vary by country.
In Canada, all provinces except Quebec base medical malpractice liability on negligence, while Quebec follows a civil law system.
Germany permits patients injured by medical negligence to bring a private action against the provider in contract, tort, or both.
Sweden has implemented a no fault system for the compensation of people injured by medical treatment. Patients who want to bring malpractice claims may choose between bringing a traditional tort claim or a no fault claim.
In New Zealand, the Accident Compensation Corporation provides no-fault compensation for victims.
In the United States, tort lawsuits may be used to seek compensation for malpractice. Awards of compensation in the United States tend to be much larger than awards for similar injuries in other nations.
A no-fault system may provide compensation to people who have medical outcomes that are significantly worse than would be anticipated under the circumstances, or where there is proof of injury resulting from medical error, without regard to whether or not malpractice occurred. Some no fault systems are restricted to specific types of injury, such as a birth injury or vaccine injury.
Demography
Medico-legal action across multiple countries is more common against male than female doctors (odds ratio of 2.45). A 2016 survey of US physicians found that 8.2 percent of physicians under the age of forty reported having been sued for malpractice during their careers, with 49.2 percent of physicians over the age of 54 reporting having been sued.
See also
Medical error
Medical malpractice in the United States
Quackery
Clinical incidents in Australia
References | 0.76171 | 0.994793 | 0.757744 |
Psychoorganic syndrome | Psychoorganic syndrome (POS), also known as organic psychosyndrome, is a progressive disease comparable to presenile dementia. It consists of psychopathological complex of symptoms that are caused by organic brain disorders that involve a reduction in memory and intellect. Psychoorganic syndrome is often accompanied by asthenia.
Psychoorganic syndrome occurs during atrophy of the brain, most commonly during presenile and senile age (e.g. Alzheimer's disease, senile dementia). There are many causes, including cerebrovascular diseases, CNS damages to traumatic brain injury, intoxication, exposure to organic solvents such as toluene, chronic metabolic disorders, tumors and abscesses of the brain, encephalitis, and can also be found in cases of diseases accompanied by convulsive seizures. Psychoorganic syndrome may occur at any age but is most pronounced in elderly and senile age.
Depending on the nosological entity, the main symptoms of psychoorganic syndrome are expressed differently. For example, in atrophic cases such as Alzheimer's disease, the symptoms are more geared towards a memory disorder, while in Pick's disease, mental disorders are more commonly expressed.
Symptoms
Patients with psychoorganic syndrome often complain about headaches, dizziness, unsteadiness when walking, poor tolerance to the heat, stuffiness, atmospheric pressure changes, loud sounds, neurological symptoms.
The common reported psychological symptoms include:
loss of memory and concentration
emotional lability
Clinical fatigue
long term major depression
severe anxiety
reduced intellectual ability
The cognitive and behavioral symptoms are chronic and have little response to treatment.
Depending on lesion location, some patients may experience visual complications.
Cause
Psycho-organic syndrome is typically diagnosed in individuals following 5–10 years of consistent exposure to chemicals like xylene, toluene, and styrene, which are generally found in paint, plastic and degreasing products.
Patients work and environmental history must be evaluated for exposure to organic chemicals. A traumatic brain injury may also lead to POS.
Although the cause varies in each individual case, localization of the atrophy in the brain can occur due to aging and without external causes.
Prevention includes proper and regular use of Preventive Personal Equipment (PPE) in work environments that involve organic chemicals and limiting alcohol and drug substance intake.
Mechanism
Psychoorganic syndrome is a combination of various symptoms that are caused by organic changes in the brain. The exact component of the solvents that causes the neurological disorder is difficult to isolate due to worker generally being exposed to mixtures of various grades, compositions, and purity of solvents.
At the initial stage, asthenia is prevalent and the progress of the disorder is slow. Acute onset can be diagnosed when a large amount of psychological symptoms surface. The final stage of the disorder is made up of numerous disorders, including dementia, Korsakov's syndrome, and includes severe personality change such as depression, anxiety, memory loss, and drastic change in intellect. Level of kindness, happiness, and insight are greatly affect in the final stage.
The disorder stems from a defect in brain tissue, usually atrophy from another neurological disorder.Although the exact mechanism that solvents have on the nervous system are not fully understood, the metabolism of the solvents in the body that turn them into toxic intermediates are important. Some evidence shows that genetic polymorphisms affect the activity of metabolic enzymes that metabolize foreign chemicals.
Diagnosis
Along with occupational and environmental evaluation, a neurological exam, ECHO, EEG, CT-San, and X-ray of the brain may be conducted to determine disorder. Neuroimaging that detects cerebral atrophy or cardiovascular subcortical alterations can help point to psychoorganic syndrome. Strong CNS lesions are detected in POS patients. However, this is found to be difficult as many psychiatric disorders, like dementia, have common diagnosis.
Diagnosing POS is an ongoing and developing in the medical and psychiatric industry. Exact diagnosis is difficult due to many symptoms mirroring other psychological disorders in the older aged patients.
Various symptom diagnosis
CT scan or MRI can confirm dementia via observation of ventricular dilation and cortical substance degeneration.
Pick's disease can be confirmed via CT scan or MRI with atrophy of frontal and temporal lobe roots.
Alzheimer's is a disease confirmed by atrophy of the parietal and temporal lobe ganglia along with changes in the cortical ganglia found in a CT scan or MRI.
Treatment
In a confirmed medical diagnosis, therapy is used to isolate and begin treating the cause of the disorder. Thereafter, psychiatric medication is used a secondary step in treatment. Medications include antipsychotic, antidepressant, or sedation-inducing, varying on the patients severity.
Treatment of psychoorganic syndrome is directed at the main disease. Nootropics like piracetam, have had positive effects on patients. Vitamin therapy, antioxidants, neurotropic, and cerebroprotective have also found to be effective when put on a repeat course.
History
POS was suggested to be associated with long term and high level solvent exposure in early studies conducted in Scandinavia. These studies found neurological deficits such as personality changes and memory loss were tied to these exposures. However, these studies were highly criticized and found biased, causing doubt in the existence of the syndrome.
Furthermore, various health organizations had difficulty coming to an agreement on the definition of the syndrome. In 1985, the syndrome was defined and provided clear criteria that could be used by patients and medical professionals to help identify the syndrome and isolate ways of prevention.
Recent research
In a 2007 clinical study conducted in Sweden on 128 subjects who had constant high exposure to solvents in their work environments, a definite link to POS was unable to be determined. However, the subject who had diagnosis of POS showed increased neurological symptoms with increased brain atrophy in as little as 3 years of exposure.
See also
Neurotoxicity
References
Neurological disorders
Psychopathological syndromes
Mental disorders due to brain damage | 0.787002 | 0.962806 | 0.757731 |
Stimulant psychosis | Stimulant psychosis is a mental disorder characterized by psychotic symptoms (such as hallucinations, paranoid ideation, delusions, disorganized thinking, grossly disorganized behaviour). It involves and typically occurs following an overdose or several day binge on psychostimulants, though one study reported occurrences at regularly prescribed doses in approximately 0.1% of individuals within the first several weeks after starting amphetamine or methylphenidate therapy. Methamphetamine psychosis, or long-term effects of stimulant use in the brain (at the molecular level), depend upon genetics and may persist for some time.
The most common causative agents are substituted amphetamines, including substituted cathinones, as well as certain dopamine reuptake inhibitors such as cocaine and phenidates.
Signs and symptoms
The symptoms of stimulant psychosis vary depending on the drug ingested, but generally involve the symptoms of organic psychosis such as hallucinations, delusions, or paranoia. Other symptoms may include mania, erratic behavior, agitation and/or aggression.
Cause
Substituted amphetamines
Drugs in the class of amphetamines, or substituted amphetamines, are known to induce "amphetamine psychosis" typically when chronically abused or used in high doses. In an Australian study of 309 active methamphetamine users, 18% had experienced a clinical level psychosis in the past year. Commonly abused amphetamines include methamphetamine, MDMA, 4-FA, as well as substituted cathinones like α-PVP, MDPV, and mephedrone, though a large number of other closely related compounds have been recently synthesized. Methylphenidate is sometimes incorrectly included in this class, although it is nonetheless still capable of producing stimulant psychosis.
The symptoms of amphetamine psychosis include auditory and visual hallucinations, grandiosity, delusions of persecution, and delusions of reference concurrent with both clear consciousness and prominent extreme agitation. A Japanese study of recovery from methamphetamine psychosis reported a 64% recovery rate within 10 days rising to an 82% recovery rate at 30 days after methamphetamine cessation. However it has been suggested that around 5–15% of users fail to make a complete recovery in the long term. Furthermore, even at a small dose, the psychosis can be quickly reestablished. Psychosocial stress has been found to be an independent risk factor for psychosis relapse even without further substituted amphetamine use in certain cases.
The symptoms of acute amphetamine psychosis are very similar to those of the acute phase of schizophrenia although in amphetamine psychosis visual hallucinations are more common and thought disorder is rare. Amphetamine psychosis may be purely related to high drug usage, or high drug usage may trigger an underlying vulnerability to schizophrenia. There is some evidence that vulnerability to amphetamine psychosis and schizophrenia may be genetically related. Relatives of methamphetamine users with a history of amphetamine psychosis are five times more likely to have been diagnosed with schizophrenia than relatives of methamphetamine users without a history of amphetamine psychosis. The disorders are often distinguished by a rapid resolution of symptoms in amphetamine psychosis, while schizophrenia is more likely to follow a chronic course.
Although rare and not formally recognized, a condition known as Amphetamine Withdrawal Psychosis (AWP) may occur upon cessation of substituted amphetamine use and, as the name implies, involves psychosis that appears on withdrawal from substituted amphetamines. However, unlike similar disorders, in AWP, substituted amphetamines reduce rather than increase symptoms, and the psychosis or mania resolves with resumption of the previous dosing schedule.
Cocaine
Cocaine has a similar potential to induce temporary psychosis with more than half of cocaine abusers reporting at least some psychotic symptoms at some point. Typical symptoms include paranoid delusions that they are being followed and that their drug use is being watched, accompanied by hallucinations that support the delusional beliefs. Delusional parasitosis with formication ("cocaine bugs") is also a fairly common symptom.
Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug. This means that psychosis becomes more severe with repeated intermittent use.
Phenidates
Methylphenidate and its analogues (such as ethylphenidate, 4F-MPH, and isopropylphenidate) share similar pharmacological profiles as other norepinephrine-dopamine reuptake inhibitors. Chronic abuse of methylphenidate has the potential to lead to psychosis. Similar psychiatric side effects have been reported in a study of ethylphenidate. No studies regarding psychosis and 4F-MPH or isopropylphenidate have been conducted, but given their high DAT binding and cellular uptake activity, the possibility of stimulant psychosis remains.
Caffeine
There is limited evidence that caffeine, in high doses or when chronically abused, may induce psychosis in normal individuals and worsen pre-existing psychosis in those diagnosed with schizophrenia.
Diagnosis
Differential diagnosis
Though less common than stimulant psychosis, stimulants such as cocaine and amphetamines as well as the dissociative drug phencyclidine (PCP, angel dust) may also cause a theorized severe and life-threatening condition known as excited delirium. This condition manifests as a combination of delirium, psychomotor agitation, anxiety, delusions, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature, and hysterical strength. Despite some superficial similarities in presentation excited delirium is a distinct (and more serious) condition than stimulant psychosis. The existence of excited delirium is currently debated.
Transition to schizophrenia
A 2019 systematic review and meta-analysis by Murrie et al. found that the pooled proportion of transition from amphetamine-induced psychosis to schizophrenia was 22% (5 studies, CI 14%–34%). This was lower than cannabis (34%) and hallucinogens (26%), but higher than 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.
Treatment
Treatment consists of supportive care during the acute intoxication phase: maintaining hydration, body temperature, blood pressure, and heart rate at acceptable levels until the drug is sufficiently metabolized to allow vital signs to return to baseline. Atypical and typical antipsychotics have been shown to be helpful in the early stages of treatment, especially olanzapine over haloperidol. The benzodiazepines temazepam and triazolam at 30 mg and 0.5 mg (prescribed independently from olanzapine and haloperidol), are highly effective if aggression, agitation, or violent behaviour is apparent. In the instance of persistent psychosis after repeated stimulant use, electroconvulsive therapy has been beneficial in some cases. This is followed by abstinence from psychostimulants supported with counselling or medication designed to assist with preventing a relapse and the resumption of a psychotic state.
See also
Aimo Koivunen
Amphetamine
Delusional parasitosis
Dopamine hypothesis of psychosis
Excited delirium
Psychosis
Substance-induced psychosis
Neuroleptic malignant syndrome
References
External links
Psychosis
Biology of bipolar disorder
Amphetamine | 0.760221 | 0.996686 | 0.757701 |
PICO process | The PICO process (or framework) is a mnemonic used in evidence-based practice (and specifically evidence-based medicine) to frame and answer a clinical or health care related question, though it is also argued that PICO "can be used universally for every scientific endeavour in any discipline with all study designs". The PICO framework is also used to develop literature search strategies, for instance in systematic reviews.
The PICO acronym has come to stand for:
PPatient, problem or population
IIntervention
CComparison, control or comparator
OOutcome(s) (e.g. pain, fatigue, nausea, infections, death)
An application that covers clinical questions about interventions, as well as exposures, risk/ prognostic factors, and test accuracy, is:
PPatient, problem or population
IInvestigated condition (e.g. intervention, exposure, risk/ prognostic factor, or test result)
CComparison condition (e.g. intervention, exposure, risk/ prognostic factor, or test result respectively)
OOutcome(s) (e.g. symptom, syndrome, or disease of interest)
Alternatives such as SPICE and PECO (among many others) can also be used. Some authors suggest adding T and S, as follows:
T - Timing (e.g. duration of intervention, or date of publication)
S - Study type (e.g. randomized controlled trial, cohort study, etc.)
PICO as a universal technique
It was argued that PICO may be useful for every scientific endeavor even beyond clinical settings. This proposal is based on a more abstract view of the PICO mnemonic, equating them with four components that is inherent to every single research, namely (1) research object; (2) application of a theory or method; (3) alternative theories or methods (or the null hypothesis); and (4) the ultimate goal of knowledge generation.
This proposition would imply that the PICO technique could be used for teaching academic writing even beyond medical disciplines.
Examples
Clinical question: "In children with headache, is paracetamol more effective than placebo against pain?"
Population = Children with headaches; keywords = children + headache
Intervention = Paracetamol; keyword = paracetamol
Compared with = Placebo; keyword = placebo
Outcome of interest = Pain; keyword = pain
Pubmed (health research database) search strategy:children headache paracetamol placebo pain
Clinical question: "Is the risk of having breast cancer higher in symptom-free women with a positive mammography compared to symptom-free women with a negative mammography?"
Population = Women without a history of breast cancer
Investigated test result = Positive result on mammography
Comparator test result = Negative result on mammography
Outcome of interest = Breast cancer according to biopsy (or not)
Similar Frameworks
The PICO framework was originally developed to frame interventional clinical questions. PICO inspired other frameworks such as PICOS, PICOT, PICOTT, PECO, PICOTS, PECODR, PEICOIS, PICOC, SPICE, PIPOH, EPICOT+, PESICO, PICo, and PS.
References
Evidence-based practices | 0.764673 | 0.990811 | 0.757646 |
Zone of proximal development | The zone of proximal development (ZPD) is a concept in educational psychology. It represents the space between what a learner is capable of doing unsupported and what the learner cannot do even with support. It is the range where the learner is able to perform, but only with support from a teacher or a peer with more knowledge or expertise (a "more knowledgeable other"). The concept was introduced, but not fully developed, by psychologist Lev Vygotsky (1896–1934) during the last three years of his life. Vygotsky argued that a child gets involved in a dialogue with the "more knowledgeable other", such as a peer or an adult, and gradually, through social interaction and sense-making, develops the ability to solve problems independently and do certain tasks without help. Following Vygotsky, some educators believe that the role of education is to give children experiences that are within their zones of proximal development, thereby encouraging and advancing their individual learning skills and strategies.
Origins
The concept of the zone of proximal development was originally developed by Vygotsky to argue against the use of academic, knowledge-based tests as a means to gauge students' intelligence. He also created ZPD to further develop Jean Piaget's theory of children being lone and autonomous learners. Vygotsky spent a lot of time studying the impact of school instruction on children and noted that children grasp language concepts quite naturally, but that math and writing did not come as naturally. Essentially, he concluded that because these concepts were taught in school settings with unnecessary assessments, they were more difficult for learners. Piaget believed that there was a clear distinction between development and teaching. He said that development is a spontaneous process that is initiated and completed by the children, stemming from their own efforts. Piaget was a proponent of independent thinking and critical of the standard teacher-led instruction that was common practice in schools.
Alternatively, Vygotsky saw natural, spontaneous development as important, but not all-important. He believed that children would not advance very far if they were left to discover everything on their own It is crucial for a child's development that they are able to interact with more knowledgeable others: they are not able to expand on what they know if this is not possible. The term more knowledgeable others (MKO) is used to describe someone who has a better understanding or higher ability level than the learner, in reference to the specific task, idea, or concept. He noted cultural experiences where children are greatly helped by knowledge and tools handed down from previous generations. Vygotsky noted that good teachers should not present material that is too difficult and "pull the students along."
Vygotsky argued that, rather than examining what a student knows to determine intelligence, it is better to examine their ability to solve problems independently and ability to solve problems with an adult's help. He proposed a question: "if two children perform the same on a test, are their levels of development the same?" He concluded that they were not. However, Vygotsky's untimely death interrupted his work on the zone of proximal development, and it remained mostly incomplete.
Definition
Since Vygotsky's original conception, the definition for the zone of proximal development has been expanded and modified. The zone of proximal development is an area of learning that occurs when a person is assisted by a teacher or peer with a higher skill set. The person learning the skill set cannot complete it without the assistance of the teacher or peer. The teacher then helps the student attain the skill the student is trying to master, until the teacher is no longer needed for that task.
Any function within the zone of proximal development matures within a particular internal context that includes not only the function's actual level but also how susceptible the child is to types of help, the sequence in which these types of help are offered, the flexibility or rigidity of previously formed stereotypes, how willing the child is to collaborate, along with other factors. This context can impact the diagnosis of a function's potential level of development.
Vygotsky stated that one cannot just look at what students are capable of doing on their own; one must look at what they are capable of doing in a social setting. In many cases students are able to complete a task within a group before they are able to complete it on their own. He notes that the teacher's job is to move the child's mind forward step-by-step (teachers cannot teach complex chemical equations to six-year-olds, for example). At the same time, teachers cannot teach all children equally; they must determine which students are ready for which lessons. An example is the often-used accelerated reading program in schools. Students are assessed and given a reading level and a range. Books rated below their level are easy to read, while books above their level challenge the student. Sometimes students are not even allowed to check out books from the school library that are outside their range. Vygotsky argued that a major shortcoming of standardized tests is that they only measure what students are capable of on their own, not in a group setting where their minds are being pushed by other students.
In the context of second language learning, the ZPD can be useful to many adult users. Prompted by this fact as well as the finding that adult peers do not necessarily need to be more capable to provide assistance in the ZPD, Vygotsky's definition has been adapted to better suit the adult L2 developmental context.
Scaffolding
The concept of the ZPD is widely used to study children's mental development as it relates to educational context. The ZPD concept is seen as a scaffolding, a structure of "support points" for performing an action. This refers to the help or guidance received from an adult or more competent peer to permit the child to work within the ZPD. Although Vygotsky himself never mentioned the term, scaffolding was first developed by Jerome Bruner, David Wood, and Gail Ross, while applying Vygotsky's concept of ZPD to various educational contexts. According to Wass and Golding, giving students the hardest tasks they can do with scaffolding leads to the greatest learning gains.
Scaffolding is a process through which a teacher or a more competent peer helps a student in their ZPD as necessary and tapers off this aid as it becomes unnecessary—much as workers remove a scaffold from a building after they complete construction. "Scaffolding [is] the way the adult guides the child's learning via focused questions and positive interactions." This concept has been further developed by Mercedes Chaves Jaime, Ann Brown, among others. Several instructional programs were developed based on this interpretation of the ZPD, including reciprocal teaching and dynamic assessment. For scaffolding to be effective, one must start at the child's level of knowledge and build from there.
One example of children using ZPD is when they are learning to speak. As their speech develops, it influences the way the child thinks, which in turn influences the child's manner of speaking. This process opens more doors for the child to expand their vocabulary. As they learn to convey their thoughts in a more effective way, they receive more sophisticated feedback, therefore increasing their vocabulary and their speaking skills. Wells gives the example of dancing: when a person is learning how to dance, they look to others around them on the dance floor and imitate their moves. A person does not copy the dance moves exactly, but takes what they can and adds their own personality to it.
In mathematics, proximal development uses mathematical exercises for which students have seen one or more worked examples. In secondary school some scaffolding is provided, and generally much less at the tertiary level. Ultimately students must find library resources or a tutor when presented with challenges beyond the zone.
Another example of scaffolding is learning to drive. Parents and driving instructors guide driving students along the way by showing them the mechanics of how the car operates, the correct hand positions on the steering wheel, the technique of scanning the roadway, etc. As the student progresses, less and less instruction is needed, until they are ready to drive on their own.
The concept of scaffolding can be observed in various life situations and arguably in the basis of how everyone learns. One does not (normally) begin knowing everything that there is to know about a subject. The basics must be learned first so one can build on prior knowledge towards mastery of a particular subject or skill.
Implications for educators
Various investigations, using different approaches and research frameworks have proved collaborative learning to be effective in many kinds of settings and contexts. Teachers should assign tasks that students cannot do on their own, but which they can do with assistance; they should provide just enough assistance so that students learn to complete the tasks independently and then provide an environment that enables students to do harder tasks than would otherwise be possible. Teachers can also allow students with more knowledge to assist students who need more assistance. Especially in the context of collaborative learning, group members who have higher levels of understanding can help the less advanced members learn within their zone of proximal development. In the context of adults, peers should challenge each other in order to support collaboration and success. Utilizing student's ZPD can assist especially with early childhood learning by guiding each child through challenges and using their student collaboration as a tool for success. Meyer used the concepts of Cognitive Evolutionary Pressure and Cognitive Empathetic Resonance to provide a theoretical underpinning for how and why the zone of proximal development arises, and this also has implications for how scaffolding can best be used.
Challenges
Scaffolding in education does have some boundaries. One of the largest hurdles to overcome when providing ample support for student learning is managing multiple students. While scaffolding is meant to be a relatively independent process for students, the initial phase of providing individual guidance can easily be overseen when managing large classrooms. Thus, time becomes a critical factor in a scaffolding lesson plan. In order to accommodate more learners, teachers are often faced with cutting parts of lessons or dedicating less time to each student. In turn, this hastened class time might result in loss of interest in students or even invalid peer-teaching. Cognitive abilities of the student also play a significant role in the success of scaffolding. Ideally, students are able to learn within this zone of proximal development, but this is often not the case. Recognizing students' individual abilities and foundation knowledge can be a challenge of successful scaffolding. If students are evidently less prepared for this learning approach and begin to compare themselves to their peers, their self-efficacy and motivation to learn can be hindered. These hurdles of scaffolding and the zone of proximal development are important to acknowledge so that teachers can find solutions to the problems or alter their teaching methods.
See also
Constructivism (learning theory)
Cultural-historical activity theory (CHAT)
Curse of knowledge
Educational psychology
Four stages of competence
Shuhari
Social constructivism (learning theory)
Sociocultural theory
References
Sources
Chaiklin, S. (2003). "The Zone of Proximal Development in Vygotsky's analysis of learning and instruction." In Kozulin, A., Gindis, B., Ageyev, V. & Miller, S. (Eds.) Vygotsky's educational theory and practice in cultural context. 39–64. Cambridge: Cambridge University.
Mayer, R. E. (2008). Learning and instruction. (2nd ed., pp. 462–463). Upper Saddle River, NJ: Pearson Education.
Developmental psychology
Developmental stage theories | 0.760466 | 0.996281 | 0.757638 |
Symphysis pubis dysfunction | Symphysis pubis dysfunction (SPD), commonly known as pubic symphysis dysfunction or lightning crotch, is a condition that causes excessive movement of the pubic symphysis, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the pelvis. Most commonly associated with pregnancy and childbirth, it is diagnosed in approximately 1 in 300 pregnancies, although some estimates of incidence are as high as 1 in 50.
SPD is associated with pelvic girdle pain and the names are often used interchangeably.
Symptoms
The main symptom is usually pain or discomfort in the pelvic region, usually centered on the joint at the front of the pelvis (the pubic symphysis). Some sufferers report being able to hear and feel the pubic symphysis and/or sacroiliac, clicking or popping in and out as they walk or change position. Sufferers frequently also experience pain in the lower back, hips, groin, lower abdomen, and legs. The severity of the pain can range from mild discomfort to extreme pain that interferes with routine activities, family, social and professional life, and sleep. There have been links between SPD and depression due to the associated physical discomfort. Sufferers may walk with a characteristic side-to-side gait and have difficulty climbing stairs, problems with leg abduction and adduction, pain when carrying out weight bearing activities, difficulties carrying out everyday activities, and difficulties standing.
Diagnosis
A diagnosis is usually made from the symptoms, history, and physical exam alone. After pregnancy, MRI scans, X-rays and ultrasound scanning are sometimes used. Patients typically initially report symptoms to a midwife, chiropractor, obstetrician, general practitioner, physiotherapist or an osteopath. On seeing a health professional, patients should expect to receive a thorough physical examination to rule out other lumbar spine problems, such as a prolapsed disc or pelvic and or pubis joint misalignment, or other conditions such as iliopsoas muscle spasms, urinary tract infections and Braxton Hicks contractions.
Unnecessary radiation from medical imaging is avoided during pregnancy, so in most cases a physical examination and history are considered sufficient to refer to physical therapy.
Treatment
A promising treatment for chronic or post natal dysfunction is prolotherapy. Other treatments include the use of elbow crutches, pelvic support devices and prescribed pain relief. The majority of problems will resolve spontaneously after delivery. There are two case studies that show reduction of pain and dysfunction with conservative chiropractic care.
Physical therapists—especially those specializing in pelvic floor physical therapy—can assist with pain relief techniques, provide manual therapy to alleviate related muscle spasms, and manage exercise protocols.
While most pregnancy-related cases are reported to resolve postpartum, definitive diagnosis and treatment are still appropriate in order to optimize comfort and function and ensure a good course of recovery.
Long-term complications can develop without proper care. Postpartum follow-up in cases of pregnancy-related SPD may include radiologic imaging, evaluation by a specialist such as an orthopedist or physiatrist, ongoing pelvic floor physical therapy, and assessment for any underlying or related musculoskeletal issues.
In extreme cases that do not resolve with conservative management, surgery is considered after pregnancy to stabilise the pelvis, but success rates are very poor.
Everyday living
Typical advice usually given to people with SPD includes avoiding strenuous exercise, prolonged standing, repetitive reaching movements, lunges, stretching exercises and squatting. Patients are also frequently advised to:
Brace the transverse abdominis (lower abdominal muscles) before performing any activity which might cause pain
Rest the pelvis
Sit down for tasks where possible (e.g. dressing, workplace discussions, teaching, repetitive manual tasks)
Avoid lifting and carrying
Avoid stepping over things
Avoid straddle movements especially when weight bearing
Bend the knees and keep the legs 'glued together' when turning in bed and getting in and out of bed, while engaging transverse abdominis
Place a pillow between the legs when in bed or resting
Avoid twisting movements of the body
If the pain is very severe, using a walker or crutches will help take the weight off the pelvis and assist with mobility. Alternatively, for more extreme cases a wheelchair may be considered advisable.
Pharmacological interventions
It is not usually considered advisable to take anti-inflammatory medication in pregnancy, which makes SPD a particularly difficult condition to manage. Acetaminophen may be a safer option. Of note, opiates are considered high risk with a more addictive nature, and carry a risk of depressed respiration in the newborn baby if taken near the time of birth, if taken at all. Therefore, it is considered advisable to discuss any pain relief medications with a physician, and cease taking any opiates 2–4 weeks before the estimated due date, as advised by a medical professional.
See also
Diastasis symphysis pubis, the separation of normally joined pubic bones
Osteitis pubis, inflammation of the pubic symphysis
Pelvic girdle pain, pregnancy related pelvic girdle pain
References
Further reading
Pelvic Partnership (2008) About SPD: A leaflet about Symphysis Pubis Dysfunction and its Management (pdf) Accessed 19 January 2009
Crichton, Margaret A. and Wellock, Vanda K. (2007) Understanding pregnant women's experiences of symphysis pubis dysfunction: the effect of pain (Royal College of Midwives Evidence Based Midwifery) Accessed 27 January 2009
BBC Radio 4 - Woman's Hour Health Archive, 21 May 2004 Accessed 27 January 2009
Pathology of pregnancy, childbirth and the puerperium
Pelvis
Health issues in pregnancy | 0.762817 | 0.993161 | 0.7576 |
Developmental disorder | Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, developmental coordination disorders, and autism spectrum disorders (ASD). In broader definitions, attention deficit hyperactivity disorder (ADHD) is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.
Developmental disorders are present from early life onward. Most improve as the child grows older, but some entail impairments that continue throughout life. These disorders differ from Pervasive developmental disorders (PPD), which uniquely describe a group of five developmental diagnoses, one of which is autism spectrum disorders (ASD). Pervasive developmental disorders reference a limited number of conditions whereas development disorders are a broad network of social, communicative, physical, genetic, intellectual, behavioral, and language concerns and diagnoses.
Emergence
Learning disabilities are often diagnosed when the children are young and just beginning school. Most learning disabilities are found under the age of 9.
Young children with communication disorders may not speak at all, or may have a limited vocabulary for their age. Some children with communication disorders have difficulty understanding simple directions or cannot name objects. Most children with communication disorders can speak by the time they enter school, however, they continue to have problems with communication. School-aged children often have problems understanding and formulating words. Teens may have more difficulty with understanding or expressing abstract ideas.
Causes
The scientific study of the causes of developmental disorders involves many theories. Some of the major differences between these theories involves whether environment disrupts normal development, if abnormalities are pre-determined, or if they are products of human evolutionary history which become disorders in modern environments (see evolutionary psychiatry).
Normal development occurs with a combination of contributions from both the environment and genetics. The theories vary in the part each factor has to play in normal development, thus affecting how the abnormalities are caused.
One theory that supports environmental causes of developmental disorders involves stress in early childhood. Researcher and child psychiatrist Bruce D. Perry, M.D., Ph.D, theorizes that developmental disorders can be caused by early childhood traumatization. In his works, he compares developmental disorders in traumatized children to adults with post-traumatic stress disorder, linking extreme environmental stress to the cause of developmental difficulties. Other stress theories suggest that even small stresses can accumulate to result in emotional, behavioral, or social disorders in children.
A 2017 study tested all 20,000 genes in about 4,300 families with children with rare developmental difficulties in the UK and Ireland in order to identify if these difficulties had a genetic cause. They found 14 new developmental disorders caused by spontaneous genetic mutations not found in either parent (such as a fault in the CDK13 gene). They estimated that about one in 300 children are born with spontaneous genetic mutations associated with rare developmental disorders.
Types
Autism spectrum disorder (ASD)
Diagnosis
The first diagnosed case of ASD was published in 1943 by American psychiatrist Leo Kanner. There is a wide range of cases and severity to ASD so it is very hard to detect the first signs of ASD. A diagnosis of ASD can be made accurately before the child is 3 years old, but the diagnosis of ASD is not commonly confirmed until the child is somewhat older. The age of diagnosis can range from 9 months to 14 years, and the mean age is 4 years old in the USA. On average each case of ASD is tested at three different diagnostic centers before confirmed. Early diagnosis of the disorder can diminish familial stress, speed up referral to special educational programs and influence family planning. The occurrence of ASD in one child can increase the risk of the next child having ASD by 50 to 100 times.
Abnormalities in the brain
The cause of ASD is still uncertain. What is known is that a child with ASD has a pervasive problem with how the brain is wired. Genes related to neurotransmitter receptors (serotonin and gamma-aminobutyric acid [GABA]) and CNS structural control (HOX genes) are found to be potential target genes that get affected in ASD. Autism spectrum disorder is a disorder of the many parts of the brain. Structural changes are observed in the cortex, which controls higher functions, sensation, muscle movements, and memory. Structural defects are seen in the cerebellum too, which affect the motor and communication skills. Sometimes the left lobe of the brain is affected and this causes neuropsychological symptoms. The distribution of white matter, the nerve fibers that link diverse parts of the brain, is abnormal. The corpus callosum, the band of nerve fibers, that connects the left and right hemispheres of the brain also gets affected in ASD. A study also found that 33% of people who have AgCC (agenesis of the corpus callosum), a condition in which the corpus callosum is partially or completely absent, had scores higher than the autism screening cut-off.
An ASD child's brain grows at a very rapid rate and is almost fully grown by the age of 10. Recent fMRI studies have also found altered connectivity within the social brain areas due to ASD and may be related to the social impairments encountered in ASD.
Symptoms
The symptoms have a wide range of severity. The symptoms of ASD can be broadly categorised as the following:
Persistent issues in social interactions and communications
These are predominantly seen by unresponsiveness in conversations, lesser emotional sharing, inability to initiate conversations, inability to interpret body language, avoidance of eye-contact and difficulty maintaining relationships.
Repetitive behavioral patterns
These patterns can be seen in the form of repeated movements of the hand or the phrases used while talking. A rigid adherence to schedules and inflexibility to adapt even if a minor change is made to their routine is also one of the behavioral symptoms of ASD. They could also display sensory patterns such as extreme aversion to certain odors or indifference to pain or temperature.
There are also different symptoms at different ages based on developmental milestones. Children between 0 and 36 months with ASD show a lack of eye contact, seem to be deaf, lack a social smile, do not like being touched or held, have unusual sensory behavior and show a lack of imitation. Children between 12 and 24 months with ASD show a lack of gestures, prefer to be alone, do not point to objects to indicate interest, are easily frustrated with challenges, and lack of functional play. And finally children between the ages 24 to 36 months with ASD show a lack of symbolic play and an unusual interest in certain objects, or moving objects.
Treatment
There is no specific treatment for autism spectrum disorders, but there are several types of therapy effective in easing the symptoms of autism, such as Applied Behavior Analysis (ABA), Speech-language therapy, Occupational therapy or Sensory integration therapy.
Applied behavioral analysis (ABA) is considered the most effective therapy for Autism spectrum disorders by the American Academy of Pediatrics. ABA focuses on teaching adaptive behaviors like social skills, play skills, or communication skills and diminishing problematic behaviors like self-injury. This is done by creating a specialized plan that uses behavioral therapy techniques, such as positive or negative reinforcement, to encourage or discourage certain behaviors over-time.
Occupational therapy helps autistic children and adults learn everyday skills that help them with daily tasks, such as personal hygiene and movement. These skills are then integrated into their home, school, and work environments. Therapists will oftentimes help patients learn to adapt their environment to their skill level. This type of therapy could help autistic people become more engaged in their environment. An occupational therapist will create a plan based on the patient's needs and desires and work with them to achieve their set goals.
Speech-language therapy can help those with autism who need to develop or improve communication skills. According to the organization Autism Speaks, “speech-language therapy is designed to coordinate the mechanics of speech with the meaning and social use of speech”. People with low-functioning autism may not be able to communicate with spoken words. Speech-language Pathologists (SLP) may teach someone how to communicate more effectively with others or work on starting to develop speech patterns. The SLP will create a plan that focuses on what the child needs.
Sensory integration therapy helps people with autism adapt to different kinds of sensory stimuli. Many children with autism can be oversensitive to certain stimuli, such as lights or sounds, causing them to overreact. Others may not react to certain stimuli, such as someone speaking to them. Many types of therapy activities involve a form of play, such as using swings, toys and trampolines to help engage the patients with sensory stimuli. Therapists will create a plan that focuses on the type of stimulation the person needs integration with.
Attention deficit hyperactivity disorder (ADHD)
Attention deficit hyperactivity disorder is a neurodevelopmental disorder that occurs in early childhood. ADHD affects 8 to 11% of children in the school going age. ADHD is characterised by significant levels of hyperactivity, inattentiveness, and impulsiveness. There are three subtypes of ADHD: predominantly inattentive, predominantly hyperactive, and combined (which presents as both hyperactive and inattentive subtypes). ADHD is twice as common in boys than girls but it is seen that the hyperactive/impulsive type is more common in boys while the inattentive type affects both sexes equally.
Symptoms
Symptoms of ADHD include inattentiveness, impulsiveness, and hyperactivity. Many of the behaviors that are associated with ADHD include poor control over actions resulting in disruptive behavior and academic problems. Another area that is affected by these disorders is the social arena for the person with the disorder. Many children that have this disorder exhibit poor interpersonal relationships and struggle to fit in socially with their peers. Behavioral study of these children can show a history of other symptoms such as temper tantrums, mood swings, sleep disturbances and aggressiveness.
Treatment options
The treatment of Attention Deficit Hyperactivity Disorder (ADHD) commonly involves a multimodal approach, combining various strategies to address the complex nature of the disorder. This comprehensive approach includes psychological, behavioral, pharmaceutical, and educational interventions tailored to the individual's specific needs. Here's a breakdown of the different components:
Psychological Interventions:
Counseling and Psychoeducation - Individuals with ADHD may benefit from counseling sessions that provide a safe space to discuss challenges, develop coping strategies, and improve self-esteem. **Psychoeducation helps individuals and their families understand the nature of ADHD and learn effective management techniques.
Cognitive Behavioral Therapy (CBT) - CBT aims to modify negative thought patterns and behaviors associated with ADHD. It helps individuals develop organizational skills, time management, and problem-solving abilities.
Behavioral Interventions:
Parent Training - Parents often participate in training programs to learn behavior management techniques. This may involve setting clear expectations, using positive reinforcement, and implementing consistent consequences for behavior.
Behavioral Modification Programs - These programs focus on shaping positive behaviors and reducing impulsive or disruptive behaviors in various settings, including home and school.
Pharmaceutical Interventions:
Stimulant Medications - Stimulant medications, such as methylphenidate (e.g., Ritalin) and amphetamines (e.g., Adderall), are commonly prescribed to manage symptoms of ADHD. These medications enhance the activity of neurotransmitters like dopamine and norepinephrine, helping to improve attention and impulse control.
Non-stimulant Medications - In cases where stimulants are not suitable or effective, non-stimulant medications like atomoxetine (Strattera) or guanfacine (Intuniv) may be prescribed.
Educational Interventions:
Individualized Education Plans (IEPs) - In educational settings, IEPs are developed to accommodate the unique learning needs of students with ADHD. This may involve classroom modifications, additional support, and specific teaching strategies.
504 Plans - These plans outline accommodations for students with ADHD in mainstream educational settings, such as extended test-taking time or preferential seating.
The effectiveness of the treatment plan depends on the individual's specific challenges and responses to interventions. A collaborative and multidisciplinary approach involving parents, educators, mental health professionals, and healthcare providers is crucial for developing and implementing a successful ADHD management plan. Regular monitoring and adjustments to the treatment plan may be necessary to meet the evolving needs of individuals with ADHD.
Behavioral therapy
Sessions of counselling, cognitive behavioral therapy (CBT), making environmental changes in noise and visual stimulation are some behavioral management techniques followed. But it has been observed that behavioral therapy alone is less effective than therapy with stimulant drugs alone.
Drug therapy
Medications commonly utilized in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) include stimulants like methylphenidate and lisdexamfetamine, as well as non-stimulants such as atomoxetine. These medications can effectively manage ADHD symptoms by targeting neurotransmitter imbalances. However, it is important to be aware of potential side effects associated with these medications. Common side effects may include headaches, which can often be mitigated by adjusting the dosage or administration timing. Gastrointestinal discomfort, including stomach pain or nausea, is another possible side effect, and taking the medication with food or modifying the dosage may help alleviate these symptoms. Additionally, while rare, changes in mood such as feelings of depression have been reported. Careful monitoring and communication with healthcare providers are essential to address and manage any side effects, ensuring the overall effectiveness and well-being of individuals undergoing ADHD treatments.
SSRI antidepressants may be unhelpful, and could worsen symptoms of ADHD. However ADHD is often misdiagnosed as depression, particularly when no hyperactivity is present.
Other disorders
Learning disabilities, such as Dysgraphia
Communication disorders and Auditory processing disorder
Developmental coordination disorder
Genetic disorders, such as Down syndrome or Williams syndrome
Tic disorders such as Tourette syndrome
Stuttering
Intellectual disability
See also
Developmental disability
References
External links
Developmental disabilities | 0.763731 | 0.991936 | 0.757572 |
Autism and memory | The relationship between autism and memory, specifically memory functions in relation to autism spectrum disorder (ASD), is an ongoing topic of research. ASD is a neurodevelopmental disorder characterised by social communication and interaction impairments, along with restricted and repetitive patterns of behavior. In this article, the word autism is used to refer to the whole range of conditions on the autism spectrum, which are not uncommon.
Although memory difficulty is not part of the diagnostic criteria for autism spectrum disorder (ASD), it is a common symptom experienced by many autistic people.
Overview
Some of the earliest references to the topic of autism and memory dated back to the 1960s and 1970s, when several studies appeared proposing that autism should be classified as amnesia. What is now diagnosed as autism was formerly diagnosed as developmental amnesia. Although the views of autism as an amnesia of memory have now been rejected, there are still many studies done on the relationship between memory functions and autism.
Long-term memory
There are two types of long-term memory; both of which have been studied in relation to autism. Declarative memory is memory that can be consciously recalled, such as facts and knowledge. Declarative memory includes semantic and episodic memory. Semantic memory involves the recollection of facts, and episodic memory involves the recollection of previous experiences in life. Studies on autistic people have shown impairments in their episodic memory but relative preservation of their semantic memory. The brain regions that play a major role in declarative learning and memory are the hippocampus and regions of the medial temporal lobe.
Declarative memory and autism
Autobiographical memory
Autobiographical memory is an example of declarative memory. One aspect of autobiographical memory is the self-reference effect, which means that typically people have a stronger memory for information that is relevant to themselves. It has been theorized that autistic people have diminished psychological self-knowledge but intact physical self-knowledge. As a result, these individuals show impaired autobiographical episodic memory and a reduced self-reference effect (which may each rely on psychological aspects of the self-concept), but do not show specific impairments in memory for their own rather than others' actions (which may rely on physical aspects of the self-concept).
Explicit memory retrieval and recognition
Autistic people do not always conform to the Levels of Processing principle since they benefit from both deep and superficial recall cues.
Recognition in HFA (highly functioning autistic) individuals has been widely studied. Overall, these studies conclude that the majority of HFA individuals have intact recognition abilities. Non-social stimulus recognition is often superior, or "robustly intact", although there is some evidence suggesting that HFA individuals have difficulty with complex scenes and color combinations. For example, HFA individuals exhibit intact recognition of non-social stimuli such as written words, spoken sentences, pictures of common objects, and meaningless patterns or shapes. For HFA individuals, impaired recognition has been found in object-location and object-color recognition tests and in the recognition of words encoded self-referentially. For more information regarding the recognition of social stimuli by autistic people, see the face perception page.
Contrary to the plethora of HFA recognition memory studies, the study of recognition for M-LFA individuals is considerably lacking. The studies that do exist predominantly point to impaired recognition of pictures, words to name objects, and other non-social stimuli. Four delayed recognition studies reported recognition impairments for M-LFA participants. Additionally, four of the seven primary studies of non-social stimuli recognition revealed significant impairment of non-social stimuli for M-LFA individuals. The other three studies were less reliable because of their methodology. Boucher, Lewis, and Collis gathered data supporting poor facial recognition, something widely observed for M-LFA individuals.
Implicit/Non-declarative memory
Implicit memory is non-declarative memory that relies on past experiences to help recall things without actively thinking of them. Procedural memory, classical conditioning, and priming are all included in implicit memory; for example, procedural skills, such as riding a bike, become so natural over time that one does not have to explicitly think about them. The brain regions that process implicit memory are the basal ganglia and the cerebellum. Research suggests that HFA and M-LFA individuals show strong implicit memory functions. HFA individuals display intact implicit memory for non-social stimuli, unimpaired classical conditioning, and performance on other implicit learning tasks. HFA individuals displayed normal perceptual and conceptual priming. Studies concerning implicit memory in M-LFA individuals are sparse, and further study is needed.
As mentioned above, there are very few reliable studies of non-declarative memory for M-LFA. However, there are some speculations. Some consider that the impaired motor skills evident in many cases of M-LFA may suggest impaired procedural learning. Other studies, including Walenski (2006) and Romero-Muguia (2008), also think that ASD behavior is indicative of implicit memory function. For example, many autistic people have exceptional implicit perceptual processing abilities in mathematics, the arts and in musical improvisation. Furthermore, there is speculation that because M-LFA individuals are often characterised by habit and routine, habit formation is likely unimpaired. Behavioral treatments and therapies used with M-LFA individuals are usually very helpful, suggesting that implicit knowledge can be acquired and conditioning is intact.
Working memory and autism
Working memory, a cognitive system with limited capacity that retains and manipulates multiple pieces of transient information, has been found to be affected in individuals with ASD. Certain studies have suggested that deficits in working memory performance exist in individuals with ASD, especially when it comes to verbally mediated working memory tasks. One reason for this impairment is due to the working memory which is a part of the executive functions (EF), an umbrella term for cognitive processes that regulate, control, and manage other cognitive processes, for instance planning and attention.
A majority of the research has found that individuals with autism perform poorly on measures of executive function. A general decrease in working memory (WM) is one of the limitations, although some studies have shown that working memory is not impaired in autistic children relative to controls matched for IQ. However, some evidence suggests that there may be minimal impairment in high-functioning autistic (HFA) individuals in that they have intact associative learning ability, verbal working memory, and recognition memory. In rare cases, there are even instances of individuals possessing extremely good memory in constricted domains which are typically characterised as savants. Bennetto, Pennington and Rogers also suggest that WM deficits and limited EF is likely compounded by the onset of autism where early development yields hindrances in social interaction which typically (i.e. without impairment) improves both WM and EF. However, due to limited ability in interpreting social gestures and an impaired ability to process such information in a holistic and comprehensive manner, individuals with autism are subject to diminishing and confounding instances of memory functions and performance.
Global working memory
Beversdorf finds that autistic individuals are not as reliant on contextual information (i.e. comparing typically related schemas) to aid in memory consolidation, they are less likely to rely on semantically similar cues (ex. Doctor-Nurse vs. Doctor-Beach). Thus, an autistic individual would fare well on discriminating and recalling accurate items from false items.
Bennetto, Pennington and Rogers investigated the degree of cognitive impairment in autistic individuals with an emphasis on illuminating the latency in executive functioning. Findings suggested a hindrance in temporal order, source, free recall and working memory. However, their participants did exhibit capable short and long-term memory, cued recall and the capacity to learn new material. In sum, they suggested that there is both a general deficit in global working memory and a specific impairment in social intelligence where the former is exacerbated by the latter and vice versa.
Other evidence points towards unique mnemonic strategies used by autistic individuals wherein they rely less on semantic associative networks and are less constricted by conventional word-word associations (ex. Orange-Apple). This may be due to abnormalities in MTL regions. Thus, autistic individuals may have the capacity for more abstract but robust associations. Firth addresses this with the term "weak Central Coherence", meaning a reduced tendency for processing information in context and integration of higher-level meaning. This may explain why autistic individuals have a heightened capacity for noticing seemingly disjointed details. For example, in the Embedded Figures Test (EFT) autistic individuals exhibited a faster and heightened ability to locate the target because of their diminished reliance on global perception.
In a study conducted on autistic children, it was shown that neurocognition influences word learning in autistic children. The process of syntactic development requires a child to match co-occurrences of words or parts of words (morphemes) and their meanings. This process can depend on working memory. The limited short term verbal memory paired with working memory may be the reason of language delay in children with autism. According to the result of this experiment the group with autism was able to perform the part of the test with nonlinguistic cues which depended on working memory but failed to pass short-term memory and the linguistic part of it. This explains the delay of language in autistic children and neurocognition is an important contributor to it.
Central executive or executive functioning
It is believed that a dysfunction in working memory significantly influences the symptoms associated with autism spectrum disorders. In examining autism through the lens of Baddeley & Hitch's model of working memory, there have been conflicting results in the research. Some studies have shown that individuals that fall within the spectrum have impaired executive functioning, which means working memory does not function correctly. However, other studies have failed to find an effect in autistic people with a high level of functioning. Tests such as the Wisconsin Card Sorting Test have been administered to autistic individuals, and the lower scores have been interpreted as indicative of a poor ability to focus on relevant information and thus a deficit within the central executive aspect of working memory. An aspect of ASD is that it might be present, to a certain extent, in first-degree relatives. One study found that siblings of autistic individuals have limited ability to focus and conceptualize categories using updated information. Given these results, it is reasonable to suggest that these so-called deficits in cognitive ability are of the cognitive endophenotypes (i.e., relatives) of ASD.
Category integration
Given these findings, it would appear that autistic individuals have trouble categorizing. Studies have shown that category induction is in fact possible and can occur at the same cognitive level as non-autistic individuals. Given that aspects of category formation such as discrimination and feature detection are enhanced among autistic individuals, it is viable to state that although autistic individuals require more trials and/or time to learn material and may employ different learning strategies than non-autistic individuals, once learned, the level of categorization displayed is on par with that of a non-autistic individual.
The idea that autistic individuals learn differently than those without autism can account for the delay in their ability to categorize. However, once they begin categorizing they are at an average level of cognitive ability as compared to those without autism. This, however, is only applicable to higher functioning individuals within the spectrum as those with lower IQ levels are notoriously difficult to test and measure.
In part with a different style of learning, individuals within the spectrum have also been proposed to have a weak central coherence. This theory meshes well with the general traits of individuals within the spectrum. Again though, this is explained through different learning styles. As opposed to viewing a forest as a collection of trees, those with autism see one tree, and another tree, and another tree and thus it takes an immense amount of time to process complex tasks in comparison with non-autistic people. Weak central coherence can be used to explain what is viewed as a working memory deficit in attention or inhibition, as autistic individuals possess an intense focus on single parts of a complex, multi-part concept and cannot inhibit this in order to withdraw focus and direct it on the whole rather than a singular aspect. Thus, this suggests that the decrement in working memory is partially inherited which is then exacerbated by further genetic complications leading to a diagnosis of autism.
Visual and spatial memory
Deficits in spatial working memory appear to be familial in people with autism, and probably even in their close relatives. Replication of movements by others, a task that requires spatial awareness and memory capacities, can also be difficult for autistic children and adults.
People with Asperger's Syndrome were found to have spatial working memory deficits compared with control subjects on the Executive-Golf Task, although these may be indicative of a more general deficit in non-verbal intelligence in people with ASD. Despite these results, autistic children have been found to be superior to typically developing children in certain tasks, such as map learning and cued path recall regarding a navigated real-life labyrinth. Steele et al. attempts to explain this discrepancy by advancing the theory that the performance of autistic people on spatial memory tasks degrades faster in the face of increasing task difficulty, when compared with normally developed individuals. These results suggest that working memory is related with an individual's ability to solve problems, and that autism is a hindrance in this area.
Autistic people appear to have a local bias for visual information processing, that is, a preference for processing local features (details, parts) rather than global features (the whole). One explanation for this local bias is that people with autism do not have the normal global precedence when looking at objects and scenes. Alternatively, autism could bring about limitations in the complexity of information that can be manipulated in short-term visual memory during graphic planning.
The difficulties that individuals with ASD often have in regards to facial recognition has prompted further questions. Some researches have shown that the fusiform gyrus in ASD individuals act differently from in non-ASD individuals which may explain the aforementioned troubles regarding facial recognition.
Research by Baltruschat et al. has shown that improvement in spatial working memory for autistic individuals may be possible. Adapting a behaviorist approach by using positive reinforcement could increase WM efficiency in young children with ASD.
Auditory and phonological memory
The research on phonological working memory in autism is extensive and at times conflicting. Some research has found that, in comparison with spatial memory, verbal memory and inner speech use remain relatively spared, while other studies have found limitations on the use of inner speech by autistic people. Others have found a benefit to phonological processing in autism when compared with semantic processing, and attribute the results to a similar developmental abnormality to that in savant syndrome.
In particular, Whitehouse et al. have found that autistic children, when compared with typically developing (TD) children of a similar mean verbal age and reading ability, performed better when asked to recall a set of pictures presented to them, but not as well when asked to recall a set of printed words presented interspersed with the pictures; a competing verbal task given to both sets of participants also worsened performance on control children more than it did on autistic children. They also reported that word length effects were greater for the control group. These results are contested by Williams, Happé, and Jarrold, who contend that it may be verbal IQ, rather than verbal ability, that is at issue, and Whitehouse et al.'s subjects were not matched on chronological age. Williams, Happé, and Jarrold themselves found no difference between autistic children and controls on a serial recall task where phonological similarity effects, rather than word length effects, were used as an alternate measure of inner speech use.
Joseph et al. found that a self-ordered pointing task in autistic children involving stimuli that could be remembered as words (e.g. shovel, cat) was impaired relative to comparison children, but the same task with abstract stimuli was not impaired in autistic children. In contrast, Williams et al. found that autistic children scored significantly lower than TD children on spatial memory tests. Williams et al. not only experimented with spatial memory tasks, but verbal memory as well. They discovered that in an experimental group and a control group of TD individuals, that while differences were found in spatial memory ability, no significant difference was seen between the groups regarding verbal memory. They ran their experiments with both children and adult participants. Autism is a developmental disorder, so it is possible that life experiences could alter the memory performance in adults who had grown up with autism. Williams et al. experimented with children separately to see if they had different results from their adult counterparts. They used a WRAML (Wide Range Assessment of Memory and Learning) test, a test specifically designed to test memory in children. Test results were similar across all age groups, that significant differences between TD and autistic participants are found only in spatial memory, not verbal working memory.
Gabig et al. discovered that children with autism, regarding verbal working memory and story retelling, performed worse than a control group of TD children. In three separate tasks designed to test verbal working memory, the autistic children scored well below the expected levels for their age. While results do show lower scores for autistic children, there was also information that suggested lack of vocabulary contributed to the lower scores, rather than working memory itself.
There is some evidence from an fMRI study that autistic individuals are more likely to use visual cues rather than verbal cues on some working memory tasks, based on the differentially high activation of right parietal regions over left parietal regions in an N-back working memory task with letters.
Opposing results
Some data has shown that individuals with ASD may not have WM (working memory) impairments and that this supposed impairment observed is a result of testing. Nakahachi et al. argue that the vagueness of many tests measuring WM levels in people with ASD is the cause. They found that people with ASD only performed worse on WM tests if the test itself could have interfered with the completion of the test. These findings show that the type of test and the way it is presented to individuals with ASD can strongly affect the results, therefore much caution should be taken in choosing the design of a study focusing on WM in people with ASD.
Ozonoff et al. have found similar results in their studies on working memory in individuals with ASD. Their research showed no significant difference between individuals with ASD and those without ASD in tests designed to measure various aspects of working memory. This supports the notion that Autism does not inhibit WM. Results from experiments that have shown lower WM facilities in ASD individuals may be due to the human interaction nature of these experiments as individuals with ASD exhibit low social functioning skills. Experiments utilizing computer rather than human interaction remove this problem and may head more accurate findings.
