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Biomedical subjects

A A Stone

Publications and source records attributed to A A Stone.

At least 91 records · Page 5Linked to original sources
PubMed1983

Sexual misconduct by psychiatrists: the ethical and clinical dilemma of confidentiality.

Psychiatrists have an ethical obligation to expose colleagues who sexually abuse their patients. However, this obligation often conflicts with the ethical obligation of confidentiality. The principled ethical dilemma is grounded in practical clinical considerations. The author suggests systematic use of consultation as a potential method to address both ethical and clinical responsibilities.

Codes of Ethics↗
PubMed1982

The dream of Irma's injection: a structural analysis.

Lévi-Strauss developed a radically new, structural approach to the analysis of myth that may be adapted for use in the analysis of dreams. The method provides an alternative to psychoanalytic dream interpretation, focusing particularly on the internal dialectic of the dream--the movement from the initial premise to the resolution. This emphasis on the internal coherence and structured development of the dream contrasts strongly with the Freudian piecemeal decoding of dreams. The method is exemplified by analysis of Freud's classic Irma dream; it reveals a structure and message that have hitherto remained obscure. The interpretation connects the dream to Freud's theoretical ideas rather than to his supposed psychosexual fixations.

Association↗
PubMed1982

The insanity defense on trial.

What was once a great romance between law and psychiatry has ended in disenchantment on both sides. Legal rulings during the 1950s intended to increase the psychiatric presence in the courtroom have been repudiated, and there is now a mood to abolish the traditional insanity defense. Abolitionists charge that the insanity defense has been successfully employed by large numbers of dangerous criminals to avoid punishment, that psychiatrists are dishonest because they serve as expert witnesses for both sides, and that the existence of the defense is evidence of a permissive society that coddles violent criminals. Each of these charges is rebutted by the author, who contends that until recently the insanity defense was a profound hypocrisy: the courts found the defendants not guilty by reason of insanity and then relied on psychiatry to confine them for the rest of their lives. But legal reforms and changes in psychiatric practice during the past 20 years have made it more difficult to confine such persons, and thus the insanity defense has real meaning for the first time. The author believes that despite the loss of protection to society, there are important legal and moral barriers to abolishing the insanity defense.

Commitment of Persons with Psychiatric Disorders↗
PubMed1981

The right to refuse treatment: why psychiatrists should and can make it work.

There is a right to refuse treatment and this right already exists in the legal doctrine of informed consent. The basic legal justification for overcoming this right is the incompetence of the patient. Incompetence is also the central consideration in overcoming any constitutional right to refuse treatment. The constitutional theories of the right to refuse treatment are briefly presented and their implementation in different recent decisions is considered. A distinction is made between the requirement of proving incompetency and the requirement of appointing a neutral party as arbiter for incompetent patients. A recent constitutional ruling that recognizes this distinction and permits psychiatrists rather than neutral arbiters to make treatment decisions for patients is discussed as a model that should be acceptable to psychiatry.

Forensic Psychiatry↗
PubMed1981

Cognitive and attentional deficits in children vulnerable to psychopathology.

Cognitive and attentional deficits were assessed in children with either a schizophrenic, and affectively disordered or a normal parent. The children were grouped both by their parents' DSM-II diagnoses (broadly defined group of schizophrenics and heterogeneous group of depressives)and by a new set of diagnoses (narrowly defined group of schizophrenics, unipolar depressive group and bipolar group). Children whose parents met the more stringent criteria for schizophrenia performed somewhat more deviantly than children whose parents met only DSM-II criteria. In addition, the importance of splitting the heterogeneous depressive group into more homogeneous subgroups is indicated by the findings that children of unipolar parents generally could not be distinguished from children whose parents are schizophrenic. On the other hand, children of bipolar parents performed reliably better than children of schizophrenics. These findings are viewed within the context of current high-risk studies and psychological deficit literature and suggest that diagnostic issues require more attention by researchers in these areas.

Adolescent↗
PubMed1981

Hypochondriasis and tendency to adopt the sick role as moderators of the relationship between life-events and somatic symptomatology.

The relationship between measures of hypochondriasis and the tendency to adopt a sick role, life-events and somatic symptomatology was explored. A sample of 85 married couples drawn from the community (n = 170) completed mailed questionnaires about the past year's events and symptoms and about hypochondriasis and sick-role tendency. Life-events were related to symptoms (r = 0.17) as were hypochondriasis, sick-role tendency, and subjects' sex (rs = 0.23, 0.16, 0.22, respectively). Hierarchical multiple regression analyses demonstrated that hypochondriasis and sick-role tendency were also related to the association between events and symptoms, such that subjects with high scores on the former measures showed a reduced event-symptoms correlation compared with low and moderate scorers. Low scorers on hypochondriasis and sick-role tendency had a considerably stronger relationship between events and symptoms compared to those typically reported in the literature. It was suggested that hypochondriasis and sick-role tendency may be moderators of the life-event-symptom relationship and as such deserve more widespread use in life-events research.

Adult↗
PubMed1979

The myth of advocacy.

In an era in which advocacy has become a buzzword, both psychiatry and the legal profession have climbed aboard the advocacy bandwagon. Yet the American Psychiatric Association's notion of advocacy--championing the medical needs of patients--is often in direct conflict with the lawyers' notion of advocacy--championing the legal rights of their clients. The author observes that psychiatry has proved to be a weak adversary for patients' legal advocates; the result has been a one-sided advocacy system that has advanced patients' rights at the expense of their needs. He believes that if the APA is to become an effective advocate for patients, it must hire lawyers and work with them to reverse the trend of turning rights into needs.

Civil Rights↗
PubMed1979

Informed consent: special problems for psychiatry.

There is a growing demand for more patient autonomy in the doctor-patient relationship, and legal reformers believe that an expanded dodctrine of informed consent is the key to change. Informed consent is meant to force the doctor to give the patient the knowledge that will make his an equal bargaining partner. However, most evidence demonstrates that the majority of patients do not comprehend or retain medical information. Further, the legal doctrine of informed consent has never been coherently worked out. Informed consent in psychiatry is particularly complicated, because of the constitutional implications of right-to-refuse-treatment litigation and because patients may be incompetent to give informed consent as a result of their illness. One