Further research by Griffith et al. also indicates that WM may not be impaired in those with autism. There may be some executive function impairments in these individuals, but not in working memory and rather in social and language skills, which can effect education early in life. Other research conducted by Griffith et al. on young autistic individuals did not measure verbal working abilities, but nonetheless found no significant difference between the executive functions in autistic and non-autistic individuals. Though there has been much research that alludes to low WM abilities in those with autism, these recent data weaken the argument that autistic individuals have little WM facilities.
Physiological underpinnings
The physical underpinnings of the cause for differences in the memory of autistic people has been studied. Bachevalier suggests a major dysfunction in the brain of an autistic individual resides in the neural mechanisms of the structures in the medial temporal lobe (MTL) and perhaps, more specifically the amygdaloid complex. This may have implications in their ability to encode information because of the role the MTL and especially the hippocampal areas play in information processing DeLong reinforces this by suggesting autism to affect hippocampal function. Because the hippocampus is pivotal in memory encoding and modulating memory consolidation, any impairment can drastically affect an autistic individual's ability to process (i.e. multi-modal) and retain information. Sumiyoshi, Kawakubo, Suga, Sumiyoshi and Kasai have suggested that it is possible that the attenuated neural activities in parahippocampal regions might have something to do with the abnormal organization of information of individuals within the autistic spectrum. The left parahippocampal region (including the parahippocampal gyrus) has an implied role in sorting, relating, and sending information to the hippocampus and thus any abnormal activity or dysfunction within these regions might be accountable for the degree of effectiveness autistic individuals organize information. This is in keeping with other findings that suggest unconventional activity or lack of activity within the hippocampal regions which have a role in explaining some aspects of ASD.
Further evidence suggests that there is abnormal circuitry in what Brothers calls the neural basis for social intelligence, or holistically interpreting people's expressions and intentions. The interaction between the amygdala, the orbitofrontal cortex (OFC), and the superior temporal sulcus and gyrus (STG) enables one to process social information for personal interaction. In the case of autistic individuals there seems to be a limitation in these structures such that facial expressions, body language and speech expressions (ex. sarcasm) go consciously unnoticed, it is theorized that this could have something to do with the sagittal stratum, which is sometimes referred to as the "sarcasm center". However, Frith and Hill suggest that through 'remediation' or training that attends to specific traits in expressions, social understanding can be partially improved. The possibility of training in social understanding has given hope that there is a path that can be taken to reduce the social divide that is between children with autism and children who are neurotypical.
Memory strengths
Although many people who have been diagnosed with autism have some memory difficulties, there are some who excel with memory. Some individuals with HFA have been diagnosed with Savant syndrome. Those who are considered savants have abilities, usually related to memory, that are far above average, while also experiencing mental disabilities. Savants can also excel in a range of skills other than memory, including math, art, and music.
Further research
Few studies of implicit/non-declarative memory exist. Almost all of the M-LFA studies were conducted with children aged 3–18. Recently a specific call has been issued for the investigation of total loss of declarative memory in significantly low-functioning, nonverbal autistic people.
See also
Monotropism
Conditions comorbid to autism spectrum disorders
References
Autism
Memory | 0.763976 | 0.991549 | 0.757519 |
Political ponerology | Political ponerology is a concept popularized by Polish psychiatrist Andrzej Łobaczewski. Łobaczewski advocated using the fields of psychology, sociology, philosophy, and history to account for such phenomena as aggressive war, ethnic cleansing, genocide, and despotism.
Andrzej Łobaczewski and early research group
During World War II, Łobaczewski worked for the Polish Home Army, an underground Polish resistance organization. After the war, he studied at Jagiellonian University under professor of psychiatry Edward Brzezicki. Łobaczewski's class was the last to receive an education uninfluenced by Soviet ideology and censorship, after which psychiatry was restricted to Pavlovian concepts. The study of genetics and psychopathy was forbidden.
Psychopathology and politics
Łobaczewski adopted the term "ponerology", which is derived from the Greek word poneros, from the branch of theology dealing with the study of evil. According to Łobaczewski, all societies fluctuate between "happy times" and "unhappy times". During happy times the privileged classes enjoy prosperity and suppress advanced psychological knowledge of psychopathological influence in the corridors of power. Though happy, these times are not necessarily morally advanced as the privileged classes' prosperity or happiness may be premised on the oppression or exploitation of others. To block out such inconvenient truths (the voice of conscience) the privileged use 'conversive thinking', which means changing the outcome of the reasoning process to a more convenient outcome. This is accompanied by a rise in egotism and emotionalism. This growing 'hysteria' of the privileged classes (emotionalism, egotism and conversive thinking) spreads across society over several generations. National hysteria is a natural cycle and forms a sine-wave almost 200 years long. Hysteria causes people to lose the ability to differentiate between psychologically healthy and pathological individuals. In this environment the behavior of 'characteropaths', or individuals with slight brain tissue damage (e.g. from toxic substances, viruses, difficult births, pathological parenting) is accepted as normal and this acts as a gateway to normalizing the behavior of those with genetic deviations, including psychopathy. Finally, near the point of maximum hysteria society becomes polarized and paralyzed and the most pathologically egotistical of all 'spellbinders' can come to power. The spellbinder worsens the psychological health of those under his or her influence. This may be the beginning of a 'pathocracy' (though not inevitable) in which individuals with biologically based psychopathology, including personality disorders (especially psychopathy) occupy positions of power and influence.
The spellbinder hides behind an 'ideological mask', a belief system that he uses to gain power. Any belief system can be used as an ideological mask, including religion. Psychopaths have no problems wearing personal masks or ideological masks and are accepted as normal within the spellbinder's movement. A network of psychopaths gradually begins to dominate, and they begin to eliminate the brain-tissue damaged and those who genuinely believe in the ideology. At a certain point the minority block of psychopaths has a showdown with all those they've usurped.
A full blown-pathocracy is known as a totalitarian state and characterized by a government turned against its own people. A pathocracy may emerge when a society is insufficiently guarded against the typical and inevitable minority of such abnormal pathology, which Łobaczewski asserts is caused by biology or genetics. He argues that in such cases these individuals infiltrate an institution or state, prevailing moral values are perverted into their opposite, and a coded language like Orwell's doublethink circulates into the mainstream, using paralogic and paramoralism in place of genuine logic and morality.
There are various identifiable stages of pathocracy described by Łobaczewski. Ultimately pathocracy dies because the pathological are promoted to positions of power, even though they have little or no talent or abilities.
The root of healthy social morality, according to Łobaczewski, is contained in the congenital instinctive infrastructure in the vast majority of the population, and while some in the normal population are more susceptible to pathocratic influence and become its lackeys, the majority instinctively resist. During unhappy times the intelligentsia and society at large can recover real values to resolve the new social order along mentally healthier lines.
See also
Antisocial personality disorder
References and notes
External links
Political Ponerology: Andrew M. Lobaczewski - Ponerology.com
Majority–minority relations
Political theories
Psychopathology
Sociological terminology | 0.774682 | 0.977839 | 0.757514 |
Avoidance coping | In psychology, avoidance coping is a coping mechanism and form of experiential avoidance. It is characterized by a person's efforts, conscious or unconscious, to avoid dealing with a stressor in order to protect oneself from the difficulties the stressor presents. Avoidance coping can lead to substance abuse, social withdrawal, and other forms of escapism. High levels of avoidance behaviors may lead to a diagnosis of avoidant personality disorder, though not everyone who displays such behaviors meets the definition of having this disorder. Avoidance coping is also a symptom of post-traumatic stress disorder and related to symptoms of depression and anxiety. Additionally, avoidance coping is part of the approach-avoidance conflict theory introduced by psychologist Kurt Lewin.
Literature on coping often classifies coping strategies into two broad categories: approach/active coping and avoidance/passive coping. Approach coping includes behaviors that attempt to reduce stress by alleviating the problem directly, and avoidance coping includes behaviors that reduce stress by distancing oneself from the problem. Traditionally, approach coping has been seen as the healthiest and most beneficial way to reduce stress, while avoidance coping has been associated with negative personality traits, potentially harmful activities, and generally poorer outcomes. However, avoidance coping can reduce stress when nothing can be done to address the stressor.
Measurement
Avoidance coping is measured via a self-reported questionnaire. Initially, the Multidimensional Experiential Avoidance Questionnaire (MEAQ) was used, which is a 62-item questionnaire that assesses experiential avoidance, and thus avoidance coping, by measuring how many avoidant behaviors a person exhibits and how strongly they agree with each statement on a scale of 1–6. Today, the Brief Experiential Avoidance Questionnaire (BEAQ) is used instead, containing 15 of the original 62 items from the MEAQ. In research, avoidance coping can be objectively quantified using immersive virtual reality.
Treatment
Cognitive behavioral and psychoanalytic therapy are used to help those coping by avoidance to acknowledge, comprehend, and express their emotions. Acceptance and commitment therapy, a behavioral therapy that focuses on breaking down avoidance coping and showing it to be an unhealthy method for dealing with traumatic experiences, is also sometimes used.
Both active-cognitive and active-behavioral coping are used as replacement techniques for avoidance coping. Active-cognitive coping includes changing one's attitude towards a stressful event and looking for any positive impacts. Active-behavioral coping refers taking positive actions after finding out more about the situation.
See also
Coping (psychology)
Mindfulness meditation
Posttraumatic stress disorder
Avoidant personality disorder
Procrastination
Stress management
Video game addiction
References
Anxiety
Interpersonal conflict
Psychological stress
Human behavior
Problem behavior
Symptoms and signs of mental disorders | 0.765238 | 0.989874 | 0.757489 |
Personality Assessment Inventory | Personality Assessment Inventory (PAI), developed by Leslie Morey (1991, 2007), is a self-report 344-item personality test that assesses a respondent's personality and psychopathology. Each item is a statement about the respondent that the respondent rates with a 4-point scale (1-"Not true at all, False", 2-"Slightly true", 3-"Mainly true", and 4-"Very true"). It is used in various contexts, including psychotherapy, crisis/evaluation, forensic, personnel selection, pain/medical, and child custody assessment. The test construction strategy for the PAI was primarily deductive and rational. It shows good convergent validity with other personality tests, such as the Minnesota Multiphasic Personality Inventory and the Revised NEO Personality Inventory.
Scales
The PAI has 22 non-overlapping scales of four varieties: 1) validity scales, 2) clinical scales, 3) treatment consideration scales, and 4) interpersonal scales.
Validity scales
The validity scales measure the respondent's overall approach to the test, including faking good or bad, exaggeration, defensiveness, carelessness, or random responding.
Inconsistency (ICN) is the degree to which respondents answer similar questions in different ways.
Infrequency (INF) is the degree to which respondents rate extremely bizarre or unusual statements as true.
Positive Impression (PIM) is the degree to which respondents describe themselves in a positive or overly positive light.
Negative Impression (NIM) is the degree to which respondents describe themselves in a negative or overly negative light; though this scale may also indicate severe levels of distress.
There are also four supplementary validity scales:
Defensiveness Index; to assist in identifying defensive responding.
Cashel Discriminant Function; to assist in identifying falsified profiles with a positive bias.
Malingering Index; to assist in identifying feigned mental illness.
Rogers Discriminant Function; to assist in identifying simulated profiles with a negative bias.
Further identification of exaggeration and/or negative bias can be calculated used the NIM Predicted Profile
Additionally, one can also apply the use of the Negative Distortion Scale
Clinical scales
The clinical scales measure the respondent's psychopathology using diagnostic categories that were judged by the developers to be relevant based on their historical and contemporary popularity among psychologists. Each clinical scale (except Alcohol Problems and Drug Problems) represents a particular trait, and each scale has sub-scales that represent more specific aspects of that trait.
Somatic concerns (SOM) measures a respondent's physical concerns and complaints.
Anxiety (ANX) measures a respondent's general feelings of tension, worry, and nervousness.
Anxiety Related Disorders (ARD) measures more specific anxiety symptoms that relate to different categories of anxiety disorders.
Depression (DEP) measures a respondent's general feelings of worthlessness, sadness, and lethargy.
Mania (MAN) measures a respondent's level of high energy and excitability.
Paranoia (PAR) measures a respondent's suspiciousness and concern about others harming them.
Schizophrenia (SCZ) measures a respondent's unusual sensory experiences, bizarre thoughts, and social detachment.
Borderline features (BOR) measures a respondent's problems with identity, emotional instability, and problems with friendships.
Antisocial features (ANT) measures a respondent's level of cruel/criminal behavior and selfishness.
Alcohol Problems (ALC) measures a respondent's problems with excessive drinking.
Drug Problems (DRG) measures a respondent's problems with excessive recreational drug use.
Treatment consideration scales
The treatment consideration scales measure factors that may relate to treatment of clinical disorders or other risk factors but which are not captured in psychiatric diagnoses.
Aggression (AGG) measures the respondent's different kinds of aggressive behaviors toward others.
Suicidal ideation (SUI) measures a respondent's frequency and severity of suicidal thoughts and plans.
Nonsupport (NON) measures how socially isolated a respondent feels, and how little support the respondent reports having.
Stress (STR) measures the controllable and uncontrollable hassles and stressors reported by the respondent.
Treatment rejection (RXR) measures certain attributes of the respondent that are known to be related to psychological treatment adherence, including motivation, willingness to accept responsibility, and openness to change and new ideas.
Interpersonal scales
The interpersonal scales measure two factors that affect interpersonal functioning for the respondent. They are based on the circumplex model of emotion classification.
Dominance (DOM) measures the degree to which a respondent acts dominant, assertive, and in control in social situations.
Warmth (WRM) measures the degree to which a respondent acts kind, empathic, and engaging in social situations.
Development
The rationale behind the development of the PAI was to create an assessment tool that would enable the measurement of psychological concepts while maintaining statistical strength. The development methodology was based on several advances that the field of personality assessment was witnessing at the time. Due to the fuzzy nature of constructs (concepts) in psychology, it is very difficult to use criterion-referenced approaches, such as those used in some parts of medicine (e.g. pregnancy tests). This is why construct validation is very important to personality test development. It is usually described as being involved when tests intend to measure some construct that is not "operationally defined". The PAI was developed because the authors of the instrument felt that there were a limited number of self-report questionnaires that were using this type of construct validation method to assess areas relevant to diagnoses and treatment planning.
The developers of the PAI examined various literary sources to come up with the five areas assessed by the PAI (validity of responses, clinical symptoms, interpersonal styles, complications for treatment, and characteristics of one's environment). Constructs were included if they had been relatively stable in their importance of diagnosing mental disorders over time, and if they were important in contemporary clinical practice. The construct validation approach that was used to construct the PAI was used to maximize two types of validity: content validity and discriminant validity. To ensure that the PAI maximized content validity, each scale had a balanced sample of items that represented a range of important items for each construct. For example, the Depression scale has items involving physical, emotional, and cognitive content (as opposed to only questions about mood or interests). Each scale also assesses a range of severity for that scale; for example, the Suicidal Ideation scale has items that range from vague ideas about suicide to distinct plans for self-harm. To ensure that the PAI maximized discriminant validity, each of the scales should be relatively distinct from one another. For example, if the depression and anxiety scales had many of the same items on them, it would be difficult to tell if elevations on these scales meant that the person was experiencing symptoms of depression, anxiety, or both. As such, the developers of the PAI stressed the fact that their measure has no overlapping items to ensure better interpretation of the scales.
The PAI focuses on the content of psychological concepts. The initial items were written so that the content would be directly relevant to the different constructs measured by the test. These items were rated for their quality, appropriateness, and bias. For example, a bias review panel identified items that could seem to be pathological but are actually normal within a subculture. After ensuring that the PAI addressed certain concepts in psychopathology, the developers proceeded to a second stage in the process. This stage involved the "empirical evaluation" of the items. The research team administered two versions of the test, first to a sample of college students and later to a normative sample. These versions were evaluated using several criteria, such as internal consistency of the scales (or how much the items in one scale correlate with each other). The ability to fake good or bad while taking the test was also evaluated using a sample of college students that were given different instructions on how to answer the test.
See also
16PF Personality Questionnaire
MBTI
Minnesota Multiphasic Personality Inventory
NEO-PI
References
Personality tests | 0.766176 | 0.988644 | 0.757475 |
Hyperreligiosity | Hyperreligiosity is a psychiatric disturbance in which a person experiences intense religious beliefs or episodes that interfere with normal functioning. Hyperreligiosity generally includes abnormal beliefs and a focus on religious content or even atheistic content, which interferes with work and social functioning. Hyperreligiosity may occur in a variety of disorders including epilepsy, psychotic disorders and frontotemporal lobar degeneration. Hyperreligiosity is a symptom of Geschwind syndrome, which is associated with temporal lobe epilepsy.
Signs and symptoms
Hyperreligiosity is characterized by an increased tendency to report supernatural or mystical experiences, spiritual delusions, rigid legalistic thoughts, and extravagant expression of piety. Hyperreligiosity may also include religious hallucinations. Hyperreligiosity can also be expressed as intense atheistic beliefs.
Pathophysiology and cause
Hyperreligiosity may be associated with epilepsy – in particular temporal lobe epilepsy involving complex partial seizures – mania, frontotemporal lobar degeneration, anti-NMDA receptor encephalitis, hallucinogen-related psychosis and psychotic disorder. In persons with epilepsy episodic hyperreligosity may occur during seizures or postictally, but is usually a chronic personality feature that occurs interictally. Hyperreligiosity was associated in one small study with decreased right hippocampal volume. Increased activity in the left temporal regions has been associated with hyperreligiosity in psychotic disorders. Pharmacological evidence points towards dysfunction in the ventral dopaminergic pathway.
Treatment
Epilepsy related cases may respond to antiepileptics.
References
External links
Psychosis
Religion and mental health | 0.767702 | 0.986662 | 0.757462 |
Group work | Group work is a form of voluntary association of members benefiting from cooperative learning, that enhances the total output of the activity than when done individually. It aims to cater for individual differences, and develop skills such as communication skills, collaborative skills, critical thinking skills, etc. It is also meant to develop generic knowledge and socially acceptable attitudes. Through group work, a "group mind" - conforming to standards of behavior and judgement - can be fostered.
Specifically in psychotherapy and social work, "group work" refers to group therapy, offered by a practitioner trained in psychotherapy, psychoanalysis, counseling or other relevant disciplines.
Social group work
Social group work is a method of social work that enhance people's social functioning through purposeful group experiences, and to cope more effectively with personal, group or community problems (Marjorie Murphy, 1959).
Social group work is a primary modality of social work in bringing about positive change. It is defined as an educational process emphasizing the development and social adjustment of an individual through voluntary association and use of this association as a means of furthering socially desirable ends. It is a psychosocial process which is concerned in developing leadership and cooperation with building on the interests of the group for a social purpose. Social group work is a method through which individuals in groups in a social agency setting are helped by a worker who guides their interaction through group activities so they may relate to others and experience growth opportunities in line with their needs and capacities of the individual, group and community development. It aims at the development of persons through the interplay of personalities in a group setting and at the creation of such group setting as provide for integrated, cooperative group action for common ends. It is also a process and a method through which group life is affected by a worker who consciously directs the interacting process towards the accomplishment of goals which are conceived in a democratic frame of reference. Its distinct characteristics lies in the fact that group work is used with group experience as a means of individual growth and development, and that the group worker is concerned in developing social responsibility and active citizenship for the improvement of democratic societies. Group work is a way to serving an individual within and through small face to face groups in order to bring about the desired change among client participants.
Models
There are four models in social group work:
Remedial model (Vinter, R. D., 1967) – Remedial model focuses on the individuals dysfunction and utilizes the group as a context and means for altering deviant behaviour.
Reciprocal or Mediating model (W. Schwartz, 1961) - A model based on open systems theory, humanistic psychology and existential perspective. Relationship rooted in reciprocal transactions and intensive commitment is considered critical in this model.
Developmental model (Berustein, S. & Lowy, 1965) - A model based on Erikson's ego psychology, group dynamics and conflict theory. In this model groups are seen as having "a degree of independence and autonomy, but the dynamics of to and fro flow between them and their members, between them and their social settings, are considered crucial to their existence, viability and achievements". The connectedness (intimacy and closeness) is considered critical in this model.
Social goals model (Gisela Konopka & Weince, 1964) - A model based on 'programming' social consciousness, social responsibility, and social change. It suggests that democratic participation with others in a group situation can promote enhancement of personal function in individuals, which in-turn can affect social change. It results in heightened self-esteem and a rise in social power for the members of the group collectively and as individuals.
See also
Social case work
Further reading
Douglas, Tom (1976), Group Work Practice, International Universities Press, New York.
Konopka, G. (1963), Social Group Work : A Helping Process, Prentice Hall, Englewood Cliffs.
Treeker, H.B. (1955), Social Group Work, Principles and Practices, Whiteside, New York.
Phillips, Helen, U. (1957), Essential of Social Group Work Skill, Association Press, New York.
References
Harleigh B. Trecker, Social Group Work: Principles and Practices, Association Press, 1972
Joan Benjamin, Judith Bessant and Rob Watts. Making Groups Work: Rethinking Practice, Allen & Unwin, 1997
Ellen Sarkisian, "Working in Groups." Working in Groups - A Quick Guide for Students, Derek Bok Center, Harvard University
Group psychotherapy
Group processes
Social work | 0.773492 | 0.979211 | 0.757412 |
Independent medical examination | An independent medical examination (IME) is a medical evaluation performed on a patient by a medical professional who was not previously involved in the treatment of that patient, to evaluate the patient's course of prior treatment and current condition. IMEs are conducted by doctors, psychologists, and other licensed healthcare professionals in essentially all medical disciplines, depending on the purpose of the exam and the claimed injuries.
Such examinations are generally conducted in the context of a legal or administrative proceeding, at the request of the party opposing the patient's request for benefits. IMEs are commonly held in the context of workers' compensation cases, disability claims, and personal injury litigation.
Limited doctor-patient relationship
Conducting an independent medical examination does not establish a typical doctor/therapist-patient relationship as exists when a clinician treats a patient in the hospital or at an outpatient clinic. However, the independent, objective (unbiased) nature of the examination does not absolve the doctor from all professional responsibilities. For example, in most independent medical examinations, the clinician should assess for possible psychiatric disorders and ask the individual if he or she has been thinking of hurting or killing themselves or someone else. If upon further questioning after an affirmative response it becomes apparent that the person poses a significant risk of imminent harm to self or others, the examiner must take steps to prevent such harm and to facilitate referral to appropriate treatment and psychosocial support. Thus, a "limited doctor-patient relationship" exists when conducting independent medical examinations.
Workers' compensation and long-term disability insurance
Independent medical examinations may be conducted to determine the cause, extent and medical treatment of a work-related or other injury where liability is at issue; whether an individual has reached maximum benefit from treatment; and whether any permanent impairment remains after treatment. An independent medical examination may be conducted at the behest of an employer or an insurance carrier to obtain an independent opinion of the clinical status of the individual. Workers' compensation insurance carriers, auto insurance carriers, and self-insured employers have a legal right to this request. Should the doctor/therapist performing the independent medical examination conclude that a patient's medical condition is not related to a compensable event, the insurer may deny the claim and refuse payment.
Notes
References
Physical examination
Health insurance in the United States
Medical jurisprudence
Forensic psychiatry | 0.776058 | 0.975951 | 0.757395 |
Ukuthwasa | Ukuthwasa is a Southern African culture-bound syndrome associated with the calling and the initiation process to become a sangoma, a type of traditional healer. In the cultural context of traditional healers in Southern Africa, the journey of ukuthwasa (or intwaso) involves a spiritual process marked by rituals, teachings, and preparations. It begins with a calling, idlozi, from ancestors, often received through dreams or altered states of consciousness. Initiates, known as ithwasane or ithwasa, undergo formal training under a mentor, gobela, which can last months to years. Ukuthwasa process entails physical, psychological, and spiritual manifestations, which are believed to cleanse and prepare the initiate. The term , meaning "come out" or "be reborn," signifies the transformative nature of the experience. Both men and women can become traditional healers through this calling.
In the community of traditional healers, Ukuthwasa is perceived to hold cultural and spiritual significance, preserving traditions, and bridging the human and spirit worlds. However, the process can lead to intense psychosocial and mental health experiences, with some cases of disorders or fatalities. While ukuthwasa was historically stigmatised, it's increasingly respected and being integrated in the health system as outlined by the South African Traditional Health Practitioners Act 35 of 2004. In addition, the initiation process has influenced literature, cinema, and popular culture, reflecting its importance in African societies.
Scientific studies revealed that ukuthwasa is associated with people having varying types of psychosis. The coexistence of traditional practices like ukuthwasa and modern healthcare and education can pose challenges.
Process (from thwasa to sangoma)
In the culture of traditional healers of Southern Africa, the journey of ukuthwasa is a deeply personal and spiritual one, marked by various rituals, teachings, and preparations. It begins when an individual receives a calling, known as or , from their ancestors, often through dreams, visions, or altered states of consciousness. The symptoms and experiences associated with ukuthwasa are significant aspects of the initiation process, or itwasa. These symptoms can include physical, psychological, and spiritual manifestations. Examples of physical symptoms may include illness, insomnia, loss of appetite, or trance-like states. These symptoms are believed to be a form of spiritual cleansing and preparation for the initiate's role as a healer or diviner, also colloquially known as amagqirha in Xhosa and sangoma in Zulu communities.
Both men and women can become traditional healers but they need to be called. Sangomas believe that failure to respond to the calling will result in further illness until the person concedes and goes to be trained. The word is derived from which means "the light of the new moon" or from ku mu thwasisa meaning "to be led to the light".
A trainee sangoma, or ithwasane, trains formally under another sangoma known as gobela, a spiritual teacher, for a period of anywhere between a number of months and many years, with some sources suggesting a minimum duration of nine months to fully explore and develop the abilities and knowledge of an initiate. This journey includes metaphysical transformation, symbolized by wearing specific garments, performing ceremonies, and undergoing a process called ivuma ukhufa, where the initiate's old identity dies to be reborn as a healer. They learn about traditional healing practices, spiritual ceremonies, herbal medicine, and the use of divination tools. The training also involves learning humility to the ancestors, purification through steaming, washing in the blood of sacrificed animals, and the use of muti, medicines with spiritual significance. The ithwasa may not see their families during training and must abstain from sexual contact and often live under harsh and strict conditions.
During the training period the ithwasa will share their ailments in the form of song and dance, a process that is nurtured by the analysis of dreams, anxieties, and with prayer. The story develops into a song which becomes a large part of the graduation-type ceremony that marks the end of the ukuthwasa training. At times in the training, and for the graduation, a ritual sacrifice of an animal is performed, usually chickens and a goat or a cow.
At the end of ukuthwasa and during initiation, early hours of the morning a goat that will be slaughtered should be a female one, that's for Umguni, the second one will be slaughtered the following morning after the chickens, which are sacrificed at Abamdzawo river. All these sacrifices are to call to the ancestors and appease them. The local community, friends and family are all invited to the initiation to witness and celebrate the completion of training. The ithwasa is also tested by the local elder sangomas to determine whether they have the skills and insight necessary to heal. This is signified and proved when other sangomas hide the ithwasa's sacred objects, including the gall bladder of the goat (Umgamase) that was sacrificed. The ithwasa must, in front of the community, call upon their ancestors, find the hidden objects, which includes the Umgamase, the ancestors clothes and return them back to the sangomas that hid them. Thus, proving they have the ability to "see" beyond the physical world.
The graduation ceremony takes three days from Friday to Sunday. In the early hours of the morning, the ithwasa sweeps the whole yard, wash their clothes, and to bath at the river and they should return when they are dry.
Significance
Ukuthwasa is a traditional African practice that involves a spiritual calling and initiation process for individuals chosen by their ancestors to become healers or diviners. The Xhosa term "ukuthwasa" translates to "come out" or "be reborn," symbolising the transformative nature of the experience. It holds significant cultural and spiritual importance, particularly among the Xhosa people and Zulu people, but its practice and understanding may vary across different African communities, including Nguni people, and Xesibe people.
In the culture of traditional healers of Southern Africa, the significance of ukuthwasa extends beyond the individual initiate. Traditional healers and diviners are respected members of their communities and they play crucial roles with providing spiritual guidance, healing, and support. They are often sought after for their ability to address various ailments, both physical and spiritual, and serve as a bridge between the human and spirit worlds. They also play a crucial part in preserving cultural traditions, guiding rituals, and acting as intermediaries between clients and ancestors. Established traditional healers' associations ensure safety and ethical practices within this cultural tradition. There are two main types of Xhosa traditional healers: Igqirha, who offer spiritual insights, and Umthandazeli, who work with ancestral spirits using water, prayers, and indigenous wisdom.
Criticism
Historically, ukuthwasa was frequently regarded as pagan and ungodly. Missionaries, colonisation, and the apartheid regime exerted significant efforts to undermine African divination practices like ukuthwasa. ukuthwasa was often linked to concepts like sorcery and witchcraft, rather than being associated with healing and spiritual calling answered by some African Christians and Muslims.
Mental health
Ukuthwasa is a culture-bound syndrome. The symptoms and experiences associated with ukuthwasa are seen as signs of spiritual connection and readiness. After study, it was discovered that this term is directed toward people with varying types of psychosis, schizophrenia, or a psychotic depression. Ukuthwasa initiates may experience intense and sometimes distressing psychosocial and mental health experiences during the process. In some cases, initiates have experienced disorders and even fatalities. A similar term, Amafufunyana refers to claims of demonic possession due to members of the Xhosa people exhibiting aberrant behaviour and psychological concerns. Sometimes, ukuthwasa exhibits signs that resemble symptoms of madness, such as hallucinations and illusions. Due to these characteristics, it's referred to as "inkenqe" (cultural madness) or "umshologu" (spiritual madness).
Zeijst et al. acknowledged that the ancestral calling is commonly associated with mental illness, including atypical sensory experiences. However, their research suggested that for certain individuals, successful completion of ukuthwasa could lead to both recovery from these symptoms and a profession where these experiences are valued. The research suggests that in this particular community, ukuthwasa serves as a culturally accepted healing process that manages experiences that might be termed psychotic by psychiatric standards while convert challenging situations into positive and esteemed occurrences by reducing societal stigma. Nevertheless, if an individual with this condition doesn't successfully transition into a healer, the community may reclassify them as mad (ukuphambana).
Despite debates about cultural influence on mental illness expression, Bakow and Low asserted that significant impact of culture on the experience and treatment of ukuthwasa. Their findings suggested that cultural perspectives deeply affect symptom interpretation, with traditional healing methods proving effective for many participants. The study acknowledged limitations in sample size and the complex nature of ukuthwasa symptoms.
Cost
Because ukuthwasa is linked to various crises and challenges like accidents, mystical occurrences, deaths, and sometimes legal issues, the Xhosa people also colloquially calls ukuthwasa "inkathazo," signifying trouble. A significant aspect of the issue is the financial burden associated with the process. The ithwasa pays for their trainer, daily expenses, and a cow and goat for graduation.
Compatibility with other modern systems
Schooling
Ukuthwasa has been associated with school dropout. Families sometimes compel children to leave school to heed the ancestral calling that ukuthwasa represents. The coexistence of traditional practices like ukuthwasa and formal education systems is complex, often raising questions about their compatibility and effects on individual trajectories.
In January 2019, a grade 10 student in Gauteng was labelled a "demon" by teachers and told to remove her sangoma beads. The student had undergone the ukuthwasa initiation process in 2018. After discussions with the student, parents, and school officials, an agreement was reached that she could wear the beads if concealed under a long-sleeved shirt to avoid drawing attention. However, according to reports, the student was compelled to consume "holy oil" as a mean to remove supposed "evil spirits" from her. Similar incident in 2021 ended with the pupil committing suicide after being called "witch". Siyamthanda Ntlani, who faced similar situation while being a student, stated that
Healthcare
In numerous cases, the interaction between traditional and modern healthcare professionals involves coexisting rather than actively collaborating. The government of South Africa acknowledged the presence of traditional healthcare institutions through "The Traditional Health Practitioners Act 35 of 2004," yet this recognition primarily took the form of allowing traditional practitioners to exist alongside physicians within a diverse healthcare framework. Instead of integrating traditional practitioners into the official national healthcare system, the government opts for a pluralistic approach to healthcare.
Workplace
According to David Bogopa, a researcher at the Nelson Mandela University, the existing leave policies in various organisations do not account for ukuthwasa. In a 2022 study, the majority of the 49 participants noted that their organisations inadequately addressed the well-being requirements of African employees. They indicated that these companies lacked African traditional healing provisions within their Employee Assistance Programs (EAPs).
In popular culture
Ukuthwasa has found its presence in various forms of popular cultural expression including cinema and literature, reflecting its significance in African societies. It has influenced theatre, as seen in works like Richard Loring's African Footprint. Also, elements of ukuthwasa found its way to Niq Mhlongo novel Paradise in Gaza. The first African designer to win the LVMH Prize in 2019, Thebe Magugu in his 2022 collection Alchemy draws inspiration from ukuthwasa, experienced by his friends who transitioned to traditional healers.
In 2018, Buhlebezwe Siwani's exhibition "Qab'imbola" explores the intersection of art and indigenous healing practices in South Africa. Siwani's work reflects on intergenerational trauma in the country's history and the reclamation of African spirituality by black women. The exhibition featured video imagery and live performances. Siwani, who practices ubungoma, indigenous healing, discusses the significance of her artistic journey and initiation into ukuthwasa.
In addition, several celebrities including Dawn Thandeka King, Nandi Nyembe, Letoya Makhene and Boity Thulo have claimed to go through the process with others sparking rumours, like Dineo Ranaka.
See also
Cultural competence in healthcare
Depression and culture
Ufufunyane
References
Further reading
External links
Schizophrenia
Psychosis
Culture-bound syndromes
Spirit possession
Zulu culture
Xhosa culture | 0.776587 | 0.975283 | 0.757392 |
Herrmann Brain Dominance Instrument | The Herrmann Brain Dominance Instrument (HBDI) is a system to measure and describe thinking preferences in people, developed by William "Ned" Herrmann while leading management education at General Electric's Crotonville facility. It is a type of cognitive style measurement and model, and is often compared to psychological pseudoscientific assessments such as the Myers-Briggs Type Indicator, Learning Orientation Questionnaire, DISC assessment, and others.
Brain dominance model
In his brain dominance model, Herrmann identifies four different modes of thinking:
A. Analytical thinking
Key words: logical, factual, critical, technical, quantitative.
Preferred activities: collecting data, analysis, understanding how things work, judging ideas based on facts, criteria and logical reasoning.
B. Sequential thinking
Key words: safekeeping, structured, organized, complexity or detailed, planned.
Preferred activities: following directions, detail-oriented work, step-by-step problem solving, organization, implementation.
C. Interpersonal thinking
Key words: kinesthetic, emotional, spiritual, sensory, feeling.
Preferred activities: listening to and expressing ideas, looking for personal meaning, sensory input, group interaction.
D. Imaginative thinking
Key words: visual, holistic, intuitive, innovative, conceptual.
Preferred activities: looking at the big picture, taking initiative, challenging assumptions, visuals, metaphoric thinking, creative problem solving, long-term thinking.
His theory was based on theories of the modularity of cognitive functions, including well-documented specializations in the brain's cerebral cortex and limbic systems, and the research into left-right brain lateralization by Roger Wolcott Sperry, Robert Ornstein, Henry Mintzberg, and Michael Gazzaniga. These theories were further developed to reflect a metaphor for how individuals think and learn. Use of that metaphor brought later criticism by brain researchers such as Terence Hines for being overly simplistic, though advocates argue that the metaphorical construct has been beneficial in organizational contexts including business and government.
Herrmann also coined the concept Whole Brain Thinking as a description of flexibility in using thinking styles that one may cultivate in individuals or in organizations allowing the situational use of all four styles of thinking.
The Herrmann Brain Dominance Instrument
The format of the instrument is a 116-question online assessment, which determines the degree of preference for each of the model's four styles of thinking. More than one style may be dominant (or a primary preference) at once in this model. For example, in Herrmann's presentation a person may have strong preferences in both analytical and sequential styles of thinking but lesser preferences in interpersonal or imaginative modes, though he asserts all people use all styles to varying degrees.
A 1985 dissertation by C. Bunderson, currently CEO of the non-profit EduMetrics Institute asserts that "four stable, discrete clusters of preference exist", "scores derived from the instrument are valid indicators of the four clusters", and "The scores permit valid inferences about a person's preferences and avoidances for each of these clusters of mental activity".
Consulting and training
Based on the HBDI Assessment and Whole Brain model, Herrmann International and its global affiliates offer consulting and solutions (including workshops, programs, books and games) to improve personal or group communication, creativity, and other benefits.
Critiques
Self reporting
Measurements that require people to state preferences between terms have received criticism. Researchers C. W. Allinson and J. Hayes, in their own 1996 publication of a competing cognitive style indicator called Cognitive Style Index in the peer reviewed Journal of Management Studies, noted that "there appears to be little or no published independent evaluation of several self-report measures developed as management training tools. [including] Herrmann Brain Dominance Instrument."
However, some find usefulness in self reporting measurements. Researchers G.P. Hodgkinson and E. Sadler-Smith in 2003 found cognitive style indicators generally useful for studying organizations. However, in a critique of the Cognitive Style Index indicator they opined that progress in the field had been "hampered by a proliferation of alternative constructs and assessment instruments" many unreliable with a lack of agreement over nomenclature.
To measure self-report consistency, a differential item functioning review of HBDI was published in 2007 by Jared Lees. However, his tests were supported by EduMetrics, a company on contract with Herrmann International to evaluate the system, and were therefore not completely independent.
Lateralization
Herrmann International describes an underlying basis for HBDI in the lateralization of brain function theory championed by Gazzaniga and others that associates each of the four thinking styles with a particular locus in the human brain. Analytical and sequential styles are associated with left brain and interpersonal and imaginative styles are associated with right brain, for example. Ned Herrmann described dominance of a particular thinking style with dominance with a portion of a brain hemisphere.
The notion of hemisphere dominance attracted some criticism from the neuroscience community, notably by Terence Hines who called it "pop psychology" based on unpublished EEG data. He asserts that current literature instead found that both hemispheres are always involved in cognitive tasks and attempting to strengthen a specific hemisphere does not improve creativity, for example. Hines stated "No evidence is presented to show that these 'brain dominance measures' measure anything related to the differences between the two hemispheres. In other words, no evidence of validity [of hemisphere dominance] is presented.".
Creativity
Herrmann offered creativity workshops based on leveraging all the quadrants within the Whole Brain Model, rather than focusing on physiological attributes. strengthening particular thinking styles and strengthening the right hemisphere, which received critiques that creativity is not localized to a particular thinking style nor to a particular hemisphere.
A study published in the peer reviewed Creativity Research Journal in 2005 by J. Meneely and M. Portillo agreed that creativity is not localized into a particular thinking style, such as a right-brain dominance resulting in more creativity. They did however find correlation between creativity in design students based on how flexible they were using all four thinking styles equally as measured by the HBDI. When students were less entrenched in a specific style of thinking they measured higher creativity using Domino's Creativity Scale (ACL-Cr).
References
Allinson, C.W., & Hayes, J. (1996) 'Cognitive Style Index: A measure of intuition-analysis for organizational research', Journal of Management Studies, 33:1 January 1996
Bentley, Joanne and Hall, Pamela (2001) Learning Orientation Questionnaire correlation with the Herrmann Brain Dominance Instrument: A validity study Dissertation Abstracts International Section A: Humanities and Social Sciences, Vol 61(10-A), Apr 2001. pp. 3961.
Deardorff, Dale S. (2005) An exploratory case study of leadership influences on innovative culture: A descriptive study Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 66(4-B), 2005. pp. 2338.
DeWald, R. E. (1989). Relationships of MBTI types and HBDI preferences in a population of student program managers (Doctoral dissertation, Western Michigan University, 1989). Dissertation Abstracts International, 50(06), 2657B. (University Microfilms No. AAC89-21867)
Herrmann, Ned (1999) The Theory Behind the HBDI and Whole Brain Technology pdf
Hines, Terence (1991) 'The myth of right hemisphere creativity.' Journal of Creative Behavior, Vol 25(3), 1991. pp. 223–227.
Hines, Terence (1987) 'Left Brain/Right Brain Mythology and Implications for Management and Training', The Academy of Management Review, Vol. 12, No. 4, October 1987
Hines, Terence (1985) 'Left brain, right brain: Who's on first?' Training & Development Journal, Vol 39(11), Nov 1985. pp. 32–34. [Journal Article]
Hodgkinson, Gerard P., and Sadler-Smith, Eugene (2003) Complex or unitary? A critique and empirical re-assessment of the Allinson-Hayes Cognitive Style Index., Journal of Occupational and Organizational Psychology, 09631798, 20030601, Vol. 76, Issue 2
Holland, Paul W. and Wainer, Howard (1993) Differential Item Functioning
Krause, M. G. (1987, June). A comparison of the MBTI and the Herrmann Participant Survey. Handout from presentation at APT-VII, the Seventh Biennial International Conference of the Association for Psychological Type, Gainesville, FL.
Lees, Jared A. (2007) Differential Item Functioning Analysis of the Herrmann Brain Dominance Instrument Masters Thesis, Brigham Young University - on ScholarsArchive
McKean, K. (1985) 'Of two minds: Selling the right brain.', Discover, 6(4), pp. 30–41.
Meneely, Jason; and Portillo, Margaret; (2005) The Adaptable Mind in Design: Relating Personality, Cognitive Style, and Creative Performance. Creativity Research Journal, Vol 17(2-3), 2005. pp. 155–166. [Journal Article]
Wilson, Dennis H. (2007) A comparison of the Herrmann Brain Dominance Instrument(TM) and the extended DISCMRTM behavior profiling tool: An attempt to create a more discerning management perspective. Dissertation Abstracts International Section A: Humanities and Social Sciences, Vol 68(3-A). pp. 1079.
Further reading
Ned Herrmann (1990) The Creative Brain, Brain Books, Lake Lure, North Carolina. . .
Ned Herrmann (1996) The Whole Brain Business Book, McGraw-Hill, New York, NY. . .
Giannini, John L. (1984) Compass of the Soul: Archetypal Guides to a Fuller Life. . .
Edward Lumsdaine, M. Lumsdaine (1994) Creative Problem Solving, McGraw-Hill . .
Peter Ferdinand Drucker, David Garvin, Dorothy Leonard, Susan Straus, and John Seely Brown. (1998). Harvard Business Review on Knowledge Management. Harvard Business School Press . .
Sala, Sergio Della, Editor (1999). Mind Myths: Exploring Popular Assumptions About the Mind and Brain, J. Wiley & Sons, New York. . .
Human resource management | 0.772499 | 0.980422 | 0.757375 |
Community health | Community health refers to non-treatment based health services that are delivered outside hospitals and clinics. Community health is a subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members as well as providing supplementary services such as support groups or wellness events that are not offered by medical institutions.
Community health is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection, and improvement of the health status of population groups and communities, in particular those who are a part of disadvantaged communities. It is a distinct field of study that may be taught within a separate school of public health or preventive healthcare. The World Health Organization defines community health as:Environmental, Social, and Economic resources to sustain emotional and physical well being among people in ways that advance their aspirations and satisfy their needs in their unique environment.
Medical interventions that occur in communities can be classified as three categories: Primary care, Secondary care, and Tertiary care. Each category focuses on a different level and approach towards the community or population group. In the United States, Community health is rooted within Primary healthcare achievements. Primary healthcare programs aim to reduce risk factors and increase health promotion and prevention. Secondary healthcare is related to "hospital care" where acute care is administered in a hospital department setting. Tertiary healthcare refers to highly specialized care usually involving disease or disability management.
Community health services are classified into categories including:
Preventive health services such as chemoprophylaxis for Tuberculosis, Cancer screening and treatment of Diabetes and Hypertension.
Promotive health services such as health education, family planning, vaccination and nutritional supplementation
Curative health services such as treatment of Jiggers, Lice infestation, Malaria and Pneumonia.
Rehabilitative health services such as provision of prosthetics, social work, occupational therapy, physical therapy, counseling and other mental health services.
Community health workers and volunteers
Community health workers (also known as community health assistants and community health officers) are local public health workers with a deep understanding of their community's health needs and challenges. They serve as a bridge between their community and local health systems to ensure high quality and culturally competent service delivery. They have vocational, professional or academic qualifications which enable them to provide training, supervisory, administrative, teaching and research services in community health departments.
Community health volunteers are members of a local community who have experience and training on the health problems prevalent in their community and care services available, in order to identify and link those in need with local providers. Community health volunteers may be referred to by different titles depending on their local health system; these titles can included lay health workers, health volunteers, village health agents, non-specialist healthcare providers, and village health agents.
Community health volunteers provide basic services such as distribution of water chlorination tablets, mosquito nets and health education material. They will involve or work with registered clinicians when they encounter sick or recovering patients or those with complex or ongoing needs.
Community health organizations are non-profit and non government organization which administers and coordinates the delivery of health care services to people living in a designated community or neighborhood. It helps people understand their status of health or social conditions. Providing advocacy for those who need it and holding groups and individual meetings with people in the community. The vital role is advocating for the rights and interests of their community members. They raise awareness about issues affecting their community by research, dialogues and lobby for policies and programs that address those issues.
Measuring Community health
Community health is generally measured by Geographical Information Systems and Demographic data. Geographic Information Systems can be used to define sub-communities when neighborhood location data is not enough. Traditionally Community health has been measured using sampling data which was then compared to well-known data sets, like the National Health Interview Survey or National Health and Nutrition Examination Survey. With technological development, information systems could store more data for small-scale communities, cities, and towns; as opposed to census data that only generalize information about small populations based on the overall population. Geographical Information Systems (GIS) can give more precise information about community resources, even at neighborhood levels. The ease of use of Geographic Information Systems (GIS), advances in multilevel statistics, and spatial analysis methods make it easier for researchers to procure and generate data related to the built environment.
Social media can also play a big role in health information analytics. Studies have found social media being capable of influencing people to change their unhealthy behaviors and encourage interventions capable of improving health status. Social media statistics combined with Geographical Information Systems (GIS) may provide researchers with a more complete image of community standards for health and well being.
Categories of Community health
Primary Healthcare and Primary Prevention
Community-based health promotion emphasizes Primary Prevention and population-based perspective (traditional prevention). It is the goal of Community Health to have individuals in a certain community improve their lifestyle or seek medical attention. Primary Healthcare is provided by health professionals, specifically the ones a patient sees first that may refer them to Secondary or Tertiary care.
Primary prevention refers to the early avoidance and identification of risk factors that may lead to certain diseases and disabilities. Community-focused efforts including immunizations, classroom teaching, and awareness campaigns are all good examples of how primary prevention techniques are utilized by communities to change certain health behaviors. Prevention programs, if carefully designed and drafted, can effectively prevent problems that children and adolescents face as they grow up. This finding also applies to all groups and classes of people. Prevention programs are one of the most effective tools health professionals can use to significantly impact individual, population, and community health.
Secondary Healthcare and Secondary Prevention
Community health can also be improved with improvements in individuals' environments. Community health status is determined by the environmental characteristics, behavioral characteristics, social cohesion in the environment of that community. Appropriate modifications in the environment can help to prevent unhealthy behaviors and negative health outcomes.
Secondary prevention refers to improvements made in a patient's lifestyle or environment after the onset of disease or disability. This sort of prevention works to make life easier for the patient since it is too late to prevent them from their current disease or disability. An example of secondary prevention is when those with occupational low back pain are provided with strategies to stop their health status from worsening; the prospects of secondary prevention may even hold more promise than primary prevention in this case.
Tertiary Healthcare
In Tertiary healthcare, community health can only be affected with professional medical care involving the entire population. Patients need to be referred to specialists and undergo advanced medical treatment. In some countries, there are more sub-specialties of medical professions than there are primary care specialists. Health inequalities are directly related to social advantage and social resources.
Challenges and difficulties in Community health
The complexity of community health and its various problems can make it difficult for researchers to assess and identify solutions. Community-Based Participatory Research (CBPR) is a unique alternative that combines community participation, inquiry, and action. Community-Based Participatory Research (CBPR) helps researchers address community issues with a broader lens and also works with the people in the community to find culturally sensitive, valid, and reliable methods and approaches.
Community health also requires clear communication to properly address health issues, disparities, and complications. Health communication is the concept that applies communication evidence, strategy, theory, and creativity to promote behaviors, policies, and practices that advance the health and well-being of people and populations. Communicating health care can be limited by a few factors, which are important to recognize to best apply community health practices. To better understand and provide community health from a provider and consumer perspective, limitations in concepts such as scientific complexity or uncertainty. When using an example such as environmental health, scientific complexity can be summarized with environmental health risks that often involve complex scientific concepts that can be difficult to understand for someone without the technical knowledge gained from specialized training or education. The use of plain language and visual aids helps to simplify complex information and increase accessibility. Uncertainty in community health exists when the scientific understanding of environmental health risks may be incomplete or uncertain. Knowing details about how communities work, specific to the individual, can also play a role in a better understanding as well as offering complete transparency about the limitations of knowledge and ongoing research efforts. Preventative actions must be taken to prevent misinformation in the face of uncertainty as it can cause grave circumstances as seen during the COVID-19 pandemic. Scientific complexity and uncertainty are concepts that can make it difficult to understand the environment and limits coherent communication about population health. Examples of successful community health initiatives can include projects addressing the issues that complicate the subject. For example, promotions for understanding, as well as initiatives working towards already acknowledged health issues in each community.
Patients with limited-English proficiency especially struggle to access health and turn to community health centers. Community health carries the burden of serving such patients. There is a need to invest more in the interpreter workforce (in both quantity and quality), letting those with limited-English proficiency know more about their rights currently available to them, potential legal avenues to take if said rights are not being provided, and increased awareness for non-verbal communication. Executive Order 13166 (2000), titled Improving Access to Services for Persons with Limited English Proficiency, offered continuing education for health professionals, certification of healthcare interpreters, and reimbursement for language services for Medicaid/ State Children's Health Insurance Program (SCHIP) enrollees in order to address the institutional issues regarding language barriers in our current healthcare system. Another avenue that has been taken is local governments partnering with community-based organizations, such as the collaboration between Alameda county and the Korean Community Center of the East Bay (KCCEB) to create RICE, the Refugee and Immigrant Collaborative for Empowerment, a coalition mobilized by various multiethnic and multilingual organizations. They partnered in 2020 during the height of the pandemic in order to support COVID-19 testing and increase vaccine awareness and accessibility across 16 language groups.
Other issues involve access and cost of medical care. A great majority of the world does not have adequate health insurance. In low-income countries, less than 40% of total health expenditures are paid for by the public/government. Community health, even Population health, is not encouraged as health sectors in developing countries are not able to link the national authorities with the local government and community action.
In the United States, the Affordable Care Act (ACA) changed the way community health centers operate and the policies that were in place, greatly influencing community health. The ACA directly affected community health centers by increasing funding, expanding insurance coverage for Medicaid, reforming the Medicaid payment system, appropriating $1.5 billion to increase the workforce and promote training. The impact, importance, and success of the Affordable Care Act is still being studied and will have a large impact on how ensuring health can affect community standards on health and also individual health.
Ethnic disparities in health statuses among different communities are also a cause of concern. Community coalition-driven interventions may bring benefits to this segment of society. This also relates to language usage, where results from a 2019 systematic review found that patients with limited English proficiency who received care from physicians who communicate in the patient's own preferred language generally had improved health outcomes.
Community health resolutions
Each community is different and should create its own Community Health Improvement Process also known as CHIP. A CHIP consists of problem identification and prioritization cycle along with an analysis and implementation cycle. Five strategies that assist the CHIP process are improving community health and well-being; community involvement, political commitment; healthy public policy; multi-sectoral collaboration; and asset-based community development. An asset-based approach involves empowering individuals and communities by focusing on community strengths along with the skills of the individuals.
The CDC makes states that "Individuals who are in good physical shape, have proper vaccination, have access to clinical services and medications, and know where to get critical health and emergency alert information create a better community than those who have poor health and don't understand where to get proper treatment and medicine."
The Problem, Identification, and Prioritization cycle have three phases that help benefit the community, which is forming a health coalition, collecting and analyzing data for health profile, and identifying critical health issues. The information that is gathered is also distributed to the community to help with important decision-making.
Following this cycle is the Analysis and Implementation cycle which helps resolve community health problems by analyzing the health issue, establishing resources, creating a health improvement strategy with the resources, and allocating responsibility throughout the community. Multiple issues are analyzed in conjunction to determine which is most important. Lastly, the authority to act is implemented, sufficient funds are allocated and access to data is released in order for the members of the community to review and move accordingly.
Community health in the Global South
Access to community health in the Global South is influenced by geographic accessibility (physical distance from the service delivery point to the user), availability (proper type of care, service provider, and materials), financial accessibility (willingness and ability of users to purchase services), and acceptability (responsiveness of providers to social and cultural norms of users and their communities). While the Epidemiological transition is shifting the disease burden from communicable to noncommunicable conditions in developing countries, this transition is still in an early stage in parts of the Global South such as South Asia, the Middle East, and Sub-Saharan Africa. Two phenomena in developing countries have created a "medical poverty trap" for underserved communities in the Global South — the introduction of user fees for public healthcare services and the growth of out-of-pocket expenses for private services. The private healthcare sector is being increasingly utilized by low and middle income communities in the Global South for conditions such as malaria, tuberculosis, and sexually transmitted infections. Private care is characterized by more flexible access, shorter waiting times, and greater choice. Private providers that serve low-income communities are often unqualified and untrained. Some policymakers recommend that governments in developing countries harness private providers to remove state responsibility from service provision.
Community development is frequently used as a public health intervention to empower communities to obtain self-reliance and control over the factors that affect their health. Community health workers are able to draw on their firsthand experience, or local knowledge, to complement the information that scientists and policy makers use when designing health interventions. Interventions with community health workers have been shown to improve access to primary healthcare and quality of care in developing countries through reduced malnutrition rates, improved maternal and child health and prevention and management of HIV/AIDS. Community health workers have also been shown to promote chronic disease management by improving the clinical outcomes of patients with diabetes, hypertension, and cardiovascular diseases.
Slum-dwellers in the Global South face threats of infectious disease, non-communicable conditions, and injuries due to violence and road traffic accidents. Participatory, multi-objective slum upgrading in the urban sphere significantly improves social determinants that shape health outcomes such as safe housing, food access, political and gender rights, education, and employment status. Efforts have been made to involve the urban poor in project and policy design and implementation. Through slum upgrading, states recognize and acknowledge the rights of the urban poor and the need to deliver basic services. Upgrading can vary from small-scale sector-specific projects (i.e. water taps, paved roads) to comprehensive housing and infrastructure projects (i.e. piped water, sewers). Other projects combine environmental interactions with social programs and political empowerment. Recently, slum upgrading projects have been incremental to prevent the displacement of residents during improvements and attentive to emerging concerns regarding climate change adaptation. By legitimizing slum-dwellers and their right to remain, slum upgrading is an alternative to slum removal and a process that in itself may address the structural determinants of population health.
Kenya
Community health refers to the first level of health services provision in Kenya that comprises;
Interventions focusing on building demand for existing health and related services, by improving community awareness and health seeking behavior and 2. Taking defined interventions and services as defined in (Kenya Health Sector Strategic and investment plan KHSSP) close to the community and households.
The current registered association for community Health professionals in Kenya is The Society of Community Health Caregivers. It was registered in the year 2020 to act as an umbrella body for the community health professionals.
Academic resources
Journal of Urban Health, Springer. (electronic) (paper).
International Quarterly of Community Health Education, Sage Publications. (electronic), (paper).
Global Public Health, Informa Healthcare. (paper).
Journal of Community Health, Springer. .
Family and Community Health, Lippincott Williams & Wilkins. (electronic).
Health Promotion Practice, Sage Publications. (electronic) (paper).
Journal of Health Services Research and Policy, Sage Publications. (electronic) (paper).
BMC Health Sciences Research, Biomed Central. (electronic).
Health Services Research, Wiley-Blackwell. (electronic).
Health Communication and Literacy: An Annotated Bibliography, Centre for Literacy of Quebec. .
See also
Community health agent
Community health center
Community mental health service
Online health communities
Prison reform
University of Community Health, Magway
References
Further reading
John Sanbourne Bockoven (1963). Moral Treatment in American Psychiatry, New York: Springer Publishing Co.
External links
Health marketing- CDC
Public health
Health | 0.760776 | 0.995514 | 0.757363 |
Hakomi | The Hakomi Method is a form of mindfulness-centered somatic psychotherapy developed by Ron Kurtz in the 1970s.
Approach and method
According to the Hakomi Institute website, the method is an experiential psychotherapy modality, wherein present, felt experience is used as an access route to core material; this unconscious material is elicited and surfaces experientially, and changes are integrated into the client's immediate experience. Hakomi combines Western psychology, systems theory, and body-centered techniques with the principles of mindfulness and nonviolence drawn from Eastern philosophy.
Hakomi is grounded in five principles:
mindfulness
nonviolence
organicity
unity
body-mind holism
These five principles are set forth in Kurtz's book, Body Centered Psychotherapy. Some Hakomi leaders add two more principles, truth and mutability.
The Hakomi Method regards people as self-organizing systems, organized psychologically around core memories, beliefs, and images; this core material expresses itself through habits and attitudes around which people unconsciously organize their behavior. The goal is to transform their way of being in the world through working with core material and changing core beliefs.
Hakomi relies on mindfulness of body sensations, emotions, and memories. Although many therapists now recommend mindfulness meditation to support psychotherapy, Hakomi is unique in that it conducts the majority of the therapy session in mindfulness.
The Hakomi Method follows this general outline:
Create healing relationship: Client and therapist work to build a relationship that maximizes safety and the cooperation of the unconscious. This includes practicing "loving presence", a state of acceptance and empathic resonance.
Establish mindfulness: The therapist helps clients study and focus on the ways they organize experience. Hakomi's viewpoint is that most behaviors are habits automatically organized by core material; therefore, studying the organization of experience is studying the influence of this core material.
Evoke experience: Client and therapist make direct contact with core feelings, beliefs, and memories using "experiments in mindfulness"—gentle somatic and verbal techniques to safely "access" the present experience behind the client's verbal presentation, or to explore "indicators": chronic physical patterns, habitual gestures, bodily tension, etc.
Processing: This process usually evokes deeper emotions and/or memories, and if the client feels ready, the therapist helps them deepen into these, often using state-specific processing such as "working with the child" and/or strong emotions. The client is helped to recognize the core beliefs as they emerge, and the therapist often provides what Kurtz called "the missing experience", a form of "memory re-consolidation" where the child, as they revisit the negative experience(s) that generated their core beliefs, now receives the nourishment and support that was needed at the time. This supports the process of transformation of core beliefs. The same process may be used working with the adult rather than the "child state".
Transformation: The client has an experience in therapy different from the one they had as a child (or are having as an adult) and experientially realizes that new healing experiences are possible and begins to be open to these experiences.
Integration: Client and therapist work to make connections between the new healing experiences and the rest of the client's life and relationships.
Other components of the Hakomi Method include the sensitivity cycle, techniques such as "contact and tracking", "prompts" and "taking over", "embracing resistance", and developing a greater sensitivity to clients and how to work with their individual issues based on character typology originated by Alexander Lowen.
Related therapies
The Hakomi Institute (founded in 1981) describes itself as an international nonprofit organization that teaches Hakomi therapy worldwide. Its website includes an international directory of Hakomi practitioners. The institute's programs focus on training psychotherapists and professionals in related fields. Its faculty are mainly professional psychotherapists who base their teaching of the Hakomi Method on current discoveries in neuroscience and on their own clinical insights. The Hakomi Institute is a professional member of the Association for Humanistic Psychology, the U.S. Association for Body Psychotherapists, and an accredited Continuing Education provider for the National Board for Certified Counselors and the National Association of Social Workers.
Ron Kurtz left the Hakomi Institute in the 1990s to create a new organization, Ron Kurtz Trainings. With a new group, he developed the Hakomi Method in new directions, offering training for both professionals and laypeople. He called the refined version of his work Hakomi Assisted Self-Discovery.
Both versions of the Hakomi Method are based in loving presence, mindfulness, somatics, and the other principles described above, and fall within the definition of body psychotherapy.
Another technique based on the Hakomi Method is Sensorimotor psychotherapy, developed by Pat Ogden.
Validation
Body psychotherapy has been scientifically validated by the European Association for Psychotherapy (EAP) as having a number of modalities within this branch of psychotherapy. Hakomi Therapy is one of the approaches or modalities within Body Psychotherapy recognized by the EAP.
Notes
Sources
Further reading
The Herald (22 September 2004) Hakomi is the topic. Page 15.
Johanson, Gregory. (22 June 2006) Annals of the American Psychotherapy Association. A survey of the use of mindfulness in psychotherapy. Volume 9; Issue 2; Page 15.
Marshall, Lisa. (15 October 2001) Daily Camera The power of touch. Body psychotherapy sees massage, movement as adjunct to counseling. Section: Fit; Page C1
Sutter, Cindy. (21 June 2004) Daily Camera Healing the body and the mind Hakomi helps clients heal with mindfulness. Section: Fit; Page D1.
Books
Weiss, Johanson, Monda, editors. Hakomi Mindfulness-Centered Somatic Psychotherapy: A Comprehensive Guide to Theory and Practice, 2015, Norton, NY. Foreword by Richard C. Schwartz, .
Benz, Dyrian and Halko Weiss. To The Core of Your Experience, Luminas Press, 1989, preface by Ron Kurtz.
Fisher, Rob. Experiential Psychotherapy With Couples: A Guide for the Creative Pragmatist. Phoenix, AZ: Zeig, Tucker & Theisen, 2002, foreword by Ron Kurtz. .
Johanson, Greg and Kurtz, Ron. Grace Unfolding, Psychotherapy in the Spirit of the Tao Te Ching, New York: Bell Tower, 1991.
Kurtz, Ron and Prestera, Hector. The Body Reveals: An Illustrated Guide to the Psychology of the Body, New York: Harper&Row/Quicksilver Books, 1976.
Kurtz, Ron: Hakomi Therapy, Boulder, CO: 1983.
Kurtz, Ron: Body-Centered Psychotherapy: The Hakomi Method. Mendecino: LifeRhythm, 1990..
Chapters
Caldwell, Christine, ed. Getting in Touch: The Guide to New Body-Centered Therapies. Wheaton: Quest Books, 1997. See ch. 3 by Ron Kurtz and Kukuni Minton on "Essentials of Hakomi Body-Centered Psychotherapy", pp. 45–60, and ch. 9 by Pat Ogden on "Hakomi Integrated Somatics: Hands-On Psychotherapy", pp. 153–178.
Capuzzi, David and Douglas Gross, eds. Counseling and Psychotherapy: Theories and Interventions. 4th ed. Upper Saddle River, NJ: Merrill Prentice Hall, 2003: See Donna M. Roy "Body-Centered Counseling and Psychotherapy", pp. 360–389.
Cole, J. David and Carol Ladas-Gaskin. Mindfulness Centered Therapies: An Integrative Approach. Seattle, WA: Silver Birch Press, 2007.
Menkin, Dan. Transformation through Bodywork: Using Touch Therapies for Inner Peace. Santa Fe, New Mexico: Bear & Company, 1996. See especially ch. 15 on "The Tao Te Ching and the Principle of Receptivity", pp. 119–128.
Morgan, Marilyn. The Alchemy of Love: Personal Growth Journeys in Psychotherapy Training. VDM Verlag, Saarbrücken, Germany, 2008.
Schaefer, Charles E., ed. Innovative Interventions in Child and Adolescent Therapy. New York: John Wiley & Sons, 1988. See Greg Johanson and Carol Taylor, "Hakomi Therapy with Seriously Emotionally Disturbed Adolescents," pp. 232–265.
Staunton, Tree. Body Psychotherapy. New York: Taylor & Francis, 2002. See Philippa Vick, "Psycho-Spiritual Body Psychotherapy", pp. 133–147.
External links
Hakomi Education Network website
Hakomi Institute website
Ron Kurtz website
Psychotherapy by type
Body psychotherapy
Mindfulness | 0.774034 | 0.978461 | 0.757362 |
Theory U | Theory U is a change management method and the title of a book by Otto Scharmer. Scharmer with colleagues at MIT conducted 150 interviews with entrepreneurs and innovators in science, business, and society and then extended the basic principles into a theory of learning and management, which he calls Theory U. The principles of Theory U are suggested to help political leaders, civil servants, and managers break through past unproductive patterns of behavior that prevent them from empathizing with their clients' perspectives and often lock them into ineffective patterns of decision-making.
Some notes about theory U
Fields of attention
Thinking (individual)
Conversing (group)
Structuring (institutions)
Ecosystem coordination (global systems)
Presencing
The author of the theory U concept expresses it as a process or journey, which is also described as Presencing, as indicated in the diagram (for which there are numerous variants).
At the core of the "U" theory is presencing: sensing + presence. According to The Learning Exchange, Presencing is a journey with five movements:
On that journey, at the bottom of the U, lies an inner gate that requires us to drop everything that isn't essential. This process of letting-go (of our old ego and self) and letting-come (our highest future possibility: our Self) establishes a subtle connection to a deeper source of knowing. The essence of presencing is that these two selves – our current self and our best future self – meet at the bottom of the U and begin to listen and resonate with each other. Once a group crosses this threshold, nothing remains the same. Individual members and the group as a whole begin to operate with a heightened level of energy and sense of future possibility. Often they then begin to function as an intentional vehicle for an emerging future.
The core elements are shown below.
"Moving down the left side of the U is about opening up and dealing with the resistance of thought, emotion, and will; moving up the right side is about intentionally reintegrating the intelligence of the head, the heart, and the hand in the context of practical applications".
Leadership capacities
According to Scharmer, a value created by journeying through the "U" is to develop seven essential leadership capacities:
Holding the space: listen to what life calls you to do (listen to oneself, to others and make sure that there is space where people can talk)
Observing: Attend with your mind wide open (observe without your voice of judgment, effectively suspending past cognitive schema)
Sensing: Connect with your heart and facilitate the opening process (i.e. see things as interconnected wholes)
Presencing: Connect to the deepest source of your self and will and act from the emerging whole
Crystallizing: Access the power of intention (ensure a small group of key people commits itself to the purpose and outcomes of the project)
Prototyping: Integrating head, heart, and hand (one should act and learn by doing, avoiding the paralysis of inaction, reactive action, over-analysis, etc.)
Performing: Playing the "macro violin" (i.e. find the right leaders, find appropriate social technology to get a multi-stakeholder project going).
The sources of Theory U include interviews with 150 innovators and thought leaders on management and change. Particularly the work of Brian Arthur, Francisco Varela, Peter Senge, Ed Schein, Joseph Jaworski, Arawana Hayashi, Eleanor Rosch, Friedrich Glasl, Martin Buber, Rudolf Steiner and Johann Wolfgang von Goethe have been critical. Artists are represented in the project from 2001 -2010 by Andrew Campbell, whose work was given a separate index page linked to the original project site. https://web.archive.org/web/20050404033150/http://www.dialogonleadership.org/indexPaintings.html
Today, Theory U constitutes a body of leadership and management praxis drawing from a variety of sources and more than 20 years of elaboration by Scharmer and colleagues. Theory U is translated into 20 languages and is used in change processes worldwide.
Meditation teacher Arawana Hayashi has explained how she considers Theory U relevant to "the feminine principle".
Earlier work: U-procedure
The earlier work by Glasl involved a sociotechnical, Goethean and anthroposophical process involving a few or many co-workers, managers and/or policymakers. It proceeded from phenomenological diagnosis of the present state of the organisation to plans for the future. They described a process in a U formation consisting of three levels (technical and instrumental subsystem, social subsystem and cultural subsystem) and seven stages beginning with the observation of organisational phenomena, workflows, resources etc., and concluding with specific decisions about desired future processes and phenomena. The method draws on the Goethean techniques described by Rudolf Steiner, transforming observations into intuitions and judgements about the present state of the organisation and decisions about the future. The three stages represent explicitly recursive reappraisals at progressively advanced levels of reflective, creative and intuitive insight and (epistemologies), thereby enabling more radically systemic intervention and redesign. The stages are: phenomena – picture (a qualitative metaphoric visual representation) – idea (the organising idea or formative principle) – and judgement (does this fit?). The first three then are reflexively replaced by better alternatives (new idea --> new image --> new phenomena) to form the design design. Glasl published the method in Dutch (1975), German (1975, 1994) and English (1997).
The seven stages are shown below.
In contrast to that earlier work on the U procedure, which assumes a set of three subsystems in the organization that need to be analyzed in a specific sequence, Theory U starts from a different epistemological view that is grounded in Varela's approach to neurophenomenology. It focuses on the process of becoming aware and applies to all levels of systems change. Theory U contributed to advancing organizational learning and systems thinking tools towards an awareness-based view of systems change that blends systems thinking with systems sensing. On the left-hand side of the U the process is going through the three main "gestures" of becoming aware that Francisco Varela spelled out in his work (suspension, redirection, letting-go). On the right-hand side of the U this process extends towards actualizing the future that is wanting to emerge (letting come, enacting, embodying).
Criticism
Sociologist Stefan Kühl criticizes Theory U as a management fashion on three main points: First of all, while Theory U posits to create change on all levels, including the level of the individual "self" and the institutional level, case studies mainly focus on clarifying the positions of individuals in groups or teams. Except of the idea of participating in online courses on Theory U, the theory remains silent on how broad organisational or societal changes may take place. Secondly, Theory U, like many management fashions, neglects structural conflicts of interest, for instance between groups, organisations and class. While it makes sense for top management to emphasize common values, visions and the community of all staff externally, Kühl believes this to be problematic if organisations internally believe too strongly in this community, as this may prevent the articulation of conflicting interests and therefore organisational learning processes. Finally, the 5 phase model of Theory U, like other cyclical (but less esoteric) management models, such as PDCA, are a gross simplification of decision-making processes in organisation that are often wilder, less structured and more complex. Kühl argues that Theory U may be useful as it allows management to make decisions despite unsure knowledge and encourages change, but expects that Theory U will lose its glamour.
See also
Appreciative inquiry
Art of Hosting
Decision cycle
Learning cycle
OODA loop
V-Model
References
External links
C. Otto Scharmer Home Page
Presencing Home Page
The U-Process for Discovery
Change management | 0.767179 | 0.987202 | 0.757361 |
Sexuality after spinal cord injury | Although spinal cord injury (SCI) often causes sexual dysfunction, many people with SCI are able to have satisfying sex lives. Physical limitations acquired from SCI affect sexual function and sexuality in broader areas, which in turn has important effects on quality of life. Damage to the spinal cord impairs its ability to transmit messages between the brain and parts of the body below the level of the lesion. This results in lost or reduced sensation and muscle motion, and affects orgasm, erection, ejaculation, and vaginal lubrication. More indirect causes of sexual dysfunction include pain, weakness, and side effects of medications. Psycho-social causes include depression and altered self-image. Many people with SCI have satisfying sex lives, and many experience sexual arousal and orgasm. People with SCI may employ a variety of adaptations to help carry on their sex lives healthily, by focusing on different areas of the body and types of sexual acts. Neural plasticity may account for increases in sensitivity in parts of the body that have not lost sensation, so people often find newly sensitive erotic areas of the skin in erogenous zones or near borders between areas of preserved and lost sensation.
Drugs, devices, surgery, and other interventions exist to help men achieve erection and ejaculation. Although male fertility is reduced, many men with SCI can still father children, particularly with medical interventions. Women's fertility is not usually affected, although precautions must be taken for safe pregnancy and delivery. People with SCI need to take measures during sexual activity to deal with SCI effects such as weakness and movement limitations, and to avoid injuries such as skin damage in areas of reduced sensation. Education and counseling about sexuality is an important part of SCI rehabilitation but is often missing or insufficient. Rehabilitation for children and adolescents aims to promote the healthy development of sexuality and includes education for them and their families. Culturally inherited biases and stereotypes negatively affect people with SCI, particularly when held by professional caregivers. Body image and other insecurities affect sexual function and have profound repercussions on self-esteem and self-concept. SCI causes difficulties in romantic partnerships, due to problems with sexual function and to other stresses introduced by the injury and disability, but many of those with SCI have fulfilling relationships and marriages. Relationships, self-esteem, and reproductive ability are all aspects of sexuality, which encompasses not just sexual practices but a complex array of factors: cultural, social, psychological, and emotional influences.
Sexuality and identity
Sexuality is an important part of each person's identity, although some people might have no interest in sex. Sexuality has biological, psychological, emotional, spiritual, social, and cultural aspects. It involves not only sexual behaviors but relationships, self-image, sex drive, reproduction, sexual orientation, and gender expression. Each person's sexuality is influenced by lifelong socialization, in which factors such as religious and cultural background play a part, and is expressed in self-esteem and the beliefs one holds about oneself (identifying as a woman, or as an attractive person).
SCI is extremely disruptive to sexuality, and it most frequently happens to young people, who are at a peak in their sexual and reproductive lives. Yet the importance of sexuality as a part of life is not diminished by a disabling injury. Although for years people with SCI were believed to be asexual, research has shown sexuality to be a high priority for people with SCI and an important aspect of quality of life. In fact, of all abilities they would like to have return, most paraplegics rated sexual function as their top priority, and most tetraplegics rated it second, after hand and arm function. Sexual function has a profound impact on self-esteem and adjustment to life post-injury. People who are able to adapt to their changed bodies and to have satisfying sex lives have better overall quality of life.
Sexual function
SCI usually causes sexual dysfunction, due to problems with sensation and the body's arousal responses. The ability to experience sexual pleasure and orgasm are among the top priorities for sexual rehabilitation among injured people.
Much research has been done into erection. By two years post-injury, 80% of men recover at least partial erectile function, though many experience problems with the reliability and duration of their erections if they do not use interventions to enhance them. Studies have found that half or up to 65% of men with SCI have orgasms, although the experience may feel different than it did before the injury. Most men say it feels weaker, and takes longer and more stimulation to achieve.
Common problems women experience post-SCI are pain with intercourse and difficulty achieving orgasm. Around half of women with SCI are able to reach orgasm, usually when their genitals are stimulated. Some women report the sensation of orgasm to be the same as before the injury, and others say the sensation is reduced.
Complete and incomplete injury
The severity of the injury is an important aspect in determining how much sexual function returns as a person recovers. According to the American Spinal Injury Association grading scale, an incomplete SCI is one in which some amount of sensation or motor function is preserved in the rectum. This indicates that the brain can still send and receive some messages to the lowest parts of the spinal cord, beyond the damaged area. In people with incomplete injury, some or all of the spinal tracts involved in sexual responses remain intact, allowing, for example, orgasms like those of uninjured people. In men, having an incomplete injury improves chances of being able to achieve erections and orgasms over those with complete injuries.
Even people with complete SCI, in whom the spinal cord cannot transmit any messages past the level of the lesion, can achieve orgasm. In 1960, in one of the earliest studies to look at orgasm and SCI, the term phantom orgasm was coined to describe women's perception of orgasmic sensations despite SCI—but subsequent studies have suggested the experience is not merely psychological. Men with complete SCI report sexual sensations at the time of ejaculation, accompanied by physical signs normally found at orgasm, such as increased blood pressure. Women can experience orgasm with vibration to the cervix regardless of level or completeness of injury; the sensation is the same as uninjured women experience.
The peripheral nerves of the parasympathetic nervous system that carry messages to the brain (afferent nerve fibers) may explain why people with complete SCI feel sexual and climactic sensations. One proposed explanation for orgasm in women despite complete SCI is that the vagus nerve bypasses the spinal cord and carries sensory information from the genitals directly to the brain. Women with complete injuries can achieve sexual arousal and orgasm through stimulation of the clitoris, cervix, or vagina, which are each innervated by different nerve pathways, which suggests that even if SCI interferes with one area, the function might be preserved in others. In both injured and uninjured people, the brain is responsible for the way sensations of climax are perceived: the qualitative experiences associated with climax are modulated by the brain, rather than a specific area of the body.
Level of injury
In addition to completeness of injury, the location of the damage on the spinal cord influences how much sexual function is retained or regained after injury. Injuries can occur in the cervical (neck), thoracic (back), lumbar (lower back), or sacral (pelvic) levels. Between each pair of vertebrae, spinal nerves branch off of the spinal cord and carry information to and from specific parts of the body. The location of injury to the spinal cord maps to the body, and the area of skin innervated by a specific spinal nerve is called a dermatome. All dermatomes below the level of injury to the spinal cord may lose sensation.
An injury at a lower point on the spine does not necessarily mean better sexual function; for example, people with injuries in the sacral region are less likely to be able to orgasm than those with injuries higher on the spine. Women with injuries above the sacral level have a greater likelihood of orgasm in response to stimulation of the clitoris than those with sacral injuries (59% vs 17%). In men, injuries above the sacral level are associated with better function in terms of erections and ejaculation, and fewer and less severe reports of dysfunction. This may be due to reflexes that do not require input from the brain, which sacral injuries might interrupt.
Psychogenic and reflexogenic responses
The body's physical arousal response (vaginal lubrication and engorgement of the clitoris in women and erection in men) occurs due to two separate pathways which normally work together: psychogenic and reflex. Arousal due to fantasies, visual input, or other mental stimulation is a psychogenic sexual experience, and arousal resulting from physical contact to the genital area is reflexogenic. In psychogenic arousal, messages travel from the brain via the spinal cord to the nerves in the genital area. The psychogenic pathway is served by the spinal cord at levels T11–L2. Thus people injured above the level of the T11 vertebra do not usually experience psychogenic erection or vaginal lubrication, but those with an injury below T12 can. Even without these physical responses, people with SCI often feel aroused, just as uninjured people do. The ability to feel the sensation of a pinprick and light touch in the dermatomes for T11–L2 predicts how well the ability to have psychogenic arousal is preserved in both sexes. Input from the psychogenic pathway is sympathetic, and most of the time it sends inhibitory signals that prevent the physical arousal response; in response to sexual stimulation, excitatory signals are increased and inhibition is reduced. Removing the inhibition that is normally present allows the spinal reflexes that trigger the arousal response to take effect.
The reflexogenic pathway activates the parasympathetic nervous system in response to the sensation of touch. It is mediated by a reflex arc that goes to the spinal cord (not to the brain) and is served by the sacral segments of the spinal cord at S2–S4. A woman with a spinal cord lesion above T11 may not be able to experience psychogenic vaginal lubrication, but may still have reflex lubrication if her sacral segments are uninjured. Likewise, although a man's ability to get a psychogenic erection when mentally aroused may be impaired after a higher-level SCI, he may still be able to get a reflex or "spontaneous" erection. These erections may result in the absence of psychological arousal when the penis is touched or brushed, e.g. by clothing, but they do not last long and are generally lost when the stimulus is removed. Reflex erections may increase in frequency after SCI, due to the loss of inhibitory input from the brain that would suppress the response in an uninjured man. Conversely, an injury below the S1 level impairs reflex erections but not psychogenic erections. People who have some preservation of sensation in the dermatomes at the S4 and S5 levels and display a bulbocavernosus reflex (contraction of the pelvic floor in response to pressure on the clitoris or glans penis) are usually able to experience reflex erections or lubrication. Like other reflexes, reflexive sexual responses may be lost immediately after injury but return over time as the individual recovers from spinal shock.
Factors in reduced function
Most people with SCI have problems with the body's physical sexual arousal response. Problems that result directly from impaired neural transmission are called primary sexual dysfunction. The function of the genitals is almost always affected by SCI, by alteration, reduction, or complete loss of sensation. Neuropathic pain, in which damaged nerve pathways signal pain in the absence of any noxious stimulus, is common after SCI and interferes with sex.
Secondary dysfunction results from factors that follow from the injury, such as loss of bladder and bowel control or impaired movement. The main barrier to sexual activity that people with SCI cite is physical limitation; e.g. balance problems and muscle weakness cause difficulty with positioning. Spasticity, tightening of muscles due to increased muscle tone, is another complication that interferes with sex. Some medications have side effects that impede sexual pleasure or interfere with sexual function: antidepressants, muscle relaxants, sleeping pills and drugs that treat spasticity. Hormonal changes that alter sexual function may take place after SCI; levels of prolactin heighten, women temporarily stop menstruating (amenorrhea), and men experience reduced levels of testosterone. Testosterone deficiency causes reduced libido, increased weakness, fatigue, and failure to respond to erection-enhancing drugs.
Tertiary sexual dysfunction results from psychological and social factors. Reduced libido, desire, or experience of arousal could be due to psychological or situational factors such as depression, anxiety, and changes in relationships. Both sexes experience reduced sexual desire after SCI, and almost half of men and almost three quarters of women have trouble becoming psychologically aroused. Depression is the most common cause of problems with arousal in people with SCI. People frequently experience grief and despair initially after the injury. Anxiety, substance use disorders and alcohol use disorder may increase after discharge from a hospital as new challenges occur, which can exacerbate sexual difficulties. Substance use increase unhealthy behaviors, straining relationships and social functioning.
SCI can lead to significant insecurities, which have repercussions for sexuality and self-image. SCI often affects body image, either due to the host of changes in the body that affect appearance (e.g. unused muscles in the legs become atrophied), or due to changes in self-perception not directly from physical changes. People frequently find themselves less attractive and expect others not to be attracted to them after SCI. These insecurities cause fear of rejection and deter people from initiating contact or sexual activity or engaging in sex. Feelings of undesirability or worthlessness even lead some to suggest to their partners that they find someone non-disabled.
Fertility
Male
Men with SCI rank the ability to father children among their highest concerns relating to sexuality. Male fertility is reduced after SCI, due to a combination of problems with erections, ejaculation, and quality of the semen. As with other types of sexual response, ejaculation can be psychogenic or reflexogenic, and the level of injury affects a man's ability to experience each type. As many as 95% of men with SCI have problems with ejaculation (anejaculation), possibly due to impaired coordination of input from different parts of the nervous system. Erection, orgasm, and ejaculation can each occur independently, although the ability to ejaculate seems linked to the quality of the erection, and the ability to orgasm is linked to the ejaculation facility. Even men with complete injuries may be able to ejaculate, because other nerves involved in ejaculation can effect the response without input from the spinal cord. In general, the higher the level of injury, the more physical stimulation the man needs to ejaculate. Conversely, premature or spontaneous ejaculation can be a problem for men with injuries at levels T12–L1. It can be severe enough that ejaculation is provoked by thinking a sexual thought, or for no reason at all, and is not accompanied by orgasm.
Most men have a normal sperm count, but a high proportion of sperm are abnormal; they are less motile and do not survive as well. The reason for these abnormalities is not known, but research points to dysfunction of the seminal vesicles and prostate, which concentrate substances that are toxic to sperm. Cytokines, immune proteins which promote an inflammatory response, are present at higher concentrations in semen of men with SCI, as is platelet-activating factor acetylhydrolase; both are harmful to sperm. Another immune-related response to SCI is the presence of a higher number of white blood cells in the semen.
Female
The numbers of women with SCI giving birth and having healthy babies are increasing. Around a half to two-thirds of women with SCI report they might want to have children, and 14–20% do get pregnant at least once. Although female fertility is not usually permanently reduced by SCI, there is a stress response that can happen immediately post-injury that alters levels of fertility-related hormones in the body. In about half of women, menstruation stops after the injury but then returns within an average of five months—it returns within a year for a large majority. After menstruation returns, women with SCI become pregnant at a rate close to that of the rest of the population.
Pregnancy is associated with greater-than-normal risks in women with SCI, among them increased risk of deep vein thrombosis, respiratory infection, and urinary tract infection. Considerations exist such as maintaining proper positioning in a wheelchair, prevention of pressure sores, and increased difficulty moving due to weight gain and changes in center of balance. Assistive devices may need to be altered and medications changed.
For women with injuries above T6, a risk during labor and delivery that threatens both mother and fetus is autonomic dysreflexia, in which the blood pressure increases to dangerous levels high enough to cause potentially deadly stroke. Drugs such as nifedipine and captopril can be used to manage an episode if it occurs, and epidural anesthesia helps although it is not very reliable in women with SCI. Anesthesia is used for labor and delivery even for women without sensation, who may only experience contractions as abdominal discomfort, increased spasticity, and episodes of autonomic dysreflexia. Reduced sensation in the pelvic area means women with SCI usually have less painful delivery; in fact, they may fail to realize when they go into labor. If there are deformities in the pelvis or spine caesarian section may be necessary. Babies of women with SCI are more likely to be born prematurely, and, premature or not, they are more likely to be small for their gestational time.
Management
Erectile problems
Although erections are not necessary for satisfying sexual encounters, many men see them as important, and treating erectile dysfunction improves their relationships and quality of life. Whatever treatment is used, it works best in combination with talk-oriented therapy to help integrate it into the sex life.
Oral medications and mechanical devices are the first choice in treatment because they are less invasive, are often effective, and are well tolerated. Oral medications include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
Penis pumps induce erections without the need for drugs or invasive treatments. To use a pump, the man inserts his penis into a cylinder, then pumps it to create a vacuum which draws blood into the penis, making it erect. He then slides a ring from the outside of the cylinder onto the base of the penis to hold the blood in and maintain the erection. A man who is able to get an erection but has trouble maintaining it for long enough can use a ring by itself. The ring cannot be left on for more than 30 minutes and cannot be used at the same time as anticoagulant medications.
If oral medications and mechanical treatments fail, the second choice is local injections: medications such as papaverine and prostaglandin that alter the blood flow and trigger erection are injected into the penis. This method is preferred for its effectiveness, but can cause pain and scarring.
Another option is to insert a small pellet of medication into the urethra, but this requires higher doses than injections and may not be as effective. Topical medications to dilate the blood vessels have been used, but are not very effective or well tolerated. Electrical stimulation of efferent nerves at the S2 level can be used to trigger an erection that lasts as long as the stimulation does.
Surgical implants, either of flexible rods or inflatable tubes, are reserved for when other methods fail because of the potential for serious complications, which occur in as many as 10% of cases. They carry the risk of eroding penile tissue (breaking through the skin). Although satisfaction among men who use them is high, if they do need to be removed implants make other methods such as injections and vacuum devices unusable due to tissue damage.
It is also possible for erectile dysfunction to exist not as a direct result of SCI but due to factors such as major depression, diabetes, or drugs such as those taken for spasticity. Finding and treating the root cause may alleviate the problem. For example, men who experience erectile problems as the result of a testosterone deficiency can receive androgen replacement therapy.
Ejaculation and male fertility
Without medical intervention, the male fertility rate after SCI is 5–14%, but the rate increases with treatments. Even with all available medical interventions, fewer than half of men with SCI can father children. Assisted insemination is usually required. As with erection, therapies used to treat infertility in uninjured men are used for those with SCI.
For anejaculation in SCI, the first-line method for sperm retrieval is penile vibratory stimulation (PVS). A high-speed vibrator is applied to the glans penis to trigger a reflex that causes ejaculation, usually within a few minutes. Reports of efficacy with PVS range from 15 to 88%, possibly due to differences in vibrator settings and experience of clinicians, as well as level and completeness of injury. Complete lesions strictly above Onuf's nucleus (S2–S4) are responsive to PVS in 98%, but complete lesions of the S2–S4 segments are not.
In case of failure with PVS, spermatozoa are sometimes collected by electroejaculation: an electrical probe is inserted into the rectum, where it triggers ejaculation. The success rate is 80–100%, but the technique requires anaesthesia and does not have the potential to be done at home that PVS has. Both PVS and electroejaculation carry a risk of autonomic dysreflexia, so drugs to prevent the condition can be given in advance and blood pressure is monitored throughout the procedures for those who are susceptible. Massage of the prostate gland and seminal vesicles is another method to retrieve stored sperm. If these methods fail to cause ejaculation or do not yield sufficient usable sperm, sperm can be surgically removed by testicular sperm extraction or percutaneous epididymal sperm aspiration. These procedures yield sperm in 86–100% of cases, but nonsurgical treatments are preferred.
Premature or spontaneous ejaculation is treated with antidepressants including selective serotonin reuptake inhibitors, which are known to delay ejaculation as a side effect.
Women
Compared with the options available for treating sexual dysfunction in men (for whom results are concretely observable), those available for women are limited. For example, PDE5 inhibitors, oral medications for treating erectile dysfunction in men, have been tested for their ability to increase sexual responses such as arousal and orgasm in women—but no controlled trials have been done in women with SCI, and trials in other women yielded only inconclusive results. In theory, women's sexual response could be improved using a vacuum device made to draw blood into the clitoris, but few studies on treatments for sexual function in women with SCI have been carried out. There is a particular paucity of information outside the area of reproduction.
Education and counseling
Counseling about sex and sexuality by medical professionals, psychologists, social workers, and nurses is a part of most SCI rehabilitation programs. Education is part of the follow-up treatment for people with SCI, as are psychotherapy, peer mentorship, and social activities; these are helpful for improving skills needed for socializing and relationships. Rather than addressing sexual dysfunction strictly as a physical problem, appropriate sexual rehabilitation care takes into account the individual as a whole, for example addressing issues with relationships and self-esteem. Sexual counseling includes teaching techniques to manage depression and stress, and to increase attention to preserved sensations during sexual activity. Education includes information about birth control or assistive devices such as those for positioning in sex, or advice and ideas for addressing problems such as incontinence and autonomic dysreflexia.
Many SCI patients have received misinformation about the effects of their injury on their sexual function and benefit from education about it. Although sexual education shortly after injury is known to be helpful and desired, it is frequently missing in rehabilitation settings; a common complaint from those who go through rehabilitation programs is that they offer insufficient information about sexuality. Longer-term education and counseling on sex after discharge from a hospital setting are especially important, yet sexuality is one of the most often neglected areas in long-term SCI rehabilitation, particularly for women. Care providers may refrain from addressing the topic because they feel intimidated or unequipped to handle it. Clinicians must be circumspect in bringing up sexual matters since people may be uncomfortable with or unready for the subject. Many patients wait for providers to broach the topic even if they do want the information.
A person's experience in managing sexuality after the injury relies not only on physical factors like severity and level of the injury, but on aspects of life circumstances and personality such as sexual experience and attitudes about sex. As well as evaluating physical concerns, clinicians must take into account factors that affect each patient's situation: gender, age, cultural, and social factors. Aspects of patients' cultural and religious backgrounds, even if unnoticed before the injury caused sexual dysfunction, affect care and treatments—particularly when cultural attitudes and assumptions of patients and care providers conflict. Health professionals must be sensitive to issues of sexual orientation and gender identity, showing respect and acceptance while communicating, listening, and emotionally supporting. Providers who treat SCI have been found to assume their patients are heterosexual or to exclude LGBTQ patients from their awareness, potentially resulting in substandard care. Academic research on sexuality and disability under-represents LGBTQ perspectives as well.
As well as the patient, the partner of an injured person frequently needs support and counseling. It can help with adjustment to a new relationship dynamic and self-image (such as being placed in the role of a caretaker) or with stresses that arise in the sexual relationship. Frequently, partners of injured people must contend with feelings like guilt, anger, anxiety, and exhaustion while dealing with the added financial burden of lost wages and medical expenses. Counseling aims to strengthen the relationship by improving communication and trust.
Children and adolescents
Not only does SCI present children and adolescents with many of the same difficulties adults face, it affects the development of their sexuality. Although substantial research exists on SCI and sexuality in adults, very little exists on the ways in which it affects development of sexuality in young people. Injured children and adolescents need ongoing, age-appropriate sex education that addresses questions of SCI as it relates to sexuality and sexual function. Very young children become aware of their disabilities before their sexuality, but as they age they become curious just as non-disabled children do, and it is appropriate to provide them with increasing amounts of information. Caregivers help the child and family prepare for transition into adulthood, including in sexuality and social interaction, beginning early and intensifying during adolescence. Parents need education about the effects of SCI on sexual function so that they can answer their children's questions.
Once patients reach their teens, they need more specific information about pregnancy, birth control, self-esteem, and dating. Teenagers with lost or reduced genital sensation benefit from education about alternative ways to experience pleasure and satisfaction from sexual acts. The teen years are often particularly difficult for those with SCI, in terms of body image and relationships. Given the importance they place on sexuality and privacy, adolescents may experience humiliation when parents or caregivers bathe them or take care of bowel and bladder needs. They can benefit from sexuality counseling, support groups, and mentoring by adults with SCI who can share experiences and lead discussions with peers. With the right care and education from family and professionals, injured children and adolescents can develop into sexually healthy adults.
Changes in sexual practices
People make a variety of sexual adaptations to help adjust to SCI. They often change their sexual practices, moving away from genital stimulation and intercourse and toward greater emphasis on touching above the level of injury and other aspects of intimacy such as kissing and caressing. It is necessary to discover new sexual positions if ones used previously have become too difficult. Other factors that enhance sexual pleasure are positive memories, fantasies, relaxation, meditation, breathing techniques, and most importantly, trust with a partner. People with SCI can make use of visual, auditory, olfactory, and tactile stimuli. It is possible to train oneself to be more mindful of the cerebral aspects of sex and of feeling in areas of the body that have sensation; this increases chances of orgasm. The importance of desire and comfort is the reasoning behind the quip "the most important sexual organ is the brain."
Adjusting to post-injury changes in the body's sensation is difficult enough to cause some to give up on the idea of satisfying sex at first. But changes in sensitivity above and at the level of injury occur over time; people may find erogenous zones like the nipples or ears have become more sensitive, enough to be sexually satisfying. They may discover new erogenous zones that were not erotic before the injury; care providers can help direct this discovery. These erogenous areas can even lead to orgasm when stimulated. Such changes may result from "remapping" of sensory areas in the brain due to neuroplasticity, particularly when sensation in the genitals is completely lost.
Commonly there is an area on the body between the areas where sensation is lost and those where is preserved called a "transition zone" that has increased sensitivity and is often sexually pleasurable when stimulated. Also known as a "border zone", this area may feel the way the penis or clitoris did before injury, and can even give orgasmic sensation. Due to such changes in sensation, people are encouraged to explore their bodies to discover what areas are pleasurable. Masturbation is a useful way to learn about the body's new responses.
Tests exist to measure how much sensation a person has retained in the genitals after an injury, which are used to tailor treatment or rehabilitation. Sensory testing helps people learn to recognize the sensations associated with arousal and orgasm. Injured people who are able to achieve orgasms from stimulation to the genitals may need stimulation for a longer time or at a greater intensity. Sex toys such as vibrators are available, e.g. to enhance sensation in areas of reduced sensitivity, and these can be modified to accommodate disabilities. For example, a hand strap can be added to a vibrator or dildo to assist someone with poor hand function.
Considerations for sexual activity
SCI presents extra needs to consider for sexual activity; for example muscle weakness and movement limitations restrict options for positioning. Pillows or devices such as wedges can be placed to help achieve and maintain a desired position for people affected by weakness or movement limitations. Assistive devices exist to aid in motion, such as sliding chairs to provide pelvic thrust. Spasticity and pain also create barriers to sexual activity; these changes may require couples to use new positions, such as seated in a wheelchair. A warm bath can be taken prior to sex, and massage and stretching can be incorporated into foreplay to ease spasticity.
Another consideration is loss of sensation, which puts people at risk for wounds such as pressure sores and injuries that could become worse before being noticed. Friction from sexual activity may damage the skin, so it is necessary after sex to inspect areas that could have been hurt, particularly the buttocks and genital area. People who already have pressure sores must take care not to make the wounds worse. Irritation to the genitals increases risk for vaginal infections, which get worse if they go unnoticed. Women who do not get sufficient vaginal lubrication on their own can use a commercially available personal lubricant to decrease friction.
Another risk is autonomic dysreflexia (AD), a medical emergency involving dangerously high blood pressure. People at risk for AD can take medications to help prevent it before sex, but if it does occur they must stop and seek treatment. Mild signs of AD such as slightly high blood pressure frequently do accompany sexual arousal and are not cause for alarm. In fact, some interpret the symptoms of AD that occur during sexual activity as pleasant or arousing, or even climactic.
A concern for sexual activity that is not dangerous but that can be upsetting for both partners is bladder or bowel leakage due to urinary or fecal incontinence. Couples can prepare for sex by draining the bladder using intermittent catheterization or placing towels down in advance. People with indwelling urinary catheters must take special care with them, removing them or taping them out of the way.
Birth control is another consideration: women with SCI are usually not prescribed oral contraceptives since the hormones in them increase the risk of blood clots, for which people with SCI are already at elevated risk. Intrauterine devices could have dangerous complications that could go undetected if sensation is reduced. Diaphragms that require something to be inserted into the vagina are not usable by people with poor hand function. An option of choice for women is for partners to use condoms.
Long-term adjustment
In the first months after an injury, people commonly prioritize other aspects of rehabilitation over sexual matters, but in the long term, adjustment to life with SCI necessitates addressing sexuality.
Although physical, psychological and emotional factors militate to reduce the frequency of sex after injury, it increases after time. As years go by, the odds that a person will become involved in a sexual relationship increase. Difficulties adjusting to a changed appearance and physical limitations contribute to reduced frequency of sexual acts, and improved body image is associated with an increase. Like frequency, sexual desire and sexual satisfaction often decrease after SCI. The reduction in women's sexual desire and frequency may be in part because they believe they can no longer enjoy sex, or because their independence or social opportunities are reduced. As time goes by people usually adjust sexually, adapting to their changed bodies. Some 80% of women return to being sexually active,
and the numbers who report being sexually satisfied range from 40 to 88%. Although women's satisfaction is usually lower than before the injury, it improves as time passes. Women report higher rates of sexual satisfaction than men post-SCI for as many as 10–45 years. More than a quarter of men have substantial problems with adjustment to their post-injury sexual functioning. Sexual satisfaction depends on a host of factors, some more important than the physical function of the genitals: intimacy, quality of relationships, satisfaction of partners, willingness to be sexually experimental, and good communication. Genital function is not as important to men's sexual satisfaction as are their partners' satisfaction and intimacy in their relationships. For women, quality of relationships, closeness with partners, sexual desire, and positive body image, as well as the physical function of the genitals, contribute sexual satisfaction. For both sexes, long-term relationships are associated with higher sexual satisfaction.
Relationships
A catastrophic injury such as SCI puts strain on marriages and other romantic relationships, which in turn has important implications for quality of life. Partners of injured people often feel out of control, overwhelmed, angry, and guilty while having added work related to the injury, less help with responsibilities like parenting, and loss of wages. Relationship stress and excessive dependence in relationships increases risk of depression for the person with SCI; supportive relationships are protective.
Relationships change as partners take on new roles, such as that of caregiver, which may conflict with the role of partner and require substantial sacrifice of time and self-care. These changes in responsibilities may mean a reverse in societally determined gender roles within relationships; inability to fulfil these roles affects sexuality in general.
Sexual dysfunction is a stressor in relationships. People are often as concerned about failing to keep a partner satisfied as they are about meeting their own sexual needs. In fact, two of the top reasons people with SCI cite for wanting to have sex are for intimacy and to keep a partner. The frequency of sex correlates with the desire of the uninjured partner.
Although problems with sexual function that result from SCI play a part in some divorces, they are not as important as emotional maturity in determining the success of a marriage. People with SCI get divorced more often than the rest of the population, and marriages that took place before the injury fail more often than those that took place after (33% vs. 21%). People married before the injury report less happy marriages and worse sexual adjustment than those married after, possibly indicating that spouses had difficulty adjusting to the new circumstances. For those who chose to become involved with someone after an injury, the disability was an accepted part of the relationship from the outset. Understanding and acceptance of the limitations that result from the injury on the part of the uninjured partner is an important factor in a successful marriage. Many divorces have been found to be initiated by the injured partner, sometimes due to the depression and denial that often occurs early after the injury. Thus counseling is important, not just for managing changes in self-perception but in perceptions about relationships.
Despite the stresses that SCI places on people and relationships, studies have shown that people with SCI are able to have happy and fulfilling romantic relationships and marriages, and to raise well-adjusted children. People with SCI who wish to be parents may question their ability to raise children and opt not to have them, but studies have shown no difference in parenting outcomes between injured and uninjured groups. Children of women with SCI do not have worse self-esteem, adjustment, or attitudes toward their parents. Women who have children post-SCI have a higher quality of life, even though parenting adds demands and challenges to their lives.
For those who are single when injured or who become single, SCI causes difficulties and insecurities with respect to one's ability to meet new partners and start relationships. In some settings, beauty standards cause people to view disabled bodies as less attractive, limiting the options for sexual and romantic partners of people with disabilities like SCI. Furthermore, physical disabilities are stigmatized, causing people to avoid contact with disabled people, particularly those with highly visible conditions like SCI. The stigma may cause people with SCI to experience self-consciousness and embarrassment in public. They can increase their social success by using impression management techniques to change how they are perceived and create a more positive image of themselves in others' eyes. Physical limitations create difficulties; with lowered independence comes reduced social interaction and fewer opportunities to find partners. Difficulties with mobility and the lack of disabled accessibility of social spaces (e.g. lack of wheelchair ramps) create a further barrier to social activity and limit the ability to meet partners. Isolation and its associated risk of depression can be limited by participating in physical activities, social gatherings, clubs, and online chat and dating.
Society and culture
Negative societal attitudes and stereotypes about people with disabilities like SCI affect interpersonal interactions and self-image, with important implications for quality of life. In fact, for women, psychological factors have a more important impact on sexual adjustment and activity than physical ones. Negative attitudes about disability (along with relationships and social support) are more predictive of outcome than even the level or completeness of injury. Stereotypes exist that people with SCI (particularly women) are uninterested in, unsuitable for, or incapable of sexual relationships or encounters. "People think we can only date people in wheelchairs, that we're lucky to get any guy, that we can't be picky", remarked Mia Schaikewitz, who is profiled in Push Girls, a 2012 reality series about four women with SCI.
Not only do they affect injured people's self-image, these stereotypes are particularly harmful when held by counselors and professionals involved in rehabilitation. Caregivers affected by these culturally transmitted beliefs may treat their patients as asexual, particularly if the injury occurred at a young age and the patient never had sexual experiences. Failure to recognize injured people's sexual and reproductive capacity restricts their access to birth control, information about sexuality, and sexual health-related medical care such as annual gynecological exams. Another common belief that affects sexual rehabilitation is that sex is strictly about genital function; this could cause caregivers to discount the importance of the rest of the body and of the individual.
Cultural attitudes toward gender roles have profound effects on people with SCI. The injury can cause insecurities surrounding sexual identity, particularly if the disability precludes fulfilment of societally taught gender norms.
Female beauty standards propagated by mass media and culture portray the ideal woman as non-disabled: as one fashion model with a SCI commented, "when you have a devastating injury or disability, you're not often thought of as sensual or pretty because you don't look like the women in the magazines." Inability to meet these standards can lower self-esteem, even if these ideals are also unattainable for most non-disabled women. Poorer self-esteem is associated with worse sexual adjustment and quality of life, and higher rates of loneliness, stress, and depression.
Males are also affected by societal expectations, such as notions about masculinity and sexual prowess. Men from some traditional backgrounds may feel performance pressure that emphasizes the ability to have erections and sexual intercourse. Men who have a strong sexual desire but who are not able to perform sexually may be at increased risk for depression, particularly when they believe strongly in traditional masculine gender norms with sexual function as core to the male identity. Men who strongly believe in these traditional roles may feel sexually inadequate, unmanly, insecure, and less satisfied with life. Since sexual dysfunction has this negative impact on self-esteem, treatment of erectile dysfunction can have a psychological benefit even though it does not help with physical sensation. SCI may necessitate reappraisal and rejection of assumptions about gender norms and sexual function in order to adjust healthily to the disability: those who are able to change the way they think about gender roles may have better life satisfaction and outcomes with rehabilitation. Counseling is helpful in this reassessment process.
References
Bibliography
External links
SCI Forum Reports: Dating and Relationships after SCI. University of Washington
Sexuality & Sexual Function following SCI. University of Alabama at Birmingham Spinal Cord Injury Model System video series
Sexuality and spinal cord injury: Where we are and where we are going. The Free Library
Sexuality in Spinal Cord Injury. University of Miami School of Medicine
Disability and sexuality
Neurotrauma
Featured articles | 0.762795 | 0.992876 | 0.757361 |
Philosophy of psychology | Philosophy of psychology is concerned with the history and foundations of psychology. It deals with both epistemological and ontological issues and shares interests with other fields, including philosophy of mind and theoretical psychology. Philosophical and theoretical psychology are intimately tied and are therefore sometimes used interchangeably or used together. However, philosophy of psychology relies more on debates general to philosophy and on philosophical methods, whereas theoretical psychology draws on multiple areas.
Epistemology
Some of the issues studied by the philosophy of psychology are epistemological concerns about the methodology of psychological investigation. For example:
What constitutes a psychological explanation?
What is the most appropriate methodology for psychology: mentalism, behaviorism, or a compromise?
Are self-reports a reliable data-gathering method?
What conclusions can be drawn from null hypothesis tests?
Can first-person experiences (emotions, desires, beliefs, etc.) be measured objectively?
Ontology
Philosophers of psychology also concern themselves with ontological issues, like:
Can psychology be theoretically reduced to neuroscience?
What are psychological phenomena?
What is the relationship between subjectivity and objectivity in psychology?
Relations to other fields
Philosophy of psychology also closely monitors contemporary work conducted in cognitive neuroscience, cognitive psychology, and artificial intelligence, for example questioning whether psychological phenomena can be explained using the methods of neuroscience, evolutionary theory, and computational modeling, respectively. Although these are all closely related fields, some concerns still arise about the appropriateness of importing their methods into psychology. Some such concerns are whether psychology, as the study of individuals as information processing systems (see Donald Broadbent), is autonomous from what happens in the brain (even if psychologists largely agree that the brain in some sense causes behavior (see supervenience)); whether the mind is "hard-wired" enough for evolutionary investigations to be fruitful; and whether computational models can do anything more than offer possible implementations of cognitive theories that tell us nothing about the mind (Fodor & Pylyshyn 1988).
Related to the philosophy of psychology are philosophical and epistemological inquiries about clinical psychiatry and psychopathology. Philosophy of psychiatry is mainly concerned with the role of values in psychiatry: derived from philosophical value theory and phenomenology, values-based practice is aimed at improving and humanizing clinical decision-making in the highly complex environment of mental health care. Philosophy of psychopathology is mainly involved in the epistemological reflection about the implicit philosophical foundations of psychiatric classification and evidence-based psychiatry. Its aims is to unveil the constructive activity underlying the description of mental phenomena.
Main areas
Different schools and systems of psychology represent approaches to psychological problems, which are often based on different philosophies of consciousness.
Functional psychology
Functionalism treats the psyche as derived from the activity of external stimuli, deprived of its essential autonomy, denying free will, which influenced behaviourism later on; one of the founders of functionalism was James, also close to pragmatism, where human action is put before questions and doubts about the nature of the world and man himself.
Psychoanalysis
Freud`s doctrine, called Metapsychology, was to give the human self greater freedom from instinctive and irrational desires in a dialogue with a psychologist through analysis of the unconscious. Later the psychoanalytic movement split, part of it treating psychoanalysis as a practice of working with archetypes (analytical psychology), part criticising the social limitations of the unconscious (Freudo-Marxism), and later Lacan`s structural psychoanalysis, which interpreted the unconscious as a language.
Phenomenological psychology
Edmund Husserl rejected the physicalism of most of the psychological teachings of his time and began to understand consciousness as the only reality accessible to reliable cognition. His disciple Heidegger added to this the assertion of the fundamental finitude of man and the threat of a loss of authenticity in the technical world, and thus laid the foundation for existential psychology.
Structuralism
The recognised creator of psychology as a science, W. Wundt described the primordial structures of the psyche that determine perception and behaviour, but faced the problem of the impossibility of direct access to these structures and the vagueness of their description. Half a century later his ideas, combined with Sossur`s semiotics, strongly influenced the general humanities of structuralism and the post-structuralism and post-modernism that emerged from it, where structures were treated as linguistic invariants.
References
Further reading
J. Stacy Adams. 1976. Advances in Experimental Social Psychology. Academic Press, 1976 , 9780120152094.
Leonard Berkowitz. 1972. Social psychology. Scott Foresman & Co, 1972.
Ned Block. 1980. Readings in Philosophy of Psychology, Volume 1. Harvard University Press, 1980. , 9780674748767.
Stuart C. Brown, Royal Institute of Philosophy. 1974. Macmillan, 1974. Original from the University of Michigan
Joseph Margolis. 2008. Philosophy of Psychology. Prentice-Hall foundations of philosophy series. Prentice-Hall, 1984. , 9780136643265.
Ken Richardson. 2008. Understanding psychology. Open University Press, 1988. , 9780335098422.
George Botterill, Peter Carruthers. 1999. The Philosophy of Psychology. Cambridge University Press. , 9780521559157.
Craig Steven Titus. 2009. Philosophical Psychology: Psychology, Emotions, and Freedom. CUA Press. , 9780977310364.
Jose Bermudez. 2005. Philosophy of Psychology: A Contemporary Introduction. Routledge. .
Terence Horgan, John Tienson. 1996. Connectionism and the Philosophy of Psychology. MIT Press. , 9780262082488
External links
Part 7 of MindPapers: Philosophy of Cognitive Science (contains over 1,500 articles, many with online copies)
Psy
Psy | 0.772601 | 0.980153 | 0.757268 |
Geriatric psychiatry | Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of psychiatry dealing with the study, prevention, and treatment of neurodegenerative, cognitive impairment, and mental disorders in people of old age. Geriatric psychiatry as a subspecialty has significant overlap with the specialties of geriatric medicine, behavioural neurology, neuropsychiatry, neurology, and general psychiatry. Geriatric psychiatry has become an official subspecialty of psychiatry with a defined curriculum of study and core competencies.
History
Origins
The origins of geriatric psychiatry began with Alois Alzheimer, a German psychiatrist and neuropathologist who first identified amyloid plaques and neurofibrillary tangles in a fifty-year-old woman he called Auguste D. These plaques and tangles were later identified as being responsible for her behavioural symptoms, short-term memory loss, and psychiatric symptoms. These brain anomalies would become identifiers of what later became known as Alzheimer's disease.
Subspecialty
The subspecialty of geriatric psychiatry originated in the United Kingdom in the 1950s.
Naming
The geropsychiatric unit, the term for a hospital-based geriatric psychiatry program, was first introduced in 1984 by Norman White MD, when he opened New England's first specialized program at a community hospital in Rochester, New Hampshire. White is a pioneer in geriatric psychiatry, being among the first psychiatrists nationally to achieve board certification in the field. The prefix psycho- had been proposed for the geriatric program, but White, knowing New Englanders' aversion to anything psycho- lobbied successfully for the name geropsychiatric rather than psychogeriatrics.
Diseases
Diseases and disorders diagnosed or managed by geriatric psychiatrists include:
Dementia
Mild cognitive impairment
Alzheimer's disease
Vascular dementia
Dementia with Lewy bodies
Parkinson's disease
Neuropsychiatric complications from stroke, multiple sclerosis
Late-life presentations of psychiatric disorders
Depression
Melancholic depression
Anxiety disorders
Bipolar disorder
Schizophrenia
Personality disorders
Medical-Psychiatric Disorders
Delirium
Catatonia
Substance use disorder
Geriatric Psychiatrist
A geriatric psychiatrist is a physician who specializes in the field of medical sub-specialty called geriatric psychiatrist. A geriatric psychiatrist holds a board certification after specialized training after attaining a medical degree, residency, and an additional geriatric psychiatry fellowship training program. The requirements may vary by countries. Geriatric psychiatrist are also psychiatrists who are qualified in the general diagnosis and treatment of psychiatric disorders. Some geriatric psychiatrists also conduct research to determine the cause and better treatments for neurodegenerative disorders and late-life mental health disorders.
Geriatric psychiatrists may perform neurological examinations, mental status examination, laboratory investigations, neuroimaging, cognitive assessments to investigate the causes of psychiatric or neurologic symptoms in old age.
Training
International
The International Psychogeriatric Association is an international community of scientists and healthcare geriatric professionals working for mental health in aging. International Psychogeriatrics is the official journal of the International Psychogeriatric Association.
Canada
The Royal College of Physicians and Surgeons of Canada is responsible for training and certifying geriatric psychiatrists in Canada. Geriatric psychiatry requires an additional year of subspecialty fellowship training in addition to general psychiatry training.
United Kingdom
The Royal College of Psychiatrists is responsible for training and certifying psychiatrists in the United Kingdom. Within the Royal College of Psychiatrists, the Faculty of Old Age Psychiatry is responsible for training in Old Age Psychiatry. Doctors who have membership of the Royal College of Psychiatrists can undertake a three or four-year training programme to become a specialist in Old Age Psychiatry. There is currently a shortage of old age psychiatrists in the United Kingdom.
United States
The American Association for Geriatric Psychiatry (AAGP) is the national organization representing health care providers specializing in late life mental disorders. The American Journal of Geriatric Psychiatry is the official journal of the AAGP. The American Board of Psychiatry and Neurology and the American Osteopathic Board of Neurology and Psychiatry both issue a board certification in geriatric psychiatry.
After a 4-year residency in psychiatry, a psychiatrist can complete a one-year fellowship in geriatric psychiatry. Many fellowships in geriatric psychiatry exist.
See also
Geriatrics
GERRI
References
External links
Geriatrics | 0.772796 | 0.979893 | 0.757257 |
Lundbeck | H. Lundbeck A/S, commonly referred to as Lundbeck, is a Danish international pharmaceutical company engaged in the research, development, manufacturing, marketing and sale of pharmaceuticals across the world. The company’s products are targeted at brain diseases, including depression, schizophrenia, Alzheimer's disease, Parkinson's disease and migraine.
Headquartered in Copenhagen, Denmark, Lundbeck has approximately 5,600 employees in more than 50 countries, and their products are registered in more than 100 countries. They have production facilities in Denmark, France and Italy and their research centers are based in Denmark and the US.
Lundbeck is listed on the Copenhagen Stock Exchange (CSE).
Lundbeck is a full member of the European Federation of Pharmaceutical Industries and Associations (EFPIA) and of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)
History
The company was founded by Hans Lundbeck in 1915, and was initially a trading company supplying a variety of goods to the Danish market, including machinery for manufacturing, aluminium foil, artificial sweeteners, and photographic equipment.
Lundbeck entered the pharmaceutical market in 1924, importing medicines and cosmetics from companies based in other European and American countries. By the late 1930s, Lundbeck had begun to produce its own medicinal products and had established its own research department. Production continued during the Second World War, although it was limited due to a lack of raw materials.
After the war, Lundbeck continued to grow and in 1957 the company introduced Truxal (chlorprothixene) for the treatment of schizophrenia, entering the market for brain disorders. In 1954, the Lundbeck Foundation was established to maintain and expand the activities of Lundbeck Group and also to provide funding for scientific research of the highest quality.
From the late 1970s, and up through the 1980s, Lundbeck diverted its old agency business and thus became a dedicated pharmaceutical company focusing on the production of drugs used to treat disorders and diseases of the central nervous system.
In 1989, Lundbeck launched the antidepressant Celexa (citalopram), which became the cornerstone for the company's international expansion and in 2009, Lundbeck, bought Ovation and established a commercial platform in the USA.
In 2012, to focus on newer, strategic CNS-products, Lundbeck sold a portfolio of non-core products to Recordati S.p.A. (Recordati Rare Diseases). In 2014 Lundbeck acquired Chelsea Therapeutics for up to $658 million.
In March 2018, the company acquired Prexton Therapeutics for up to €905 million ($1.1 billion)
In June 2018, the former Millennium Pharmaceuticals CEO, Deborah Dunsire, was named the new CEO of Lundbeck.
In September 2019, Lundbeck announced it would acquire Alder BioPharmaceuticals $18 per share, valuing Alder at almost $2 billion.
In June 2023, Charl van Zyl, head of neurology solutions at UCB, has announced as the next CEO and President to succeed Dunsire.
In October 2024, Lundbeck agreed to acquire American epilepsy drug maker Longboard Pharmaceuticals for $2.6 billion.
Key products
Lundbeck markets a number of different pharmaceuticals for the treatment of psychiatric and neurological disorders. The most recently launched compounds include: Rexulti (depression and schizophrenia), Brintellix (depression) and Abilify Maintena (schizophrenia and bipolar 1).
Lundbeck manufactures drugs such as:
Products under development
Brexpiprazole for Alzheimer's disease, bipolar disease and PTSD
Foliglurax for Parkinson's disease
Lu AF35700 for schizophrenia
Controversy
Lundbeck formerly held the only license to manufacture pentobarbital (Nembutal) in the United States. The drug is commonly used for execution by lethal injection in the United States (either as part of a three drug cocktail or by itself). After coming under criticism for not adding an ‘end user’ agreement to prevent importers from selling Nembutal to American prisons for use in executions, Lundbeck announced that it would not sell Nembutal to prisons in U.S. states that carry out executions. By introducing a new distribution system, Nembutal will be supplied exclusively through a specialty pharmacy drop ship program that will deny distribution of the product to prisons in U.S. states currently active in carrying out the death penalty by lethal injection.
In December 2011, Lundbeck divested a portfolio of products including Nembutal to US pharmaceutical company Akorn Inc. As part of the agreement, Akorn committed to continue with Lundbeck's restricted distribution program for Nembutal, which was implemented to restrict the use of the product in the US. Since 2012, US prisons have reported a serious shortage of Nembutal.
2013 fine
On June 19, 2013, the European Commission imposed a fine of €93.8 million on Lundbeck and fined several producers of generic pharmaceuticals a total of €52.2 million after Lundbeck made agreements in 2002 with the other companies to delay less expensive generics of Lundbeck's citalopram from entering the market. In return for the ability to maintain a monopoly on the drug's manufacture, Lundbeck offered payments and other kickbacks.
See also
Tarenflurbil, which the company had arranged for EU distribution rights on prior to termination of its development by Myriad.
References
External links
The Lundbeck Institute
Companies based in Copenhagen Municipality
Companies listed on Nasdaq Copenhagen
Danish brands
Danish companies established in 1915
Life science companies based in Copenhagen
Multinational companies headquartered in Denmark
Pharmaceutical companies established in 1915
Pharmaceutical companies of Denmark
Valby | 0.766264 | 0.988223 | 0.75724 |
Adaptation model of nursing | In 1976, Sister Callista Roy developed the Adaptation Model of Nursing, a prominent nursing theory. Nursing theories frame, explain or define the practice of nursing. Roy's model sees the individual as a set of interrelated systems (biological, psychological and social). The individual strives to maintain a balance between these systems and the outside world, but there is no absolute level of balance. Individuals strive to live within a unique band in which he or she can cope adequately.
Overview of the theory
This model comprises the four domain concepts of person, health, environment, and nursing; it also involves a six-step nursing process. Andrews & Roy (1991) state that the person can be a representation of an individual or a group of individuals. Roy's model sees the person as "a biopsychosocial being in constant interaction with a changing environment". The person is an open, adaptive system who uses coping skills to deal with stressors. Roy sees the environment as "all conditions, circumstances and influences that surround and affect the development and behaviour of the person". Roy describes stressors as stimuli and uses the term residual stimuli to describe those stressors whose influence on the person is not clear. Originally, Roy wrote that health and illness are on a continuum with many different states or degrees possible. More recently, she states that health is the process of being and becoming an integrated and whole person. Roy's goal for nursing is "the promotion of adaptation in each of the four modes, thereby contributing to the person's health, quality of life and dying with dignity". These four modes are physiological, self-concept, role function and interdependence.
Roy employs a six-step nursing process: assessment of behaviour; assessment of stimuli; nursing diagnosis; goal setting; intervention and evaluation. In the first step, the person's behaviour in each of the four modes is observed. This behaviour is compared with norms and is deemed either adaptive or ineffective. The second step is concerned with factors that influence behaviour. Stimuli are classified as focal, contextual or residual. The nursing diagnosis is the statement of the ineffective behaviours along with the identification of the probable cause. This is typically stated as the nursing problem related to the focal stimuli, forming a direct relationship. In the fourth step, goal setting is the focus. Goals need to be realistic and attainable and are set in collaboration with the person. There are usually both short term and long-term goals that the nurse sets for the patient. Intervention occurs as the fifth step, and this is when the stimuli are manipulated. It is also called the 'doing phase' . In the final stage, evaluation takes place. The degree of change as evidenced by change in behaviour, is determined. Ineffective behaviours would be reassessed, and the interventions would be revised.
The model had its inception in 1964 when Roy was a graduate student. She was challenged by nursing faculty member Dorothy E. Johnson to develop a conceptual model for nursing practice. Roy's model drew heavily on the work of Harry Helson, a physiologic psychologist. The Roy adaptation model is generally considered a "systems" model; however, it also includes elements of an "interactional" model. The model was developed specifically for the individual client, but it can be adapted to families and to communities (Roy, 1983). Roy states (Clements and Roberts, 1983) that "just as the person as an adaptive system has input, output. and internal processes so too the family can be described from this perspective."
Basic to Roy's model are three concepts: the human being, adaptation, and nursing. The human being is viewed as a biopsychosocial being who is continually interacting with the environment. The human being's goal through this interaction is adaptation. According to Roy and Roberts (1981, p. 43), ‘The person has two major internal processing subsystems, the regulator and the cognator." These subsystems are the mechanisms used by human beings to cope with stimuli from the internal and external environment. The regulator mechanism works primarily through the autonomic nervous system and includes endocrine, neural, and perception pathways. This mechanism prepares the individual for coping with environmental stimuli. The cognator mechanism includes emotions, perceptual/information processing, learning, and judgment. The process of perception bridges the two mechanisms (Roy and Roberts, 1981).
Types of Stimuli
Three types of stimuli influence an individual's ability to cope with the environment. These include focal stimuli, contextual stimuli, and residual stimuli. Focal stimuli are those that immediately confront the individual in a particular situation. Focal stimuli for a family include individual needs; the level of family adaptation; and changes within the family members, among the members and in the family environment (Roy, 1983). Contextual stimuli are those other stimuli that influence the situation. Residual stimuli include the individual's beliefs or attitudes that may influence the situation. Many times this is the nurse's "hunch" about other factors that can affect the problem. Contextual and residual stimuli for a family system include nurturance, socialization, and support (Roy, 1983). Adaptation occurs when the total stimuli fall within the individual's/family's adaptive capacity, or zone of adaptation. The inputs for a family include all of the stimuli that affect the family as a group. The outputs of the family system are three basic goals: survival, continuity, and growth (Roy, 1983). Roy states (Clements and Roberts, 1983):
Since adaptation level results from the pooled effect of all other relevant stimuli, the nurse examines the contextual and residual stimuli associated with the focal stimulus to ascertain the zone within which positive family coping can take place and to predict when the given stimulus is outside that zone and will require nursing intervention.
Four Modes of Adaptation
Levine believes that an individual's adaptation occurs in four different modes. This also holds true for families (Hanson, 1984). These include the physiologic mode, the self-concept mode, the role function mode, and the interdependence mode.
The individual's regulator mechanism is involved primarily with the physiologic mode, whereas the cognator mechanism is involved in all four modes (Roy and Roberts, 1981). The family goals correspond to the model's modes of adaptation: survival = physiologic mode; growth = self-concept mode; continuity = role function mode. Transactional patterns fall into the interdependence mode (Clements and Roberts, 1983).
In the physiologic mode, adaptation involves the maintenance of physical integrity. Basic human needs such as nutrition, oxygen, fluids, and temperature regulation are identified with this mode (Fawcett, 1984). In assessing a family, the nurse would ask how the family provides for the physical and survival needs of the family members.
A function of the self-concept mode is the need for maintenance of psychic integrity. Perceptions of one's physical and personal self are included in this mode. Families also have concepts of themselves as a family unit. Assessment of the family in this mode would include the amount of understanding provided to the family members, the solidarity of the family, the values of the family, the amount of companionship provided to the members, and the orientation (present or future) of the family (Hanson, 1984).
The need for social integrity is emphasized in the role function mode. When human beings adapt to various role changes that occur throughout a lifetime, they are adapting in this mode. According to Hanson (1984), the family's role can be assessed by observing the communication patterns in the family. Assessment should include how decisions are reached, the roles and communication patterns of the members, how role changes are tolerated, and the effectiveness of communication (Hanson, 1984). For example, when a couple adjusts their lifestyle appropriately following retirement from full-time employment, they are adapting in this mode.
The need for social integrity is also emphasized in the interdependence mode. Interdependence involves maintaining a balance between independence and dependence in one's relationships with others. Dependent behaviors include affection seeking, help seeking, and attention seeking. Independent behaviors include mastery of obstacles and initiative taking. According to Hanson (1984), when assessing this mode in families, the nurse tries to determine how successfully the family lives within a given community. The nurse would assess the interactions of the family with the neighbors and other community groups, the support systems of the family, and the significant others (Hanson, 1984).
The goal of nursing is to promote adaptation of the client during both health and illness in all four of the modes. Actions of the nurse begin with the assessment process, The family is assessed on two levels. First, the nurse makes a judgment with regard to the presence or absence of maladaptation. Then, the nurse focuses the assessment on the stimuli influencing the family's maladaptive behaviors. The nurse may need to manipulate the environment, an element or elements of the client system, or both in order to promote adaptation.
Many nurses, as well as schools of nursing, have adopted the Roy adaptation model as a framework for nursing practice. The model views the client in a holistic manner and contributes significantly to nursing knowledge. The model continues to undergo clarification and development by the author.
Applying Roy’s Model to Family Assessment
When using Roy's model as a theoretical framework, the following can serve as a guide for the assessment of families.
I. Adaptation Modes
A. Physiologic Mode
1. To what extent is the family able to meet the basic survival needs of its members?
2. Are any family members having difficulty meeting basic survival needs?
B. Self-Concept Mode
1. How does the family view itself in terms of its ability to meet its goals and to assist its members to achieve their goals? To what extent do they see themselves as self-directed? Other directed?
2. What are the values of the family?
3. Describe the degree of companionship and understanding given to the family members
C. Role Function Mode
1. Describe the roles assumed by the family members.
2. To what extent are the family roles supportive, in conflict, reflective of role overload?
3. How are family decisions reached?
D. Interdependence Mode
1. To what extent are family members and subsystems within the family allowed to be independent in goal identification and achievement (e.g., adolescents)?
2. To what extent are the members supportive of one another?
3. What are the family's support systems? Significant others?
4. To what extent is the family open to information and assistance from outside the family unit? Willing to assist other families outside the family unit?
5. Describe the interaction patterns of the family In the community.
II. Adaptive Mechanisms
A. Regulator: Physical status of the family in terms of health? i.e., nutritional state, physical strength, availability of physical resources
B. Cognator: Educational level, knowledge base of family, source of decision making, power base, degree of openness in the system to input, ability to process
III. Stimuli
A. Focal
1. What are the major concerns of the family at this time?
2. What are the major concerns of the individual members?
3. This is usually related to the nursing diagnoses or the main stimuli causing the problem behaviors. It is important for the nurse to try to fix this before they can fix the problem behaviors as they are related to each other.
B. Contextual
1. What elements in the family structure, dynamic, and environment are impinging on the manner and degree to which the family can cope with and adapt to their major concerns (i.e., financial and physical resources, presence or absence of support systems, clinical setting and so on)?
These can be either negative or positive as it relates to the main nursing problem.
C. Residual
1. What knowledge, skills, beliefs, and values of this family must be considered as the family attempts to adapt (i.e., stage of development, cultural background, spiritual/religious beliefs, goals, expectations)? This is normally an assumption that the nurse has that could impact care. One could describe it as one's educational guess about something going on in the patient's life that could be further contributing to the problem.
The nurse assesses the degree to which the family's actions in each mode are leading to positive coping and adaptation to the focal stimuli. If coping and adaptation are not health promoting, assessment of the types of stimuli and the effectiveness of the regulators provides the basis for the design of nursing interventions to promote adaptation.
By answering each of these questions in each assessment, a nurse can have a full understanding of the problem's a patient may be having. It is important to recognize each stimuli because without it, not every aspect of the person's problem can be confronted and fixed. As a nurse, it is their job to recognize all of these modes, mechanisms, and stimuli while taking care of a patient. They do so through the use of their advanced knowledge of the nursing process as well as with interviews with the individuals and the family members.
Callista Roy maintains there are four main adaptation systems, which she calls modes of adaptation. She calls these the
1. the physiological - physical system
2. the self-concept group identity system
3. the role mastery/function system
4. the interdependency system.
See also
Nursing theory
References
Bibliography
External links
Roy's faculty profile, Boston College
Nursing theory | 0.773221 | 0.97933 | 0.757239 |
Oral stage | In Freudian psychoanalysis, the term oral stage or hemitaxia denotes the first psychosexual development stage wherein the mouth of the infant is their primary erogenous zone. Spanning the life period from birth to the age of 18 months, the oral stage is the first of the five Freudian psychosexual development stages: (i) the oral, (ii) the anal, (iii) the phallic, (iv) the latent, and (v) the genital.
Oral-stage fixation
Freud proposed that if the nursing child's appetite were thwarted during any libidinal development stage, the anxiety would persist into adulthood as a neurosis (functional mental disorder). Therefore, an infantile oral fixation would be manifest as an obsession with oral stimulation. If weaned either too early or too late, the infant might fail to resolve the emotional conflicts of the oral stage of psychosexual development and might develop a maladaptive oral fixation.
The infant who is neglected (insufficiently fed) or who is over-protected (over-fed) in the course of being nursed, might become an orally-fixated person. This fixation might have two effects: (i) the neglected child might become a psychologically dependent adult continually seeking the oral stimulation denied in infancy, thereby becoming a manipulative person in fulfilling their needs, rather than maturing to independence; (ii) the over-protected child might resist maturation and return to dependence upon others in fulfilling their needs. Theoretically, oral-stage fixations are manifested as garrulousness (talkativeness), smoking, continual oral stimulus (eating, chewing objects), and alcoholism.
See also
Amphimixis
Psychosexual development
References
Further reading
External links
Freud's Psychosexual Stages
Freudian psychology | 0.760293 | 0.995973 | 0.757231 |
Calgary–Cambridge model | The Calgary–Cambridge model (Calgary-Cambridge guide) is a method for structuring medical interviews. It focuses on giving a clear structure of initiating a session, gathering information, physical examination, explaining results and planning, and closing a session. It is popular in medical education in many countries.
Method
The Calgary–Cambridge model involves:
initiating a session: This involves preparation by the clinician, building rapport with the patient, and an understanding of why the interview is needed.
gathering information: This may be split into a focus on a biomedical perspective, the patient's experience, and contextual information about the patient. Contextual information may include personal history, social history, and other medical history.
a physical examination of a patient: This varies based on the purpose of the interview.
explaining results and planning: This aims to ensure a shared understanding, and allowing for shared decision-making.
closing a session: This may involve discussing further plans.
This is designed to give a clear structure to the interview, and to help to build the relationship between the clinician and the patient. The importance of nonverbal communication is noted.
The model is based on 71 skills and techniques that improve patient interviews. These include maintaining eye contact, active listening (not interrupting, giving verbal cues), summarizing information frequently, asking about patient ideas and beliefs, and showing empathy.
Advantages
The Calgary–Cambridge model was developed based on evidence from interviews of patients, and what made them successful. It is generally focussed on the patient and their experience. The guide of skills and techniques is generally seen as comprehensive.
Disadvantages
The Calgary–Cambridge model has been criticized for creating a separation between the process of interviewing a patient and the information gained. The 71 skills are very difficult to incorporate simultaneously, making it more difficult to learn for clinicians than other techniques.
History
The Calgary–Cambridge model is named after Calgary, Canada, and Cambridge, United Kingdom where the three authors worked. It is popular in medical education in many countries. It has also been adapted for veterinarians. Other models, such as the Global Consultation Rating Scale, have been based on the Calgary–Cambridge model.
References
External links
Book chapter summarising the model and the 71 skills
Practice of medicine
Theory of medicine
Interviews
Medical education | 0.775599 | 0.976316 | 0.75723 |
M'Naghten rules | The M'Naghten rule(s) (pronounced, and sometimes spelled, McNaughton) is a legal test defining the defence of insanity, first formulated by the House of Lords in 1843. It is the established standard in UK criminal law. Versions have been adopted in some US states, currently or formerly, and other jurisdictions, either as case law or by statute. Its original wording is a proposed jury instruction:
The rule was created in reaction to the acquittal in 1843 of Daniel M'Naghten on the charge of murdering Edward Drummond. M'Naghten had shot Drummond after mistakenly identifying him as the British Prime Minister Robert Peel, who was the intended target. The acquittal of M'Naghten on the basis of insanity, a hitherto unheard-of defence per se in modern form, caused a public uproar, with protests from the establishment and the press, even prompting Queen Victoria to write to Robert Peel calling for a "wider interpretation of the verdict". The House of Lords, using a medieval right to question judges, asked a panel of judges presided over by Sir Nicolas Conyngham Tindal, Chief Justice of the Common Pleas, a series of hypothetical questions about the defence of insanity. The principles expounded by this panel have come to be known as the "M'Naghten Rules". M'Naghten himself would have been found guilty if they had been applied at his trial.
The rules so formulated as M'Naghten's Case 1843 10 C & F 200, or variations of them, are a standard test for criminal liability in relation to mentally disordered defendants in various jurisdictions, either in common law or enacted by statute. When the tests set out by the rules are satisfied, the accused may be adjudged "not guilty by reason of insanity" or "guilty but insane" and the sentence may be a mandatory or discretionary, but usually indeterminate, period of treatment in a secure hospital facility, or otherwise at the discretion of the court, depending on the country and the offence charged, instead of a punitive disposal.
Historical development
There are various justifications for the exemption of the insane from criminal responsibility. When mental incapacity is successfully raised as a defence in a criminal trial it absolves a defendant from liability: it applies public policies in relation to criminal responsibility by applying a rationale of compassion, accepting that it is morally wrong to punish a person if that person is deprived permanently or temporarily of the capacity to form a necessary mental intent that the definition of a crime requires. Punishment of the obviously mentally ill by the state may undermine public confidence in the penal system. A utilitarian and humanitarian approach suggests that the interests of society are better served by treatment.
Historically, insanity was seen as grounds for leniency. In pre-Norman times in England there was no distinct criminal code – a murderer could pay compensation to the victim's family under the principle of "buy off the spear or bear it". The insane person's family were expected to pay any compensation for the crime. In Norman times, insanity was not seen as a defence in itself, but a special circumstance in which the jury would deliver a guilty verdict and refer the defendant to the King for a pardon
since they are without sense and reason and can no more commit a tort or a felony than a brute animal, since they are not far removed from brutes, as is evident in the case of a minor, for if he should kill another while under age he would not suffer judgment.
In R v Arnold 1724 16 How St. Tr. 765, the test for insanity was expressed in the following terms
whether the accused is totally deprived of his understanding and memory and knew what he was doing "no more than a wild beast or a brute, or an infant".
The next major advance occurred in Hadfield's Trial 1800 27 How St. Tr. 765, in which the court decided that a crime committed under some delusion would be excused, only if it would have been excusable had the delusion been true. This would deal with the situation, for example, when the accused imagines he is cutting through a loaf of bread, whereas in fact he is cutting through a person's neck.
Each jurisdiction may have its own standards of the insanity defence. More than one standard can be applied to any case based on multiple jurisdictions.
M'Naghten rules
The House of Lords delivered the following exposition of the rules:
the jurors ought to be told in all cases that every man is to be presumed to be sane, and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved to their satisfaction; and that to establish a defence on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong.
The central issue of this definition may be stated as, "Did the defendant know what he was doing, or, if so, that it was wrong?", and the issues raised have been analysed in subsequent appellate decisions.
Presumption of sanity and burden of proof
Sanity is a rebuttable presumption and the burden of proof is on the party denying it; the standard of proof is on a balance of probabilities, that is to say that mental incapacity is more likely than not. If this burden is successfully discharged, the party relying upon it is entitled to succeed. In Lord Denning's judgement in Bratty v Attorney-General for Northern Ireland 1963 AC 386, whenever the defendant makes an issue of his state of mind, the prosecution can adduce evidence of insanity. However, this will normally only arise to negate the defence case when automatism or diminished responsibility is in issue.
In practical terms, the defence will be more likely to raise the issue of mental incapacity to negate or minimise criminal liability. In R v Clarke 1972 1 All E R 219 a defendant charged with a shoplifting claimed she had no mens rea because she had absent-mindedly walked out of the shop without paying because she suffered from depression. When the prosecution attempted to adduce evidence that this constituted insanity within the Rules, she changed her plea to guilty, but on appeal the Court ruled that she had been merely denying mens rea rather than raising a defence under the Rules and her conviction was quashed. The general rule was stated that the Rules apply only to cases in which the defect of reason is substantial.
Disease of the mind
Whether a particular condition amounts to a disease of the mind within the Rules is not a medical but a legal question to be decided in accordance with the ordinary rules of interpretation. It seems that any disease which produces a malfunctioning of the mind is a disease of the mind and need not be a disease of the brain itself. The term has been held to cover numerous conditions:
The courts have clearly drawn a distinction between internal and external factors affecting a defendant's mental condition. This is partly based on risk of recurrence, whereby the High Court of Australia has expressed that the defence of automatism is unable to be considered when the mental disorder has been proved transient and as such not likely to recur. However, the distinction between insanity and automatism is difficult because the distinction between internal and external divide is difficult.
Many diseases consist of a predisposition, considered an internal cause, combined with a precipitant, which would be considered an external cause. Actions committed while sleepwalking would normally be considered as "non-insane automatism", but often alcohol and stress trigger bouts of sleepwalking and make them more likely to be violent. The diabetic who takes insulin but does not eat properly – is that an internal or external cause?
Nature and quality of the act
This phrase refers to the physical nature and quality of the act, rather than the moral quality. It covers the situation where the defendant does not know what he is physically doing. Two common examples used are:
The defendant cuts a woman's throat under the delusion that he is cutting a loaf of bread,
The defendant chops off a sleeping man's head because he has the deluded idea that it would be great fun to see the man looking for it when he wakes up.
The judges were specifically asked if a person could be excused if he committed an offence in consequence of an insane delusion. They replied that if he labours under such partial delusion only, and is not in other respects insane, "he must be considered in the same situation as to responsibility as if the facts with respect to which the delusion exists were real". This rule requires the court to take the facts as the accused believed them to be and follows Hadfield's Trial, above. If the delusions do not prevent the defendant from having mens rea there will be no defence.
In R v Bell 1984 Crim. LR 685, the defendant smashed a van through the entrance gates of a holiday camp because "It was like a secret society in there, I wanted to do my bit against it" as instructed by God. It was held that, as the defendant had been aware of his actions, he could neither have been in a state of automatism nor insane, and the fact that he believed that God had told him to do this merely provided an explanation of his motive and did not prevent him from knowing that what he was doing was wrong in the legal sense.
Knowledge that the act was wrong
The interpretation of this clause is a subject of controversy among legal authorities, and different standards may apply in different jurisdictions.
"Wrong" was interpreted to mean legally wrong, rather than morally wrong, in the case of Windle 1952 2QB 826; 1952 2 All ER 1 246, where the defendant killed his wife with an overdose of aspirin; he telephoned the police and said, "I suppose they will hang me for this." It was held that this was sufficient to show that although the defendant was suffering from a mental illness, he was aware that his act was wrong, and the defence was not allowed.
Under this interpretation, there may be cases where the mentally ill know that their conduct is legally prohibited, but it is arguable that their mental condition prevents them making the connection between an act being legally prohibited and the societal requirement to conform their conduct to the requirements of the criminal law.
As an example of a contrasting interpretation in which defendant lacking knowledge that the act was morally wrong meets the M'Naghten standards, there are the instructions the judge is required to provide to the jury in cases in New York State when the defendant has raised an insanity plea as a defence:
... with respect to the term "wrong", a person lacks substantial capacity to know or appreciate that conduct is wrong if that person, as a result of mental disease or defect, lacked substantial capacity to know or appreciate either that the conduct was against the law or that it was against commonly held moral principles, or both.
There is other support in the authorities for this interpretation of the standards enunciated in the findings presented to the House of Lords regarding M'Naghten's case:
If it be accepted, as can hardly be denied, that the answers of the judges to the questions asked by the House of Lords in 1843 are to be read in the light of the then existing case-law and not as novel pronouncements of a legislative character, then the [Australian] High Court's analysis in Stapleton's Case is compelling. Their exhaustive examination of the extensive case-law concerning the defence of insanity prior to and at the time of the trial of M'Naughten establishes convincingly that it was morality and not legality which lay as a concept behind the judges' use of "wrong" in the M'Naghten rules.
Offences of strict liability
In DPP v Harper (1997) it was held that insanity is not generally a defence to strict liability offences. In this instance, the accused was driving with excess alcohol. By definition, the accused is sufficiently aware of the nature of the activity to commit the actus reus of driving and presumably knows that driving while drunk is legally wrong. Any other feature of the accused's knowledge is irrelevant.
Function of the jury
Section 1 of the United Kingdoms' Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 provides that a jury shall not return a special verdict that "the accused is not guilty by reason of insanity" except on the written or oral evidence of two or more registered medical practitioners of whom at least one has special experience in the field of mental disorder. This may require the jury to decide between conflicting medical evidence which they are not necessarily equipped to do, but the law goes further and allows them to disagree with the experts if there are facts or surrounding circumstances which, in the opinion of the court, justify the jury in coming to that conclusion.
Sentencing
Under section 5 of the United Kingdom's Criminal Procedure (Insanity) Act 1964 (as amended):
Where the sentence for the offence to which the finding relates is fixed by law (e.g. murder), the court must make a hospital order (see section 37 Mental Health Act 1983) with a restriction order limiting discharge and other rights (see section 41 Mental Health Act 1983).
In any other case the court may make:
a hospital order (with or without a restriction order);
a supervision order; or
an order for absolute discharge.
Criticisms
There have been four major criticisms of the law as it currently stands:
Medical irrelevance – The legal definition of insanity has not advanced significantly since 1843; in 1953 evidence was given to the Royal Commission on Capital Punishment that doctors even then regarded the legal definition to be obsolete and misleading. This distinction has led to absurdities such as
even though a legal definition suffices, mandatory hospitalisation can be ordered in cases of murder; if the defendant is not medically insane, there is little point in requiring medical treatment.
Article 5 of the European Convention on Human Rights, imported into English law by the Human Rights Act 1998, provides that a person of unsound mind may be detained only where proper account of objective medical expertise has been taken. As yet, no cases have occurred in which this point has been argued.
Ineffectiveness – The rules currently do not distinguish between defendants who represent a public danger and those who do not. Illnesses such as diabetes and epilepsy can be controlled by medication such that sufferers are less likely to have temporary aberrations of mental capacity, but the law does not recognise this.
Sentencing for murder – A finding of insanity may well result in indefinite confinement in a hospital, whereas a conviction for murder may well result in a determinate sentence of between ten and 15 years; faced with this choice, it may be that defendants would prefer the certainty of the latter option. The defence of diminished responsibility in section 2(1) of the Homicide Act would reduce the conviction to voluntary manslaughter with more discretion on the part of the judge in regards to sentencing.
Scope – A practical issue is whether the fact that an accused is labouring under a "mental disability" should be a necessary but not sufficient condition for negating responsibility i.e. whether the test should also require an incapacity to understand what is being done, to know that what one is doing is wrong, or to control an impulse to do something and so demonstrate a causal link between the disability and the potentially criminal acts and omissions. For example, the Irish insanity defence comprises the M'Naghten Rules and a control test that asks whether the accused was debarred from refraining from committing the act because of a defect of reason due to mental illness (see Doyle v Wicklow County Council 1974) 55 IR 71. The Butler Committee recommended that proof of severe mental disorder should be sufficient to negate responsibility, in effect creating an irrebuttable presumption of irresponsibility arising from proof of a severe mental disorder. This has been criticised as it assumes a lack of criminal responsibility simply because there is evidence of some sort of mental dysfunction, rather than establishing a standard of criminal responsibility. According to this view, the law should be geared to culpability not mere psychiatric diagnosis.
Alternative rules
The insanity defence article has a number of alternative tests that have been used at different times and places. As one example, the ALI test replaced the M'Naghten rule in many parts of the United States for many years until the 1980s; when, in the aftermath of John Hinckley shooting US President Ronald Reagan, many ALI states returned to a variation of M'Naghten.
Case law
People v. Drew
In popular culture
The M'Naghten rules are at the focus of John Grisham's legal thriller A Time to Kill. The M'Naghten rules apply in the US State of Mississippi, where the plot is set, and using them is the only way for the lawyer protagonist to save his client.
See also
Insanity defence
Policeman at the elbow
References
Notes
Bibliography
Boland, F. (1996). "Insanity, the Irish Constitution and the European Convention on Human Rights". 47 Northern Ireland Legal Quarterly 260.
Butler Committee. (1975). The Butler Committee on Mentally Abnormal Offenders, London: HMSO, Cmnd 6244
Gostin, L. (1982). "Human Rights, Judicial Review and the Mentally Disordered Offender". (1982) Crim. LR 779.
The Law Reform Commission of Western Australia. The Criminal Process and Persons Suffering from Mental Disorder, Project No. 69, August 1991.
External links
M'Naghten Rule – FindLaw
Criminal defenses
Forensic psychology
English criminal law
English law
Insanity in law
Rules
1843 in British law
Mental health legal history of the United Kingdom | 0.760372 | 0.995819 | 0.757193 |
Priory Hospital | The Priory Hospital, Roehampton, often referred to as The Priory, is a private mental health hospital in South West London. It was founded in 1872 and is now part of the Priory Group, which was acquired in 2011 by an American private equity firm, Advent International.
The Priory has an international reputation and, because of the number of celebrities who have sought treatment there, widespread coverage in the press. The hospital treats mild to moderate mental health issues, such as stress and anxiety, through outpatient treatments such as cognitive behavioural therapy as well as in-patient care for more severe psychiatric illness such as depression, psychotic illness, addictions or eating disorders. It has residential facilities for 107 patients.
Building
The Priory operates from a Grade II listed building located in Roehampton in south-west London. Originally a private home, it was built in 1811 in the Gothic revival style. The Priory has been variously described in the press as a "white Gothic mansion", "Strawberry Hill Gothic", and "a white-painted fantasy of Gothic spikes and battlements".
History
The building was converted from a private home into a hospital in 1872 by William Wood, one of the first modern psychiatrists. It is London's longest established private psychiatric hospital. Early celebrity patients included, in the 1880s, the wife of the Victorian politician Jabez Balfour, and, in the 1960s, the American singer Paul Robeson.
In 1980 the hospital was acquired by an American healthcare company, and became the first clinic in what was to become the Priory Group. The Priory subsequently benefited from two developments in the 1980s. Firstly, celebrities began seeking treatment at the hospital, attracted not only by clinical excellence, but also by location and, according to one press report, "a version, much-updated, of the smartest 19th century spa experience". Secondly, the National Health Service was forced to close down some of its mental health hospitals and instead began referring patients to the Priory. By the early 1990s, almost half the Priory Group's patients were funded by the UK government.
The Priory has also been subject to adverse comment in recent years. The British Association for Counselling and Psychotherapy has criticised the hospital for offering treatment for "lifestyle addictions", such as compulsive texting, and because patients were paying for "the kudos attached to the clinic's name" (although it acknowledged the hospital provided a first-class service).
The Priory is regulated by the UK's Care Quality Commission and is registered with the commission to provide medical treatment including the treatment of patients detained under the Mental Health Act 1983. In 2011, the Commission inspected the Priory and found that it "was not meeting one or more essential standards. Improvements are needed." The commission has also stated that they have required the Priory to undertake improvements in four out of the five areas which they reviewed: treating people with respect and involving them in their care; providing care, treatment and support that meets people's needs; staffing; and quality and suitability of management. In the remaining fifth area, caring for people safely and protecting them from harm, the Commission considered that all standards were met and no improvements were required.
It was reported in 2010 that the Priory had undergone a £3 million refurbishment to restore it to its original 1811 condition. Rooms were reportedly refurnished and repainted in colours intended to promote "well-being".
Ultimate ownership of the Priory has passed through several hands since the 1980s and, in 2011, the Priory Group was sold to Advent International, an American private equity firm, by the then owner the Royal Bank of Scotland.
Facilities
The Priory is the flagship hospital of the Priory Group and is best known for treating celebrities particularly for drug addiction. It has been described as the British equivalent of the Betty Ford Clinic in terms of its popular image.
Treatment programmes
The hospital provides outpatient and day patient care for people suffering from mild to moderate mental health issues and in-patient care for more severe psychiatric illness such as depression, psychotic illness or eating disorders. Its healthcare services cover the following:
General psychiatry including depression, anxiety, post traumatic stress disorder, obsessive compulsive disorders, schizophrenia and other acute psychiatric illnesses.
Addiction treatment programme for addictions relating to alcohol, drugs, gambling, relationships and shopping
Eating disorder unit and day care services with programmes for anorexia, bulimia, binge eating and other conditions related to eating disorders.
Child and adolescent mental health service for ages 12 to 18.
Treatments offered reportedly include cognitive behavioural therapy, psychotherapy, EMDR (eye movement desensitisation and reprocessing), Neuro-linguistic Programming (NLP) equine assisted psychotherapy, psychodrama, and art and movement therapy. ECT (Electro-convulsive therapy) is also used, with about 500 to 600 treatments per year. The other facilities include a fully equipped gym with fitness instructor, tai chi, yoga, and aerobics classes, swimming, aromatherapy and shiatsu massage. It has residential facilities for 107 patients who stay in individual rooms with en-suite bathrooms; fees are said to be in excess of £2,500 per week.
It has been reported that the Priory has had contracts with the UK's Ministry of Defence to treat military personnel (including for PTSD, post-traumatic stress disorder) and with the BBC to treat a number of its executives.
Priory Lodge School
In 2010, the hospital opened the Priory Lodge School in its grounds. The school specialises in caring for and educating children with autistic spectrum disorders, in particular Asperger’s Syndrome and associated learning difficulties and charges fees of £65,000 per year. In 2014 it was rated "Good" by Ofsted, the second-highest rating in a four-point scale.
Celebrity patients
Caroline Aherne
Lily Allen
Michael Barrymore
George Best
Susan Boyle
Antonio Carluccio
Tom Chaplin
Craig Charles
Eric Clapton
Graham Coxon
Pete Doherty
Johnny Depp
Richey Edwards
Michael Elphick
Paul Gascoigne
Jade Goody
Justin Hawkins
Lady Isabella Hervey
Michael Johnson
John McGeogh
Jim Mollison
Kate Moss
Sinéad O'Connor
António Horta Osório
Ronnie O'Sullivan
Marti Pellow
Katie Price
Gail Porter
Paul Robeson
Ruby Wax
Robbie Williams
Amy Winehouse
Paula Yates
See also
List of hospitals in England
Grovelands Park, a Priory Hospital in Southgate, London
References
External links
NHS online: the Priory Hospital, Roehampton
Priory Group: The Priory Hospital Roehampton Overview
1872 establishments in England
Addiction organisations in the United Kingdom
Drug and alcohol rehabilitation centers
Gothic Revival architecture in London
Grade II listed buildings in the London Borough of Wandsworth
Grade II listed houses in London
Hospitals established in 1872
Hospitals in London
Psychiatric hospitals in England
Private hospitals in the United Kingdom
Roehampton | 0.766574 | 0.987748 | 0.757181 |
Stilted speech | In psychiatry, stilted speech or pedantic speech is communication characterized by situationally inappropriate formality. This formality can be expressed both through abnormal prosody as well as speech content that is "inappropriately pompous, legalistic, philosophical, or quaint". Often, such speech can act as evidence for autism spectrum disorder (ASD) or a thought disorder, a common symptom in schizophrenia or schizoid personality disorder.
To diagnose stilted speech, researchers have previously looked for the following characteristics:
speech conveying more information than necessary
vocabulary and grammar expected from formal writing rather than conversational speech
unneeded repetition or corrections
While literal and long-winded word content is often the most identifiable feature of stilted speech, such speech often displays irregular prosody, especially in resonance. Often, the loudness, pitch, rate, and nasality of pedantic speech vary from normal speech, resulting in the perception of pedantic or stilted speaking. For example, overly loud or high-pitched speech can come across to listeners as overly forceful while slow or nasal speech creates an impression of condescension.
These attributions, which are commonly found in patients with ASD, partially account for why stilted speech has been considered a diagnostic criterion for the disorder. Stilted speech, along with atypical intonation, semantic drift, terseness, and perseveration, are all known deficits with adolescents on the autistic spectrum. Often, stilted speech found in children with ASD will also be especially stereotypic or in some cases even rehearsed.
Patients with schizophrenia are also known to experience stilted speech. This symptom is attributed to both an inability to access more commonly used words and a difficulty understanding pragmatics—the relationship between language and context. However, stilted speech appears as a less common symptom compared to a certain number of other symptoms of the psychosis (Adler et al 1999). This element of cognitive disorder is also exhibited as a symptom in the narcissistic personality disorder (Akhtar & Thomson 1982).
See also
Communication deviance
Literary language
Register (sociolinguistics)
References
Symptoms and signs of mental disorders
Communication disorders
Autism | 0.761063 | 0.994746 | 0.757065 |
Acute stress reaction | Acute stress reaction (ASR, also known as psychological shock, mental shock, or simply shock) and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).
Diagnostic criteria
The International Classification of Diseases (ICD) treats this condition differently from the Diagnostic and Statistical Manual of Mental Disorders (DSM).
According to the ICD-11, acute stress reaction refers to the symptoms experienced a few hours to a few days after exposure to a traumatic event. In contrast, DSM-5 defines acute stress disorder by symptoms experienced 48 hours to one month following the event. Symptoms experienced for longer than one month are consistent with a diagnosis of PTSD per both classifications.
Acute stress reaction per ICD
The ICD-11 MMS gives the following description:
Acute stress disorder per DSM
According to the DSM-5, acute stress disorder requires the exposure to actual or threatened death, serious injury, or sexual violation by either directly experiencing it, witnessing it in person, learning it occurred to a close family or friend, or experiencing repeated exposure to aversive details of a traumatic event. In addition to the initial exposure, individuals may also present with a variety of different symptoms that fall within several clusters including intrusion, negative mood, dissociation, avoidance of distressing memories and emotional arousal. Intrusion symptoms include recurring and distressing dreams, flashbacks, or memories related to the traumatic event and related somatic symptoms. Negative mood refers to ones inability to experience positive emotions such as happiness or satisfaction. Dissociative symptoms include a sense of numbing or detachment from emotional reactions, a sense of physical detachment, decreased awareness of one's surroundings, the perception that one's environment is unreal or dreamlike, and the inability to recall critical aspects of the traumatic event (dissociative amnesia). Emotional arousal symptoms include sleep disturbances, hypervigilance, difficulties with concentration, more common startle response, and irritability. Symptom presentation must last for at least three consecutive days after trauma exposure to be classified as acute stress disorder. If symptoms persist past one month, the diagnosis of PTSD should be assessed for. The presenting symptoms must also cause significant impairment in multiple domains of one's life to be diagnosed.
Additional diagnoses that may develop from acute stress disorder include depression, anxiety, mood disorders, and substance abuse problems. Untreated acute stress disorder can also lead to the development of post-traumatic stress disorder.
Diagnostic assessment
Evaluation of patients is done through close examination of emotional response. Using self-report from patients is a large part of diagnosing acute stress disorder, as acute stress is the result of reactions to stressful situations.
Development and course
There are several theoretical perspectives on trauma response, including cognitive, biological, and psycho-biological. While PTSD-specific, these theories are still useful in understanding acute stress disorder, as the two disorders share many symptoms. A recent study found that even a single stressful event may have long-term consequences on cognitive function. This result calls the traditional distinction between the effects of acute and chronic stress into question.
Risk factors
Risk factors for developing acute stress disorder include a previously existing mental health diagnosis, avoidant coping mechanisms, and exaggerated appraisals of events. Additional factors also include prior trauma history and heightened emotional reactivity. The DSM-5 specifies that there is a higher prevalence of acute stress disorder among females compared to males due to neurobiological gender differences in stress response, as well as an alleged higher risk of experiencing traumatic events (a now defunct assumption originating from the continued prevalence of the Duluth Model in the legal cultures of relevant demographics, despite its having been soundly discredited in modern times by an overwhelming body of combined research and clinical experience); even though this specification has since been demonstrated to be erroneous, no official updates to the DSM have been committed to reflect as much. As a consequence of this oversight combined with the multitude of pervasive social stigmas and double-standards currently surrounding male mental health in many areas of the world, acute stress disorder and PTSD are both under-reported and under-diagnosed in a majority of male populations to date. A substantially increased realization of risk factors followed by a corresponding surge in diagnoses for males over the next several decades should be expected.
Types
Sympathetic
Sympathetic acute stress disorder is caused by the release of excessive adrenaline and norepinephrine into the nervous system. These hormones may speed up a person's pulse and respiratory rate, dilate pupils, or temporarily mask pain. This type of ASR developed as an evolutionary advantage to help humans survive dangerous situations. The "fight or flight" response may allow for temporarily-enhanced physical output, even in the face of severe injury. However, other physical illnesses become more difficult to diagnose, as ASR masks the pain and other vital signs that would otherwise be symptomatic.
Parasympathetic
Parasympathetic acute stress disorder is characterised by feeling faint and nauseated. This response is fairly often triggered by the sight of blood. In this stress response, the body releases acetylcholine. In many ways, this reaction is the opposite of the sympathetic response, in that it slows the heart rate and can cause the patient to either regurgitate or temporarily lose consciousness. The evolutionary value of this is unclear, although it may have allowed for prey to appear dead to avoid being eaten.
Pathophysiology
Stress is characterised by specific physiological responses to adverse or noxious stimuli.
Hans Selye was the first to coin the term "general adaptation syndrome" to suggest that stress-induced physiological responses proceed through the stages of alarm, resistance, and exhaustion.
The sympathetic branch of the autonomic nervous system gives rise to a specific set of physiological responses to physical or psychological stress. The body's response to stress is also termed a "fight or flight" response, and it is characterised by an increase in blood flow to the skeletal muscles, heart, and brain, a rise in heart rate and blood pressure, dilation of pupils, and an increase in the amount of glucose released by the liver.
The onset of an acute stress response is associated with specific physiological actions in the sympathetic nervous system, both directly and indirectly through the release of adrenaline and, to a lesser extent, noradrenaline from the medulla of the adrenal glands. These catecholamine hormones facilitate immediate physical reactions by triggering increases in heart rate and breathing, constricting blood vessels. An abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviours often related to combat or escape.
Normally, when a person is in a serene, non-stimulated state, the firing of neurons in the locus ceruleus is minimal. A novel stimulus, once perceived, is relayed from the sensory cortex of the brain through the thalamus to the brain stem. That route of signalling increases the rate of noradrenergic activity in the locus ceruleus, and the person becomes more alert and attentive to their environment.
If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system. The activation of the sympathetic nervous system leads to the release of norepinephrine from nerve endings acting on the heart, blood vessels, respiratory centers, and other sites. The ensuing physiological changes constitute a major part of the acute stress response. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis. Stress activates this axis and produces neuro-biological changes. These chemical changes increase the chances of survival by bringing the physiological system back to homeostasis.
The autonomic nervous system controls all automatic functions in the body and contains two subsections within it that aid the response to an acute stress reaction. These two subunits are the sympathetic nervous system and the parasympathetic nervous system. The sympathetic response is colloquially known as the "fight or flight" response, indicated by accelerated pulse and respiration rates, pupil dilation, and a general feeling of anxiety and hyper-awareness. This is caused by the release of epinephrine and norepinephrine from the adrenal glands. The epinephrine and norepinephrine strike the beta receptors of the heart, which feeds the heart's sympathetic nerve fibres to increase the strength of heart muscle contraction; as a result, more blood gets circulated, increasing the heart rate and respiratory rate. The sympathetic nervous system also stimulates the skeletal system and muscular system to pump more blood to those areas to handle the acute stress. Simultaneously, the sympathetic nervous system inhibits the digestive system and the urinary system to optimise blood flow to the heart, lungs, and skeletal muscles. This plays a role in the alarm reaction stage. The parasympathetic response is colloquially known as the "rest and digest" response, indicated by reduced heart and respiration rates, and, more obviously, by a temporary loss of consciousness if the system is fired at a rapid rate. The parasympathetic nervous system stimulates the digestive system and urinary system to send more blood to those systems to increase the process of digestion. To do this, it must inhibit the cardiovascular system and respiratory system to optimise blood flow to the digestive tract, causing low heart and respiratory rates. The parasympathetic nervous system plays no role in acute stress response.
Studies have shown that patients with acute stress disorder have overactive right amygdalae and prefrontal cortices; both structures are involved in the fear-processing pathway.
Treatment
This disorder may resolve itself with time or may develop into a more severe disorder, such as PTSD. However, results of Creamer, O'Donnell, and Pattison's (2004) study of 363 patients suggests that a diagnosis of acute stress disorder had only limited predictive validity for PTSD. Creamer et al. found that re-experiences of the traumatic event and arousal were better predictors of PTSD. Early pharmacotherapy may prevent the development of post-traumatic symptoms. Additionally, early trauma-focused cognitive behavioural therapy (TF-CBT) for those with a diagnosis of ASD can protect an individual from developing chronic PTSD.
Studies have been conducted to assess the efficacy of counselling and psychotherapy for people with acute stress disorder. Cognitive behavioural therapy, which includes exposure and cognitive restructuring, was found to be effective in preventing PTSD in patients diagnosed with acute stress disorder with clinically significant results at six-month follow-up appointments. A combination of relaxation, cognitive restructuring, imaginal exposure, and in-vivo exposure was superior to supportive counselling. Mindfulness-based stress reduction programmes also appear to be effective for stress management.
The pharmacological approach has made some progress in lessening the effects of ASD. To relax patients and allow for better sleep, Prazosin can be given to patients, which regulates their sympathetic response. Hydrocortisone has shown some success as an early preventative measure following a traumatic event, typically in the treatment of PTSD.
In a wilderness context where counselling, psychotherapy, and cognitive behavioural therapy is unlikely to be available, the treatment for acute stress reaction is very similar to the treatment of cardiogenic shock, vascular shock, and hypovolemic shock; that is, allowing the patient to lie down, providing reassurance, and removing the stimulus that prompted the reaction. In traditional shock cases, this generally means relieving injury pain or stopping blood loss. In an acute stress reaction, this may mean pulling a rescuer away from the emergency to calm down or blocking the sight of an injured friend from a patient.
History
The term "acute stress disorder" (ASD) was first used to describe the symptoms of soldiers during World War I and II, and it was therefore also termed "combat stress reaction" (CSR). Approximately 20% of U.S. troops displayed symptoms of CSR during WWII. It was assumed to be a temporary response of healthy individuals to witnessing or experiencing traumatic events. Symptoms include depression, anxiety, withdrawal, confusion, paranoia, and sympathetic hyperactivity.
The American Psychiatric Association officially included ASD in the DSM-IV in 1994. Before that, symptomatic individuals within the first month of trauma were diagnosed with adjustment disorder.
Initially, being able to describe different ASRs was one of the goals of introducing ASD. Some criticisms surrounding ASD's focal point include issues with ASD recognising other distressing emotional reactions, like depression and shame. Emotional reactions similar to these may then be diagnosed as adjustment disorder under the current system of trying to diagnose ASD.
Since its addition to the DSM-IV, questions about the efficacy and purpose of the ASD diagnosis have been raised. The diagnosis of ASD was criticized as an unnecessary addition to the progress of diagnosing PTSD, as some considered it more akin to a sign of PTSD than an independent issue requiring diagnosis. Also, the terms ASD and ASR have been criticized for not fully covering the range of stress reactions.
In animals
Notes
References
Aftermath of war
Shock
Stress-related disorders | 0.760194 | 0.995838 | 0.757031 |
Penology | Penology is a subfield of criminology that deals with the philosophy and practice of various societies in their attempts to repress criminal activities, and satisfy public opinion via an appropriate treatment regime for persons convicted of criminal offences.
The Oxford English Dictionary defines penology as "the study of the punishment of crime and prison management," and in this sense it is equivalent with corrections. The term penology comes from "penal", Latin poena, "punishment" and the Greek suffix -logia, "study of".
Penology is concerned with the effectiveness of those social processes devised and adopted for the prevention of crime, via the repression or inhibition of criminal intent via the fear of punishment. The study of penology therefore deals with the treatment of prisoners and the subsequent rehabilitation of convicted criminals. It also encompasses aspects of probation (rehabilitation of offenders in the community) as well as penitentiary science relating to the secure detention and retraining of offenders committed to secure institutions.
Penology concerns many topics and theories, including those concerning prisons (prison reform, prisoner abuse, prisoners' rights, and recidivism), as well as theories of the purposes of punishment (deterrence, retribution, incapacitation and rehabilitation). Contemporary penology concerns itself mainly with criminal rehabilitation and prison management. The word seldom applies to theories and practices of punishment in less formal environments such as parenting, school and workplace correctional measures.
History
Historical theories were based on the notion that fearful consequences would discourage potential offenders. An example of this principle can be found in the Draconian law of Ancient Greece and the Bloody Code which persisted in Renaissance England, when (at various times) capital punishment was prescribed for over 200 offenses. Similarly, certain hudud offenses under Sharia hadith tradition may incur fearful penalties.
Modern theories of the punishment and rehabilitation of offenders are broadly based on principles articulated in the seminal pamphlet "On Crimes and Punishments" published by Cesare, Marquis of Beccaria in 1764. They center on the concept of proportionality. In this respect, they differ from many previous systems of punishment, for example, England's Bloody Code, under which the penalty of theft had been the same regardless of the value stolen, giving rise to the English expression "It is as well to be hanged for a sheep or a lamb". Subsequent development of the ideas of Beccaria made non-lethal punishment more acceptable. Consequently, convicted prisoners had to be re-integrated into society when their punishment was complete.
Penologists have consequently evolved occupational and psychological education programs for offenders detained in prison, and a range of community service and probation orders which entail guidance and aftercare of the offender within the community. The importance of inflicting some measure of punishment on those persons who breach the law is however maintained in order to maintain social order and to moderate public outrage which might provoke appeals for cruel vengeance.
More recently, some penologists have shifted from a retributive based punishment to a form of community corrections. "Community corrections involves the management and supervision of offenders in the community. These offenders are serving court-imposed orders either as an alternative to imprisonment or as a condition of their release on parole from prison. This means they must report regularly to their community corrections officer and may have to participate in unpaid community work and rehabilitation programs."
See also
Auburn System
Zebulon Brockway
Elmira Correctional Facility
His Majesty's Prison Service
Offender workforce development
Panopticon
Penal transportation
Prison reform
Protective Pairing
References
Further reading
Diiulio, John J., Governing Prisons: A Comparative Study of Correctional Management, Simon and Schuster, 1990.
Feeley, M. M., & Simon, J. (1992). The new penology: Notes on the emerging strategy of corrections and its implications. Criminology, 30(4), 449-474.
Kazemian, L., McCoy, C., & Sacks, M. (2013). Does law matter? An old bail law confronts the New Penology. Punishment & Society, 15(1), 43-70.
External links
CrimLinks UK based site
Criminal law
Crime | 0.764381 | 0.990375 | 0.757024 |
Steps to an Ecology of Mind | Steps to an Ecology of Mind is a collection of Gregory Bateson's short works over his long and varied career. Subject matter includes essays on anthropology, cybernetics, psychiatry, and epistemology. It was originally published by Ballantine Books in 1972 (republished 2000 with foreword by Mary Catherine Bateson).
Part I: Metalogues
The book begins with a series of metalogues, which take the form of conversations with his daughter Mary Catherine Bateson. The metalogues are mostly thought exercises with titles such as "What is an Instinct" and "How Much Do You Know." In the metalogues, the playful dialectic structure itself is closely related to the subject matter of the piece.
DEFINITION: A metalogue is a conversation about some problematic subject. This conversation should be such that not only do the participants discuss the problem but the structure of the conversation as a whole is also relevant to the same subject. Only some of the conversations here presented achieve this double format.
Notably, the history of evolutionary theory is inevitably a metalogue between man and nature, in which the creation and interaction of ideas must necessarily exemplify evolutionary process.
Why Do Things Get in a Muddle? (01948, previously unpublished)
Why Do Frenchmen? (01951, Impulse ; 01953, ETC: A Review of General Semantics, Vol. X)
About Games and Being Serious (01953, ETC: A Review of General Semantics, Vol. X)
How Much Do You Know? (01953, ETC: A Review of General Semantics, Vol. X)
Why Do Things Have Outlines? (01953, ETC: A Review of General Semantics, Vol. XI)
Why a Swan? (01954, Impulse)
What Is an Instinct? (01969, Sebeok, Approaches to Animal Communication)
Part II: Form and Pattern in Anthropology
Part II is a collection of anthropological writings, many of which were written while he was married to Margaret Mead.
Culture Contact and Schismogenesis (01935, Man, Article 199, Vol. XXXV)
Experiments in Thinking About Observed Ethnological Material (01940, Seventh Conference on Methods in Philosophy and the Sciences ; 01941, Philosophy of Science, Vol. 8, No. 1)
Morale and National Character (01942, Civilian Morale, Watson)
Bali: The Value System of a Steady State (01949, Social Structure: Studies Presented to A.R. Radcliffe-Brown, Fortes)
Style, Grace, and Information in Primitive Art (01967, A Study of Primitive Art, Forge)
Part III: Form and Pathology in Relationship
Part III is devoted to the theme of "Form and Pathology in Relationships." His essay on alcoholism examines the alcoholic state of mind, and the methodology of Alcoholics Anonymous within the framework of the then-nascent field of cybernetics.
Social Planning and the Concept of Deutero-Learning was a "comment on Margaret Mead's article "The Comparative Study of Culture and the Purposive Cultivation of Democratic Values," 01942, Science, Philosophy and Religion, Second Symposium)
A Theory of Play and Fantasy (01954, A.P.A. Regional Research Conference in Mexico City, March 11 ; 01955, A.P.A. Psychiatric Research Reports)
Epidemiology of a Schizophrenia (edited version of a talk, "How the Deviant Sees His Society," from 01955, at a conference on "The Epidemiology of Mental Health," Brighton, Utah)
Toward a Theory of Schizophrenia (01956, Behavioral Science, Vol. I, No. 4)
The Group Dynamics of Schizophrenia (01960)
Minimal Requirements for a Theory of Schizophrenia (01959)
Double Bind, 1969 (01969)
The Logical Categories of Learning and Communication (01968)
The Cybernetics of "Self": A Theory of Alcoholism (01971)
Part IV: Biology and Evolution
On Empty-Headedness Among Biologists and State Boards of Education (in BioScience, Vol. 20, 1970)
The Role of Somatic Change in Evolution (in the journal of Evolution, Vol 17, 1963)
Problems in Cetacean and Other Mammalian Communication (appeared as Chapter 25, pp. 569–799, in Whales, Dolphins and Purpoises, edited by Kenneth S. Norris, University of California Press, 1966)
A Re-examination of "Bateson's Rule" (accepted for publication in the Journal of Genetics)
Part V: Epistemology and Ecology.
Cybernetic Explanation (from the American Behavioral Scientist, Vol. 10, No. 8, April 1967, pp. 29–32)
Redundancy and Coding (appeared as Chapter 22 in Animal Communication: Techniques of Study and Results of Research, edited by Thomas A. Sebeok, 1968, Indiana University Press)
Conscious Purpose Versus Nature (this lecture was given in August, 1968, to the London Conference on the Dialectics of Liberation, appearing in a book of the same name, Penguin Books)
Effects of Conscious Purpose on Human Adaptation (prepared as the Bateson's position paper for Wenner-Gren Foundation Conference on "Effects of Conscious Purpose on Human Adaptation". Bateson chaired the conference held in Burg Wartenstein, Austria, July 17–24, 1968)
Form, Substance, and Difference (the Nineteenth Annual Korzbski Memorial Lecture, January 9, 1970, under the auspices of the Institute of General Semantics; appeared in the General Semantics'' Bulletin, No. 37, 1970)
Part VI: Crisis in the Ecology of Mind
From Versailles to Cybernetics (previously unpublished. This lecture was given 21 April 1966, to the "Two Worlds Symposium" at (CSU) Sacramento State College)
Pathologies of Epistemology (given at the Second Conference on Mental Health in Asia and the Pacific, 1969, at the East–West Center, Hawaii, appearing in the report of that conference)
The Roots of Ecological Crisis (testimony on behalf of the University of Hawaii Committee on Ecology and Man, presented in March 1970)
Ecology and Flexibility in Urban Civilization (written for a conference convened by Bateson in October 1970 on "Restructuring the Ecology of a Great City" and subsequently edited)
See also
Double bind
Information ecology
Philosophy of mind
Social sustainability
Systems philosophy
Systems theory
Notes and references
1972 books
Anthropology books
Cognitive science literature
Systems theory books
University of Chicago Press books | 0.775526 | 0.976018 | 0.756928 |
Psychobabble | Psychobabble (a portmanteau of "psychology" or "psychoanalysis" and "babble") is a derogatory name for therapy speech or writing that uses psychological jargon, buzzwords, and esoteric language to create an impression of truth or plausibility. The term implies that the speaker or writer lacks the experience and understanding necessary for the proper use of psychological terms. Additionally, it may imply that the content of speech deviates markedly from common sense and good judgement.
Some buzzwords that are commonly heard in psychobabble have come into widespread use in business management, motivational seminars, self-help, folk psychology, and popular psychology.
Frequent use of psychobabble can associate a clinical, psychological word with meaningless, or less meaningful, buzzword definitions. Laypersons often use such words when they describe life problems as clinical maladies even though the clinical terms are not meaningful or appropriate.
Most professions develop a unique vocabulary or jargon which, with frequent use, may become commonplace buzzwords. Professional psychologists may reject the "psychobabble" label when it is applied to their own special terminology.
The allusions to psychobabble imply that some psychological concepts lack precision and have become meaningless or pseudoscientific.
Origin
Psychobabble was defined by the writer who coined the word, R.D. Rosen, as a set of repetitive verbal formalities that kills off the very spontaneity, candour, and understanding it pretends to promote. It’s an idiom that reduces psychological insight to a collection of standardized observations that provides a frozen lexicon to deal with an infinite variety of problems. The word itself came into popular use after his 1977 publication of Psychobabble: Fast Talk and Quick Cure in the Era of Feeling.
Rosen coined the word in 1975 in a book review for The Boston Phoenix, then featured it in a cover story for the magazine New Times titled "Psychobabble: The New Language of Candor." His book Psychobabble explores the dramatic expansion of psychological treatments and terminology in both professional and non-professional settings.
Likely contexts
Certain terms considered to be psychological jargon may be dismissed as psychobabble when they are used by laypersons or in discussions of popular psychology themes. New Age philosophies, self-help groups, personal development coaching, and large-group awareness training are often said to employ psychobabble.
The word "psychobabble" may refer contemptuously to pretentious psychological gibberish. Automated talk-therapy offered by various ELIZA computer programs produce notable examples of conversational patterns that are psychobabble, even though they may not be loaded with jargon. ELIZA programs parody clinical conversations in which a therapist replies to a statement with a question that requires little or no specific knowledge.
"Neurobabble" is a related term. Beyerstein (1990) wrote that neurobabble can appear in "ads [that] suggest that brain 'repatterning' will foster effortless learning, creativity, and prosperity." He associated neuromythologies of left/right brain pseudoscience with specific New Age products and techniques. He stated that "the purveyors of neurobabble urge us to equate truth with what feels right and to abandon the commonsense insistence that those who would enlighten us provide at least as much evidence as we demand of politicians or used-car salesmen."
Examples
Psychobabble terms are typically words or phrases which have their roots in psychotherapeutic practice. Psychobabblers commonly overuse such terms as if they possessed some special value or meaning.
Rosen has suggested that the following terms often appear in psychobabble:
co-dependent,
delusion,
denial,
dysfunctional,
empowerment,
holistic,
meaningful relationship,
multiple personality disorder,
narcissism,
psychosis,
self-actualization,
synergy, and
mindfulness.
Extensive examples of psychobabble appear in Cyra McFadden's satirical novel The Serial: A Year in the Life of Marin County (1977). In his collection of critical essays, Working with Structuralism (1981), the British scholar and novelist David Lodge gives a structural analysis of the language used in the novel and notes that McFadden endorsed the use of the term.
In 2010, Theodore Dalrymple defined psychobabble as "the means by which people talk about themselves without revealing anything."
See also
References
Jargon
Popular psychology
Rhetoric
Gibberish language
Diversionary tactics | 0.77043 | 0.982474 | 0.756927 |
Support group | In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. Members with the same issues can come together for sharing coping strategies, to feel more empowered and for a sense of community. The help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others' experiences, providing sympathetic understanding and establishing social networks. A support group may also work to inform the public or engage in advocacy.
History
Formal support groups may appear to be a modern phenomenon, but they supplement traditional fraternal organizations such as Freemasonry in some respects, and may build on certain supportive functions (formerly) carried out in (extended) families.
Other types of groups formed to support causes, including causes outside of themselves, are more often called advocacy groups, interest groups, lobby groups, pressure groups or promotional groups. Trade unions and many environmental groups, for example, are interest groups. The term support group in this article refers to peer-to-peer support.
Maintaining contact
Support groups maintain interpersonal contact among their members in a variety of ways. Traditionally, groups meet in person in sizes that allow conversational interaction. Support groups also maintain contact through printed newsletters, telephone chains, internet forums, and mailing lists. Some support groups are exclusively online (see below).
Membership in some support groups is formally controlled, with admission requirements and membership fees. Other groups are "open" and allow anyone to attend an advertised meeting, for example, or to participate in an online forum.
Management by peers or professionals
A self-help support group is fully organized and managed by its members, who are commonly volunteers and have personal experience in the subject of the group's focus. These groups may also be referred to as fellowships, peer support groups, lay organizations, mutual help groups, or mutual aid self-help groups. Most common are 12-step groups such as Alcoholics Anonymous and self-help groups for mental health.
Professionally operated support groups are facilitated by professionals who most often do not share the problem of the members, such as social workers, psychologists, or members of the clergy. The facilitator controls discussions and provides other managerial service. Such professionally operated groups are often found in institutional settings, including hospitals, drug-treatment centers and correctional facilities. These types of support groups may run for a specified period of time, and an attendance fee is sometimes charged.
Types
In the case of a disease, an identity or a pre-disposition, for example, a support group will provide information, act as a clearing-house for experiences, and may serve as a public relations voice for affected people, other members, and their families. Groups for high IQ or LGBTQIA+ individuals, for example, differ in their inclusivity, but both connect people on the basis of identity or pre-disposition.
For more temporary concerns, such as bereavement or episodic medical conditions, a support group may veer more towards helping those involved to overcome or push through their condition/experience.
Some support groups and conditions for which such groups may be formed are:
Addiction
AIDS
Alzheimer's
Alcoholics Anonymous
Anxiety disorders
Asperger syndrome
Borderline personality disorder
Breastfeeding
Brain attack or Brain trauma
Cancer
Circadian rhythm disorders, e.g. DSPD, Non-24
Codependency
Diabetes
Debtors Anonymous
Domestic violence
Eating disorders
Erythema nodosum
Families of addicts & alcoholics
Fibromyalgia
Gamblers Anonymous
Grief
Infertility
Inflammatory bowel disease
Irritable bowel syndrome
Mental Health
Miscarriage
Mood disorders
Narcolepsy
Parkinson's disease
Red Skin Syndrome/Topical Steroid Addiction and Withdrawal
Sexual abuse survivors
Sleep disorders
Stuttering
Suicide prevention
Ulcerative colitis
Online support groups
Since at least 1982, the Internet has provided a venue for support groups. Discussing online self-help support groups as the precursor to e-therapy, Martha Ainsworth notes that "the enduring success of these groups has firmly established the potential of computer-mediated communication to enable discussion of sensitive personal issues."
In one study of the effectiveness of online support groups among patients with head and neck cancer, longer participation in online support groups were found to result in a better health-related quality of life.
Appropriate groups still difficult to find
A researcher from University College London says the lack of qualitative directories, and the fact that many support groups are not listed by search engines can make finding an appropriate group difficult. Even so, he does say that the medical community needs "to understand the use of personal experiences rather than an evidence-based approach... these groups also impact on how individuals use information. They can help people learn how to find and use information: for example, users swap Web sites and discuss Web sites."
It is not difficult to find an online support group, but it is hard to find a good one. In the article What to Look for in Quality Online Support Groups, John M. Grohol gives tips for evaluating online groups and states: "In good online support groups, members stick around long after they've received the support they were seeking. They stay because they want to give others what they themselves found in the group. Psychologists call this high group cohesion, and it is the pinnacle of group achievement."
Benefits and pitfalls
Several studies have shown the importance of the Internet in providing social support, particularly to groups with chronic health problems. Especially in cases of uncommon ailments, a sense of community and understanding in spite of great geographical distances can be important, in addition to sharing of knowledge.
Online support groups, online communities for those affected by a common problem, give mutual support and provide information, two often inseparable features. They are, according to Henry Potts of University College London, "an overlooked resource for patients." Many studies have looked at the content of messages, while what matters is the effect that participation in the group has on the individual. Potts complains that research on these groups has lagged behind, particularly on the groups which are set up by the people with the problems, rather than by researchers and healthcare professionals. User-defined groups can share the sort of practical knowledge that healthcare professionals can overlook, and they also impact on how individuals find, interpret and use information.
There are many benefits to online support groups that have been found through research studies. Although online support group users are not required to be anonymous, a study conducted by Baym (2010) finds that anonymity is beneficial to those who are lonely or anxious. This does not pertain to some people seeking support groups, because not all are lonely and/or anxious, but for those who are, online support groups are a great outlet where one can feel comfortable honestly expressing themselves because the other users do not know who they are.
A study was conducted by Walther and Boyd (2000) and they found a common trend to why people find online support groups appealing. First, the social distance between members online reduced embarrassment and they appreciated the greater range of expertise offered in the larger online social network. Next, they found that anonymity increased one's confidence in providing support to others and decreased embarrassment. The users of the social support websites were more comfortable being able to reread and edit their comments and discussion forum entries before sending them, and they have access to the website any time during the day. Each of these characteristics of online support groups are not offered when going to an in-person support group.
In a study conducted by Gunther Eysenbach, John Powell, Marina Englesakis, Carlos Rizo, and Anita Stern (2004), the researchers found it difficult to draw conclusions on the effectiveness of online peer-to-peer support groups. In online support groups, people must have the desire to support and help each other, and many times participants go on the sites in order to get help themselves or are limited to a certain subgroup.
An additional benefit to online support groups is that participation is asynchronous. This means that it is not necessary for all participants to be logged into the forum simultaneously in order to communicate. An experience or question can be posted and others can answer questions or comment on posts whenever they are logged in and have an appropriate response. This characteristic allows for participation and mass communication without having to worry about time constraints. Additionally, there are 24-hour chat rooms and spaces for focused conversation at all times of the day or night. This allows users to get the support they need whenever they need it, while remaining comfortable and, if they so wish, anonymous.
Mental health
Although there has been relatively little research on the effectiveness of online support groups in mental health, there is some evidence that online support groups can be beneficial. Large randomised controlled trials have both found positive effects and failed to find positive effects.
See also
Group psychotherapy
Self-help groups for mental health
List of Twelve-Step groups
References
External links
Aftermath of war
Self-care
Types of organization
Personal development
Grief | 0.766586 | 0.987358 | 0.756895 |
Savior complex | In psychology, a savior complex is an attitude and demeanor in which a person believes they are responsible for assisting other people. A person with a savior complex will often experience empathic episodes and commit to impulsive decisions such as volunteering, donating, or advocating for a cause. A person with the complex will usually make an attempt to assist or continue to assist even if they are not helpful or are detrimental to the situation, others, or themselves. It is often associated with other disorders, such as schizophrenia and bipolar disorder, and is commonly used interchangebly with the similar term 'Messiah complex'.
See also
Hero syndrome
Messiah complex
Superman complex
White knight
White savior
References
Complex (psychology)
Popular psychology | 0.760516 | 0.995103 | 0.756791 |
Sexual medicine | Sexual medicine or psychosexual medicine as defined by Masters and Johnsons in their classic Textbook of Sexual Medicine, is "that branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence rate." Examples of disorders treated with sexual medicine are erectile dysfunction, hypogonadism, and prostate cancer. Sexual medicine often uses a multidisciplinary approach involving physicians, mental health professionals, social workers, and sex therapists. Sexual medicine physicians often approach treatment with medicine and surgery, while sex therapists often focus on behavioral treatments.
While literature on the prevalence of sexual dysfunction is very limited especially in women, about 31% of women report at least one sexual dysfunction regardless of age. About 43% of men report at least one sexual dysfunction, and most increase with age except for premature ejaculation.
Scope
Sexual medicine addresses issues of sexual dysfunction, sex education, disorders of sex development, sexually transmitted infections, puberty, and diseases of the reproductive system. The field connects to multiple medical disciplines with varying degrees of overlap including reproductive medicine, urology, psychiatry, genetics, gynaecology, andrology, endocrinology, and primary care.
However, sexual medicine differs from reproductive medicine in that sexual medicine addresses disorders of the sexual organs or psyche as it relates to sexual pleasure, mental health, and well-being, while reproductive medicine addresses disorders of organs that affect reproductive potential.
History
The concept of sexual medicine did not arise in North America until the latter half of the 20th century, specifically around the time of the sexual revolution during the 1960s and 70s where the baby boomer generation had an increase in birth control pill use. Prior to that, open discussion of sex was seen as taboo. Psychoanalytic theories about sexuality, such as those proposed by Sigmund Freud and Helene Deutsch, were considered highly controversial. It was not until the post-World War II baby boom era and the sexual revolution of the 1960s and 1970s that sex, and subsequently sexual disorders, became a more accepted topic of discussion.
In fact, urologists were the first medical specialty to practice sexual medicine. Not only does their practice focus on the urinary tract (the kidneys, urinary bladder, and urethra), there is a large emphasis on male reproductive organs and male fertility. Today, sexual medicine has reached a wider range of medical specialties, as well as psychologists and social workers, to name a few.
What really opened the doors for societal normalcy of sexual medicine was the Massachusetts Male Aging Study performed in 1994 that clearly defined erectile dysfunction (ED) as a condition that affects a large population of American males. It also had reported that, if possible, men would be willing to improve their sexual performance if a medication was deemed to be safe. On March 27, 1998, sildenafil citrate was approved by the Food and Drug Administration (FDA) for the treatment of ED. The approval of Sildenafil transformed the way America talked about a topic that was once very private before.
Diagnosis
Sexual medicine plays a role in a wide range of medical specialties, from a primary care provider to a sexual health physician to a sexologist. A physician's role in taking a sexual history is vital in diagnosing someone who presents with a sexual dysfunction.
There is some anxiety that arises when sex comes up for discussion, especially between a healthcare provider and an individual. It is reported that only 35% of primary care physicians have taken a sexual history and, due to this, there is a gap in achieving holistic healthcare. Clinicians fear individuals are not willing to share information, but in reality, it may be that the provider is shying away from the discussion. This steering away can be a result of lack of training, lack of structured tools and knowledge to assess a sexual history, and fears of offending individuals they are treating. Thus, knowing how to take an objective sexual history can help a clinician narrow down the pathogenesis of an individual's sexual health problem.
Issues related to sexual or reproductive medicine may be inhibited by a reluctance of an individual to disclose intimate or uncomfortable information. Even if such an issue is on an individual's mind, it is important that the physician initiates the subject. Some familiarity with the doctor generally makes it easier for people to talk about intimate issues such as sexual subjects, but for some people, a very high degree of familiarity may make an individual reluctant to reveal such intimate issues. When visiting a health care provider about sexual issues, having both partners of a couple present is often necessary, and is typically a good thing, but may also prevent the disclosure of certain subjects, and, according to one report, increases the stress level.
Taking a sexual history is an important component of sexual medicine when diagnosing an individual with a sexual dysfunction. A sexual history incorporates social, medical, and surgical information, and should touch on all factors that affect an individual's sexuality. Essentially, it is a conversation between a health care provider and an individual that is geared towards obtaining information about the person's sexual health status. If this is done properly, it will be easier for the physician to address concerns the individual may have. Some people may not be comfortable in sharing information, but it is the role of the physician to create a comfortable and non-judgemental, private environment for those they are working with to speak openly.
Sexual dysfunctions in men are often associated with testosterone deficiency. Signs and symptoms of testosterone deficiencies vary in each individual. Therefore, physical examinations could be done for men who suspect testosterone deficiencies to identify physical signs of the disorder. Common physical signs include fatigue, increased body fat, weight gain, muscle weakness, and depressed mood.
Laboratory tests may also be used to assist with diagnosis, such as blood glucose levels, lipid panel, and hormonal profile. Additionally, diagnostic categories of sexual disorders are listed in both the ICD-10 and DSM-5. ICD-10 categorizes the disorders by sexual desire, sexual arousal, orgasm, and sexual pain, while DSM-5 categorizes the dysfunctions by gender, substance/medication induced, paraphilic, or gender dysphoria.
Risk factors for sexual dysfunction
The risk of developing a sexual dysfunction increases with age in both men and women. There are several risk factors that are associated with sexual dysfunction in both men and women. Cardiovascular disease, diabetes mellitus, genitourinary disease, psychological/psychiatric disorders, and presence of a chronic disease are all common risk factors for developing a sexual dysfunction. Endothelial dysfunction is a risk factor that is specifically associated with erectile dysfunction. Past family medical history of sexual dysfunction disorders are also a risk factor for development.
Sociocultural factors may also contribute to sexual problems, such as personal, religious, or cultural beliefs about sex. Personal well-being may also impact an individual's sexual activity. Stress and fatigue may contribute to developing a decreased sexual response or interest. Fatigue may result from poor sleep or another underlying medical problem. Current or past sexual abuse, whether physical or emotional, is also a risk factor for developing sexual problems.
Disorders of sexual function
Sexual dysfunctions are sexual problems that are continuous in a person's life, adding stress and difficulty to personal relationships. Congenital or acquired, these conditions refer to any pathology which interferes with the perception of satisfactory sexual health. Varied conditions include absent sexual organs, hermaphrodite and other genetic malformations, or trauma such as amputation or lacerations.
Examples of conditions which may be treated by specialists in this field include:
Female
Vaginismus
Genito-pelvic pain-penetration disorder
Vulvodynia
Imperforate hymen
Vaginal septum
Vaginitis
Endometriosis
Atrophic vaginitis
Vaginal yeast infection
Pelvic floor dysfunction
Male
Premature ejaculation
Delayed ejaculation
Erectile dysfunction
Retrograde ejaculation
Anejaculation
Hard Flaccid Syndrome
Non-exclusive
Lack or loss of sexual desire (Libido)
Hypoactive sexual desire disorder
Lack of sexual enjoyment
Sexual arousal disorder
Failure of sexual response
Anorgasmia
Hypersexuality
Dyspareunia
Substance or medication induced sexual dysfunction
Painful orgasm
Chronic pelvic pain
Sexually transmitted infection
Hypogonadism
Sexuality issues
Pelvic floor dysfunction
Treatment
Once a diagnosis of sexual dysfunction has been made, treatment is often integrative and individualized. Sexual medicine experts aim to discover both the physical and psychologic factors that are the cause of an individual's sexual dysfunction.
Male sexual dysfunction
The most common male sexual dysfunction disorders are erectile dysfunction (ED), low libido, and ejaculatory dysfunction.
Once etiology and cardiovascular risk factors for ED have been identified, lifestyle or non-pharmacological therapy can be initiated to mitigate risk factors. As of 2018, the American Urological Association (AUA) ED guidelines recommend shared medical decision-making between patient and provider over first-, second-. and third-line therapies. However, phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis), are often recommended due to their favorable efficacy and side effect profile and work by increasing the lifespan of the vasodilator nitric oxide in the corpus cavernosum. Alternative treatments for ED are the use of vacuum-assisted erection devices, intracavernosal injection or intraurethral administration of alprostadil (prostaglandin E1), and surgery if necessary.
Treatment for decreased libido is often directed towards the cause of the low libido. Low levels of hormones such as testosterone, serum prolactin, TSH, and estradiol can be associated with low libido, and thus hormone replacement therapy is often used to restore the levels of these hormones in the body. Low libido can also be secondary to use of medications such as selective serotonin reuptake inhibitors (SSRIs), and so reduction of dose of the SSRI is used to improve libido. Additionally, low libido due to psychological causes is often approached with psychotherapy.
Similarly, treatment of ejaculatory dysfunction such as premature ejaculation is dependent on the etiology. SSRIs, topical anesthetics, and psychotherapy are commonly used to treat premature ejaculation.
Female sexual dysfunction
Similar to male sexual dysfunctions, sexual problems in women are also prevalent; however, they differ in the kind of dysfunction. For example, males have more problems related to function of their reproductive organs, where as for women it is more common to experience psychological problems, like lack of a sexual desire and more pain related to sexual activity. In 2008, 40% of U.S. women reported they were experiencing low sexual desire.
Treatment approach is dependent on the type of dysfunction the women is experiencing.
The treatment of female sexual dysfunction is varied as multiple causes are often identified. Following evaluation of symptoms and diagnosis, the woman's goals for treatment are determined and used to track progress. Health professionals are also trained to include the woman's sexual partner in the treatment plan, including noting any sexual dysfunction of the partner. Referral of the woman or couple to a sex therapist is also common to increase communication and expression of concerns and desires. Finally, conditions associated with the documented sexual dysfunction are simultaneously treated and included in the treatment plan.
Non-pharmacologic treatment for female sexual dysfunction can include lifestyle modifications, biofeedback, and physical therapy. Pharmacologic therapy can include topical treatments, hormone therapy, antidepressants, and muscle relaxants.
In fact, low sexual desire is the most common sexual problem for women at any age. With this, sexual ideas and thoughts are also absent. Counseling sessions addressing changes the couple can make can improve a woman's sexual desire. Other ways to treat include: trying a new sex position, using a sexual toy or device, having sex in an unusual location. Also, a woman enjoying her time with her partner outside of the bedroom, on a "date night", can improve the relationship inside the bedroom.
Sexual pain is another large factor for women, caused by Genitourinary Syndrome of Menopause (GSM), which includes hypoestrogenic vulvovaginal atrophy, provoked pelvic floor hypertonus, and vulvodynia. These can all be treated with lubricants and moisturizers, estrogen, and ospemifene.
Psychiatric barriers
Sexual disorders are common in individuals with psychiatric disorders. Depression and anxiety disorders are strongly connected with reduced sex drive and a lack of sexual enjoyment. These individuals experience a decreased sexual desire and sexual aversion. Bipolar disorder, schizophrenia, obsessive–compulsive personality disorder, and eating disorders, are all associated with an increased risk of sexual dysfunction and dissatisfaction of sexual activity. Many factors can induce sexual dysfunction in individuals with psychiatric disorders, such as the effects of antipsychotics and antidepressants. Treatment may include switching medications to one with less sexual dysfunction side effects, decreasing the dose of the medication to decrease these side effects, or psychiatric counseling therapy.
Lifestyle barriers
General health greatly relates to sexual health in both males and females. Sexual medicine specialists take into consideration unhealthy lifestyle habits that may contribute to the sexual quality of life of individuals who are experiencing sexual dysfunction. Obesity, tobacco smoking, alcohol, substance abuse, and chronic stress are all lifestyle factors that may have negative impacts on sexual health and can lead to the development of sexual dysfunctions. Both obesity and tobacco smoking have negative impacts on cardiovascular and metabolic function, which contributes to the development of sexual dysfunctions. Chronic smoking causes erectile dysfunction in men due to a decrease in vasodilation of vascular endothelial tissue. Alcohol dependence can lead to erectile dysfunction in mend and reduced vaginal lubrication in women. Long term substance abuse of multiple recreational drugs (MDMA, cocaine, heroin, amphetamine), leads to a decrease in sexual desire, inability to achieve orgasm, and a reduction of sexual satisfaction. Chronic stress may potentially contribute to sexual dysfunction, as it can induce high levels of cortisol, which may cause harmful effects in if it remains altered long term. High levels of cortisol have been shown to cause a reduction in gonadic steroids and adrenal androgens. Studies have shown that these steroids and adrenal androgens have effects on genital arousal as well as sexual desire.
Sexual medicine experts are responsible for promoting healthy lifestyle habits in order to help prevent sexual dissatisfaction. Adoption of healthy lifestyle routines include: avoiding drugs, smoke, and excessive alcohol, as well as incorporating regular physical activity accompanied by a balanced diet and use of stress-management strategies. These habits can be proposed before trying to incorporate pharmacological therapies and/or psychiatric therapies.
Sexual dysfunction in transgender persons
Limited research has been performed on sexual dysfunction in those who are transgender, but preliminary research suggests that initiating a sexual relationship is difficult for some. One recent study published in the Journal of Sexual Medicine surveyed 518 transgender individuals about sexual dysfunction and disturbances and reported that difficulty initiating sexual encounters and difficulties achieving orgasm were the most prevalent sexual dysfunctions experienced in the study sample.
Challenges
While the awareness of sexual health importance has increased in regards to individuals' general health and well-being, there is still a taboo that follows sexual health. The perception of sexual health varies among different cultures, as the notion is tied with many cultural norms, religion, laws, traditions, and many more. Sexual medicine is a unique component of the medical practice that has its own challenges. The main obstacle that stands between these discussions have been reported as the lack of education regarding sexual issues in individuals. The discussion of sexual health and taking a sexual history faces barriers as physicians infrequently address these topics in visits, and individuals are reluctant to discuss openly due to the perception that it is the physician's duty to initiate the topic and fears that the conversation will make the physician uncomfortable.
Another challenge in sexual medicine is that in a standard process of drug discovery and development, human tissue and cells are not used in testing the candidate drug. Instead, animal models are often used to study sexual function, pathophysiology of diseases that cause sexual dysfunction, and new drugs. Pharmacokinetic and pharmacodynamic relationships are studied in animal models to test the safety and efficacy of candidate drugs. With animal models, there is a limitation to understanding sexual dysfunction and sexual medicine, as the results achieved can only mount to predictions.
Identification and treatment of female sexual dysfunctions are also a challenge as women often encounter difficulty within multiple disorders and sexual phases. The various sexual phases that are encompassed within female sexual dysfunctions (FSD) include hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), female orgasmic disorder (FOD) and female sexual pain disorders (FPD). Because many of these domains overlap, it is difficult to identify the target of treatment and many limitations are placed in the approach for research. Risk factors for female sexual dysfunctions were observed to be embedded with biopsychosocial aspects in epidemiological studies such as depression, urinary tract symptoms, cancer and cancer treatment, relationship problems, and menopausal transition. As a result, a multidimensional approach must be taken in the identification and treatment of female sexual dysfunctions.
The issue of psychological dilemmas that are associated with sexual dysfunctions is another challenge that is faced in sexual medicine. There are many psychological aspects that are tied in with sexual dysfunctions. Despite much of sex therapy originating from psychological and cognitive-behavioral practices, many of the psychological dynamics have been lost in the sexual medicine protocols. Approaching from a psychological and existential perspective helps link the understanding between sexual function and sexual dysfunction in the individual. Because the psychological aspects underneath the sexual distress are not being addressed within sexual therapy and treatments are mostly focused on the specific symptoms in sexual medicine, there are many situations where individuals still experience disappointment and dissatisfaction within sexual activities despite the dysfunction being resolved.
See also
Reproductive medicine
Sexology
Urology
References
Sexual health | 0.764316 | 0.990148 | 0.756786 |
Acclimatization | Acclimatization or acclimatisation (also called acclimation or acclimatation) is the process in which an individual organism adjusts to a change in its environment (such as a change in altitude, temperature, humidity, photoperiod, or pH), allowing it to maintain fitness across a range of environmental conditions. Acclimatization occurs in a short period of time (hours to weeks), and within the organism's lifetime (compared to adaptation, which is evolution, taking place over many generations). This may be a discrete occurrence (for example, when mountaineers acclimate to high altitude over hours or days) or may instead represent part of a periodic cycle, such as a mammal shedding heavy winter fur in favor of a lighter summer coat. Organisms can adjust their morphological, behavioral, physical, and/or biochemical traits in response to changes in their environment. While the capacity to acclimate to novel environments has been well documented in thousands of species, researchers still know very little about how and why organisms acclimate the way that they do.
Names
The nouns acclimatization and acclimation (and the corresponding verbs acclimatize and acclimate) are widely regarded as synonymous, both in general vocabulary and in medical vocabulary. The synonym acclimation is less commonly encountered, and fewer dictionaries enter it.
Methods
Biochemical
In order to maintain performance across a range of environmental conditions, there are several strategies organisms use to acclimate. In response to changes in temperature, organisms can change the biochemistry of cell membranes making them more fluid in cold temperatures and less fluid in warm temperatures by increasing the number of membrane proteins. In response to certain stressors, some organisms express so-called heat shock proteins that act as molecular chaperones and reduce denaturation by guiding the folding and refolding of proteins. It has been shown that organisms which are acclimated to high or low temperatures display relatively high resting levels of heat shock proteins so that when they are exposed to even more extreme temperatures the proteins are readily available. Expression of heat shock proteins and regulation of membrane fluidity are just two of many biochemical methods organisms use to acclimate to novel environments.
Morphological
Organisms are able to change several characteristics relating to their morphology in order to maintain performance in novel environments. For example, birds often increase their organ size to increase their metabolism. This can take the form of an increase in the mass of nutritional organs or heat-producing organs, like the pectorals (with the latter being more consistent across species).
The theory
While the capacity for acclimatization has been documented in thousands of species, researchers still know very little about how and why organisms acclimate in the way that they do. Since researchers first began to study acclimation, the overwhelming hypothesis has been that all acclimation serves to enhance the performance of the organism. This idea has come to be known as the beneficial acclimation hypothesis. Despite such widespread support for the beneficial acclimation hypothesis, not all studies show that acclimation always serves to enhance performance (See beneficial acclimation hypothesis). One of the major objections to the beneficial acclimation hypothesis is that it assumes that there are no costs associated with acclimation. However, there are likely to be costs associated with acclimation. These include the cost of sensing the environmental conditions and regulating responses, producing structures required for plasticity (such as the energetic costs in expressing heat shock proteins), and genetic costs (such as linkage of plasticity-related genes with harmful genes).
Given the shortcomings of the beneficial acclimation hypothesis, researchers are continuing to search for a theory that will be supported by empirical data.
The degree to which organisms are able to acclimate is dictated by their phenotypic plasticity or the ability of an organism to change certain traits. Recent research in the study of acclimation capacity has focused more heavily on the evolution of phenotypic plasticity rather than acclimation responses. Scientists believe that when they understand more about how organisms evolved the capacity to acclimate, they will better understand acclimation.
Examples
Plants
Many plants, such as maple trees, irises, and tomatoes, can survive freezing temperatures if the temperature gradually drops lower and lower each night over a period of days or weeks. The same drop might kill them if it occurred suddenly. Studies have shown that tomato plants that were acclimated to higher temperature over several days were more efficient at photosynthesis at relatively high temperatures than were plants that were not allowed to acclimate.
In the orchid Phalaenopsis, phenylpropanoid enzymes are enhanced in the process of plant acclimatisation at different levels of photosynthetic photon flux.
Animals
Animals acclimatize in many ways. Sheep grow very thick wool in cold, damp climates. Fish are able to adjust only gradually to changes in water temperature and quality. Tropical fish sold at pet stores are often kept in acclimatization bags until this process is complete. Lowe & Vance (1995) were able to show that lizards acclimated to warm temperatures could maintain a higher running speed at warmer temperatures than lizards that were not acclimated to warm conditions. Fruit flies that develop at relatively cooler or warmer temperatures have increased cold or heat tolerance as adults, respectively (See Developmental plasticity).
Humans
The salt content of sweat and urine decreases as people acclimatize to hot conditions. Plasma volume, heart rate, and capillary activation are also affected.
Acclimatization to high altitude continues for months or even years after initial ascent, and ultimately enables humans to survive in an environment that, without acclimatization, would kill them. Humans who migrate permanently to a higher altitude naturally acclimatize to their new environment by developing an increase in the number of red blood cells to increase the oxygen carrying capacity of the blood, in order to compensate for lower levels of oxygen intake.
See also
Acclimatisation society
Beneficial acclimation hypothesis
Heat index
Introduced species
Phenotypic plasticity
Wind chill
References
Physiology
Ecological processes
Climate
Biology terminology | 0.76112 | 0.994293 | 0.756776 |
The three Rs | The three Rs are three basic skills taught in schools: reading, writing and arithmetic (the "R's", pronounced in the English alphabet "ARs", refer to "Reading, wRiting (where the W is unnecessary), and ARithmetic"). The phrase appears to have been coined at the beginning of the 19th century.
The term has also been used to name other triples (see Other uses).
Origin and meaning
The skills themselves are alluded to in St. Augustine's Confessions: 'learning to read, and write, and do arithmetic'.
The phrase is sometimes attributed to a speech given by Sir William Curtis circa 1807: this is disputed. An extended modern version of the three Rs consists of the "functional skills of literacy, numeracy and ICT".
The educationalist Louis P. Bénézet preferred "to read", "to reason", "to recite", adding, "by reciting I did not mean giving back, verbatim, the words of the teacher or of the textbook. I meant speaking the English language."
Other uses
More recent meanings of "the three Rs" are:
In the subject of CNC code generation by Edgecam Workflow: Rapid, Reliable, and Repeatable
In the subject of sustainability: Reduce, Reuse, and Recycle
In the subject of American politics and the New Deal: Relief, Recovery, and Reform
In animal welfare principles in research (see The Three Rs for animals). The Three Rs principle stands for Reduction, Refinement, and Replacement. It promotes the use of alternative methods whenever possible, reducing the number of animals used, refining the experimental techniques to minimize harm, and replacing animals with non-animal models when feasible
(See also 3R disambiguation)
See also
Standards based education reform
Traditional education
Trivium (education)
Notes
Education reform
Latin words and phrases | 0.763008 | 0.991817 | 0.756764 |
Fregoli delusion | The Fregoli delusion (or Fregoli syndrome) is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. The syndrome may be related to a brain lesion and is often of a paranoid nature, with the delusional person believing themselves persecuted by the person they believe is in disguise.
A person with the Fregoli delusion can also inaccurately recall places, objects, and events. This disorder can be explained by "associative nodes". The associative nodes serve as a biological link of information about other people with a particular familiar face (to the patient). This means that for any face that is similar to a recognizable face to the patient, the patient will recall that face as the person they know.
The Fregoli delusion is classed both as a monothematic delusion, since it only encompasses one delusional topic, and as a delusional misidentification syndrome (DMS), a class of delusional beliefs that involve misidentifying people, places, or objects. Like Capgras delusion, psychiatrists believe it is related to a breakdown in normal face perception.
Signs and symptoms
Signs and symptoms of Fregoli's:
delusions
visual memory deficit
deficit in self-monitoring
deficit in self-awareness
hallucinations
deficit in executive functions
deficit in cognitive flexibility
history of seizure activity
epileptogenic activity
Causes
Levodopa treatment
Levodopa, also known as L-DOPA, is the precursor to several catecholamines, specifically of dopamine, epinephrine and norepinephrine. It is clinically used to treat Parkinson's disease and dopamine-responsive dystonia. Clinical studies have shown that the use of levodopa can lead to visual hallucinations and delusions. In most patients, delusions were more salient than hallucinations. With prolonged use of levodopa, the delusions occupy almost all of a patient's attention. In experimental studies, when the concentration of levodopa decreases, the number of reported delusions decreases as well. It has been concluded that delusions related to antiparkinsonian medications are one of the leading causes of Fregoli syndrome.
Traumatic brain injury
Injury to the right frontal and left temporo-parietal areas can cause Fregoli syndrome. Research by Feinberg, et al. has shown that significant deficits in executive and memory functions follow shortly after damage in the right frontal or left temporoparietal areas. Tests performed on patients that have had a brain injury revealed that basic attention ability and visuomotor processing speed are typically normal. However, these patients made many errors when they were called to participate in detailed attention tasks. Selective attention tests involving auditory targets were also performed, and brain-injured patients had many errors; this meant that they were deficient in their response regulation and inhibition.
The most profound finding in Feinberg et al.'s paper is that performance tests on the retrieval process of memory was significantly damaged in brain-injured patients. They found, however, that these patients chose incorrect answers that were related semantically (i.e., chose vegetable instead of fruit). More importantly, tests of visual memory showed that there was a severe inability in visual recollection. Overall, brain-injured patients were severely impaired in many executive functions such as self-monitoring, mental flexibility, and social reasoning.
Fregoli syndrome is an illusion of positive doubles where there is an over-familiarity with the environment. This over-familiarity may have four causes:
impaired self monitoring — passive acceptance of inaccurate conclusions
faulty filtering — tendency to select salient associations rather than a relevant one
mnemonic association from routine thoughts
perseveration — unable to come up with an alternate hypothesis
Thus, executive dysfunction appears to be necessary to identify one as having Fregoli's syndrome.
Fusiform gyrus
Current research has shown that lesions in the right temporal lobe and the fusiform gyrus may contribute to DMSs. MRIs of patients exemplifying Fregoli symptoms have shown parahippocampal and hippocampal damage in the anterior fusiform gyrus, as well as the middle and inferior of the right temporal gyri. The inferior and medial of the right temporal gyri are the storage locations for long-term memory in retrieving information on visual recognition, specifically of faces; thus, damage to these intricate connections could be one of the leading factors in face misidentification disorders.
Recently, a face-specific area in the fusiform gyrus has been discovered and is close to the anterior fusiform gyrus. MRI studies performed by Hudson, et al. have shown lesions in the anterior fusiform gyrus, which is close to the face specific area (ventral fusiform cortex), may also be associated with Fregoli syndrome and other DMSs. Such damage may cause disruption in long-term visual memory and lead to improper associations of human faces.
On another note, our brains interpret visual scenes in two pathways: one is via the Parietal lobe-occipital dorsal pathway (visual spatial material is analyzed here), and the other is via the temporal-occipital ventral pathway (recognizes objects and faces). Thus, lesions in either structures or disruption of delicate connections may produce DMSs.
Abnormal P300
Delusional misidentification syndrome is thought to occur due to a dissociation between identification and recognition processes. The integration of information for further processing is referred to as working memory (WM). The P300 (P stands for positive voltage potential and the 300 for the 300-millisecond poststimulus) is an index of WM and is used during a WM test in DMS patients. In comparison to normal patients, DMS patients generally exhibit an attenuated amplitude of P300 at many abductions. These patients also exhibit prolonged latencies of P300 at all abductions. These implications suggest that DMSs are accompanied by abnormal WM, specifically affecting the prefrontal cortex (both outside and inside).
Past studies have shown correlations between DMS and damages to the right-hemispheric function, which has an array of functions (insight, 3D shapes, art awareness, imagination, left-hand control, music awareness, etc.). In recent years, the P300 auditory component, which forms in response to a detection task that occurs a short time after a stimulus, has acquired a great deal of recognition. The P300 component is an index of mental activity in that its amplitude increases highly with increased stimuli. This P300 component is correlated with updating the working memory to what is expected in the environment. Other findings enhance the belief that defects in the working memory are associated with DMS. Papageorgio et al.'s paper, psychological evidence for altered information processing in delusional misidentification syndromes, hypothesized that electrophysiological brain activity in the working memory and P300 component can help identify the mechanisms of DMS. Thus, they concentrated on P300 released during a working memory test in DMS patients.
Papageorgio et al. also found that DMS patients had a lower P300 amplitude in the right hemisphere compared to the control group (non-DMS patients). From this result, the researchers implied that shorter P300 amplitudes are highly correlated with gray matter abnormalities; this finding is consistent with the DMS patients' characteristics and the presence of gray-matter deterioration. DMS patients were also found to have prolonged P300 lag, and their memory performance was lower than the control groups. The researchers were, thus, able to imply that DMS patients have trouble in focusing their resources to a stimulus; this was hypothesized to be caused by the neurodegeneration of the right hemisphere. Overall, other research studies have also provided evidence in the correlation of DMS and gray-matter degeneration of the right frontal region, which controls attentional resources. This research is important, because it can help determine the mechanisms of DMS, which can then help conjure a more effective target drug and/or treatment plan for those with DMS.
Treatment
Once it has been positively identified, pharmacotherapy follows. Antipsychotic drugs are the frontrunners in treatment for Fregoli and other DMSs. In addition to antipsychotics, anticonvulsants and antidepressants are also prescribed in some treatment courses.
History
The condition is named after the Italian actor Leopoldo Fregoli, who was renowned for his ability to make quick changes of appearance during his stage act.
P. Courbon and G. Fail first reported the condition in a 1927 paper (Syndrome d'illusion de Frégoli et schizophrénie). They described a 27-year-old woman living in London who believed she was being persecuted by two actors she often saw at the theatre. She believed these people pursued her closely, taking the form of people she knew or met.
Delusional misidentification syndromes and Fregoli
Delusional misidentification syndromes (DMS) are rooted in the inability to register the identity of something, whether it is an object, event, place or even a person. There are various forms of DMS, such as the syndrome of subjective doubles, intermetamorphosis, Capgras syndrome and Fregoli syndrome. However, all of these various syndromes have a common denominator: they are all due to malfunctional familiarity processing during information processing. The most common syndromes are Capgras and Fregoli. Capgras syndrome is the delusional belief that a friend, family member, etc., has been replaced by a twin impostor. Fregoli syndrome is the delusional belief that different people are in fact a single person who is in disguise. Other commonalities among these syndromes are that they are discriminatory in which object(s) are misidentified. Lastly, dopamine hyperactivity is evident in all DMSs and thus, all syndromes utilize antipsychotic medications to help control DMS.
Coexistence of Capgras and Fregoli
Delusional misidentification syndromes (DMSs) are four types of syndromes: the syndrome of subjective doubles, the syndrome of intermetamorphosis, Fregoli delusion and Capgras syndrome. Of the four, Fregoli syndrome is the least frequent, followed by Capgras. Of more rarity is the coexistence of both Fregoli and Capgras syndromes. Coexistence of DMSs are enhanced when coupled with other mental disorders such as schizophrenia, bipolar disorder and other mood disorders. Depersonalization and derealization symptoms are usually manifested in patients exhibiting two misidentification delusions. However, such symptoms have been witnessed to cease once the coexisting DMSs are fully developed.
Fregoli syndrome for environment
Some patients can experience Fregoli delusion for environment or place; in this instance the patient misidentifies their current and unfamiliar location (e.g. a hospital) for a place that is familiar to them, such as their home or job. A patient can simultaneously suffer from Fregoli delusion for both persons and environments. In some cases, the patient holds the belief that they exist in both the correct and an incorrect location, a delusion that has been termed reduplicative paramnesia; the latter being a variant of the delusional misidentification syndromes.
Current research
The study of DMS currently remains controversial, as they are often coupled with many psychological disorders (i.e. schizophrenia, bipolar disorder, obsessive compulsive disorder, etc.). Although there is an abundance of information on DMS, there are still many mysteries of the physiological and anatomical details of DMS. An accurate semiological analysis of higher visual anomalies and their corresponding topographic sites may help elucidate the aetiology of Fregoli's and other misidentification disorders.
In popular culture
Charlie Kaufman's 2015 film Anomalisa has several direct and indirect references to the Fregoli delusion. Kaufman adapted the screenplay from his 2005 audio play Anomalisa, written under the pseudonym Francis Fregoli, and the hotel that Michael stays in is called "The Fregoli".
The science fiction short story "Liking What You See: A Documentary", from the collection Stories of Your Life and Others by Ted Chiang, refers to Fregoli syndrome in the context of artificial targeted neurological impairment.
In March 2020, the delusion was covered in an episode of the BBC medical soap opera Doctors when Lizzie Milton (Adele James) believes she is being stalked by Joe Pasquale.
There is an oblique reference to the delusion in Marco Polo, an episode of The Sopranos. The character Russ Fegoli (R Fegoli being an anagram of Fregoli) is implied to be the father of Paulie "Walnuts" Gualtieri.
See also
Schizophrenia
Cotard delusion, the delusional belief that the sufferer is dead
Capgras delusion, the delusional belief that the sufferer's close friends and/or loved ones have been replaced by identical impostors
Erotomania
Psychosis
Paramnesia
Prosopagnosia
Agnosia
Mirrored-self misidentification
References
Psychosis
Delusional disorders
Delusions | 0.760643 | 0.994839 | 0.756718 |
Mental health law | Mental health law includes a wide variety of legal topics and pertain to people with a diagnosis or possible diagnosis of a mental health condition, and to those involved in managing or treating such people. Laws that relate to mental health include:
employment laws, including laws that prohibit employment discrimination on the basis of a mental health condition, require reasonable accommodations in the workplace, and provide mental health-related leave;
insurance laws, including laws governing mental health coverage by medical insurance plans, disability insurance, workers compensation, and Social Security Disability Insurance;
housing laws, including housing discrimination and zoning;
education laws, including laws that prohibit discrimination, and laws that require reasonable accommodations, equal access to programs and services, and free appropriate public education;
laws that provide a right to treatment;
involuntary commitment and guardianship laws;
laws governing treatment professionals, including licensing laws, confidentiality, informed consent, and medical malpractice;
laws governing admission of expert testimony or other psychiatric evidence in court; and
criminal laws, including laws governing fitness for trial or execution, and the insanity defense.
Mental health law has received relatively little attention in scholarly legal forums. The University of Memphis Cecil C. Humphreys School of Law in 2011 announced the formation of a student-edited law journal entitled "Mental Health Law & Policy Journal."
United States
Employment
Title I of the Americans with Disabilities Act of 1990 ("ADA") is a civil rights law that protects individuals with depression, posttraumatic stress disorder ("PTSD"), and other mental health conditions in the workplace. It prohibits employers with 15 or more employees from firing, refusing to hire, or taking other adverse actions against a job applicant or employee based on real or perceived mental health conditions. It also strictly limits the circumstances under which an employer can ask for information about medical conditions, including mental health conditions, and imposes confidentiality requirements on any medical information that the employer does have.
The ADA also requires employers to provide reasonable accommodations to job applicants or employees with mental health conditions under some circumstances. A reasonable accommodation is a special arrangement or piece of equipment that a person needs because of a medical condition to apply for a job, do a job, or enjoy the benefits and privileges of employment. Examples include a flexible schedule, changes in the method of supervision, and permission to work from home. To have the right to a reasonable accommodation, the worker's mental health condition must meet the ADA's definition of a "current disability." Conditions that should easily qualify include major depression, PTSD, bipolar disorder, obsessive-compulsive disorder ("OCD"), and schizophrenia. Other conditions may also qualify, depending on what the symptoms would be if the condition were left untreated, during an active episode (if the condition involves active episodes). The symptoms do not need to be severe or permanent for the condition to be a disability under the ADA.
Under the Family and Medical Leave Act of 1993 (FMLA), certain employees are entitled to up to twelve weeks of job-protected and unpaid leave to recover from a serious illness or to care for a family member with a serious illness, among other reasons. To be eligible, the employer must have had 50 or more employees in 20 or more workweeks in the current or preceding calendar year, or else must be a public agency, elementary school, or secondary school, and the employee must have worked for the employer for at least
12 months, must have at least 1,250 hours of service for the employer during the 12-month period immediately preceding the leave, and must work at a location where the employer has at least 50 employees within 75 miles.
United Kingdom
Various pieces of legislation including Mental Health Act 1983 and the Mental Capacity Act 2005 govern mental health law giving mental health professionals the ability to commit individuals, treat them without consent and place restrictions on them while in public through outpatient commitment, according to the rules of this legislation. These decisions can be challenged through the mental health tribunals which contain members of the judiciary, though the initial decisions are made by mental health professionals alone.
Around the world
Civil commitment
Mental health legislation is largely used in the management of psychiatric disorders, such as dementia or psychosis, and developmental disabilities where a person does not possess the ability to act in a legally competent manner and requires treatment and/or another person to act in his or her best interests. The laws generally cover the requirements and procedures for involuntary commitment and compulsory treatment in a psychiatric hospital or other facility.
In some jurisdictions, court orders are required for compulsory treatment; in others, psychiatrists may treat compulsorily by following set procedures, usually with means of appeal or regular scrutiny to ensure compliance with the law such as through mental health tribunals.
Sources of law
Mental health law includes areas of both civil and criminal common and statutory law.
Common law is based on long-standing English legal principles, as interpreted through case law. Mental health-related legal concepts include mens rea, insanity defences; legal definitions of "sane," "insane," and "incompetent;" informed consent; and automatism, amongst many others.
Statutory law usually takes the form of a mental health statute. An example is the Mental Health Act 1983 in England and Wales. These acts codify aspects of the treatment of mental illness and provides rules and procedures to be followed and penalties for breaches.
Not all countries have mental health acts. The World Health Report (2001) lists the following percentages, by region, for countries with and without mental health legislation.
See also
Basaglia Law
Bazelon Center for Mental Health Law
Mental Capacity Act 2005
Mental Disability Advocacy Center
Mental Health (Care and Treatment) (Scotland) Act 2003
Psychiatric advance directive
Mentally ill people in United States jails and prisons#Legal aspects
Notes
Presence of mental health policies and legislation, The World Health Report 2001, chap. 4, fig. 4.1 (accessed June 8, 2005).
Further reading
Atkinson, J. (2006), Private and Public Protection: Civil Mental Health Legislation, Edinburgh, Dunedin Academic Press
Whelan, D. (2009), Mental Health Law and Practice: Civil and Criminal Aspects, Dublin, Round Hall
References
United States federal civil rights legislation
Disability legislation
Anti-discrimination law in the United States | 0.783524 | 0.965787 | 0.756717 |
Feldsher | A feldsher (, , , , , , ) is a health care professional who provides various medical services limited to emergency treatment and ambulance practice. As such, a feldsher is one kind of mid-level medical practitioner.
In Russia, Ukraine and in other countries of the former Soviet Union, feldshers provide primary-, obstetric- and surgical-care services in many rural medical centres and clinics across Russia, Armenia, Kazakhstan, Kyrgyzstan, Mongolia and Uzbekistan.
Similar types of mid-level practitioners are known by different titles in different countries, including advanced practitioner (United Kingdom), clinical associate/clinical officer (in parts of sub-Saharan Africa), community health officer (India), medical assistant (United States), nurse practitioner (Australia, Canada and US), and physician assistant (Canada and US). The International Standard Classification of Occupations, 2008 revision, collectively groups such workers under the category paramedical practitioners.
History
The word Feldsher is derived from the German Feldscher, which was coined in the 15th century. Feldscher (or Feldscherer) literally means "(battle-)field shearer" and was the term used for barber surgeons in the German and Swiss armies from the 17th century until professional military medical services were established, first by Prussia in the early 18th century. Today, Feldshers do not exist in Germany anymore, but the term was exported with Prussian officers and nobles to Russia. An All-Russia Union of Feldshers was founded in 1905. They were regarded as "Middle Medical Workers".
The Feldsher system of rural primary care provided some of the inspiration for China's barefoot doctors.
Today feldshers can be found in every medical setting from primary to intensive care. They are often the first point of contact with health professionals for people in rural areas.
Education and training
Training for feldshers can include up to four years of post-secondary education, including medical diagnosis and prescribing. They have clinical responsibilities that may be considered midway between those of physicians and those of nurses. They do not have full professional qualifications as physicians.
The training program typically includes basic pre-clinical sciences: anatomy, physiology, pharmacology, microbiology, laboratory subjects, etc.; and advanced clinical sciences: internal medicine and therapeutics, neurology and psychiatry, obstetrics, infectious diseases and epidemiology, preventive medicine, surgery and trauma, anesthesiology and intensive care, pediatrics, and other clinical subjects such as ophthalmology, otolaryngology, dermatology and sexually transmitted diseases, ambulance service and pre-hospital emergency medical care, army field medical-surgical training.
See also
Allied health professions
Clinical officer, a similar category of health care provider in sub-Saharan Africa
Health care providers
Medical assistant
Mid-level practitioner
Nurse practitioner
Physician assistant, a similar category of health care provider in the United States
References
Kossoy E. & Ohry A. The Feldsher: Medical, Sociological and Historical Aspects of Practitioners of Medicine with below University Level Education, the Magnes Press, the Hebrew University, Jerusalem, 1992..
Health care occupations | 0.773231 | 0.978629 | 0.756706 |
History of psychiatry | History of Psychiatry
History of psychiatry is the study of the history of and changes in psychiatry, a medical specialty which diagnoses, prevents and treats mental disorders
Ancient
Specialty in psychiatry can be traced in Ancient India. The oldest texts on psychiatry include the ayurvedic text, Charaka Samhita. Some of the first hospitals for curing mental illness were established during the 3rd century BCE.
During the 5th century BCE, mental disorders, especially those with psychotic traits, were considered supernatural in origin, a view which existed throughout ancient Greece and Rome. The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century, although one may trace its germination to the late eighteenth century.
Some of the early manuals about mental disorders were created by the Greeks. In the 4th century BCE, Hippocrates theorized that physiological abnormalities may be the root of mental disorders. In 4th- to 5th-century BCE Greece, Hippocrates wrote that he visited Democritus and found him in his garden cutting open animals. Democritus explained that he was attempting to discover the cause of madness and melancholy. Hippocrates praised his work. Democritus had with him a book on madness and melancholy.
Religious leaders often turned to versions of exorcism to treat mental disorders, often utilizing methods that many consider to be cruel and/or barbaric.
Middle Ages
A number of hospitals known as bimaristans were built throughout Arab countries beginning around the early 9th century, with the first in Baghdad. They sometimes contained wards for mentally ill patients, typically those who exhibited violence or had debilitating chronic illness.
Physicians who wrote on mental disorders and their treatment in the Medieval Islamic period included Muhammad ibn Zakariya al-Razi (Rhazes), the Arab physician Najab ud-din Muhammad, and Abu Ali al-Hussain ibn Abdallah ibn Sina, known in the West as Avicenna.
Specialist hospitals were built in medieval Europe from the 13th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment.
Early modern period
During the early modern period, mentally ill people were often held captive in cages or kept up within the city walls, or they were compelled to amuse members of courtly society.
From the 13th century onwards, sick and poor people were kept in newly founded ecclesiastical hospitals, such as the "Spittal sente Jorgen" erected in 1212 in Leipzig, in Saxony, Germany. Here, those with serious mental problems were isolated from the rest of the community in accordance with contemporary European practice. Also founded in the 13th century, Bethlem Royal Hospital in London was one of the oldest lunatic asylums.
In the late 17th century, privately run asylums for the insane began to proliferate and expand in size. Already in 1632 it was recorded that Bethlem Royal Hospital, London had "below stairs a parlor, a kitchen, two larders, a long entry throughout the house, and 21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in". Inmates who were deemed dangerous or disturbing were chained, but Bethlem was an otherwise open building for its inhabitants to roam around its confines and possibly throughout the general neighborhood in which the hospital was situated. In 1676, Bethlem expanded into newly built premises at Moorfields with a capacity for 100 inmates.
In 1621, Oxford University mathematician, astrologer, and scholar Robert Burton published one of the earliest treatises on mental illness, The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections, Members, and Subsections. Philosophically, Medicinally, Historically, Opened and Cut Up. Burton thought that there was "no greater cause of melancholy than idleness, no better cure than business." Unlike English philosopher of science Francis Bacon, Burton argued that knowledge of the mind, not natural science, is humankind's greatest need.
In 1656, Louis XIV of France created a public system of hospitals for those with mental disorders, but as in England, no real treatment was applied.
In 1713, the Bethel Hospital Norwich was opened, the first purpose-built asylum in England, founded by Mary Chapman.
Humanitarian reform
In Saxony, a new social policy was implemented at the beginning of the 18th century in which criminals, prostitutes, vagrants, orphans, and the mentally ill were incarcerated and re-educated in the concepts of the Enlightenment. As a result, a variety of jails, approved schools, and insane asylums were constructed, including the hospital "Chur-Sachisches Zucht-Waysen und Armen-Haus" in Waldheim in 1716, which was the first governmental institution dedicated to the care of the mentally ill on the German territory.
Attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. In 1758, English physician William Battie wrote his Treatise on Madness on the management of mental disorder. It was a critique aimed particularly at the Bethlem Hospital, where a conservative regime continued to use barbaric custodial treatment. Battie argued for a tailored management of patients entailing cleanliness, good food, fresh air, and distraction from friends and family. He argued that mental disorder originated from dysfunction of the material brain and body rather than the internal workings of the mind.
Thirty years later, then ruling monarch in England George III was known to have a mental disorder. Following the King's remission in 1789, mental illness came to be seen as something which could be treated and cured. The introduction of moral treatment was initiated independently by the French doctor Philippe Pinel and the English Quaker William Tuke.
In 1792, Pinel became the chief physician at the Bicêtre Hospital. In 1797, Jean-Baptiste Pussin first freed patients of their chains and banned physical punishment, although straitjackets could be used instead.
Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pussin and Pinel's approach was seen as remarkably successful and they later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière. Pinel's student and successor, Jean Esquirol (1772–1840), went on to help establish 10 new mental hospitals that operated on the same principles. There was an emphasis on the selection and supervision of attendants in order to establish a suitable setting to facilitate psychological work, and particularly on the employment of ex-patients as they were thought most likely to refrain from inhumane treatment while being able to stand up to pleading, menaces, or complaining.
William Tuke led the development of a radical new type of institution in northern England, following the death of a fellow Quaker in a local asylum in 1790. In 1796, with the help of fellow Quakers and others, he founded the York Retreat, where eventually about 30 patients lived as part of a small community in a quiet country house and engaged in a combination of rest, talk, and manual work. Rejecting medical theories and techniques, the efforts of the York Retreat centered around minimizing restraints and cultivating rationality and moral strength. The entire Tuke family became known as founders of moral treatment.
William Tuke's grandson, Samuel Tuke, published an influential work in the early 19th century on the methods of the retreat; Pinel's Treatise On Insanity had by then been published, and Samuel Tuke translated his term as "moral treatment". Tuke's Retreat became a model throughout the world for humane and moral treatment of patients with mental disorders. The York Retreat inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now The Institute of Living).
Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19th century. At the Lincoln Asylum in England, Robert Gardiner Hill, with the support of Edward Parker Charlesworth, pioneered a mode of treatment that suited "all types" of patients, so that mechanical restraints and coercion could be dispensed with — a situation he finally achieved in 1838. In 1839, Sergeant John Adams and Dr. John Conolly were impressed by the work of Hill, and introduced the method into their Hanwell Asylum, by then the largest in the country. Hill's system was adapted, since Conolly was unable to supervise each attendant as closely as Hill had done. By September 1839, mechanical restraint was no longer required for any patient.
Phrenology
Scotland's Edinburgh medical school of the eighteenth century developed an interest in mental illness, with influential teachers including William Cullen (1710–1790) and Robert Whytt (1714–1766) emphasising the clinical importance of psychiatric disorders. In 1816, the phrenologist Johann Spurzheim (1776–1832) visited Edinburgh and lectured on his craniological and phrenological concepts; the central concepts of the system were that the brain is the organ of the mind and that human behaviour can be usefully understood in neurological rather than philosophical or religious terms. Phrenologists also laid stress on the modularity of mind.
Some of the medical students, including William A. F. Browne (1805–1885), responded very positively to this materialist conception of the nervous system and, by implication, of mental disorder. George Combe (1788–1858), an Edinburgh solicitor, became an unrivaled exponent of phrenological thinking, and his brother, Andrew Combe (1797–1847), who was later appointed a physician to Queen Victoria, wrote a phrenological treatise entitled Observations on Mental Derangement (1831). They also founded the Edinburgh Phrenological Society in 1820.
Institutionalization
The modern era of providing care for the mentally ill began in the early 19th century with a large state-led effort. Public mental asylums were established in Britain after the passing of the 1808 County Asylums Act. This empowered magistrates to build rate-supported asylums in every county to house the many 'pauper lunatics'. Nine counties first applied, and the first public asylum opened in 1812 in Nottinghamshire. Parliamentary Committees were established to investigate abuses at private madhouses like Bethlem Hospital - its officers were eventually dismissed and national attention was focused on the routine use of bars, chains and handcuffs and the filthy conditions the inmates lived in. However, it was not until 1828 that the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums.
The Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment. The Act created the Lunacy Commission, headed by Lord Shaftesbury, to focus on lunacy legislation reform. The commission was made up of eleven Metropolitan Commissioners who were required to carry out the provisions of the Act; the compulsory construction of asylums in every county, with regular inspections on behalf of the Home Secretary. All asylums were required to have written regulations and to have a resident qualified physician. A national body for asylum superintendents - the Medico-Psychological Association - was established in 1866 under the Presidency of William A. F. Browne, although the body appeared in an earlier form in 1841.
In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. Édouard Séguin developed a systematic approach for training individuals with mental deficiencies, and, in 1839, he opened the first school for the severely "retarded". His method of treatment was based on the assumption that the mentally deficient did not experience disease.
In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The Utica State Hospital was opened approximately in 1850. The creation of this hospital, as of many others, was largely the work of Dorothea Lynde Dix, whose philanthropic efforts extended over many states, and in Europe as far as Constantinople. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect.
At the turn of the century, England and France combined had only a few hundred individuals in asylums. By the late 1890s and early 1900s, this number had risen to the hundreds of thousands. However, the idea that mental illness could be ameliorated through institutionalization was soon disappointed. Psychiatrists were pressured by an ever-increasing patient population. The average number of patients in asylums kept on growing. Asylums were quickly becoming almost indistinguishable from custodial institutions, and the reputation of psychiatry in the medical world had hit an extreme low.
Scientific advances
In the early 1800s, psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include mood disorders, in addition to disease level delusion or irrationality. The term psychiatry (Greek "ψυχιατρική", psychiatrikē) which comes from the Greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer") was coined by Johann Christian Reil in 1808. Jean-Étienne Dominique Esquirol, a student of Pinel, defined lypemania as an 'affective monomania' (excessive attention to a single thing). This was an early diagnosis of depression.
In 1870, Louis Mayer, a gynecologist in Germany, cured a woman's "melancholia" using a pessary: "It relieved her physical problems and many severe disorders of mood ... application of a Mayer Ring improved her quite considerably." According to The American Journal of Obstetrics and Diseases of Women and Children Mayer reportedly decried the "neglect of the investigation of the relations between mental and sexual diseases of women in German insane hospitals".
The 20th century introduced a new psychiatry into the world. Different perspectives of looking at mental disorders began to be introduced. The career of Emil Kraepelin reflects the convergence of different disciplines in psychiatry. Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry. Following his appointment to a professorship of psychiatry and his work in a university psychiatric clinic, Kraepelin's interest in pure psychology began to fade and he introduced a plan for a more comprehensive psychiatry. Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kahlbaum. The initial ideas behind biological psychiatry, stating that the different mental disorders were all biological in nature, evolved into a new concept of "nerves" and psychiatry became a rough approximation of neurology and neuropsychiatry. However, Kraepelin was criticized for considering schizophrenia as a biological illness in the absence of any detectable histologic or anatomic abnormalities. While Kraepelin tried to find organic causes of mental illness, he adopted many theses of positivist medicine, but he favoured the precision of nosological classification over the indefiniteness of etiological causation as his basic mode of psychiatric explanation.
Following Sigmund Freud's pioneering work, ideas stemming from psychoanalytic theory also began to take root in psychiatry. The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums. Freud resisted subjecting his theories to scientific testing and verification, as did his followers. As evidence-based investigations in cognitive psychology led to treatments like cognitive behavioral therapy, many of Freud's ideas appeared to be unsupported or contradicted by evidence. By the 1970s, the psychoanalytic school of thought had become marginalized within the field.
Biological psychiatry reemerged during this time. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the neuromodulatory properties of acetylcholine; thus identifying it as the first-known neurotransmitter. Neuroimaging was first utilized as a tool for psychiatry in the 1980s. The discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disorder, as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948. Psychotherapy was still utilized, but as a treatment for psychosocial issues. In the 1920s and 1930s, most asylum and academic psychiatrists in Europe believed that manic depressive disorder and schizophrenia were inherited, but in the decades after World War II, the conflation of genetics with Nazi racist ideology thoroughly discredited genetics.
Now, genetics are once again thought by some prominent researchers to play a large role in mental illness. The genetic and heritable proportion of the cause of five major psychiatric disorders found in family and twin studies is 81% for schizophrenia, 80% for autism spectrum disorder, 75% for bipolar disorder, 75% for attention deficit hyperactivity disorder, and 37% for major depressive disorder. Geneticist Müller-Hill is quoted as saying "Genes are not destiny, they may give an individual a pre-disposition toward a disorder, for example, but that only means they are more likely than others to have it. It (mental illness) is not a certainty.” Molecular biology opened the door for specific genes contributing to mental disorders to be identified.
Deinstitutionalization
Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (1961), written by sociologist Erving Goffman, examined the social situation of mental patients in the hospital. Based on his participant observation field work, the book developed the theory of the "total institution" and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor". The book suggested that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them. Asylums was a key text in the development of deinstitutionalisation. At the same time, academic psychiatrist and psychoanalyst Thomas Szasz began publishing articles and books that were highly critical of psychiatry and involuntary treatment, including his best-known work The Myth of Mental Illness in 1961.
In 1963, US president John F. Kennedy introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals. Later, though, the Community Mental Health Centers focus shifted to providing psychotherapy for those with acute but less serious mental disorders. Ultimately there were no arrangements made for actively following and treating severely mentally ill patients who were being discharged from hospitals. Some of those with mental disorders drifted into homelessness or ended up in prisons and jails. Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.
In 1973, psychologist David Rosenhan published the Rosenhan experiment, a study with results that led to questions about the validity of psychiatric diagnoses. Critics such as Robert Spitzer placed doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement. Spitzer went on to chair the writing of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, which aimed to improve reliability by emphasizing measurable symptoms.
Psychiatry, like most medical specialties, has a continuing, significant need for research into its diseases, classifications and treatments. Psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment. But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements. In addition to external factors, the human brain must contain and organize an individual's hopes, fears, desires, fantasies and feelings. Psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.
See also
History of child and adolescent psychiatry
History of psychiatric institutions
History of neurology
History of psychology
History of neuropsychology
History of neurophysiology
References
Cited texts
Further reading
Psychiatry | 0.768687 | 0.984371 | 0.756674 |
SAMPLE history | SAMPLE history is a mnemonic acronym to remember key questions for a person's medical assessment. The SAMPLE history is sometimes used in conjunction with vital signs and OPQRST. The questions are most commonly used in the field of emergency medicine by first responders during the secondary assessment. It is used for alert (conscious) people, but often much of this information can also be obtained from the family or friend of an unresponsive person. In the case of severe trauma, this portion of the assessment is less important. A derivative of SAMPLE history is AMPLE history which places a greater emphasis on a person's medical history.
Meaning
The parts of the mnemonic are:
S – Signs/Symptoms (Symptoms are important but they are subjective.)
A – Allergies
M – Medications
P – Past Pertinent medical history
L – Last Oral Intake (Sometimes also Last Menstrual Cycle.)
E – Events Leading Up To Present Illness / Injury
See also
OPQRST
ABC (medicine)
Past Medical History
References
External links
Emergency medical services
First aid
Medical mnemonics
Mnemonic acronyms | 0.765082 | 0.988999 | 0.756665 |
Dosha | Dosha (, IAST: doṣa) is a central term in ayurveda originating from Sanskrit, which can be translated as "that which can cause problems" (literally meaning "fault" or "defect"), and which refers to three categories or types of substances that are believed to be present conceptually in a person's body and mind. These Dosha are assigned specific qualities and functions. These qualities and functions are affected by external and internal stimuli received by the body. Beginning with twentieth-century ayurvedic literature, the "three-dosha theory" (, ) has described how the quantities and qualities of three fundamental types of substances called wind, bile, and phlegm (, , ; , , ) fluctuate in the body according to the seasons, time of day, process of digestion, and several other factors and thereby determine changing conditions of growth, aging, health, and disease.
Doshas are considered to shape the physical body according to a natural constitution established at birth, determined by the constitutions of the parents as well as the time of conception and other factors. This natural constitution represents the healthy norm for a balanced state for a particular individual. The particular ratio of the doshas in a person's natural constitution is associated with determining their mind-body type including various physiological and psychological characteristics such as physical appearance, physique, and personality.
The ayurvedic three-dosha theory is often compared to European humorism although it is a distinct system with a separate history. The three-dosha theory has also been compared to astrology and physiognomy in similarly deriving its tenets from ancient philosophy and superstitions. Using them to diagnose or treat disease is considered pseudoscientific.
Role in disease, Roga
There is some evidence that the three dosha's are based in metabolism. The three different constitutions may correspond with microbiotic patterns.
The ayurvedic notion of doshas describes how bad habits, wrong diet, overwork, etc., may cause relative deficiencies or excesses which cause them to become imbalanced in relation to the natural constitution resulting in a current condition which may potentially lead to disease. For example, an excess of is blamed for mental, nervous, and digestive disorders, including low energy and weakening of all body tissues. Similarly, excess is blamed for blood toxicity, inflammation, and infection. Excess of is blamed for increase in mucus, weight, oedema, and lung disease, etc. The key to managing all doshas is taking care of ; it is taught that this will regulate the other two.
Principles
The doshas derive their qualities from the five elements (; ) of classical Indian philosophy.
Vāta or vata is characterized by the properties of dry, cold, light, subtle, and mobile. All movement in the body is due to properties of vata. Pain is the characteristic feature of deranged vata. Some of the diseases connected to unbalanced vata are flatulence, gout, rheumatism, etc. Vāta is the normal Sanskrit word meaning "air" or "wind", and was so understood in pre-modern Sanskrit treatises on ayurveda. Some modern interpreters prefer not to translate Vata as air, but rather to equated it with a modern metabolic process or substance.
Pitta represents metabolism; It is characterized by heat, moistness, liquidity, sharpness, and sourness. Its chief quality is heat. It is the energy principle which uses bile to direct digestion and enhance metabolism. Unbalanced pitta is primarily characterized by body heat or a burning sensation and redness. Pitta is the normal Sanskrit word meaning "bile". It is etymologically related to the Sanskrit word pīta "yellow".
Kapha is the watery element. It is a combination of earth and water. It is characterized by heaviness, coldness, tenderness, softness, slowness, lubrication, and the carrier of nutrients. It is the nourishing element of the body. All soft organs are made by kapha and it plays an important role in the perception of taste together with nourishment and lubrication. Kapha (synonym: ) is the normal Sanskrit word meaning "phlegm".
Prana, tejas, and ojas
Yoga is a set of disciplines, some that aim to balance and transform energies of the psyche. At the roots of , and are believed to consist of its subtle counterparts called , and . Unlike the doshas, which in excess create diseases, this is believed to promote health, creativity and well-being.
Ultimately, ayurveda seeks to reduce disease, particularly those that are chronic, and increase positive health in the body and mind via these three vital essences that aid in renewal and transformation. Increased is associated with enthusiasm, adaptability and creativity, all of which are considered necessary when pursuing a spiritual path in yoga and to enable one to perform. is claimed to provide courage, fearlessness and insight and to be important when making decisions. Lastly, is considered to create peace, confidence and patience to maintain consistent development and sustain continued effort. Eventually, the most important element to develop is , believed to engender physical and psychological endurance. Aims to achieve this include ayurvedic diet, tonic herbs, control of the senses, a devotion and most importantly celibacy.
Criticism
Writing in the Skeptical Inquirer, Harriet Hall likened dosha to horoscope. She found that different online dosha websites gave different results in personalized quizzes, and summarized that "Ayurveda is basically superstition mixed with a soupçon of practical health advice." Professional practitioners of ayurveda in the United States are certified by the National Ayurvedic Medical Association Certification Board, which advocates for the safe and effective practice of ayurveda. Alternative medicines used in ayurvedic treatments have been found to contain harmful levels of lead, mercury, and other heavy metals.
See also
Dhātu (ayurveda)
References
Ayurveda
Tamil culture
Traditional medicine in India
Alternative medical systems | 0.760801 | 0.994561 | 0.756663 |
Health informatics | Health informatics is the study and implementation of computer structures and algorithms to improve communication, understanding, and management of medical information. It can be viewed as a branch of engineering and applied science.
The health domain provides an extremely wide variety of problems that can be tackled using computational techniques.
Health informatics is a spectrum of multidisciplinary fields that includes study of the design, development and application of computational innovations to improve health care. The disciplines involved combines medicine fields with computing fields, in particular computer engineering, software engineering, information engineering, bioinformatics, bio-inspired computing, theoretical computer science, information systems, data science, information technology, autonomic computing, and behavior informatics.
In academic institutions, medical informatics research focus on applications of artificial intelligence in healthcare and designing medical devices based on embedded systems. In some countries term informatics is also used in the context of applying library science to data management in hospitals. In this meaning health informatics aims at developing methods and technologies for the acquisition, processing, and study of patient data, An umbrella term of biomedical informatics has been proposed.
There are many variations in the name of the field involved in applying information and communication technologies to healthcare, public health, and personal health, ranging from those focused on the molecular (e.g., genomic), organ system (e.g., imaging), individual (e.g., patient or consumer, care provider, and interaction between them), to population-level of application. A spectrum of activity spans efforts ranging from theory and model development, to empirical research, to implementation and management, to widespread adoption.
'Clinical informaticians' are qualified health and social care professionals and 'clinical informatics' is a subspecialty within several medical specialties.
Subject areas
Jan van Bemmel has described medical informatics as the theoretical and practical aspects of information processing and communication based on knowledge and experience derived from processes in medicine and health care.
The Faculty of Clinical Informatics has identified six high level domains of core competency for clinical informaticians:
Health and Wellbeing in Practice
Information Technologies and Systems
Working with Data and Analytical Methods
Enabling Human and Organizational Change
Decision Making
Leading Informatics Teams and projects.
Tools to support practitioners
Clinical informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and health informatics tools to:
Assess information and knowledge needs of health care professionals, patients and their families.
Characterize, evaluate, and refine clinical processes,
Develop, implement, and refine clinical decision support systems, and
Lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.
Clinicians collaborate with other health care and information technology professionals to develop health informatics tools which promote patient care that is safe, efficient, effective, timely, patient-centered, and equitable. Many clinical informaticists are also computer scientists.
Telehealth and telemedicine
Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma.
These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective. Telerehabilitation (or e-rehabilitation[40][41]) is the delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient's functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology, speech-language pathology, audiology, occupational therapy, and physical therapy. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.
Decision support, artificial intelligence and machine learning in healthcare
A pioneer in the use of artificial intelligence in healthcare was American biomedical informatician Edward H. Shortliffe. This field deals with utilization of machine-learning algorithms and artificial intelligence, to emulate human cognition in the analysis, interpretation, and comprehension of complicated medical and healthcare data. Specifically, AI is the ability of computer algorithms to approximate conclusions based solely on input data. AI programs are applied to practices such as diagnosis processes, treatment protocol development, drug development, personalized medicine, and patient monitoring and care. A large part of industry focus of implementation of AI in the healthcare sector is in the clinical decision support systems.
As more data is collected, machine learning algorithms adapt and allow for more robust responses and solutions. Numerous companies are exploring the possibilities of the incorporation of big data in the healthcare industry. Many companies investigate the market opportunities through the realms of "data assessment, storage, management, and analysis technologies" which are all crucial parts of the healthcare industry. The following are examples of large companies that have contributed to AI algorithms for use in healthcare:
IBM's Watson Oncology is in development at Memorial Sloan Kettering Cancer Center and Cleveland Clinic. IBM is also working with CVS Health on AI applications in chronic disease treatment and with Johnson & Johnson on analysis of scientific papers to find new connections for drug development. In May 2017, IBM and Rensselaer Polytechnic Institute began a joint project entitled Health Empowerment by Analytics, Learning and Semantics (HEALS), to explore using AI technology to enhance healthcare.
Microsoft's Hanover project, in partnership with Oregon Health & Science University's Knight Cancer Institute, analyzes medical research to predict the most effective cancer drug treatment options for patients. Other projects include medical image analysis of tumor progression and the development of programmable cells.
Google's DeepMind platform is being used by the UK National Health Service to detect certain health risks through data collected via a mobile app. A second project with the NHS involves analysis of medical images collected from NHS patients to develop computer vision algorithms to detect cancerous tissues.
Tencent is working on several medical systems and services. These include AI Medical Innovation System (AIMIS), an AI-powered diagnostic medical imaging service; WeChat Intelligent Healthcare; and Tencent Doctorwork.
Intel's venture capital arm Intel Capital recently invested in startup Lumiata which uses AI to identify at-risk patients and develop care options.
Kheiron Medical developed deep learning software to detect breast cancers in mammograms.
Fractal Analytics has incubated Qure.ai which focuses on using deep learning and AI to improve radiology and speed up the analysis of diagnostic x-rays.
Neuralink has come up with a next generation neuroprosthetic which intricately interfaces with thousands of neural pathways in the brain. Their process allows a chip, roughly the size of a quarter, to be inserted in place of a chunk of skull by a precision surgical robot to avoid accidental injury.
Digital consultant apps like Babylon Health's GP at Hand, Ada Health, Alibaba Health Doctor You, KareXpert and Your.MD use AI to give medical consultation based on personal medical history and common medical knowledge. Users report their symptoms into the app, which uses speech recognition to compare against a database of illnesses. Babylon then offers a recommended action, taking into account the user's medical history. Entrepreneurs in healthcare have been effectively using seven business model archetypes to take AI solution[buzzword] to the marketplace. These archetypes depend on the value generated for the target user (e.g. patient focus vs. healthcare provider and payer focus) and value capturing mechanisms (e.g. providing information or connecting stakeholders). IFlytek launched a service robot "Xiao Man", which integrated artificial intelligence technology to identify the registered customer and provide personalized recommendations in medical areas.
It also works in the field of medical imaging. Similar robots are also being made by companies such as UBTECH ("Cruzr") and Softbank Robotics ("Pepper"). The Indian startup Haptik recently developed a WhatsApp chatbot which answers questions associated with the deadly coronavirus in India. With the market for AI expanding constantly, large tech companies such as Apple, Google, Amazon, and Baidu all have their own AI research divisions, as well as millions of dollars allocated for acquisition of smaller AI based companies. Many automobile manufacturers are beginning to use machine learning healthcare in their cars as well. Companies such as BMW, GE, Tesla, Toyota, and Volvo all have new research campaigns to find ways of learning a driver's vital statistics to ensure they are awake, paying attention to the road, and not under the influence of substances or in emotional distress. Examples of projects in computational health informatics include the COACH project.
Clinical Research Informatics
Clinical research informatics (CRI) is a sub-field of health informatics that tries to improve the efficiency of clinical research by using informatics methods. Some of the problems tackled by CRI are: creation of data warehouses of health care data that can be used for research, support of data collection in clinical trials by the use of electronic data capture systems, streamlining ethical approvals and renewals (in US the responsible entity is the local institutional review board), maintenance of repositories of past clinical trial data (de-identified). CRI is a fairly new branch of informatics and has met growing pains as any up and coming field does. Some issue CRI faces is the ability for the statisticians and the computer system architects to work with the clinical research staff in designing a system and lack of funding to support the development of a new system.
Researchers and the informatics team have a difficult time coordinating plans and ideas in order to design a system that is easy to use for the research team yet fits in the system requirements of the computer team. The lack of funding can be a hindrance to the development of the CRI. Many organizations who are performing research are struggling to get financial support to conduct the research, much less invest that money in an informatics system that will not provide them any more income or improve the outcome of the research (Embi, 2009). Ability to integrate data from multiple clinical trials is an important part of clinical research informatics. Initiatives, such as PhenX and Patient-Reported Outcomes Measurement Information System triggered a general effort to improve secondary use of data collected in past human clinical trials. CDE initiatives, for example, try to allow clinical trial designers to adopt standardized research instruments (electronic case report forms).
A parallel effort to standardizing how data is collected are initiatives that offer de-identified patient level clinical study data to be downloaded by researchers who wish to re-use this data. Examples of such platforms are Project Data Sphere, dbGaP, ImmPort or Clinical Study Data Request. Informatics issues in data formats for sharing results (plain CSV files, FDA endorsed formats, such as CDISC Study Data Tabulation Model) are important challenges within the field of clinical research informatics. There are a number of activities within clinical research that CRI supports, including:
More efficient and effective data collection and acquisition
Improved recruitment into clinical trials
Optimal protocol design and efficient management
Patient recruitment and management
Adverse event reporting
Regulatory compliance
Data storage, transfer, processing and analysis
Repositories of data from completed clinical trials (for secondary analyses)
One of the fundamental elements of biomedical and translation research is the use of integrated data repositories. A survey conducted in 2010 defined "integrated data repository" (IDR) as a data warehouse incorporating various sources of clinical data to support queries for a range of research-like functions. Integrated data repositories are complex systems developed to solve a variety of problems ranging from identity management, protection of confidentiality, semantic and syntactic comparability of data from different sources, and most importantly convenient and flexible query.
Development of the field of clinical informatics led to the creation of large data sets with electronic health record data integrated with other data (such as genomic data). Types of data repositories include operational data stores (ODSs), clinical data warehouses (CDWs), clinical data marts, and clinical registries. Operational data stores established for extracting, transferring and loading before creating warehouse or data marts. Clinical registries repositories have long been in existence, but their contents are disease specific and sometimes considered archaic. Clinical data stores and clinical data warehouses are considered fast and reliable. Though these large integrated repositories have impacted clinical research significantly, it still faces challenges and barriers.
One big problem is the requirement for ethical approval by the institutional review board (IRB) for each research analysis meant for publication. Some research resources do not require IRB approval. For example, CDWs with data of deceased patients have been de-identified and IRB approval is not required for their usage. Another challenge is data quality. Methods that adjust for bias (such as using propensity score matching methods) assume that a complete health record is captured. Tools that examine data quality (e.g., point to missing data) help in discovering data quality problems.
Translational bioinformatics
Translational Bioinformatics (TBI) is a relatively new field that surfaced in the year of 2000 when human genome sequence was released. The commonly used definition of TBI is lengthy and could be found on the AMIA website. In simpler terms, TBI could be defined as a collection of colossal amounts of health related data (biomedical and genomic) and translation of the data into individually tailored clinical entities.
Today, TBI field is categorized into four major themes that are briefly described below:
Clinical big data is a collection of electronic health records that are used for innovations. The evidence-based approach that is currently practiced in medicine is suggested to be merged with the practice-based medicine to achieve better outcomes for patients. As CEO of California-based cognitive computing firm Apixio, Darren Schutle, explains that the care can be better fitted to the patient if the data could be collected from various medical records, merged, and analyzed. Further, the combination of similar profiles can serve as a basis for personalized medicine pointing to what works and what does not for certain condition (Marr, 2016).
Genomics in clinical careGenomic data are used to identify the genes involvement in unknown or rare conditions/syndromes. Currently, the most vigorous area of using genomics is oncology. The identification of genomic sequencing of cancer may define reasons of drug(s) sensitivity and resistance during oncological treatment processes.
Omics for drugs discovery and repurposingRepurposing of the drug is an appealing idea that allows the pharmaceutical companies to sell an already approved drug to treat a different condition/disease that the drug was not initially approved for by the FDA. The observation of "molecular signatures in disease and compare those to signatures observed in cells" points to the possibility of a drug ability to cure and/or relieve symptoms of a disease.
Personalized genomic testingIn the US, several companies offer direct-to-consumer (DTC) genetic testing. The company that performs the majority of testing is called 23andMe. Utilizing genetic testing in health care raises many ethical, legal and social concerns; one of the main questions is whether the health care providers are ready to include patient-supplied genomic information while providing care that is unbiased (despite the intimate genomic knowledge) and a high quality. The documented examples of incorporating such information into a health care delivery showed both positive and negative impacts on the overall health care related outcomes.
Medical signal processing
An important application of information engineering in medicine is medical signal processing. It refers to the generation, analysis, and use of signals, which could take many forms such as image, sound, electrical, or biological.
Medical image computing and imaging informatics
Imaging informatics and medical image computing develops computational and mathematical methods for solving problems pertaining to medical images and their use for biomedical research and clinical care. Those fields aims to extract clinically relevant information or knowledge from medical images and computational analysis of the images. The methods can be grouped into several broad categories: image segmentation, image registration, image-based physiological modeling, and others.
Medical robotics
A medical robot is a robot used in the medical sciences. They include surgical robots. These are in most telemanipulators, which use the surgeon's activators on one side to control the "effector" on the other side. There are the following types of medical robots:
Surgical robots: either allow surgical operations to be carried out with better precision than an unaided human surgeon or allow remote surgery where a human surgeon is not physically present with the patient.
Rehabilitation robots: facilitate and support the lives of infirm, elderly people, or those with dysfunction of body parts affecting movement. These robots are also used for rehabilitation and related procedures, such as training and therapy.
Biorobots: a group of robots designed to imitate the cognition of humans and animals.
Telepresence robots: allow off-site medical professionals to move, look around, communicate, and participate from remote locations.
Pharmacy automation: robotic systems to dispense oral solids in a retail pharmacy setting or preparing sterile IV admixtures in a hospital pharmacy setting.
Companion robot: has the capability to engage emotionally with users keeping them company and alerting if there is a problem with their health.
Disinfection robot: has the capability to disinfect a whole room in mere minutes, generally using pulsed ultraviolet light. They are being used to fight Ebola virus disease.
Pathology informatics
Pathology informatics is a field that involves the use of information technology, computer systems, and data management to support and enhance the practice of pathology. It encompasses pathology laboratory operations, data analysis, and the interpretation of pathology-related information.
Key aspects of pathology informatics include:
Laboratory information management systems (LIMS): Implementing and managing computer systems specifically designed for pathology departments. These systems help in tracking and managing patient specimens, results, and other pathology data.
Digital pathology: Involves the use of digital technology to create, manage, and analyze pathology images. This includes side scanning and automated image analysis.
Telepathology: Using technology to enable remote pathology consultation and collaboration.
Quality assurance and reporting: Implementing informatics solutions to ensure the quality and accuracy of pathology processes.
International history
Worldwide use of computer technology in medicine began in the early 1950s with the rise of the computers. In 1949, Gustav Wagner established the first professional organization for informatics in Germany. Specialized university departments and Informatics training programs began during the 1960s in France, Germany, Belgium and The Netherlands. Medical informatics research units began to appear during the 1970s in Poland and in the U.S. Since then the development of high-quality health informatics research, education and infrastructure has been a goal of the U.S. and the European Union.
Early names for health informatics included medical computing, biomedical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering, and medical computer technology.
The health informatics community is still growing, it is by no means a mature profession, but work in the UK by the voluntary registration body, the UK Council of Health Informatics Professions has suggested eight key constituencies within the domain–information management, knowledge management, portfolio/program/project management, ICT, education and research, clinical informatics, health records(service and business-related), health informatics service management. These constituencies accommodate professionals in and for the NHS, in academia and commercial service and solution providers.
Since the 1970s the most prominent international coordinating body has been the International Medical Informatics Association (IMIA).
History, current state and policy initiatives by region and country
Americas
Argentina
The Argentinian health system is heterogeneous in its function, and because of that, the informatics developments show a heterogeneous stage. Many private health care centers have developed systems, such as the Hospital Aleman of Buenos Aires, or the Hospital Italiano de Buenos Aires that also has a residence program for health informatics.
Brazil
The first applications of computers to medicine and health care in Brazil started around 1968, with the installation of the first mainframes in public university hospitals, and the use of programmable calculators in scientific research applications. Minicomputers, such as the IBM 1130 were installed in several universities, and the first applications were developed for them, such as the hospital census in the School of Medicine of Ribeirão Preto and patient master files, in the Hospital das Clínicas da Universidade de São Paulo, respectively at the cities of Ribeirão Preto and São Paulo campuses of the University of São Paulo.
In the 1970s, several Digital Corporation and Hewlett-Packard minicomputers were acquired for public and Armed Forces hospitals, and more intensively used for intensive-care unit, cardiology diagnostics, patient monitoring and other applications. In the early 1980s, with the arrival of cheaper microcomputers, a great upsurge of computer applications in health ensued, and in 1986 the Brazilian Society of Health Informatics was founded, the first Brazilian Congress of Health Informatics was held, and the first Brazilian Journal of Health Informatics was published. In Brazil, two universities are pioneers in teaching and research in medical informatics, both the University of São Paulo and the Federal University of São Paulo offer undergraduate programs highly qualified in the area as well as extensive graduate programs (MSc and PhD). In 2015 the Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, also started to offer undergraduate program.
Canada
Health Informatics projects in Canada are implemented provincially, with different provinces creating different systems. A national, federally funded, not-for-profit organisation called Canada Health Infoway was created in 2001 to foster the development and adoption of electronic health records across Canada. As of December 31, 2008, there were 276 EHR projects under way in Canadian hospitals, other health-care facilities, pharmacies and laboratories, with an investment value of $1.5-billion from Canada Health Infoway.
Provincial and territorial programmes include the following:
eHealth Ontario was created as an Ontario provincial government agency in September 2008. It has been plagued by delays and its CEO was fired over a multimillion-dollar contracts scandal in 2009.
Alberta Netcare was created in 2003 by the Government of Alberta. Today the netCARE portal is used daily by thousands of clinicians. It provides access to demographic data, prescribed/dispensed drugs, known allergies/intolerances, immunizations, laboratory test results, diagnostic imaging reports, the diabetes registry and other medical reports. netCARE interface capabilities are being included in electronic medical record products that are being funded by the provincial government.
United States
Even though the idea of using computers in medicine emerged as technology advanced in the early 20th century, it was not until the 1950s that informatics began to have an effect in the United States.
The earliest use of electronic digital computers for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley. During the mid-1950s, the United States Air Force (USAF) carried out several medical projects on its computers while also encouraging civilian agencies such as the National Academy of Sciences – National Research Council (NAS-NRC) and the National Institutes of Health (NIH) to sponsor such work. In 1959, Ledley and Lee B. Lusted published "Reasoning Foundations of Medical Diagnosis," a widely read article in Science, which introduced computing (especially operations research) techniques to medical workers. Ledley and Lusted's article has remained influential for decades, especially within the field of medical decision making.
Guided by Ledley's late 1950s survey of computer use in biology and medicine (carried out for the NAS-NRC), and by his and Lusted's articles, the NIH undertook the first major effort to introduce computers to biology and medicine. This effort, carried out initially by the NIH's Advisory Committee on Computers in Research (ACCR), chaired by Lusted, spent over $40 million between 1960 and 1964 in order to establish dozens of large and small biomedical research centers in the US.
One early (1960, non-ACCR) use of computers was to help quantify normal human movement, as a precursor to scientifically measuring deviations from normal, and design of prostheses. The use of computers (IBM 650, 1620, and 7040) allowed analysis of a large sample size, and of more measurements and subgroups than had been previously practical with mechanical calculators, thus allowing an objective understanding of how human locomotion varies by age and body characteristics. A study co-author was Dean of the Marquette University College of Engineering; this work led to discrete Biomedical Engineering departments there and elsewhere.
The next steps, in the mid-1960s, were the development (sponsored largely by the NIH) of expert systems such as MYCIN and Internist-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. Around this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital in Boston, another center of biomedical computing that received significant support from the NIH. In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. , a descendant of this system is being used in the United States Veterans Affairs hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient's electronic medical record at any of the VA's over 1,000 health care facilities.
During the 1960s, Morris Collen, a physician working for Kaiser Permanente's Division of Research, developed computerized systems to automate many aspects of multi-phased health checkups. These systems became the basis the larger medical databases Kaiser Permanente developed during the 1970s and 1980s.
In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems. In 1970, Warner V. Slack, MD, and Howard Bleich, MD, co-founded the academic division of clinical informatics (DCI) at Beth Israel Deaconess Medical Center and Harvard Medical School. Warner Slack is a pioneer of the development of the electronic patient medical history, and in 1977 Dr. Bleich created the first user-friendly search engine for the worlds biomedical literature.
Computerised systems involved in patient care have led to a number of changes. Such changes have led to improvements in electronic health records which are now capable of sharing medical information among multiple health care stakeholders (Zahabi, Kaber, & Swangnetr, 2015); thereby, supporting the flow of patient information through various modalities of care. One opportunity for electronic health records (EHR) to be even more effectively used is to utilize natural language processing for searching and analyzing notes and text that would otherwise be inaccessible for review. These can be further developed through ongoing collaboration between software developers and end-users of natural language processing tools within the electronic health EHRs.
Computer use today involves a broad ability which includes but is not limited to physician diagnosis and documentation, patient appointment scheduling, and billing. Many researchers in the field have identified an increase in the quality of health care systems, decreased errors by health care workers, and lastly savings in time and money (Zahabi, Kaber, & Swangnetr, 2015). The system, however, is not perfect and will continue to require improvement. Frequently cited factors of concern involve usability, safety, accessibility, and user-friendliness (Zahabi, Kaber, & Swangnetr, 2015).
Homer R. Warner, one of the fathers of medical informatics, founded the Department of Medical Informatics at the University of Utah in 1968. The American Medical Informatics Association (AMIA) has an award named after him on application of informatics to medicine.
The American Medical Informatics Association created a, board certification for medical informatics from the American Board of Preventive Medicine. The American Nurses Credentialing Center offers a board certification in Nursing Informatics. For Radiology Informatics, the CIIP (Certified Imaging Informatics Professional) certification was created by ABII (The American Board of Imaging Informatics) which was founded by SIIM (the Society for Imaging Informatics in Medicine) and ARRT (the American Registry of Radiologic Technologists) in 2005. The CIIP certification requires documented experience working in Imaging Informatics, formal testing and is a limited time credential requiring renewal every five years.
The exam tests for a combination of IT technical knowledge, clinical understanding, and project management experience thought to represent the typical workload of a PACS administrator or other radiology IT clinical support role. Certifications from PARCA (PACS Administrators Registry and Certifications Association) are also recognized. The five PARCA certifications are tiered from entry-level to architect level. The American Health Information Management Association offers credentials in medical coding, analytics, and data administration, such as Registered Health Information Administrator and Certified Coding Associate. Certifications are widely requested by employers in health informatics, and overall the demand for certified informatics workers in the United States is outstripping supply. The American Health Information Management Association reports that only 68% of applicants pass certification exams on the first try.
In 2017, a consortium of health informatics trainers (composed of MEASURE Evaluation, Public Health Foundation India, University of Pretoria, Kenyatta University, and the University of Ghana) identified the following areas of knowledge as a curriculum for the digital health workforce, especially in low- and middle-income countries: clinical decision support; telehealth; privacy, security, and confidentiality; workflow process improvement; technology, people, and processes; process engineering; quality process improvement and health information technology; computer hardware; software; databases; data warehousing; information networks; information systems; information exchange; data analytics; and usability methods.
In 2004, President George W. Bush signed Executive Order 13335, creating the Office of the National Coordinator for Health Information Technology (ONCHIT) as a division of the U.S. Department of Health and Human Services (HHS). The mission of this office is widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. See quality improvement organizations for more information on federal initiatives in this area. In 2014 the Department of Education approved an advanced Health Informatics Undergraduate program that was submitted by the University of South Alabama. The program is designed to provide specific Health Informatics education, and is the only program in the country with a Health Informatics Lab. The program is housed in the School of Computing in Shelby Hall, a recently completed $50 million state of the art teaching facility. The University of South Alabama awarded David L. Loeser on May 10, 2014, with the first Health Informatics degree.
The program currently is scheduled to have 100+ students awarded by 2016. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July 2006, CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements. Harvard Medical School added a department of biomedical informatics in 2015. The University of Cincinnati in partnership with Cincinnati Children's Hospital Medical Center created a biomedical informatics (BMI) Graduate certificate program and in 2015 began a BMI PhD program. The joint program allows for researchers and students to observe the impact their work has on patient care directly as discoveries are translated from bench to bedside.
Europe
European Union
The European Commission's preference, as exemplified in the 5th Framework as well as currently pursued pilot projects, is for Free/Libre and Open Source Software (FLOSS) for health care.
The European Union's Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality health care at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union's strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services. The European Institute for Health Records is involved in the promotion of high quality electronic health record systems in the European Union.
UK
The broad history of health informatics has been captured in the book UK Health Computing: Recollections and reflections, Hayes G, Barnett D (Eds.), BCS (May 2008) by those active in the field, predominantly members of BCS Health and its constituent groups. The book describes the path taken as "early development of health informatics was unorganized and idiosyncratic". In the early 1950s, it was prompted by those involved in NHS finance and only in the early 1960s did solutions including those in pathology (1960), radiotherapy (1962), immunization (1963), and primary care (1968) emerge. Many of these solutions, even in the early 1970s were developed in-house by pioneers in the field to meet their own requirements. In part, this was due to some areas of health services (for example the immunization and vaccination of children) still being provided by Local Authorities.
The coalition government has proposed broadly to return to the 2010 strategy Equity and Excellence: Liberating the NHS (July 2010); stating: "We will put patients at the heart of the NHS, through an information revolution and greater choice and control' with shared decision-making becoming the norm: "no decision about me without me' and patients having access to the information they want, to make choices about their care. They will have increased control over their own care records."
There are different models of health informatics delivery in each of the home countries (England, Scotland, Northern Ireland and Wales) but some bodies like UKCHIP (see below) operate for those 'in and for' all the home countries and beyond.
NHS informatics in England was contracted out to several vendors for national health informatics solutions under the National Programme for Information Technology (NPfIT) label in the early to mid-2000s, under the auspices of NHS Connecting for Health (part of the Health and Social Care Information Centre as of 1 April 2013). NPfIT originally divided the country into five regions, with strategic 'systems integration' contracts awarded to one of several Local Service Providers (LSP).
The various specific technical solutions were required to connect securely with the NHS 'Spine', a system designed to broker data between different systems and care settings. NPfIT fell significantly behind schedule and its scope and design were being revised in real time, exacerbated by media and political lambasting of the Programme's spend (past and projected) against the proposed budget. In 2010 a consultation was launched as part of the new Conservative/Liberal Democrat Coalition Government's White Paper "Liberating the NHS". This initiative provided little in the way of innovative thinking, primarily re-stating existing strategies within the proposed new context of the Coalition's vision for the NHS.
The degree of computerization in NHS secondary care was quite high before NPfIT, and the programme stagnated further development of the install base – the original NPfIT regional approach provided neither a single, nationwide solution nor local health community agility or autonomy to purchase systems, but instead tried to deal with a hinterland in the middle.
Almost all general practices in England and Wales are computerized under the GP Systems of Choice programme, and patients have relatively extensive computerized primary care clinical records. System choice is the responsibility of individual general practices and while there is no single, standardized GP system, it sets relatively rigid minimum standards of performance and functionality for vendors to adhere to. Interoperation between primary and secondary care systems is rather primitive. It is hoped that a focus on interworking (for interfacing and integration) standards will stimulate synergy between primary and secondary care in sharing necessary information to support the care of individuals. Notable successes to date are in the electronic requesting and viewing of test results, and in some areas, GPs have access to digital x-ray images from secondary care systems.
In 2019 the GP Systems of Choice framework was replaced by the GP IT Futures framework, which is to be the main vehicle used by clinical commissioning groups to buy services for GPs. This is intended to increase competition in an area that is dominated by EMIS and TPP. 69 technology companies offering more than 300 solutions have been accepted on to the new framework.
Wales has a dedicated Health Informatics function that supports NHS Wales in leading on the new integrated digital information services and promoting Health Informatics as a career.
The British Computer Society (BCS) provides 4 different professional registration levels for Health and Care Informatics Professionals: Practitioner, Senior Practitioner, Advanced Practitioner, and Leading Practitioner. The Faculty of Clinical Informatics (FCI) is the professional membership society for health and social care professionals in clinical informatics offering Fellowship, Membership and Associateship. BCS and FCI are member organizations of the Federation for Informatics Professionals in Health and Social Care (FedIP), a collaboration between the leading professional bodies in health and care informatics supporting the development of the informatics professions.
The Faculty of Clinical Informatics has produced a Core Competency Framework that describes the wide range of skills needed by practitioners.
Netherlands
In the Netherlands, health informatics is currently a priority for research and implementation. The Netherlands Federation of University medical centers (NFU) has created the Citrienfonds, which includes the programs eHealth and Registration at the Source. The Netherlands also has the national organizations Society for Healthcare Informatics (VMBI) and Nictiz, the national center for standardization and eHealth.
Asia and Oceania
In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI) was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.
Australia
The Australasian College of Health Informatics (ACHI) is the professional association for health informatics in the Asia-Pacific region. It represents the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere through a commitment to quality, standards and ethical practice. ACHI is an academic institutional member of the International Medical Informatics Association (IMIA) and a full member of the Australian Council of Professions.
ACHI is a sponsor of the "e-Journal for Health Informatics", an indexed and peer-reviewed professional journal. ACHI has also supported the "Australian Health Informatics Education Council" (AHIEC) since its founding in 2009.
Although there are a number of health informatics organizations in Australia, the Health Informatics Society of Australia (HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association (IMIA). Nursing informaticians were the driving force behind the formation of HISA, which is now a company limited by guarantee of the members. The membership comes from across the informatics spectrum that is from students to corporate affiliates. HISA has a number of branches (Queensland, New South Wales, Victoria and Western Australia) as well as special interest groups such as nursing (NIA), pathology, aged and community care, industry and medical imaging (Conrick, 2006).
China
After 20 years, China performed a successful transition from its planned economy to a socialist market economy. Along this change, China's health care system also experienced a significant reform to follow and adapt to this historical revolution. In 2003, the data (released from Ministry of Health of the People's Republic of China (MoH)), indicated that the national health care-involved expenditure was up to RMB 662.33 billion totally, which accounted for about 5.56% of nationwide gross domestic products. Before the 1980s, the entire health care costs were covered in central government annual budget. Since that, the construct of health care-expended supporters started to change gradually. Most of the expenditure was contributed by health insurance schemes and private spending, which corresponded to 40% and 45% of total expenditure, respectively. Meanwhile, the financially governmental contribution was decreased to 10% only. On the other hand, by 2004, up to 296,492 health care facilities were recorded in statistic summary of MoH, and an average of 2.4 clinical beds per 1000 people were mentioned as well.
Along with the development of information technology since the 1990s, health care providers realized that the information could generate significant benefits to improve their services by computerized cases and data, for instance of gaining the information for directing patient care and assessing the best patient care for specific clinical conditions. Therefore, substantial resources were collected to build China's own health informatics system.
Most of these resources were arranged to construct hospital information system (HIS), which was aimed to minimize unnecessary waste and repetition, subsequently to promote the efficiency and quality-control of health care. By 2004, China had successfully spread HIS through approximately 35–40% of nationwide hospitals. However, the dispersion of hospital-owned HIS varies critically. In the east part of China, over 80% of hospitals constructed HIS, in northwest of China the equivalent was no more than 20%. Moreover, all of the Centers for Disease Control and Prevention (CDC) above rural level, approximately 80% of health care organisations above the rural level and 27% of hospitals over town level have the ability to perform the transmission of reports about real-time epidemic situation through public health information system and to analysis infectious diseases by dynamic statistics.
China has four tiers in its health care system. The first tier is street health and workplace clinics and these are cheaper than hospitals in terms of medical billing and act as prevention centers. The second tier is district and enterprise hospitals along with specialist clinics and these provide the second level of care. The third tier is provisional and municipal general hospitals and teaching hospitals which provided the third level of care. In a tier of its own is the national hospitals which are governed by the Ministry of Health. China has been greatly improving its health informatics since it finally opened its doors to the outside world and joined the World Trade Organization (WTO). In 2001, it was reported that China had 324,380 medical institutions and the majority of those were clinics. The reason for that is that clinics are prevention centers and Chinese people like using traditional Chinese medicine as opposed to Western medicine and it usually works for the minor cases. China has also been improving its higher education in regards to health informatics.
At the end of 2002, there were 77 medical universities and medical colleges. There were 48 university medical colleges which offered bachelor, master, and doctorate degrees in medicine. There were 21 higher medical specialty institutions that offered diploma degrees so in total, there were 147 higher medical and educational institutions. Since joining the WTO, China has been working hard to improve its education system and bring it up to international standards.
SARS played a large role in China quickly improving its health care system. Back in 2003, there was an outbreak of SARS and that made China hurry to spread HIS or Hospital Information System and more than 80% of hospitals had HIS. China had been comparing itself to Korea's health care system and figuring out how it can better its own system. There was a study done that surveyed six hospitals in China that had HIS. The results were that doctors did not use computers as much so it was concluded that it was not used as much for clinical practice than it was for administrative purposes. The survey asked if the hospitals created any websites and it was concluded that only four of them had created websites and that three had a third-party company create it for them and one was created by the hospital staff. In conclusion, all of them agreed or strongly agreed that providing health information on the Internet should be utilized.
Collected information at different times, by different participants or systems could frequently lead to issues of misunderstanding, dis-comparing or dis-exchanging. To design an issues-minor system, health care providers realized that certain standards were the basis for sharing information and interoperability, however a system lacking standards would be a large impediment to interfere the improvement of corresponding information systems. Given that the standardization for health informatics depends on the authorities, standardization events must be involved with government and the subsequently relevant funding and supports were critical. In 2003, the Ministry of Health released the Development Lay-out of National Health Informatics (2003–2010) indicating the identification of standardization for health informatics which is 'combining adoption of international standards and development of national standards'.
In China, the establishment of standardization was initially facilitated with the development of vocabulary, classification and coding, which is conducive to reserve and transmit information for premium management at national level. By 2006, 55 international/ domestic standards of vocabulary, classification and coding have served in hospital information system. In 2003, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the ICD-10 Clinical Modification (ICD-10-CM) were adopted as standards for diagnostic classification and acute care procedure classification. Simultaneously, the International Classification of Primary Care (ICPC) were translated and tested in China 's local applied environment.
Another coding standard, named Logical Observation Identifiers Names and Codes (LOINC), was applied to serve as general identifiers for clinical observation in hospitals.
Personal identifier codes were widely employed in different information systems, involving name, sex, nationality, family relationship, educational level and job occupation. However, these codes within different systems are inconsistent, when sharing between different regions. Considering this large quantity of vocabulary, classification and coding standards between different jurisdictions, the health care provider realized that using multiple systems could generate issues of resource wasting and a non-conflicting national level standard was beneficial and necessary. Therefore, in late 2003, the health informatics group in Ministry of Health released three projects to deal with issues of lacking national health information standards, which were the Chinese National Health Information Framework and Standardization, the Basic Data Set Standards of Hospital Information System and the Basic Data Set Standards of Public Health Information System.
The objectives of the Chinese National Health Information Framework and Standardization project were:
Establish national health information framework and identify in what areas standards and guidelines are required
Identify the classes, relationships and attributes of national health information framework. Produce a conceptual health data model to cover the scope of the health information framework
Create logical data model for specific domains, depicting the logical data entities, the data attributes, and the relationships between the entities according to the conceptual health data model
Establish uniform represent standard for data elements according to the data entities and their attributes in conceptual data model and logical data model
Circulate the completed health information framework and health data model to the partnership members for review and acceptance
Develop a process to maintain and refine the China model and to align with and influence international health data models
Comparing China's EHR Standard and ASTM E1384
In 2011, researchers from local universities evaluated the performance of China's Electronic Health Record (EHR) Standard compared with the American Society for Testing and Materials Standard Practice for Content and Structure of Electronic Health Records in the United States (ASTM E1384 Standard, withdrawn in 2017). The deficiencies that were found are listed in the following.
The lack of supporting on privacy and security. The ISO/TS 18308 specifies "The EHR must support the ethical and legal use of personal information, in accordance with established privacy principles and frameworks, which may be culturally or jurisdictionally specific" (ISO 18308: Health Informatics-Requirements for an Electronic Health Record Architecture, 2004). However this China's EHR Standard did not achieve any of the fifteen requirements in the subclass of privacy and security.
The shortage of supporting on different types of data and reference. Considering only ICD-9 is referenced as China's external international coding systems, other similar systems, such as SNOMED CT in clinical terminology presentation, cannot be considered as familiar for Chinese specialists, which could lead to internationally information-sharing deficiency.
The lack of more generic and extensible lower level data structures. China's large and complex EHR Standard was constructed for all medical domains. However, the specific and time-frequent attributes of clinical data elements, value sets and templates identified that this once-for-all purpose cannot lead to practical consequence.
In Hong Kong, a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority since 1994. This system has been deployed at all the sites of the authority (40 hospitals and 120 clinics). It is used for up to 2 million transactions daily by 30,000 clinical staff. The comprehensive records of 7 million patients are available on-line in the electronic patient record (ePR), with data integrated from all sites. Since 2004 radiology image viewing has been added to the ePR, with radiography images from any HA site being available as part of the ePR.
The Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development, with input from hundreds of clinicians being incorporated through a structured process. The health informatics section in the Hospital Authority has a close relationship with the information technology department and clinicians to develop health care systems for the organization to support the service to all public hospitals and clinics in the region.
The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in health care. The eHealth Consortium has been formed to bring together clinicians from both the private and public sectors, medical informatics professionals and the IT industry to further promote IT in health care in Hong Kong.
India
eHCF School of Medical Informatics
eHealth-Care Foundation
Malaysia
Since 2010, the Ministry of Health (MoH) has been working on the Malaysian Health Data Warehouse (MyHDW) project. MyHDW aims to meet the diverse needs of timely health information provision and management, and acts as a platform for the standardization and integration of health data from a variety of sources (Health Informatics Centre, 2013). The Ministry of Health has embarked on introducing the electronic Hospital Information Systems (HIS) in several public hospitals including Putrajaya Hospital, Serdang Hospital and Selayang Hospital. Similarly, under Ministry of Higher Education, hospitals such as University of Malaya Medical Centre (UMMC) and University Kebangsaan Malaysia Medical Centre (UKMMC) are also using HIS for healthcare delivery.
A hospital information system (HIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. As an area of medical informatics, the aim of hospital information system is to achieve the best possible support of patient care and administration by electronic data processing. HIS plays a vital role in planning, initiating, organizing and controlling the operations of the subsystems of the hospital and thus provides a synergistic organization in the process.
New Zealand
Health informatics is taught at five New Zealand universities. The most mature and established programme has been offered for over a decade at Otago. Health Informatics New Zealand (HINZ), is the national organization that advocates for health informatics. HINZ organizes a conference every year and also publishes a journal, Healthcare Informatics Review Online.
Saudi Arabia
The Saudi Association for Health Information (SAHI) was established in 2006 to work under direct supervision of King Saud bin Abdulaziz University for Health Sciences to practice public activities, develop theoretical and applicable knowledge, and provide scientific and applicable studies.
Russia
The Russian health care system is based on the principles of the Soviet health care system, which was oriented on mass prophylaxis, prevention of infection and epidemic diseases, vaccination and immunization of the population on a socially protected basis. The current government health care system consists of several directions:
Preventive health care
Primary health care
Specialized medical care
Obstetrical and gynecologic medical care
Pediatric medical care
Surgery
Rehabilitation/ Health resort treatment
One of the main issues of the post-Soviet medical health care system was the absence of the united system providing optimization of work for medical institutes with one, single database and structured appointment schedule and hence hours-long lines. Efficiency of medical workers might have been also doubtful because of the paperwork administrating or lost book records.
Along with the development of the information systems IT and health care departments in Moscow agreed on design of a system that would improve public services of health care institutes. Tackling the issues appearing in the existing system, the Moscow Government ordered that the design of a system would provide simplified electronic booking to public clinics and automate the work of medical workers on the first level.
The system designed for that purposes was called EMIAS (United Medical Information and Analysis System) and presents an electronic health record (EHR) with the majority of other services set in the system that manages the flow of patients, contains outpatient card integrated in the system, and provides an opportunity to manage consolidated managerial accounting and personalized list of medical help. Besides that, the system contains information about availability of the medical institutions and various doctors.
The implementation of the system started in 2013 with the organization of one computerized database for all patients in the city, including a front-end for the users. EMIAS was implemented in Moscow and the region and it is planned that the project should extend to most parts of the country.
Law
Health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health-related fields. It addresses the privacy, ethical and operational issues that invariably arise when electronic tools, information and media are used in health care delivery. Health Informatics Law also applies to all matters that involve information technology, health care and the interaction of information. It deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care.
As many health care systems are making an effort to have patient records more readily available to them via the internet, it is important that providers implement security standards in order to ensure that the patients' information is safe. They have to be able to assure confidentiality, integrity, and security of the people, process, and technology. Since there is also the possibility of payments being made through this system, it is vital that this aspect of their private information will also be protected through cryptography.
The use of technology in health care settings has become popular and this trend is expected to continue. Various health care facilities had instigated different kinds of health information technology systems in the provision of patient care, such as electronic health records (EHRs), computerized charting, etc. The growing popularity of health information technology systems and the escalation in the amount of health information that can be exchanged and transferred electronically increased the risk of potential infringement in patients' privacy and confidentiality. This concern triggered the establishment of strict measures by both policymakers and individual facility to ensure patient privacy and confidentiality.
One of the federal laws enacted to safeguard patient's health information (medical record, billing information, treatment plan, etc.) and to guarantee patient's privacy is the Health Insurance Portability and Accountability Act of 1996 or HIPAA. HIPAA gives patients the autonomy and control over their own health records. Furthermore, according to the U.S. Department of Health & Human Services (n.d.), this law enables patients to:
View their own health records
Request a copy of their own medical records
Request correction to any incorrect health information
Know who has access to their health record
Request who can and cannot view/access their health information
Health and medical informatics journals
Computers and Biomedical Research, published in 1967, was one of the first dedicated journals to health informatics. Other early journals included Computers and Medicine, published by the American Medical Association; Journal of Clinical Computing, published by Gallagher Printing; Journal of Medical Systems, published by Plenum Press; and MD Computing, published by Springer-Verlag. In 1984, Lippincott published the first nursing-specific journal, titled Journal Computers in Nursing, which is now known as Computers Informatics Nursing (CIN).
As of September 7, 2016, there are roughly 235 informatics journals listed in the National Library of Medicine (NLM) catalog of journals. The Journal Citation Reports for 2018 gives the top three journals in medical informatics as the Journal of Medical Internet Research (impact factor of 4.945), JMIR mHealth and uHealth (4.301) and the Journal of the American Medical Informatics Association (4.292).
Competencies, education and certification
In the United States, clinical informatics is a subspecialty within several medical specialties. For example, in pathology, the American Board of Pathology offers clinical informatics certification for pathologists who have completed 24 months of related training, and the American Board of Preventive Medicine offers clinical informatics certification within preventive medicine.
In October 2011 American Board of Medical Specialties (ABMS), the organization overseeing the certification of specialist MDs in the United States, announced the creation of MD-only physician certification in clinical informatics. The first examination for board certification in the subspecialty of clinical informatics was offered in October 2013 by American Board of Preventive Medicine (ABPM) with 432 passing to become the 2014 inaugural class of Diplomates in clinical informatics. Fellowship programs exist for physicians who wish to become board-certified in clinical informatics. Physicians must have graduated from a medical school in the United States or Canada, or a school located elsewhere that is approved by the ABPM. In addition, they must complete a primary residency program such as Internal Medicine (or any of the 24 subspecialties recognized by the ABMS) and be eligible to become licensed to practice medicine in the state where their fellowship program is located. The fellowship program is 24 months in length, with fellows dividing their time between Informatics rotations, didactic method, research, and clinical work in their primary specialty.
See also
Related concepts
Clinical documentation improvement
Continuity of care record (CCR)
Diagnosis-related group (DRG)
eHealth
Health information exchange (HIE)
Health information management (HIM)
Human resources for health (HRH) information system
International Classification of Diseases (ICD)
National minimum dataset
Neuroinformatics
Nosology
Nursing documentation
Personal health record (PHR)
Clinical data standards
DICOM
Health Metrics Network
Health network surveillance
HL7
Fast Healthcare Interoperability Resources (FHIR)
Integrating the Healthcare Enterprise
Omaha System
openEHR
SNOMED
xDT
Algorithms
Datafly algorithm
Governance
References
Further reading
External links | 0.760036 | 0.995536 | 0.756643 |
Positive youth development | Positive youth development (PYD) programs are designed to optimize youth developmental progress. This is sought through a positivistic approach that emphasizes the inherent potential, strengths, and capabilities youth hold. PYD differs from other approaches within youth development work in that it rejects an emphasis on trying to correct what is considered wrong with children's behavior or development, renouncing a problem-oriented lens. Instead, it seeks to cultivate various personal assets and external contexts known to be important to human development.
Youth development professionals live by the motto originally coined by Karen Pittman, "problem free is not fully prepared", as they work to grow youth into productive members of society. Seen through a PYD lens, young people are not regarded as "problems to be solved"; rather, they are seen as assets, allies, and agents of change who have much to contribute in solving the problems that affect them most. Programs and practitioners seek to empathize with, educate, and engage children in productive activities in order to help youth "reach their full potential". Though the field is still growing, PYD has been used across the world to address social divisions, such as gender and ethnic differences.
Background
Positive youth development originated from ecological systems theory to focus on the strengths of adolescents. Central to this theory is the understanding that there are multiple environments that influence children. Similar to the principles of positive psychology, the theory of PYD suggests that "if young people have mutually beneficial relations with the people and institutions of their social world, they will be on the way to a hopeful future marked by positive contributions to self, family, community, and civil society."
The major catalyst of positive youth development came as a response to the punitive methods of the "traditional youth development" approach. The traditional approach makes a connection between the changes occurring during adolescent years and the beginning or peaking of several public health and social problems, including homicide, suicide, substance use and abuse, sexually transmitted infections, teen and unplanned pregnancies. This connection was made infamous by developmental psychologist G. Stanley Hall who described adolescence as a time of "storm and stress".
Another aspect of the traditional approach is that many professionals and mass media portrayed adolescents as inevitable problems that simply needed to be fixed. This "fixing" motivated the "solving" of single-problem behavior, such as substance abuse. Specific evidence of this "problem-centered" model is present across professional fields that deal with young people. Language that reflects this approach includes the “at-risk child” and “the juvenile delinquent”. Many connections can also be made to the current U.S. criminal justice model that favors punishment as opposed to prevention.
The concept and practice of positive youth development "grew from the dissatisfaction with a predominant view that underestimated the true capacities of young people by focusing on their deficits rather than their development potential." PYD asserts that youth have inherent strengths and if given opportunities, support, and acknowledgement they can thrive. Encouraging the positive development of adolescents can ease the transition into healthy adulthood. Therefore, emphasis is placed on asset-building. Crucial to the outlining of asset-building is Peter Benson's list of developmental assets. This list is divided into two categories: internal assets (positive individual characteristics) and external assets (community characteristics). Furthermore, research findings point out that PYD provides a sense of “social belonging”, participatory motivation in academic-based and community activities for positive educational outcomes, a sense of social responsibility and civic engagement, and participation in organized activities that would aid in self-development.
Goals
PYD focuses on the active promotion of optimal human development, rather than on the scientific study of age related change, distinguishing it from the study of child development or adolescent development. or as solely a means of avoiding risky behaviors. Rather than grounding its developmental approach in the presence of adversity, risk or challenge, a PYD approach considers the potential and capacity of each individual young person. A hallmark of these programs is that they are based on the concept that children and adolescents have strengths and abilities unique to their developmental stage and that they are not merely "inadequate" or "undeveloped" adults. Lerner and colleagues write: "The goal of the positive youth development perspective is to promote positive outcomes. This idea is in contrast to a perspective that focuses on punishment and the idea that adolescents are broken".
Positive youth development is both a vision, an ideology and a new vocabulary for engaging with youth development. Its tenets can be organized into the 5 C's which are: competence, confidence, connection, character, and caring. When these 5 C's are present, the 6th C of "contribution" is realized.
Key features
Positive youth development programs typically recognize contextual variability in youths' experience and in what is considered healthy or optimal development for youth in different settings or cultures. This cultural sensitivity reflects the influence of Bronfenbrenner's ecological systems theory. The influence of ecological systems theory is also seen on the emphasis many youth development programs place on the interrelationship of different social contexts through which the individual moves (e.g. family, peers, school, work, and leisure). This means that PYD seeks to involve youth in multiple kinds of prosocial relationships to promote the young person's wellness, safety, and healthy maturation. Such engagement may be sought "within their communities, schools, organizations, peer groups, and families". As a result, PYD seeks to build "community capacity". The community is involved in order to facilitate a sense of security and identity. Likewise, youth are encouraged to be involved in the community.
The University of Minnesota's Keys to Quality Youth Development summarizes eight key elements of programs that successfully promote youth development. Such programs are physically and emotionally safe, give youth a sense of belonging and ownership, foster self-worth, facilitates discovery of their "selves" (identities, interests, strengths), foster high-quality and supportive relationships with peers and adults, help youth recognize conflicting values and develop their own, foster the development of new skills, creates a fun environment, and develops hope for the future.
In addition, programs that employ PYD principles generally have one or more of the following features:
promote bonding
foster resilience
promote social, emotional, cognitive, behavioral, and moral competence
encourages service
foster self-determination
foster spirituality
foster self-efficacy
foster clear and positive identity
foster belief in the future
sets expectations
facilitation of identity creation
provide recognition for positive behavior and opportunities for pro-social involvement
promote empowerment
promotes responsibility
foster pro-social norms
Using PYD to address stereotypes and inequality
Gender
Positive youth development principles can be used to address gender inequities through the promotion of programs such as "Girls on the Run." Physical activity-based programs like "Girls on the Run" are being increasingly used around the world for their ability to encourage psychological, emotional, and social development for youth. "Girls on the Run" enhances this type of physical activity program by specifically targeting female youth in an effort to reduce the gendered view of a male-dominated sports arena. "Girls on the Run" is a non-profit organization begun in 1996 that distributes a 12-week training program to help girls prepare for a 5k running competition. This particular program is made available to 3rd through 5th grade female students throughout the United States and Canada to be implemented in either school or community-based settings.
Another example of positive youth development principles being used to target youth gender inequities can be seen in that of a participatory diagramming approach in Kibera, Kenya. This community development effort enabled participants to feel safe discussing their concerns regarding gender inequities in the community with the dominant male group. This approach also enabled youth to voice their needs and identify potential solutions related to topics like HIV/AIDS and family violence.
Ethnic minorities in the United States
Positive youth development can be used to combat negative stereotypes surrounding youth of minority ethnic groups in the U.S. after-school programs have been directly geared to generate increased participation for African American and Latino youth with a focus on academic achievement and increasing high school graduation rates. Studies have found programs targeting African American youth are more effective when they work to bolster a sense of their cultural identity. PYD has even been used to help develop and strengthen the cultural identities of American Indian and Alaskan Native youth. PYD methods have been used to provide a supportive setting in which to engage youth in traditional activities. Various programs have been implemented related to sports, language, and arts and crafts. Sports programs that use positive youth development principles are commonly referred to as "sports-based youth development" (SBYD) programs. SBYD incorporates positive youth development principles into program and curricula design and coach training.
Many factors, such as low income, redlining, racial barriers and racial prejudice, mental health illness or challenges and substance abuse, have impacted ethnic minorities in the United States. Youth who are at-risk of falling into negative behaviors need positive youth development programs to help them avoid going to juvenile system. Research shows that there is improvement in youth's behavior with PYD, "Programs consisting of repressive and punitive elements were ineffective, whereas programs targeting positive social relations of at-risk youth (providing informal and supportive social control) proved to be successful". When PYD is incorporated in after-school programs, youth receive academic support and mental health services. PYD also provides mentors who lend support to youth and encourage them to believe in themselves, despite what the system and society tells them.
Models of implementation
Asia
The key constructs of PYD listed above have been generally accepted throughout the world with some regional distinctions. For example, a Chinese Positive Youth Development Scale has been developed to conceptualize how these features are applicable to Chinese youth. The Chinese Positive Youth Development Scale was used as a measure in a study of Chinese youth in secondary schools in Hong Kong that indicated positive youth development has a direct impact on life satisfaction and reducing problem behavior for Chinese youth. One specific example of PYD implementation is seen in the project "P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) to Adulthood: A Jockey Club Youth Enhancement Scheme." This program targets junior secondary school students in Hong Kong (grades 7 through 9 in the North American System). The program is composed of two terms, the first of which is a structured curriculum focusing on the 15 PYD constructs and designed for all students as a "universal prevention initiative." The Tier 2 Program is a more selective prevention model directly targeting students with greater psychosocial needs identified by the school social work service providers. The label "at-risk" is intentionally avoided because the term denotes a very negative stigma in Chinese culture, and therefore discourages participation in the program. Although Chinese social work agencies commonly target students with greater psychosocial needs, these PYD programs have rarely undergone thorough systemic evaluation and documentation.
Europe
In Portugal, the utility of positive youth development principles in sporting contexts is beginning to be recognized. Several athletic-based programs have been implemented in the country, but more research is necessary to determine their effectiveness at this point.
Latin America and the Caribbean
Positive youth development has also been seen in the form of youth volunteer service throughout Latin America and the Caribbean. From Mexico and the Caribbean to Central and South America, this form of implementation has been acknowledged for encouraging both personal and community development, while oftentimes contributing to poverty reduction. It has furthermore been seen as a way of promoting civil engagement through various service opportunities in communities.
Positive youth development efforts can be seen in the work of the United States Agency for International Development (USAID) in collaboration with various regional governments and the private sector across Latin America and the Caribbean. This work has focused on providing broader educational options, skills training, and opportunities for economically disadvantaged youth to obtain apprenticeships. The ¡Supérate! Centers across El Salvador are one example, as they are supported by USAID in combination with private companies and foundations, and offer expanded education for high-performing students from poorer economic backgrounds. As of 2011, there were 7 centers in El Salvador and USAID expressed plans to expand this model across Central America. In Brazil, the Jovem Plus program offers high-demand skills training for youth in disadvantaged communities in Rio de Janeiro and the northeastern area of the nation. Other programs include the "Youth Movement against Violence" in Guatemala and "Youth Upliftment through Employment" in Jamaica.
USA
The rates of juvenile offenders were increasing, as youth were steering to bad habits affecting their academic standing and outside of school. The rates of juvenile offenders affected the community's well-being, so it became a governmental issue to find positive development solutions for youth to behave well at schools and elsewhere. The government realized they would need to start working with youth at the school level, as youth who got suspended have a higher chance of getting involved in the juvenile system. A debate that has been happening is the socio-emotional learning (SEL) program that consists of Monarch Room(MR) intervention, a trauma-informed alternative to school discipline. The MR was to promote socio-emotional regulation, and the staff were trained in counseling and trauma-informed to help the youth with sensory states, thoughts, feelings, and "subsequent behaviors". The research for SEL was a 10-year study, and the results showed that Grade 9 students had the highest use of the MR, and, on average, students used it five times a year. The program was successful overall as it showed interest in the youth wanting support, and the introduction of MR led to a decrease in the use of school suspension. However, there was no comparison group to help determine if the decreased levels of the School Disciplinary Act (SDA) were due to the MR initiative.
Another solution up for debate to reduce school suspension is the Positive Behaviour Interventions and Support framework (PBIS). This program worked in 3 tiers approach to improve school climate. Tier 1 is teaching the expectations to all students; tier 2 is target support for the small groups of students displaying challenging behavior; tier 3 is individually intervening when working with students with intense behavioral needs. PBIS did find a statistical difference between the schools using PBIS and not for reducing SDA for all students, particularly students with disability and BIPOC students. However, the researchers did acknowledge that using a PBIS framework does not significantly affect the most severe behaviors, e.g., weapons offenses, because, as an intervention, it does not target those types of incidents. PBIS is a proactive and preventative approach. The ratings from the participants were overwhelmingly positive; however, there are concerns about the time requirement to implement the study, which is worth exploring further.
An additional solution is Restorative Practices, which are associated with reduced suspension rates and suggest that school-based restorative practices are a promising approach to reducing exclusionary discipline outcomes. The practices are to build a positive school culture and environment. They focus on the problem and not blaming or punishing. To see the effectiveness of this study, they looked at interviews, focus groups, observations, school artifacts, and suspension data to determine the effectiveness of RJP. RJP uses responsive circles, mediations, and re-entry circles for students involved in conflict. They implement RJP to facilitate conflict resolution and remove policies that compete with these practices, i.e., punitive consequences.
See also
Comprehensive sex education
Culture and positive psychology
Growth mindset
Positive education
Youth services
Youth intervention
References
External links
Youth | 0.778251 | 0.972214 | 0.756626 |
Sick role | Sick role is a term used in medical sociology regarding sickness and the rights and obligations of the affected. It is a concept created by American sociologist Talcott Parsons in 1951. The sick role fell out of favour in the 1990s replaced by social constructist theories.
Concept
Parsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. The patterns of sickness are often caused by persistent pain which helps to support their attitude of not wanting to take positive action to get better. Therefore this deviance needs to be policed, which is the role of the medical profession. Generally, Parsons argued that the best way to understand illness sociologically is to view it as a form of deviance which disturbs the social function of the society.
The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined three rights of a sick person and two obligations:
Rights:
The sick person is exempt from normal social roles
The sick person is not responsible for their condition
Obligations:
The sick person should try to get well
The sick person should seek technically competent help and cooperate with the medical professional(s)
There are three versions of sick role:
Conditional, wherein both rights and duties apply
Unconditionally legitimate - wherein obligations may not apply (the terminally ill are not obligated to try to get well)
Illegitimate role: condition that is stigmatized by others (wherein rights do not apply as the sick person is blamed for their condition)
Criticisms
Critics of Parsons and the functionalist perspective point to different flaws they see with his argument. The model assumes that the individual voluntarily accepts the sick role, and ignores that the individual may not comply with expectations of the sick role, may not give up social obligations, may resist dependency, and may avoid the public sick role, particularly if their illness is stigmatized. The model also blames the sick, where “rights” do not always apply.
The sick role fell out of favour in the 1990s, with alternatives conceptualisations in terms of labeling theory viewing illness as a social construction to label socially deviant as inferior, with the medical system and physicians used as a means of control. Burnham argues that this rejection was combined with an explicit or implicit rejection of the idea unconscious (replaced with cognitive-behavioral theories) together with an explicit or implicit adoption of a Marxist perspective that disease was caused by economic circumstances.
See also
e-Patient
References
Medical sociology
Role status | 0.775282 | 0.975868 | 0.756573 |
Psychological pain | Psychological pain, mental pain, or emotional pain is an unpleasant feeling (a suffering) of a psychological, non-physical origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment." There are numerous ways psychological pain is referred to, using a different word usually reflects an emphasis on a particular aspect of mind life. Technical terms include algopsychalia and psychalgia, but it may also be called mental pain, emotional pain, psychic pain, social pain,
spiritual or soul pain, or suffering. While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling. Psychological pain is widely believed to be an inescapable aspect of human existence.
Other descriptions of psychological pain are "a wide range of subjective experiences characterized as an awareness of negative changes in the self and in its functions accompanied by negative feelings", "a diffuse subjective experience ... differentiated from physical pain which is often localized and associated with noxious physical stimuli", and "a lasting, unsustainable, and unpleasant feeling resulting from negative appraisal of an inability or deficiency of the self."
Causes
The adjective "psychological" is thought to encompass the functions of beliefs, thoughts, feelings, and behaviors, which may be seen as an indication for the many sources of psychological pain. One way of grouping these different sources of pain was offered by Shneidman, who stated that psychological pain is caused by frustrated psychological needs. For example, the need for love, autonomy, affiliation, and achievement, or the need to avoid harm, shame, and embarrassment. Psychological needs were originally described by Henry Murray in 1938 as needs that motivate human behavior. Shneidman maintained that people rate the importance of each need differently, which explains why people's level of psychological pain differs when confronted with the same frustrated need. This needs perspective coincides with Patrick David Wall's description of physical pain that says that physical pain indicates a need state much more than a sensory experience.
Unmet psychological needs in youth may cause an inability to meet human needs later in life. As a consequence of neglectful parenting, children with unmet psychological needs may be linked to psychotic disorders in childhood throughout life.
In the fields of social psychology and personality psychology, the term social pain is used to denote psychological pain caused by harm or threat to social connection; bereavement, embarrassment, shame and hurt feelings are subtypes of social pain. From an evolutionary perspective, psychological pain forces the assessment of actual or potential social problems that might reduce the individual's fitness for survival. The way people display their psychological pain socially (for example, crying, shouting, moaning) serves the purpose of indicating that they are in need.
Neuropsychology
Physical pain and psychological pain share common underlying neurological mechanisms. Brain regions that were consistently found to be implicated in both types of pain are the anterior cingulate cortex and prefrontal cortex (some subregions more than others), and may extend to other regions as well. Brain regions that were also found to be involved in psychological pain include the insular cortex, posterior cingulate cortex, thalamus, parahippocampal gyrus, basal ganglia, and cerebellum. Some advocate that, because similar brain regions are involved in both physical pain and psychological pain, pain should be seen as a continuum that ranges from purely physical to purely psychological. Moreover, many sources mention the fact that many metaphors of physical pain are used to refer to psychologically painful experiences. Further connection between physical and psychological pain has been supported through proof that acetaminophen, an analgesic, can suppress activity in the anterior cingulate cortex and the insular cortex when experiencing social exclusion, the same way that it suppresses activity when experiencing physical pain, and reduces the agitation of people with dementia. However, use of paracetamol for more general psychological pain remains disputed.
Borderline personality disorder
Borderline personality disorder (BPD) has long been believed to be a disorder that produces the most intense emotional pain and distress in those who have this condition. Studies have shown that borderline patients experience chronic and significant emotional suffering and mental agony. Borderline patients may feel overwhelmed by negative emotions, experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness. People with BPD are especially sensitive to feelings of rejection, isolation and perceived failure. Both clinicians and laymen alike have witnessed the desperate attempts to escape these subjective inner experiences of these patients. Borderline patients are severely impulsive and their attempts to alleviate the agony are often very destructive or self-destructive. Suicidal ideation, suicide attempts, eating disorders (anorexia nervosa, binge eating disorder, and bulimia nervosa), self-harm (cutting, overdosing, starvation, etc.), compulsive spending, gambling, sex addiction, violent and aggressive behavior, sexual promiscuity and deviant sexual behaviors, are desperate attempts to escape this pain.
The intrapsychic pain experienced by those diagnosed with BPD has been studied and compared to normal healthy controls and to others with major depression, bipolar disorder, substance use disorder, schizophrenia, other personality disorders, and a range of other conditions. Although the excruciatingly painful inner experience of the borderline patient is both unique and perplexing, it is often linked to severe childhood trauma of abuse and neglect. In clinical populations, the rate of suicide of patients with borderline personality disorder is estimated to be 10%, a rate far greater than that in the general population and still considerably greater than for patients with schizophrenia and bipolar disorder, though studies on suicidality in bipolar subjects have found that 4-19% of bipolar patients (mostly untreated) commit suicide. However, 60–70% of patients with borderline personality disorder make suicide attempts, so suicide attempts are far more frequent than completed suicides in patients with BPD.
The intense dysphoric states which patients diagnosed with BPD endure on a regular basis distinguishes them from those with other personality disorders: major depressive disorder, bipolar disorder, and virtually all known DSM-IV Axis I and Axis II conditions. In a 1998 study entitled "The Pain of Being Borderline: Dysphoric States Specific to Borderline Personality Disorder", 146 diagnosed borderline patients took a 50-item self-report measure test. The conclusions from this study suggest "that the subjective pain of borderline patients may be both more pervasive and more multifaceted than previously recognised and that the overall "amplitude" of this pain may be a particularly good marker for the borderline diagnosis".
Feelings of emptiness are a central problem for patients with personality disturbances. In an attempt to avoid this feeling, these patients employ defences to preserve their fragmentary selves. Feelings of emptiness may be so painful that suicide is considered.
See also
Emotion
Psychological abuse
Psychological trauma
Psychosomatic medicine
Sensory overload
References
Emotion
Suffering
Borderline personality disorder
Limbic system | 0.760243 | 0.995165 | 0.756567 |
Functional analysis (psychology) | Functional analysis in behavioral psychology is the application of the laws of operant and respondent conditioning to establish the relationships between stimuli and responses. To establish the function of operant behavior, one typically examines the "four-term contingency": first by identifying the motivating operations (EO or AO), then identifying the antecedent or trigger of the behavior, identifying the behavior itself as it has been operationalized, and identifying the consequence of the behavior which continues to maintain it.
Functional assessment in behavior analysis employs principles derived from the natural science of behavior analysis to determine the "reason", purpose, or motivation for a behavior. The most robust form of functional assessment is functional analysis, which involves the direct manipulation, using some experimental design (e.g., a multielement design or a reversal design) of various antecedent and consequent events and measurement of their effects on the behavior of interest; this is the only method of functional assessment that allows for demonstration of clear cause of behavior.
Applications in clinical psychology
Functional analysis and consequence analysis are commonly used in certain types of psychotherapy to better understand, and in some cases change, behavior. It is particularly common in behavioral therapies such as behavioral activation, although it is also part of Aaron Beck's cognitive therapy. In addition, functional analysis modified into a behavior chain analysis is often used in dialectical behavior therapy.
There are several advantages to using functional analysis over traditional assessment methods. Firstly, behavioral observation is more reliable than traditional self-report methods. This is because observing the individual from an objective stand point in their regular environment allows the observer to observe both the antecedent and the consequence of the problem behavior. Secondly, functional analysis is advantageous as it allows for the development of behavioral interventions, either antecedent control or consequence control, specifically designed to reduce a problem behavior. Thirdly, functional analysis is advantageous for interventions for young children or developmentally delayed children with problem behaviors, who may not be able to answer self-report questions about the reasons for their actions.
Despite these benefits, functional analysis also has some disadvantages. The first that no standard methods for determining function have been determined and meta-analysis shows that different methodologies appear to bias results toward particular functions as well as not effective in improving outcomes. Second, Gresham and colleagues (2004) in a meta-analytic review of JABA articles found that functional assessment did not produce greater effect sizes compared to simple contingency management programs. However, Gresham et al. combined the three types of functional assessment, of which descriptive assessment and indirect assessment have been reliably found to produce results with limited validity Third, although functional assessment has been conducted with a variety host of populations (i.e.) much of the current functional assessment research has been limited to children with developmental disabilities.
Professional organizations
The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on the use of behavior analysis in the school setting including functional analysis.
Doctoral level behavior analysts who are psychologists belong to the American Psychological Association's division 25 – Behavior analysis. APA offers a diplomate in behavioral psychology and school psychology both of which focus on the use of functional analysis in the school setting.
The World Association for Behavior Analysis offers a certification for clinical behavior therapy and behavioral consultation, which covers functional analysis.
The UK Society for Behaviour Analysis also provides a forum for behavior analysts for accreditation, professional development, continuing education and networking, and serves as an advocate body in public debate on issues relating to behavior analysis. The UK-SBA promotes the ethical and effective application of the principles of behavior and learning to a wide range of areas including education, rehabilitation and health care, business and the community and is committed to maintaining the availability of high-quality evidence-based professional behavior analysis practice in the UK. The society also promotes and supports the academic field of behavior analysis with in the UK both in terms of university-based training and research, and theoretical develop.
See also
Applied behavior analysis
Behavioral therapy
Clinical formulation
Functional behavioral assessment
Operant conditioning
Professional practice of behavior analysis
References
Behaviorism | 0.778048 | 0.972346 | 0.756532 |
Neurobiological effects of physical exercise | The neurobiological effects of physical exercise involve possible interrelated effects on brain structure, brain function, and cognition. Research in humans has demonstrated that consistent aerobic exercise (e.g., 30 minutes every day) may induce improvements in certain cognitive functions, neuroplasticity and behavioral plasticity; some of these long-term effects may include increased neuron growth, increased neurological activity (e.g., c-Fos and BDNF signaling), improved stress coping, enhanced cognitive control of behavior, improved declarative, spatial, and working memory, and structural and functional improvements in brain structures and pathways associated with cognitive control and memory. The effects of exercise on cognition may affect academic performance in children and college students, improve adult productivity, preserve cognitive function in old age, preventing or treating certain neurological disorders, and improving overall quality of life.
In healthy adults, aerobic exercise has been shown to induce transient effects on cognition after a single exercise session and persistent effects on cognition following consistent exercise over the course of several months. People who regularly perform an aerobic exercise (e.g., running, jogging, brisk walking, swimming, and cycling) have greater scores on neuropsychological function and performance tests that measure certain cognitive functions, such as attentional control, inhibitory control, cognitive flexibility, working memory updating and capacity, declarative memory, spatial memory, and information processing speed.
Aerobic exercise has both short and long term effects on mood and emotional states by promoting positive affect, inhibiting negative affect, and decreasing the biological response to acute psychological stress. Aerobic exercise may affect both self-esteem and overall well-being (including sleep patterns) with consistent, long term participation. Regular aerobic exercise may improve symptoms associated with central nervous system disorders and may be used as adjunct therapy for these disorders. There is some evidence of exercise treatment efficacy for major depressive disorder and attention deficit hyperactivity disorder. The American Academy of Neurology's clinical practice guideline for mild cognitive impairment indicates that clinicians should recommend regular exercise (two times per week) to individuals who have been diagnosed with this condition.
Some preclinical evidence and emerging clinical evidence supports the use of exercise as an adjunct therapy for the treatment and prevention of drug addictions.
Reviews of clinical evidence also support the use of exercise as an adjunct therapy for certain neurodegenerative disorders, particularly Alzheimer's disease and Parkinson's disease. Regular exercise may be associated with a lower risk of developing neurodegenerative disorders.
Long-term effects
Neuroplasticity
Neuroplasticity is the process by which neurons adapt to a disturbance over time, and most often occurs in response to repeated exposure to stimuli. Aerobic exercise increases the production of neurotrophic factors (e.g., BDNF, IGF-1, VEGF) which mediate improvements in cognitive functions and various forms of memory by promoting blood vessel formation in the brain, adult neurogenesis, and other forms of neuroplasticity. Consistent aerobic exercise over a period of several months induces clinically significant improvements in executive functions and increased gray matter volume in nearly all regions of the brain, with the most marked increases occurring in brain regions that give rise to executive functions. The brain structures that show the greatest improvements in gray matter volume in response to aerobic exercise are the prefrontal cortex, caudate nucleus, and hippocampus; less significant increases in gray matter volume occur in the anterior cingulate cortex, parietal cortex, cerebellum, and nucleus accumbens. The prefrontal cortex, caudate nucleus, and anterior cingulate cortex are among the most significant brain structures in the dopamine and norepinephrine systems that give rise to cognitive control. Exercise-induced neurogenesis (i.e., the increases in gray matter volume) in the hippocampus is associated with measurable improvements in spatial memory. Higher physical fitness scores, as measured by VO2 max, are associated with better executive function, faster information processing speed, and greater gray matter volume of the hippocampus, caudate nucleus, and nucleus accumbens.
Structural growth
Reviews of neuroimaging studies indicate that consistent aerobic exercise increases gray matter volume in nearly all regions of the brain, with more pronounced increases occurring in brain regions associated with memory processing, cognitive control, motor function, and reward; the most prominent gains in gray matter volume are seen in the prefrontal cortex, caudate nucleus, and hippocampus, which support cognitive control and memory processing, among other cognitive functions. Moreover, the left and right halves of the prefrontal cortex, the hippocampus, and the cingulate cortex appear to become more functionally interconnected in response to consistent aerobic exercise. Three reviews indicate that marked improvements in prefrontal and hippocampal gray matter volume occur in healthy adults that regularly engage in medium intensity exercise for several months. Other regions of the brain that demonstrate moderate or less significant gains in gray matter volume during neuroimaging include the anterior cingulate cortex, parietal cortex, cerebellum, and nucleus accumbens.
Regular exercise has been shown to counter the shrinking of the hippocampus and memory impairment that naturally occurs in late adulthood. Sedentary adults over age 55 show a 1–2% decline in hippocampal volume annually. A neuroimaging study with a sample of 120 adults revealed that participating in regular aerobic exercise increased the volume of the left hippocampus by 2.12% and the right hippocampus by 1.97% over a one-year period. Subjects in the low intensity stretching group who had higher fitness levels at baseline showed less hippocampal volume loss, providing evidence for exercise being protective against age-related cognitive decline. In general, individuals that exercise more over a given period have greater hippocampal volumes and better memory function. Aerobic exercise has also been shown to induce growth in the white matter tracts in the anterior corpus callosum, which normally shrink with age.
The various functions of the brain structures that show exercise-induced increases in gray matter volume include:
Caudate nucleus – responsible for stimulus-response learning and inhibitory control; implicated in Parkinson's disease and ADHD
Cerebellum – responsible for motor coordination and motor learning
Hippocampus – responsible for storage and consolidation of declarative memory and spatial memory
Nucleus accumbens – responsible for incentive salience ("wanting" or desire, the form of motivation associated with reward) and positive reinforcement; implicated in addiction
Parietal cortex – responsible for sensory perception, working memory, and attention
Prefrontal and anterior cingulate cortices – required for the cognitive control of behavior, particularly: working memory, attentional control, decision-making, cognitive flexibility, social cognition, and inhibitory control of behavior; implicated in attention deficit hyperactivity disorder (ADHD) and addiction
Persistent effects on cognition
Concordant with the functional roles of the brain structures that exhibit increased gray matter volumes, regular exercise over a period of several months has been shown to persistently improve numerous executive functions and several forms of memory. In particular, consistent aerobic exercise has been shown to improve attentional control, information processing speed, cognitive flexibility (e.g., task switching), inhibitory control, working memory updating and capacity, declarative memory, and spatial memory. In healthy young and middle-aged adults, the effect sizes of improvements in cognitive function are largest for indices of executive functions and small to moderate for aspects of memory and information processing speed. It may be that in older adults, individuals benefit cognitively by taking part in both aerobic and resistance type exercise of at least moderate intensity. Individuals who have a sedentary lifestyle tend to have impaired executive functions relative to other more physically active non-exercisers. A reciprocal relationship between exercise and executive functions has also been noted: improvements in executive control processes, such as attentional control and inhibitory control, increase an individual's tendency to exercise.
Mechanism of effects
BDNF signaling
One of the most significant effects of exercise on the brain is increased synthesis and expression of BDNF, a neuropeptide and hormone, resulting in increased signaling through its receptor tyrosine kinase, tropomyosin receptor kinase B (TrkB). Since BDNF is capable of crossing the blood–brain barrier, higher peripheral BDNF synthesis also increases BDNF signaling in the brain. Exercise-induced increases in BDNF signaling are associated with improved cognitive function, improved mood, and improved memory. Furthermore, research has provided a great deal of support for the role of BDNF in hippocampal neurogenesis, synaptic plasticity, and neural repair. Engaging in moderate-high intensity aerobic exercise such as running, swimming, and cycling increases BDNF biosynthesis through myokine signaling, resulting in up to a threefold increase in blood plasma and BDNF levels; exercise intensity is positively correlated with the magnitude of increased BDNF biosynthesis and expression. A meta-analysis of studies involving the effect of exercise on BDNF levels found that consistent exercise modestly increases resting BDNF levels as well. This has important implications for exercise as a mechanism to reduce stress since stress is closely linked with decreased levels of BDNF in the hippocampus. In fact, studies suggest that BDNF contributes to the anxiety-reducing effects of antidepressants. The increase in BDNF levels caused by exercise helps reverse the stress-induced decrease in BDNF which mediates stress in the short term and buffers against stress-related diseases in the long term.
IGF-1 signaling
is a peptide and neurotrophic factor that mediates some of the effects of growth hormone; IGF-1 elicits its physiological effects by binding to a specific receptor tyrosine kinase, the IGF-1 receptor, to control tissue growth and remodeling. In the brain, IGF-1 functions as a neurotrophic factor that, like , plays a significant role in cognition, neurogenesis, and neuronal survival. Physical activity is associated with increased levels of IGF-1 in blood serum, which is known to contribute to neuroplasticity in the brain due to its capacity to cross the blood–brain barrier and blood–cerebrospinal fluid barrier; consequently, one review noted that IGF-1 is a key mediator of exercise-induced adult neurogenesis, while a second review characterized it as a factor which links "body fitness" with "brain fitness". The amount of IGF-1 released into blood plasma during exercise is positively correlated with exercise intensity and duration.
VEGF signaling
is a neurotrophic and angiogenic (i.e., blood vessel growth-promoting) signaling protein that binds to two receptor tyrosine kinases, VEGFR1 and VEGFR2, which are expressed in neurons and glial cells in the brain. Hypoxia, or inadequate cellular oxygen supply, strongly upregulates VEGF expression and VEGF exerts a neuroprotective effect in hypoxic neurons. Like and , aerobic exercise has been shown to increase VEGF biosynthesis in peripheral tissue which subsequently crosses the blood–brain barrier and promotes neurogenesis and blood vessel formation in the central nervous system. Exercise-induced increases in VEGF signaling have been shown to improve cerebral blood volume and contribute to exercise-induced neurogenesis in the hippocampus.
Irisin
A study using FNDC5 knock-out mice as well as artificial elevation of circulating irisin levels showed that irisin confers beneficial cognitive effects of physical exercise and that it can serve an exercise mimetic in mice in which it could "improve both the cognitive deficit and neuropathology in Alzheimer's disease mouse models". The mediator and its regulatory system is therefore being investigated for potential interventions to improve – or further improve – cognitive function or alleviate Alzheimer's disease in humans. Experiments indicate irisin may be linked to regulation of BDNF and neurogenesis in mice.
Short-term effects
Transient effects on cognition
In addition to the persistent effects on cognition that result from several months of daily exercise, acute exercise (i.e., a single bout of exercise) has been shown to transiently improve a number of cognitive functions. Reviews and meta-analyses of research on the effects of acute exercise on cognition in healthy young and middle-aged adults have concluded that information processing speed and a number of executive functions – including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision making, and inhibitory control – all improve for a period of up to 2 hours post-exercise. A systematic review of studies conducted on children also suggested that some of the exercise-induced improvements in executive function are apparent after single bouts of exercise, while other aspects (e.g., attentional control) only improve following consistent exercise on a regular basis. Other research has suggested immediate performative enhancements during exercise, such as exercise-concurrent improvements in processing speed and accuracy during both visual attention and working memory tasks.
Exercise-induced euphoria
Continuous exercise can produce a transient state of euphoria – an emotional state involving the experience of pleasure and feelings of profound contentment, elation, and well-being – which is colloquially known as a "runner's high" in distance running or a "rower's high" in rowing.
Effects on neurochemistry
β-Phenylethylamine
β-Phenylethylamine, commonly referred to as phenethylamine, is a human trace amine and potent catecholaminergic and glutamatergic neuromodulator that has similar psychostimulant and euphoriant effects and a similar chemical structure to amphetamine. Thirty minutes of moderate to high intensity physical exercise has been shown to induce an enormous increase in urinary , the primary metabolite of phenethylamine. Two reviews noted a study where the average 24 hour urinary concentration among participants following just 30 minutes of intense exercise increased by 77% relative to baseline concentrations in resting control subjects; the reviews suggest that phenethylamine synthesis sharply increases while an individual is exercising, during which time it is rapidly metabolized due to its short half-life of roughly 30 seconds. In a resting state, phenethylamine is synthesized in catecholamine neurons from by aromatic amino acid decarboxylase (AADC) at approximately the same rate at which dopamine is produced.
In light of this observation, the original paper and both reviews suggest that phenethylamine plays a prominent role in mediating the mood-enhancing euphoric effects of a runner's high, as both phenethylamine and amphetamine are potent euphoriants.
β-Endorphin
β-Endorphin (contracted from "endogenous morphine") is an endogenous opioid neuropeptide that binds to μ-opioid receptors, in turn producing euphoria and pain relief. A meta-analytic review found that exercise significantly increases the secretion of and that this secretion is correlated with improved mood states. Moderate intensity exercise produces the greatest increase in synthesis, while higher and lower intensity forms of exercise are associated with smaller increases in synthesis. A review on and exercise noted that an individual's mood improves for the remainder of the day following physical exercise and that one's mood is positively correlated with overall daily physical activity level.
However, humans studies showed that pharmacological blockade of endogenous endorphins does not inhibit a runner's high, while blockade of endocannabinoids may have such an effect.
Anandamide
Anandamide is an endogenous cannabinoid and retrograde neurotransmitter that binds to cannabinoid receptors (primarily CB1), in turn producing euphoria. It has been shown that aerobic exercise causes an increase in plasma anandamide levels, where the magnitude of this increase is highest at moderate exercise intensity (i.e., exercising at ~70–80% maximum heart rate). Increases in plasma anandamide levels are associated with psychoactive effects because anandamide is able to cross the blood–brain barrier and act within the central nervous system. Thus, because anandamide is a euphoriant and aerobic exercise is associated with euphoric effects, it has been proposed that anandamide partly mediates the short-term mood-lifting effects of exercise (e.g., the euphoria of a runner's high) via exercise-induced increases in its synthesis.
Cortisol and the psychological stress response
The "stress hormone", cortisol, is a glucocorticoid that binds to glucocorticoid receptors. Psychological stress induces the release of cortisol from the adrenal gland by activating the hypothalamic–pituitary–adrenal axis (HPA axis). Short-term increases in cortisol levels are associated with adaptive cognitive improvements, such as enhanced inhibitory control; however, excessively high exposure or prolonged exposure to high levels of cortisol causes impairments in cognitive control and has neurotoxic effects in the human brain. For example, chronic psychological stress decreases expression, which has detrimental effects on hippocampal volume and can lead to depression.
As a physical stressor, aerobic exercise stimulates cortisol secretion in an intensity-dependent manner; however, it does not result in long-term increases in cortisol production since this exercise-induced effect on cortisol is a response to transient negative energy balance. Aerobic exercise increases physical fitness and lowers neuroendocrine (i.e., ) reactivity and therefore reduces the biological response to psychological stress in humans (e.g., reduced cortisol release and attenuated heart rate response). Exercise also reverses stress-induced decreases in expression and signaling in the brain, thereby acting as a buffer against stress-related diseases like depression.
Glutamate and GABA
Glutamate, one of the most common neurochemicals in the brain, is an excitatory neurotransmitter involved in many aspects of brain function, including learning and memory. Based upon animal models, exercise appears to normalize the excessive levels of glutamate neurotransmission into the nucleus accumbens that occurs in drug addiction. A review of the effects of exercise on neurocardiac function in preclinical models noted that exercise-induced neuroplasticity of the rostral ventrolateral medulla (RVLM) has an inhibitory effect on glutamatergic neurotransmission in this region, in turn reducing sympathetic activity; the review hypothesized that this neuroplasticity in the RVLM is a mechanism by which regular exercise prevents inactivity-related cardiovascular disease.
Exerkines and other circulating compounds
Exerkines are putative "signalling moieties released in response to acute and/or chronic exercise, which exert their effects through endocrine, paracrine and/or autocrine pathways".
Effects in children
Engaging in active physical pursuits has demonstrated positive effects on the mental health of children and adolescents, enhances their academic performance, boosts cognitive function, and diminishes the likelihood of obesity and cardiovascular diseases among this demographic. Establishing consistent exercise routines with regular frequency and duration is pivotal. Cultivating beneficial exercise habits and sustaining adequate physical activity may support the overall physical and mental well-being of young individuals. Therefore, identifying factors that either impede or encourage exercise behaviors could be a significant strategy in promoting the development of healthy exercise habits among children and adolescents.
A 2003 meta-analysis found a positive effect of exercise in children on perceptual skills, intelligence quotient, achievement, verbal tests, mathematic tests, and academic readiness. The correlation was strongest for the age ranges of 4–7 and 11–13 years.
A 2010 meta-analysis of the effect of activity on children's executive function found that aerobic exercise may briefly aid children's executive function and also influence more lasting improvements to executive function. Other studies suggested that exercise is unrelated to academic performance, perhaps due to the parameters used to determine exactly what academic achievement is. This area of study has been a focus for education boards that make decisions on whether physical education should be implemented in the school curriculum, how much time should be dedicated to physical education, and its impact on other academic subjects.
Another study found that sixth-graders who participated in vigorous physical activity at least three times a week had the highest scores compared to those who participated in moderate or no physical activity at all. Children who participated in vigorous physical activity scored three points higher, on average, on their academic test, which consisted of math, science, English, and world studies.
Neuroimaging studies indicate that exercise may influence changes in brain structure and function. Some investigations have linked low levels of aerobic fitness in children with impaired executive function when older as adults, but lack of selective attention, response inhibition, and interference control may also explain this outcome.
Effects on central nervous system disorders
Exercise as prevention and treatment of drug addictions
Clinical and preclinical evidence indicate that consistent aerobic exercise, especially endurance exercise (e.g., marathon running), actually prevents the development of certain drug addictions and is an effective adjunct treatment for drug addiction, and psychostimulant addiction in particular. Consistent aerobic exercise magnitude-dependently (i.e., by duration and intensity) may reduce drug addiction risk, which appears to occur through the reversal of drug-induced, addiction-related neuroplasticity. Moreover, aerobic exercise decreases psychostimulant self-administration, reduces the reinstatement (i.e., relapse) of drug-seeking, and induces opposite effects on striatal dopamine receptor D2 (DRD2) signaling (increased DRD2 density) to those induced by pathological stimulant use (decreased DRD2 density). Consequently, consistent aerobic exercise may lead to better treatment outcomes when used as an adjunct treatment for drug addiction. , more clinical research is still needed to understand the mechanisms and confirm the efficacy of exercise in drug addiction treatment and prevention.
Attention deficit hyperactivity disorder
Regular physical exercise, particularly aerobic exercise, is an effective add-on treatment for ADHD in children and adults, particularly when combined with stimulant medication (i.e., amphetamine or methylphenidate), although the best intensity and type of aerobic exercise for improving symptoms are not currently known. In particular, the long-term effects of regular aerobic exercise in ADHD individuals include better behavior and motor abilities, improved executive functions (including attention, inhibitory control, and planning, among other cognitive domains), faster information processing speed, and better memory. Parent-teacher ratings of behavioral and socio-emotional outcomes in response to regular aerobic exercise include: better overall function, reduced ADHD symptoms, better self-esteem, reduced levels of anxiety and depression, fewer somatic complaints, better academic and classroom behavior, and improved social behavior. Exercising while on stimulant medication augments the effect of stimulant medication on executive function. It is believed that these short-term effects of exercise are mediated by an increased abundance of synaptic dopamine and norepinephrine in the brain.
Major depressive disorder
A number of medical reviews have indicated that exercise has a marked and persistent antidepressant effect in humans, an effect believed to be mediated through enhanced signaling in the brain. Several systematic reviews have analyzed the potential for physical exercise in the treatment of depressive disorders. The 2013 Cochrane Collaboration review on for depression noted that, based upon limited evidence, it is more effective than a control intervention and comparable to psychological or antidepressant drug therapies. Three subsequent 2014 systematic reviews that included the Cochrane review in their analysis concluded with similar findings: one indicated that physical exercise is effective as an adjunct treatment (i.e., treatments that are used together) with antidepressant medication; the other two indicated that physical exercise has marked antidepressant effects and recommended the inclusion of physical activity as an adjunct treatment for mild–moderate depression and mental illness in general. One systematic review noted that yoga may be effective in alleviating symptoms of prenatal depression. Another review asserted that evidence from clinical trials supports the efficacy of physical exercise as a treatment for depression over a 2–4 month period. These benefits have also been noted in old age, with a review conducted in 2019 finding that exercise is an effective treatment for clinically diagnosed depression in older adults.
A meta-analysis from July 2016 concluded that physical exercise improves overall quality of life in individuals with depression relative to controls.
Cerebrovascular disease
Physical exercise plays a significant role in the prevention and management of stroke. It is well established that physical activity decrease the risk of ischemic stroke and intracerebral haemorrhage. Engaging in physical activity before experiencing a stroke has been found to have a positive impact on the severity and outcomes of stroke. Exercise has the potential to increase the expression of VEGF, caveolin, and angiopoietin in the brain. These changes may promote angiogenesis and neovascularization that contribute to improved blood supply to the stroke affected areas of the brain. Exercise may affect the activation of endothelial nitric oxide synthase (eNOS) and subsequent production of nitric oxide (NO). The increase in NO production may lead to improved post-stroke cerebral blood flow, ensuring a sufficient oxygen and nutrient supply to the brain. Physical activity has been associated with increased expression and activation of hypoxia-inducible factor 1 alpha (HIF-1α), heat shock proteins, and brain-derived neurotrophic factor (BDNF). These factors play crucial roles in promoting cellular survival, neuroprotection, and repair processes in the brain following a stroke. Exercise also inhibit glutamate and caspase activities, which are involved in neuronal death pathways. Additionally, it may promote neurogenesis in the brain. These effects collectively contribute to the reduction of brain infarction and edema, leading to potential improvements in neurological and functional outcomes. The neuroprotective properties of physical activity in relation to haemorrhagic strokes are less studied. Pre-stroke physical activity has been associated with improved outcomes after intracerebral haemorrhages. Furthermore, physical activity may reduce the volume of intracerebral haemorrhages. Being physically active after stroke also enhance the functional recovery.
Mild cognitive impairment
The American Academy of Neurology's January 2018 update of their clinical practice guideline for mild cognitive impairment states that clinicians should recommend regular exercise (two times per week) to individuals who have been diagnosed with this condition. This guidance is based upon a moderate amount of high-quality evidence which supports the efficacy of regular physical exercise (twice weekly over a 6-month period) for improving cognitive symptoms in individuals with mild cognitive impairment.
Neurodegenerative disorders
Alzheimer's disease
Alzheimer's disease is a cortical neurodegenerative disorder and the most prevalent form of dementia, representing approximately 65% of all cases of dementia; it is characterized by impaired cognitive function, behavioral abnormalities, and a reduced capacity to perform basic activities of daily life. Two reviews found evidence for possible positive effects of physical exercise on cognitive function, the rate of cognitive decline, and the ability to perform activities of daily living in individuals with Alzheimer's disease. A subsequent review found higher levels of physical activity may be associated with reduced risk of dementia and cognitive decline.
Parkinson's disease
Parkinson's disease symptoms reflect various functional impairments and limitations, such as postural instability, gait disturbance, immobility, and frequent falls. Some evidence suggests that physical exercise may lower the risk of Parkinson's disease. A 2017 study found that strength and endurance training in people with Parkinson's disease had positive effects lasting for several weeks. A 2023 Cochrane review on the effects of physical exercise in people with Parkinson's disease indicated that aquatic exercise might reduce severity of motor symptoms and improve quality of life. Furthermore, endurance training, functional training, and multi-domain training (i.e., engaging in several types of exercise) may provide improvements.
See also
Brain fitness
Exercise is Medicine
Exercise prescription
Exercise therapy
Memory improvement
Neuroinflammation#Exercise
Nootropic
Notes
References
Addiction
Addiction medicine
Aerobic exercise
Antidepressants
Attention
Cognition
Cognitive neuroscience
Epigenetics
Euphoriants
Exercise physiology
Memory
Neuropsychology
Physical exercise
Physical psychiatric treatments
Treatment of depression
Sports science | 0.76269 | 0.991867 | 0.756487 |
VALS | VALS (Values and Lifestyle Survey) is a proprietary research methodology used for psychographic market segmentation. Market segmentation is designed to guide companies in tailoring their products and services in order to appeal to the people most likely to purchase them.
History and description
VALS was developed in 1978 by social scientist and consumer futurist Arnold Mitchell and his colleagues at SRI International. It was immediately embraced by advertising agencies and is currently offered as a product of SRI's consulting services division. VALS draws heavily on the work of Harvard sociologist David Riesman and psychologist Abraham Maslow.
Mitchell used statistics to identify attitudinal and demographic questions that helped categorize adult American consumers into one of nine lifestyle types: survivors (4%), sustainers (7%), belongers (35%), emulators (9%), achievers (22%), I-am-me (5%), experiential (7%), societally conscious (9%), and integrated (2%). The questions were weighted using data developed from a sample of 1,635 Americans and their significant others, who responded to an SRI International survey in 1980.
The main dimensions of the VALS framework are resources (the vertical dimension) and primary motivation (the horizontal dimension). The vertical dimension segments people based on the degree to which they are innovative and have resources such as income, education, self-confidence, intelligence, leadership skills, and energy. The horizontal dimension represents primary motivations and includes three distinct types:
Consumers driven by knowledge and principles are motivated primarily by ideals. These consumers include groups called Thinkers and Believers.
Consumers driven by demonstrating success to their peers are motivated primarily by achievement. These consumers include groups referred to as Achievers and Strivers.
Consumers driven by a desire for social or physical activity, variety, and risk taking are motivated primarily by self-expression. These consumers include the groups known as Experiencers and Makers.
At the top of the rectangle are the Innovators, who have such high resources that they could have any of the three primary motivations. At the bottom of the rectangle are the Survivors, who live complacently and within their means without a strong primary motivation of the types listed above. The VALS Framework gives more details about each of the groups.
VALS
Researchers faced some problems with the VALS method, and in response, SRI developed the VALS2 programme in 1978; additionally, SRI significantly revised it in 1989. VALS2 places less emphasis on activities and interests and more on a psychological base to tap relatively enduring attitudes and values. The VALS2 program has two dimensions. The first dimension, Self-orientation, determines the type of goals and behaviours that individuals will pursue, and refers to patterns of attitudes and activities which help individuals reinforce, sustain, or modify their social self-image. This is a fundamental human need.
The second dimension, Resources, reflects the ability of individuals to pursue their dominant self-orientation and includes full-range of physical, psychological, demographic, and material means such as self-confidence, interpersonal skills, inventiveness, intelligence, eagerness to buy, money, position, education, etc. According to VALS 2, a consumer purchases certain products and services because the individual is a specific type of person. The purchase is believed to reflect a consumer's lifestyle, which is a function of self–orientation and resources.
In 1991, the name VALS2 was switched back to VALS, because of brand equity.
Criticisms
Psychographic segmentation has been criticized by well-known public opinion analyst and social scientist Daniel Yankelovich, who says psychographics are "very weak" at predicting people's purchases, making it a "very poor" tool for corporate decision-makers.
The VALS Framework has also been criticized as too culturally specific for international use.
Segments
The following types correspond to VALS segments of US adults based on two concepts for understanding consumers: primary motivation and resources.
Innovators. These consumers are on the leading edge of change, have the highest incomes, and such high self-esteem and abundant resources that they can indulge in any or all self-orientations. They are located above the rectangle. Image is important to them as an expression of taste, independence, and character. Their consumer choices are directed toward the "finer things in life."
Thinkers. These consumers are the high-resource group of those who are motivated by ideals. They are mature, responsible, well-educated professionals. Their leisure activities center on their homes, but they are well informed about what goes on in the world and are open to new ideas and social change. They have high incomes but are practical consumers and rational decision makers.
Believers. These consumers are the low-resource group of those who are motivated by ideals. They are conservative and predictable consumers who favor local products and established brands. Their lives are centered on family, community, and the nation. They have modest incomes.
Achievers. These consumers are the high-resource group of those who are motivated by achievement. They are successful work-oriented people who get their satisfaction from their jobs and families. They are politically conservative and respect authority and the status quo. They favor established products and services that show off their success to their peers.
Strivers. These consumers are the low-resource group of those who are motivated by achievements. They have values very similar to achievers but have fewer economic, social, and psychological resources. Style is extremely important to them as they strive to emulate people they admire.
Experiencers. These consumers are the high-resource group of those who are motivated by self-expression. They are the youngest of all the segments, with a median age of 25. They have a lot of energy, which they pour into physical exercise and social activities. They are avid consumers, spending heavily on clothing, fast-foods, music, and other youthful favorites, with particular emphasis on new products and services.
Makers. These consumers are the low-resource group of those who are motivated by self-expression. They are practical people who value self-sufficiency. They are focused on the familiar - family, work, and physical recreation - and have little interest in the broader world. As consumers, they appreciate practical and functional products.
Survivors. These consumers have the lowest incomes. They have too few resources to be included in any consumer self-orientation and are thus located below the rectangle. They are the oldest of all the segments, with a median age of 61. Within their limited means, they tend to be brand-loyal consumers.
See also
Advertising
Data mining
Demographics
Fear, uncertainty, and doubt
Marketing
Psychographics
References
Further reading
External links
Strategic Business Insights Official website (was formerly SRI Consulting Business Intelligence)
Market research
Market segmentation | 0.764238 | 0.989805 | 0.756446 |
Beck Depression Inventory | The Beck Depression Inventory (BDI, BDI-1A, BDI-II), created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.
In its current version, the BDI-II is designed for individuals aged 13 and over, and is composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex.
There are three versions of the BDI—the original BDI, first published in 1961 and later revised in 1978 as the BDI-1A, and the BDI-II, published in 1996. The BDI is widely used as an assessment tool by health care professionals and researchers in a variety of settings.
The BDI was used as a model for the development of the Children's Depression Inventory (CDI), first published in 1979 by clinical psychologist Maria Kovacs.
Development and history
According to Beck's publisher, 'When Beck began studying depression in the 1950s, the prevailing psychoanalytic theory attributed the syndrome to inverted hostility against the self.' By contrast, the BDI was developed in a novel way for its time; by collating patients' verbatim descriptions of their symptoms and then using these to structure a scale which could reflect the intensity or severity of a given symptom.
Beck drew attention to the importance of "negative cognitions" described as sustained, inaccurate, and often intrusive negative thoughts about the self. In his view, it was the case that these cognitions caused depression, rather than being generated by depression.
Beck developed a triad of negative cognitions about the world, the future, and the self, which play a major role in depression.
An example of the triad in action taken from Brown (1995) is the case of a student obtaining poor exam results:
The student has negative thoughts about the world, so he may come to believe he does not enjoy the class.
The student has negative thoughts about his future because he thinks he may not pass the class.
The student has negative thoughts about his self, as he may feel he does not deserve to be in college.
The development of the BDI reflects that in its structure, with items such as "I have lost all of my interest in other people" to reflect the world, "I feel discouraged about the future" to reflect the future, and "I blame myself for everything bad that happens" to reflect the self. The view of depression as sustained by intrusive negative cognitions has had particular application in cognitive behavioral therapy (CBT), which aims to challenge and neutralize them through techniques such as cognitive restructuring.
BDI
The original BDI, first published in 1961, consisted of twenty-one questions about how the subject has been feeling in the last week. Each question had a set of at least four possible responses, ranging in intensity. For example:
(0) I do not feel sad
(1) I feel sad.
(2) I am sad all the time and I can't snap out of it.
(3) I am so sad or unhappy that I can't stand it.
When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-off scores were as follows:
0–9: indicates minimal depression
10–18: indicates mild depression
19–29: indicates moderate depression
30–63: indicates severe depression.
Higher total scores indicate more severe depressive symptoms.
Some items on the original BDI had more than one statement marked with the same score. For instance, there are two responses under the Mood heading that score a 2: (2a) "I am blue or sad all the time and I can't snap out of it" and (2b) "I am so sad or unhappy that it is very painful".
BDI-IA
The BDI-IA was a revision of the original instrument developed by Beck during the 1970s, and copyrighted in 1978. To improve ease of use, the "a and b statements" described above were removed, and respondents were instructed to endorse how they had been feeling during the preceding two weeks. The internal consistency for the BDI-IA was good, with a Cronbach's alpha coefficient of around 0.85, meaning that the items on the inventory are highly correlated with each other.
However, this version retained some flaws; the BDI-IA only addressed six out of the nine DSM-III criteria for depression. This and other criticisms were addressed in the BDI-II.
BDI-II
The BDI-II was a 1996 revision of the BDI, developed in response to the American Psychiatric Association's publication of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which changed many of the diagnostic criteria for Major Depressive Disorder.
Items involving changes in body image, hypochondriasis, and difficulty working were replaced. Also, sleep loss and appetite loss items were revised to assess both increases and decreases in sleep and appetite. All but three of the items were reworded; only the items dealing with feelings of being punished, thoughts about suicide, and interest in sex remained the same. Finally, participants were asked to rate how they have been feeling for the past two weeks, as opposed to the past week as in the original BDI.
Like the BDI, the BDI-II also contains about 21 questions, each answer being scored on a scale value of 0 to 3. Higher total scores indicate more severe depressive symptoms. The standardized cutoffs used differ from the original:
0–13: minimal depression
14–19: mild depression
20–28: moderate depression
29–63: severe depression.
One measure of an instrument's usefulness is to see how closely it agrees with another similar instrument that has been validated against information from a clinical interview by a trained clinician. In this respect, the BDI-II is positively correlated with the Hamilton Depression Rating Scale with a Pearson r of 0.71, showing good convergent validity. The test was also shown to have a high one-week test–retest reliability (Pearson's r = 0.93), suggesting that it was not overly sensitive to day-to-day variations in mood. The test also has high internal consistency (α = .91).
Impact
The development of the BDI was an important event in psychiatry and psychology; it represented a shift in health care professionals' view of depression from a Freudian, psychodynamic perspective, to one guided by the patient's own thoughts or "cognitions". It also established the principle that instead of attempting to develop a psychometric tool based on a possibly invalid theory, self-report questionnaires when analysed using techniques such as factor analysis can suggest theoretical constructs.
The BDI was originally developed to provide a quantitative assessment of the intensity of depression. Because it is designed to reflect the depth of depression, it can monitor changes over time and provide an objective measure for judging improvement and the effectiveness or otherwise of treatment methods. The instrument remains widely used in research; in 1998, it had been used in over 2000 empirical studies. It has been translated into multiple European languages as well as Arabic, Chinese, Japanese, Persian, and Xhosa.
Limitations
The BDI has the same limitations as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can have an effect on the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey.
In participants with concomitant physical illness the BDI's reliance on physical symptoms such as fatigue may artificially inflate scores due to symptoms of the illness, rather than of depression. In an effort to deal with this concern Beck and his colleagues developed the "Beck Depression Inventory for Primary Care" (BDI-PC), a short screening scale consisting of seven items from the BDI-II considered to be independent of physical function. Unlike the standard BDI, the BDI-PC produces only a binary outcome of "not depressed" or "depressed" for patients above a cutoff score of 4.
Although designed as a screening device rather than a diagnostic tool, the BDI is sometimes used by health care providers to reach a quick diagnosis.
The BDI is copyrighted; a fee must be paid for each copy used. There is no evidence that the BDI-II is more valid or reliable than other depression scales, and public domain scales such as the Patient Health Questionnaire – Nine Item (PHQ-9) have been studied as a useful tool.
See also
Beck Anxiety Inventory
Beck Hopelessness Scale
Diagnostic classification and rating scales used in psychiatry
Major Depression Inventory
Quality of Life in Depression Scale
Notes
Further reading
Beck A.T. (1988). "Beck Hopelessness Scale." The Psychological Corporation.
External links
A list of psychiatric rating scales for depression from Neurotransmitter.net
Beck Depression Inventory (BDI-II). Test Online
Depression screening and assessment tools | 0.760437 | 0.994735 | 0.756433 |
Safe, sane and consensual | The fundamental principles for the exercise of BDSM require that it be performed with the informed consent of all parties. Since the 1980s, many practitioners and organizations have adopted the motto safe, sane and consensual, commonly abbreviated SSC, which means that everything is based on safe activities, that all participants are of sufficiently sound mind in their conduct, and that all participants do consent. It is mutual consent that makes a clear legal and ethical distinction between BDSM and such crimes as sexual assault and domestic violence.
Some BDSM practitioners prefer a code of behavior that differs from SSC. Described as "risk-aware consensual kink" (RACK), this code shows a preference for a style in which the individual responsibility of the involved parties is emphasized more strongly, with each participant being responsible for his or her own well-being. Advocates of RACK argue that SSC can hamper discussion of risk because no activity is truly "safe", and that discussion of even low-risk possibilities is necessary for truly informed consent.
Still other BDSM practitioners prefer a code of behavior described as "Personal Responsibility, Informed, Consensual Kink" (PRICK). This code is considered the next evolution beyond RACK. It was developed in response to individuals within the community questioning if a person can truly consent if they are not informed about the potential risks involved with certain acts or behaviors. PRICK makes it clear that all practitioners should take personal responsibility for their kink. Informed means (or implies) that you understand what is about to happen - risks and all. The idea being that if you take personal responsibility for yourself and you're informed, now you can truly consent.
Likewise, Safe, Sane, Informed, Consensual, Kink (SSICK) incorporates all of the above, to preclude abuse and violation of another's well being. Safety and sanity are objective "reasonable person" standards under the circumstances of the participants and the Kink, which incorporate mutual responsibilities for both the foreseeable and unforeseeable consequences of the participant's choices and decisions. Being adequately informed is a subjective determination of one's self awareness, and another participant's awareness. Consent pertains to the continuous choice: to delegate authority for another to choose how to act in a particular manner; to accept a fiduciary duty in exercising delegated authority (placing another's interests above one's own interests); or, to otherwise interact within communicated boundaries and no more. A common misconceptions is that one can relinquish their personal power -- often called consensual non-consent, which merely equates to abuse. Every person always has the inherent and inalienable power to amend consent at any time, in relation to any BDSM interaction.
See also
Consent (BDSM)
Limits (BDSM)
Risk-aware consensual kink (RACK)
Safeword
References
BDSM terminology
Consent
Sexual ethics | 0.76295 | 0.991455 | 0.756431 |
Donabedian model | The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. According to the model, information about quality of care can be drawn from three categories: "structure", "process", and "outcomes". Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refer to the effects of healthcare on the health status of patients and populations. Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966. While there are other quality of care frameworks, including the World Health Organization (WHO)-Recommended Quality of Care Framework and the Bamako Initiative, the Donabedian Model continues to be the dominant paradigm for assessing the quality of health care.
Dimensions of care
The model is most often represented by a chain of three boxes containing structure, process, and outcome connected by unidirectional arrows in that order. These boxes represent three types of information that may be collected in order to draw inferences about quality of care in a given system.
Structure
Structure includes all of the factors that affect the context in which care is delivered. This includes the physical facility, equipment, and human resources, as well as organizational characteristics such as staff training and payment methods. These factors control how providers and patients in a healthcare system act and are measures of the average quality of care within a facility or system. Structure is often easy to observe and measure and it may be the upstream cause of problems identified in process.
Process
Process is the sum of all actions that make up healthcare. These commonly include diagnosis, treatment, preventive care, and patient education but may be expanded to include actions taken by the patients or their families. Processes can be further classified as technical processes, how care is delivered, or interpersonal processes, which all encompass the manner in which care is delivered. According to Donabedian, the measurement of process is nearly equivalent to the measurement of quality of care because process contains all acts of healthcare delivery. Information about process can be obtained from medical records, interviews with patients and practitioners, or direct observations of healthcare visits.
Outcome
Outcome contains all the effects of healthcare on patients or populations, including changes to health status, behavior, or knowledge as well as patient satisfaction and health-related quality of life. Outcomes are sometimes seen as the most important indicators of quality because improving patient health status is the primary goal of healthcare. However, accurately measuring outcomes that can be attributed exclusively to healthcare is very difficult. Drawing connections between process and outcomes often requires large sample populations, adjustments by case mix, and long-term follow ups as outcomes may take considerable time to become observable.
Although it is widely recognized and applied in many health care related fields, the Donabedian Model was developed to assess quality of care in clinical practice. The model does not have an implicit definition of quality care so that it can be applied to problems of broad or narrow scope. Donabedian notes that each of the three domains has advantages and disadvantages that necessitate researchers to draw connections between them in order to create a chain of causation that is conceptually useful for understanding systems as well as designing experiments and interventions.
Applications
Donabedian developed his quality of care framework to be flexible enough for application in diverse healthcare settings and among various levels within a delivery system.
At its most basic level, the framework can be used to modify structures and processes within a healthcare delivery unit, such as a small group practice or ambulatory care center, to improve patient flow or information exchange. For instance, health administrators in a small physician practice may be interested in improving their treatment coordination process through enhanced communication of lab results from laboratorian to provider in an effort to streamline patient care. The process for information exchange, in this case the transfer of lab results to the attending physician, depends on the structure for receiving and interpreting results. The structure could involve an electronic health record (EHR) that a laboratorian fills out with lab results for use by the physician to complete a diagnosis. To improve this process, a healthcare administrator may look at the structure and decide to purchase an information technology (IT) solution of pop-up alerts for actionable lab results to incorporate into the EHR. The process could be modified through a change in standard protocol of determining how and when an alert is released and who is responsible for each step in the process. The outcomes to evaluate the efficacy of this quality improvement (QI) solution might include patient satisfaction, timeliness of diagnosis, or clinical outcomes.
In addition to examining quality within a healthcare delivery unit, the Donabedian model is applicable to the structure and process for treating certain diseases and conditions with the aim to improve the quality of chronic disease management. For example, systemic lupus erythematosus (SLE) is a condition with significant morbidity and mortality and substantial disparities in outcomes among rheumatic diseases. The propensity for SLE care to be fragmented and poorly coordinated, as well as evidence that healthcare system factors associated with improved SLE outcomes are modifiable, points to an opportunity for process improvement through changes in preventive care, monitoring, and effective self-care. A researcher may develop evidence within these areas to analyze the relationship between structure and process to outcomes in SLE care for the purposes of finding solutions to improve outcomes. An analysis of SLE care structure may reveal an association between access to care and financing to quality outcomes. An analysis of process may look at hospital and physician specialty in SLE care and how it relates to SLE mortality in hospitals, or the effect on outcomes by including additional QI indicators to the diagnosis and treatment of SLE. To assess these changes in structure and process, evidence garnered from changes in mortality, disease damage, and health-related quality of life would be used to validate structure-process changes.
Donabedian’s model can also be applied to a large health system to measure overall quality and align improvement work across a hospital, group practice or the large integrated health system to improve quality and outcomes for a population. In 2007, the US Institute for Healthcare Improvement proposed “whole system measures” that address structure, process, and outcomes of care. These indicators supply health care leaders with data to evaluate the organization’s performance in order to design strategic QI planning. The indicators are limited to 13 non-disease specific measures that provide system-level indications of quality, applicable to both inpatient and outpatient settings and across the continuum of care. In addition to informing the QI plan, these measures can be used to evaluate the quality of the system’s care over time, how it performs relative to stated strategic planning goals, and how it performs compared to similar organizations.
Criticisms and adaptations
While the Donabedian model continues to serve as a touchstone framework in health services research, potential limitations have been suggested by other researchers, and, in some cases, adaptations of the model have been proposed. The sequential progression from structure to process to outcome has been described by some as too linear of a framework, and consequently has a limited utility for recognizing how the three domains influence and interact with each other. The model has also been criticized for failing to incorporate antecedent characteristics (e.g. patient characteristics, environmental factors) which are important precursors to evaluating quality care. Coyle and Battles suggest that these factors are vital to fully understanding the true effectiveness of new strategies or modifications within the care process. According to Coyle and Battles, patient factors include genetics, socio-demographics, health habits, beliefs and attitudes, and preferences. Environmental factors include the patients' cultural, social, political, personal, and physical characteristics, as well as factors related to the health profession itself.
History
Avedis Donabedian first described the three elements of the Donabedian Model in his 1966 article, “Evaluating the Quality of Medical Care.” As a preface to his analysis of methodologies used in health services research, Donabedian identified the three dimensions that can be utilized to assess quality of care (structure, process, and outcome) that would later become the core divisions of the Donabedian Model. “Evaluating the Quality of Medical Care” became one of the most frequently cited public health-related articles of the 20th century, and the Donabedian Model gained widespread acceptance.
In 1980, Donabedian published The Definition of Quality and Approaches to its Assessment, vol. 1: Explorations in Quality Assessment and Monitoring, which provided a more in-depth description of the structure—process– outcome paradigm. In his book, Donabedian once again defines structure, process, and outcome, and clarifies that these categories should not be mistaken for attributes of quality, but rather they are the classifications for the types of information that can be obtained in order to infer whether the quality of care is poor, fair, or good. Furthermore, he states that in order to make inferences about quality, there needs to be an established relationship between the three categories and that this relationship between categories is a probability rather than a certainty.
References
Health care management | 0.766245 | 0.987172 | 0.756415 |
Soft systems methodology | Soft systems methodology (SSM) is an organised way of thinking that's applicable to problematic social situations and in the management of change by using action. It was developed in England by academics at the Lancaster Systems Department on the basis of a ten-year action research programme.
Overview
The Soft Systems Methodology was developed primarily by Peter Checkland, through 10 years of research with his colleagues, such as Brian Wilson. The method was derived from numerous earlier systems engineering processes, primarily from the fact traditional 'hard' systems thinking was not able to account for larger organisational issues, with many complex relationships. SSM has a primary use in the analysis of these complex situations, where there are divergent views about the definition of the problem.
These complex situations are known as "soft problems". They are usually real world problems where the goals and purposes of the problem are problematic themselves. Examples of soft problems include: How to improve the delivery of health services? and How to manage homelessness with young people? Soft approaches take as tacit that people's view of the world will change all the time and their preferences of it will also change.
Depending on the current circumstances of a situation, trying to agree on the problem may be difficult as there might be multiple factors to take into consideration, such as all the different kinds of methods used to tackle these problems. Additionally, Peter Checkland had moved away from the idea of 'obvious' problems and started working with situations to make concepts of models to use them as a source of questions to help with the problem, soft systems methodologies then started emerging to be an organised learning system.
Purposeful activity models could be declared using worldviews, meaning they were never models of real-world action. Still, those relevant to disclosure and argument about real-world action led to them being called epistemological devices that could be used for discourse and debate. The distinction between the everyday world and systems thinking was to draw attention to the conscious use of systems language in developing intellectual devices which were used to structure debates or an exploration of the problem situation being addressed.
In its 'classic' form the methodology consists of seven steps, with initial appreciation of the problem situation leading to the modelling of several human activity systems that might be thought relevant to the problem situation. By getting all the relevant people who are the decision-makers in this situation to come together, sit down in discussion and exploration about the definition of the problem. Only then will the decision makers in said situation will more likely arrive at a mutual agreement which will settle any arguments or problems and help get to the solution over exactly what kind of changes could be either systemically desirable and feasible in the situation at hand.
Later explanations of the ideas give a more sophisticated view of this systemic method and give more attention to locating the methodology with respect to its philosophical underpinnings. It is the earlier classical view which is most widely used in practice (created by Peter Checkland). A common criticism of this earlier methodology is that it follows an approach that is too linear. Checkland himself agreed that the earlier methodology is 'rather bald'. Most advanced SSM analysts will agree, though, that the classical view is an easy way for inexperienced analysts to learn the SSM methodology.
SSM has been successfully used as a business analysis methodology in various fields. Real-world examples of SSM's wide range of applicability include research applying SSM in the sugar industry leading to improvements in business partner relationships, successful use as an approach in project management by directly involving stakeholders or aiding in business management by improving communication between stakeholders. It has proven to be a useful analysis approach to teaching and learning processes, as it does not require a specific problem to be identified as its starting point – which has led to "outside of the box" suggestions for improvement. SSM was even used by the UK government as part of the revaluation of their Structured Systems Analysis and Design Method (SSADM) system development methodology.
Even professional researchers who are to take the change for face value structure of thinking, show the same tendency to distort perceptions of the world rather than change the mental structure which we give our bearings with. Failure of classic systems in rich 'management' problem situations during the research programme led to examining the adequacy of the systems thinking.
The methodology has been described in several books and many academic articles.
SSM remains the most widely used and practical application of systems thinking, and other systems approaches such as critical systems thinking have incorporated many of its ideas.
Representation evolution
SSM had a gradual development process of the methodology as a whole from 1972 to 1990. During this period of time, four different representations of SSM were designed, becoming more sophisticated and at the same time less structured and broader in scope.
Blocks and arrows (1972)
The first studies in the research programme were carried out in 1969, and the first account of what became SSM was published in a paper three-years later titled "Towards a systems-based methodology for real-world problem solving" (Checkland 1972). In this paper, soft systems methodology is presented as a sequence of stages with iteration back to previous stages.The sequence was as follows: analysis, root definition of relevant systems, conceptualisation, comparison and definition of changes, selection of change to implement, design of change and implementation and appraisal.
The overall aim to implement change instead of introducing or enhancing a system implies that the thinking was ongoing as a result of these early experiences, even if the straight arrows in the diagrams and the rectangular blocks in some of the models can now be misleading!
Seven stages (1981)
Soft systems methodology (SSM) is a powerful tool that is utilised to analyse very complex organisational and systemic problems, that do not have an obvious solution. The methodology incorporates seven steps to come up with a viable solution for the problem defined. The seven steps are;
Enter situation in which a problem situation(s) have been identified
Address the issue at hand
Formulate root definitions of relevant systems of purposeful activity
Build conceptual models of the systems named in the root definitions : This methodology comes into place from raising concerns/ capturing problems within an organisation and looking into ways how it can be solved. Defining the root definition also describes the root purpose of a system.
The comparison stage: The systems thinker is to compare the perceived conceptual models against an intuitive perception of a real-world situation or scenario. Checkland defines this stage as the comparison of Stage 4 with Stage 2, formally, "Comparison of 4 with 2". Parts of the problem situation analysed in Stage 2 are to be examined alongside the conceptual model(s) created in Stage 4, this helps to achieve a "complete" comparison.
Problems identified should be accompanied now by feasible and desirable changes that will distinctly help the problem situation based in the system given. Human activity systems and other aspects of the system should be considered so that soft systems thinking, and Mumford's needs can be achieved with the potential changes. These potential changes should not be acted on until step 7 but they should be feasible enough to act upon to improve the problem situation.
Take action to improve the problem situation
Two streams (1988)
The two-stream model of SSM recognizes the crucially important role of history in human affairs, and for a given group of people their history determines what will be noticed as significant and how it will be judged. This expression of SSM is presented as an approach embodying not only a logic-based stream of analysis (via activity models) but also a cultural and political stream which enable judgements to be made about the accommodations between conflicting interests which might be reachable by the people concerned and which would enable action to be taken.
This particular expression of SSM removes the dividing line between the world of the problem situation and the systems thinking world.
Four main activities (1990)
The four-activities model is iconic rather than descriptive and subsumes the cultural stream of analysis in the four activities. The four activities are:
The seven stage model gave an approach which applies real world situations, both large and small and public and private sector. The four main activities were created as a way to capture the more flexible use of SSM and it used to include more of the cultural aspect of the workplace into the concept of SSM. The four activities are used to show that SSM does not have to be used rigidly; it's there to show real life and not be constrained. The four main activities should be seen as an individual concept rather than a descriptive which incorporates the cultural stream of analysis.
Finding out about a problem situation, including culturally/politically
Formulating some relevant purposeful activity models: Creating and drawing specific diagrammatic illustrations of activity processes that occur in an organisation, which shows the relevant processes that take place in a structured order, and depicts any problem situation visually by showing the flow of one action to another. An example of this would be a diagram of a Soft Systems Methodology method, which is a 'Conceptual Model', which is a representation of a systems' human actions, or an 'Architecture System Map', which is a visual representation of the implementation of sections of a software system.
Debating the situation, using the models, seeking from that debate both:
changes which would improve the situation and are regarded as both desirable and (culturally) feasible, and
the accommodations between conflicting interests which will enable action
Taking action in the situation to bring about improvement
CATWOE
In 1975, David Smyth, a researcher in Checkland's department, observed that SSM was most successful when the root definition included certain elements. These elements, captured in the mnemonic CATWOE, identified the people, processes and environment that contribute to a situation, issue or problem that required analyzing.
This is used to prompt thinking about what the business is trying to achieve. In further detail, CATWOE helps explore a system by underlining the roots which involve turning the inputs into outputs. CATWOE helps businesses as it analyses a gap between current and useful systems. Business perspectives help the business analyst to consider the impact of any proposed solution on the people involved. This mainly involves stakeholders which allows them to test assumptions they have made as stakeholders will all have different opinions about certain problems and opportunities. CATWOE's method helps gain better and achievable results, as well as avoiding additional problems using six elements.
The six elements of CATWOE are:
Customers – Who are the beneficiaries of the highest level business process and how does the issue affect them?
Actors - The person or people directly involved in the transformation (T) part of CATWOE (Checkland & Scholes, 1999, p. 35). Implementation and involvement by the actors allows for the input to be transformed into an output (Checkland & Scholes, 1999, p. 35). Actors are also stakeholders as their actions can affect the transformation process and the system as a whole. As actors are directly involved, they also have a 'holon' by which they interpret the world outside (Checkland & Scholes, 1999, p. 19) and so how they view the situation would impact their work and success.
Transformation process – Change, in one word, is the centre of the transformation system; the process of the transformation is more important for the business solution system. This is because the change is what the industry 5.0 sustainability system intends. The purpose behind the transformation system where change is applied holds value. For example, when converting grapes into wine the purpose for Change is to supply to grape consumers more value of the grape (product), thus sustaining the product value systemically. What is the transformation that lies at the heart of the system - transforming grapes into wine, transforming unsold goods into sold goods, transforming a societal need into a societal need met? This means change, in one word, is the centre of the transformation system; the process of becoming is more important than the business solution system. This is because the change is what the industry 2.0 systemic sustainability system practice purpose solves. The purpose behind the transformation system where change is provides the change, thus the results. For example when converting grapes into wine the purpose for Change is to supply to members of the public interest or involvement in grapes more value of the product, thus sustaining the product value more systemically.
Weltanschauung (or Worldview) – What is the big picture and what are the wider impacts of the issue? "The word Weltanschauung is a German word that has no real English equivalent. It refers to "all the things that you take for granted" and is related to our values". But the closest translation would be "world view", which is the collective summary of the stakeholders belief that gives meaning to the root definition. Model of the human activity system as a whole.
Owner – Who owns the process or situation being investigated and what role will they play in the solution?
Environmental constraints – What are the constraints and limitations that will impact the solution and its success?
CATWOE can also be related to the holistic multi-benefit analysis due to the multiple perspectives that are taken into consideration. It further understands the perspectives and concerns of different stakeholders involved in the human activity systems adhering to the core values of soft systems thinking allowing multiple perspectives to be appreciated with good knowledge management
Human activity system
A human activity system can be defined as "notional system (i.e. not existing in any tangible form) where human beings are undertaking some activities that achieve some purpose".
Within most systems there will be many human activity systems integrated within it to form the whole system. Human activity systems can be used in SSM to establish worldviews (Weltanschauung) for people involved in problematic situations. The assumption with all human activity systems is that all actors within them will act accordingly with their own worldviews.
See also
Enterprise modelling
Hard systems
Holism
List of thought processes
Problem structuring methods
Rich picture
Structured systems analysis and design method
Systems theory
Systems philosophy
References
Further reading
Books
Avison, D., & Fitzgerald, G. (2006). Information Systems Development. methodologies, techniques & tools (4th ed.). McGraw-Hill Education.
Wilson, B. and van Haperen, K. (2015) Soft Systems Thinking, Methodology and the Management of Change (including the history of the systems engineering department at Lancaster University), London: Palgrave MacMillan. .
Checkland, P.B. and J. Scholes (2001) Soft Systems Methodology in Action, in J. Rosenhead and J. Mingers (eds), Rational Analysis for a Problematic World Revisited. Chichester: Wiley
Checkland, P.B. & Poulter, J. (2006) Learning for Action: A short definitive account of Soft Systems Methodology and its use for Practitioners, teachers and Students, Wiley, Chichester.
Checkland, P.B. Systems Thinking, Systems Practice, John Wiley & Sons Ltd. 1981, 1998.
Checkland, P.B. and S. Holwell Information, Systems and Information Systems, John Wiley & Sons Ltd. 1998.
Wilson, B. Systems: Concepts, Methodologies and Applications, John Wiley & Sons Ltd. 1984, 1990.
Wilson, B. Soft Systems Methodology, John Wiley & Sons Ltd. 2001.
Articles
Dale Couprie et al. (2007) Soft Systems Methodology Department of Computer Science, University of Calgary.
Mark P. Mobach, Jos J. van der Werf & F.J. Tromp (2000). The art of modelling in SSM, in papers ISSS meeting 2000.
Ian Bailey (2008) MODAF and Soft Systems. white paper.
Ivanov, K. (1991). Critical systems thinking and information technology. - In J. of Applied Systems Analysis, 18, 39-55. (ISSN 0308-9541). A review of soft systems methodology as related to critical systems thinking.
Michael Rada (2015-12-01) . white paper, INDUSTRY 5.0 launch.
Michael Rada (2015-02-03) . white paper, INDUSTRY 5.0 DEFINITION.
External links
Peter Checkland homepage.
Models for Change Soft Systems Methodology . Business Process Transformation, 1996.
Soft systems methodology Action research and evaluation on line, 2007.
Checkland and Smyth's CATWOE and Soft Systems Methodology, Business Open Learning Archive 2007.
Systems theory
Methodology
Enterprise modelling
Problem structuring methods | 0.769767 | 0.982625 | 0.756393 |
Clinical pathway | A clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or care map, is one of the main tools used to manage the quality in healthcare concerning the standardisation of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways aim to promote organised and efficient patient care based on evidence-based medicine, and aim to optimise outcomes in settings such as acute care and home care. A single clinical pathway may refer to multiple clinical guidelines on several topics in a well specified context.
Definition
A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or visit (homecare). Outcomes are tied to specific interventions.
The concept of clinical pathways may have different meanings to different stakeholders. Managed care organizations often view clinical pathways in a similar way as they view care plans, in which the care provided to a patient is definitive and deliberate. Clinical pathways can range in scope from simple medication utilization to a comprehensive treatment plan. Clinical pathways aim for greater standardization of treatment regimens and sequencing as well as improved outcomes, from both a quality of life and a clinical outcomes perspective.
History
The clinical pathway concept appeared for the first time at the New England Medical Center (Boston, United States) in 1985, inspired by Karen Zander and Kathleen Bower. Clinical pathways appeared as a result of the adaptation of the documents used in industrial quality management, the standard operating procedures (SOPs), whose goals are:
Improve efficiency in the use of resources.
Finish work in a set time.
Characteristics
Clinical pathways (integrated care pathways) can be seen as an application of process management thinking to the improvement of patient healthcare. An aim is to re-center the focus on the patient's overall journey, rather than the contribution of each specialty or caring function independently. Instead, all are emphasised to be working together, in the same way as a cross-functional team.
More than just a guideline or a protocol, a care pathway is typically recorded in a single all-encompassing bedside document that will stand as an indicator of the care a patient is likely to be provided in the course of the pathway going forward; and ultimately as a single unified legal record of the care the patient has received, and the progress of their condition, as the pathway has been undertaken.
The pathway design tries to capture the foreseeable actions which will most commonly represent best practice for most patients most of the time, and include prompts for them at the appropriate time in the pathway document to ascertain whether they have been carried out, and whether results have been as expected. In this way results are recorded, and important questions and actions are not overlooked. However, pathways are typically not prescriptive; the patient's journey is an individual one, and an important part of the purpose of the pathway documents is to capture information on "variances", where due to circumstances or clinical judgment different actions have been taken, or different results unfolded. The combined variances for a sufficiently large population of patients are then analysed to identify important or systematic features, which can be used to improve the next iteration of the pathway.
Selection criteria
The following signals may indicate that it may be useful to commit resources to establish and implement a clinical pathway for a particular condition:
Prevalent pathology within the care setting
Pathology with a significant risk for patients
Pathology with a high cost for the hospital
Predictable clinical course
Pathology well defined and that permits homogeneous care
Existence of recommendations of good practices or experts opinions
Unexplained variability of care
Possibility of obtaining professional agreement
Multidisciplinary implementation
Motivation by professionals to work on a specific condition
Examples
Liverpool Care Pathway for the Dying Patient
See also
Clinical formulation
European Pathway Association
Health economics
Medical case management
Nursing care plan
References
Further reading
External links
Health care management
Health care quality
Medical terminology | 0.780052 | 0.969607 | 0.756344 |
Biomedical sciences | Biomedical sciences are a set of sciences applying portions of natural science or formal science, or both, to develop knowledge, interventions, or technology that are of use in healthcare or public health. Such disciplines as medical microbiology, clinical virology, clinical epidemiology, genetic epidemiology, and biomedical engineering are medical sciences. In explaining physiological mechanisms operating in pathological processes, however, pathophysiology can be regarded as basic science.
Biomedical Sciences, as defined by the UK Quality Assurance Agency for Higher Education Benchmark Statement in 2015, includes those science disciplines whose primary focus is the biology of human health and disease and ranges from the generic study of biomedical sciences and human biology to more specialised subject areas such as pharmacology, human physiology and human nutrition. It is underpinned by relevant basic sciences including anatomy and physiology, cell biology, biochemistry, microbiology, genetics and molecular biology, pharmacology, immunology, mathematics and statistics, and bioinformatics. As such the biomedical sciences have a much wider range of academic and research activities and economic significance than that defined by hospital laboratory sciences. Biomedical Sciences are the major focus of bioscience research and funding in the 21st century.
Roles within biomedical science
A sub-set of biomedical sciences is the science of clinical laboratory diagnosis. This is commonly referred to in the UK as 'biomedical science' or 'healthcare science'. There are at least 45 different specialisms within healthcare science, which are traditionally grouped into three main divisions:
specialisms involving life sciences
specialisms involving physiological science
specialisms involving medical physics or bioengineering
Life sciences specialties
Molecular toxicology
Molecular pathology
Blood transfusion science
Cervical cytology
Clinical biochemistry
Clinical embryology
Clinical immunology
Clinical pharmacology and therapeutics
Electron microscopy
External quality assurance
Haematology
Haemostasis and thrombosis
Histocompatibility and immunogenetics
Histopathology and cytopathology
Molecular genetics and cytogenetics
Molecular biology and cell biology
Microbiology including mycology
Bacteriology
Tropical diseases
Phlebotomy
Tissue banking/transplant
Virology
Physiological science specialisms
Physics and bioengineering specialisms
Biomedical science in the United Kingdom
The healthcare science workforce is an important part of the UK's National Health Service. While people working in healthcare science are only 5% of the staff of the NHS, 80% of all diagnoses can be attributed to their work.
The volume of specialist healthcare science work is a significant part of the work of the NHS. Every year, NHS healthcare scientists carry out:
nearly 1 billion pathology laboratory tests
more than 12 million physiological tests
support for 1.5 million fractions of radiotherapy
The four governments of the UK have recognised the importance of healthcare science to the NHS, introducing the Modernising Scientific Careers initiative to make certain that the education and training for healthcare scientists ensures there is the flexibility to meet patient needs while keeping up to date with scientific developments.
Graduates of an accredited biomedical science degree programme can also apply for the NHS' Scientist training programme, which gives successful applicants an opportunity to work in a clinical setting whilst also studying towards an MSc or Doctoral qualification.
Biomedical Science in the 20th century
At this point in history the field of medicine was the most prevalent sub field of biomedical science, as several breakthroughs on how to treat diseases and help the immune system were made. As well as the birth of body augmentations.
1910s
In 1912, the Institute of Biomedical Science was founded in the United Kingdom. The institute is still standing today and still regularly publishes works in the major breakthroughs in disease treatments and other breakthroughs in the field 117 years later. The IBMS today represents approximately 20,000 members employed mainly in National Health Service and private laboratories.
1920s
In 1928, British Scientist Alexander Fleming discovered the first antibiotic penicillin. This was a huge breakthrough in biomedical science because it allowed for the treatment of bacterial infections.
In 1926, the first artificial pacemaker was made by Australian physician Dr. Mark C. Lidwell. This portable machine was plugged into a lighting point. One pole was applied to a skin pad soaked with strong salt solution, while the other consisted of a needle insulated up to the point and was plunged into the appropriate cardiac chamber and the machine started. A switch was incorporated to change the polarity. The pacemaker rate ranged from about 80 to 120 pulses per minute and the voltage also variable from 1.5 to 120 volts.
1930s
The 1930s was a huge era for biomedical research, as this was the era where antibiotics became more widespread and vaccines started to be developed. In 1935, the idea of a polio vaccine was introduced by Dr. Maurice Brodie. Brodie prepared a died poliomyelitis vaccine, which he then tested on chimpanzees, himself, and several children. Brodie's vaccine trials went poorly since the polio-virus became active in many of the human test subjects. Many subjects had fatal side effects, paralyzing, and causing death.
1940s
During and after World War II, the field of biomedical science saw a new age of technology and treatment methods. For instance in 1941 the first hormonal treatment for prostate cancer was implemented by Urologist and cancer researcher Charles B. Huggins. Huggins discovered that if you remove the testicles from a man with prostate cancer, the cancer had nowhere to spread, and nothing to feed on thus putting the subject into remission. This advancement lead to the development of hormonal blocking drugs, which is less invasive and still used today. At the tail end of this decade, the first bone marrow transplant was done on a mouse in 1949. The surgery was conducted by Dr. Leon O. Jacobson, he discovered that he could transplant bone marrow and spleen tissues in a mouse that had both no bone marrow and a destroyed spleen. The procedure is still used in modern medicine today and is responsible for saving countless lives.
1950s
In the 1950s, we saw innovation in technology across all fields, but most importantly there were many breakthroughs which led to modern medicine. On 6 March 1953, Dr. Jonas Salk announced the completion of the first successful killed-virus Polio vaccine. The vaccine was tested on about 1.6 million Canadian, American, and Finnish children in 1954. The vaccine was announced as safe on 12 April 1955.
See also
Biomedical research institution Austral University Hospital
References
External links
Extraordinary You: Case studies of Healthcare scientists in the UK's National Health Service
National Institute of Environmental Health Sciences
The US National Library of Medicine
National Health Service
Health sciences
Health care occupations
Science occupations | 0.760068 | 0.995015 | 0.756279 |
Cognitive therapy | Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working with the therapist to develop skills for testing and changing beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A cognitive case conceptualization is developed by the cognitive therapist as a guide to understand the individual's internal reality, select appropriate interventions and identify areas of distress.
History
Precursors of certain aspects of cognitive therapy have been identified in various ancient philosophical traditions, particularly Stoicism. For example, Beck's original treatment manual for depression states, "The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers".
Albert Ellis worked on cognitive treatment methods from the 1950s (Ellis, 1956). He called his approach Rational Therapy (RT) at first, then Rational Emotive Therapy (RET) and later Rational Emotive Behavior Therapy (REBT).
Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions, in the late 1950s Aaron T. Beck came to the conclusion that the way in which his patients perceived and attributed meaning in their daily lives—a process known as cognition—was a key to therapy.
Beck outlined his approach in Depression: Causes and Treatment in 1967. He later expanded his focus to include anxiety disorders, in Cognitive Therapy and the Emotional Disorders in 1976, and other disorders later on. He also introduced a focus on the underlying "schema"—the underlying ways in which people process information about the self, the world or the future.
This new cognitive approach came into conflict with the behaviorism common at the time, which claimed that talk of mental causes was not scientific or meaningful, and that assessing stimuli and behavioral responses was the best way to practice psychology. However, the 1970s saw a general "cognitive revolution" in psychology. Behavioral modification techniques and cognitive therapy techniques became joined, giving rise to a common concept of cognitive behavioral therapy. Although cognitive therapy has often included some behavioral components, advocates of Beck's particular approach sought to maintain and establish its integrity as a distinct, standardized form of cognitive behavioral therapy in which the cognitive shift is the key mechanism of change.
Aaron and his daughter Judith S. Beck founded the Beck Institute for Cognitive Therapy and Research in 1994. This was later renamed the "Beck Institute for Cognitive Behavior Therapy."
In 1995, Judith released Cognitive Therapy: Basics and Beyond, a treatment manual endorsed by her father Aaron.
As cognitive therapy continued to grow in popularity, the non-profit "Academy of Cognitive Therapy" was created in 1998 to accredit cognitive therapists, create a forum for members to share research and interventions, and to educate the public about cognitive therapy and related mental health issues. The academy later changed its name to the "Academy of Cognitive & Behavioral Therapies".
The 2011 second edition of "Basics and Beyond" (also endorsed by Aaron T. Beck) was titled Cognitive Behavioral Therapy: Basics and Beyond, Second Edition, and adopted the name "CBT" for Aaron's therapy from its beginning. This further blurred the boundaries between the concepts of "CT" and "CBT".
Basis
Therapy may consist of testing the assumptions which one makes and looking for new information that could help shift the assumptions in a way that leads to different emotional or behavioral reactions. Change may begin by targeting thoughts (to change emotion and behavior), behavior (to change feelings and thoughts), or the individual's goals (by identifying thoughts, feelings or behavior that conflict with the goals). Beck initially focused on depression and developed a list of "errors" (cognitive distortion) in thinking that he proposed could maintain depression, including arbitrary inference, selective abstraction, overgeneralization, and magnification (of negatives) and minimization (of positives).
As an example of how CT might work: Having made a mistake at work, a man may believe: "I'm useless and can't do anything right at work." He may then focus on the mistake (which he takes as evidence that his belief is true), and his thoughts about being "useless" are likely to lead to negative emotion (frustration, sadness, hopelessness). Given these thoughts and feelings, he may then begin to avoid challenges at work, which is behavior that could provide even more evidence for him that his belief is true. As a result, any adaptive response and further constructive consequences become unlikely, and he may focus even more on any mistakes he may make, which serve to reinforce the original belief of being "useless." In therapy, this example could be identified as a self-fulfilling prophecy or "problem cycle," and the efforts of the therapist and patient would be directed at working together to explore and change this cycle.
People who are working with a cognitive therapist often practice more flexible ways to think and respond, learning to ask themselves whether their thoughts are completely true, and whether those thoughts are helping them to meet their goals. Thoughts that do not meet this description may then be shifted to something more accurate or helpful, leading to more positive emotion, more desirable behavior, and movement toward the person's goals. Cognitive therapy takes a skill-building approach, where the therapist helps the person to learn and practice these skills independently, eventually "becoming their own therapist."
"Consistent with the cognitive theory of psychopathology, CT is designed to be structured, directive, active, and time-limited, with the express purpose of identifying, reality-testing, and correcting distorted cognition and underlying dysfunctional beliefs".
Cognitive model
The cognitive model was originally constructed following research studies conducted by Aaron Beck to explain the psychological processes in depression.
It divides the mind beliefs in three levels:
Automatic thought
Intermediate belief
Core belief or basic belief
In 2014, an update of the cognitive model was proposed, called the Generic Cognitive Model (GCM). The GCM is an update of Beck's model that proposes that mental disorders can be differentiated by the nature of their dysfunctional beliefs. The GCM includes a conceptual framework and a clinical approach for understanding common cognitive processes of mental disorders while specifying the unique features of the specific disorders.
Cognitive restructuring (methods)
Cognitive restructuring involves four steps:
Identification of problematic cognitions known as "automatic thoughts" (ATs) which are dysfunctional or negative views of the self, world, or future based upon already existing beliefs about oneself, the world, or the future
Identification of the cognitive distortions in the ATs
Rational disputation of ATs with the Socratic method
Development of a rational rebuttal to the ATs
There are six types of automatic thoughts:
Self-evaluated thoughts
Thoughts about the evaluations of others
Evaluative thoughts about the other person with whom they are interacting
Thoughts about coping strategies and behavioral plans
Thoughts of avoidance
Any other thoughts that were not categorized
Other major techniques include:
Activity monitoring and activity scheduling
Behavioral experiments
Catching, checking, and changing thoughts
Collaborative empiricism: therapist and patient become investigators by examining the evidence to support or reject the patient's cognitions. Empirical evidence is used to determine whether particular cognitions serve any useful purpose.
Downward arrow technique
Exposure and response prevention
Cost benefit analysis
acting "as if"'
Guided discovery: therapist elucidates behavioral problems and faulty thinking by designing new experiences that lead to acquisition of new skills and perspectives. Through both cognitive and behavioral methods, the patient discovers more adaptive ways of thinking and coping with environmental stressors by correcting cognitive processing.
Mastery and pleasure technique
Problem solving
Socratic questioning: involves the creation of a series of questions to a) clarify and define problems, b) assist in the identification of thoughts, images and assumptions, c) examine the meanings of events for the patient, and d) assess the consequences of maintaining maladaptive thoughts and behaviors.
Socratic questioning
Socratic questions are the archetypal cognitive restructuring techniques. These kinds of questions are designed to challenge assumptions by:
Conceiving reasonable alternatives:
"What might be another explanation or viewpoint of the situation?
Why else did it happen?"
Evaluating those consequences:
"What's the effect of thinking or believing this?
What could be the effect of thinking differently and no longer holding onto this belief?"
Distancing:
"Imagine a specific friend/family member in the same situation or if they viewed the situation this way, what would I tell them?"
Examples of socratic questions are:
"Describe the way you formed your viewpoint originally."
"What initially convinced you that your current view is the best one available?"
"Think of three pieces of evidence that contradict this view, or that support the opposite view. Think about the opposite of this viewpoint and reflect on it for a moment. What's the strongest argument in favor of this opposite view?"
"Write down any specific benefits you get from holding this belief, such as social or psychological benefits. For example, getting to be part of a community of like-minded people, feeling good about yourself or the world, feeling that your viewpoint is superior to others", etc. Are there any reasons that you might hold this view other than because it's true?"
"For instance, does holding this viewpoint provide some peace of mind that holding a different viewpoint would not?"
"In order to refine your viewpoint so that it's as accurate as possible, it's important to challenge it directly on occasion and consider whether there are reasons that it might not be true. What do you think the best or strongest argument against this perspective is?"
"What would you have to experience or find out in order for you to change your mind about this viewpoint?"
"Given your thoughts so far, do you think that there may be a truer, more accurate, or more nuanced version of your original view that you could state right now?"
False assumptions
False assumptions are based on "cognitive distortions", such as:
Always Being Right: "We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, 'I don't care how badly arguing with me makes you feel, I'm going to win this argument no matter what because I'm right.' Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones."
Heaven's Reward Fallacy: "We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn't come."
Awfulizing and Must-ing
Rational emotive behavior therapy (REBT) includes awfulizing, when a person causes themselves disturbance by labeling an upcoming situation as "awful", rather than envisaging how the situation may actually unfold, and Must-ing, when a person places a false demand on themselves that something "must" happen (e.g. "I must get an A in this exam.")
Application
Depression
According to Beck's theory of the etiology of depression, depressed people acquire a negative schema of the world in childhood and adolescence; children and adolescents who experience depression acquire this negative schema earlier. Depressed people acquire such schemas through the loss of a parent, rejection by peers, bullying, criticism from teachers or parents, the depressive attitude of a parent or other negative events. When a person with such schemas encounters a situation that resembles the original conditions of the learned schema, the negative schemas are activated.
Beck's negative triad holds that depressed people have negative thoughts about themselves, their experiences in the world, and the future. For instance, a depressed person might think, "I didn't get the job because I'm terrible at interviews. Interviewers never like me, and no one will ever want to hire me." In the same situation, a person who is not depressed might think, "The interviewer wasn't paying much attention to me. Maybe she already had someone else in mind for the job. Next time I'll have better luck, and I'll get a job soon." Beck also identified a number of other cognitive distortions, which can contribute to depression, including the following: arbitrary inference, selective abstraction, overgeneralization, magnification and minimization.
In 2008, Beck proposed an integrative developmental model of depression that aims to incorporate research in genetics and the neuroscience of depression. This model was updated in 2016 to incorporate multiple levels of analyses, new research, and key concepts (e.g., resilience) within the framework of an evolutionary perspective.
Other applications
Cognitive therapy has been applied to a very wide range of behavioral health issues including:
Academic achievement
Addiction
Anxiety disorders
Bipolar disorder
Low self-esteem
Phobia
Schizophrenia
Substance abuse
Suicidal ideation
Weight loss
Criticisms
A criticism has been that clinical studies of CT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.
See also
Cognitive analytic therapy
Cognitive bias mitigation
Cognitive-shifting
David D. Burns
Debiasing
History of psychotherapy
Journal of Cognitive Psychotherapy
Recognition-primed decision
Schema therapy
References
External links
An Introduction to Cognitive Therapy & Cognitive Behavioural Approaches
What is Cognitive Therapy
Academy of Cognitive Therapy
International Association of Cognitive Psychotherapy | 0.761682 | 0.99285 | 0.756236 |
Subsets and Splits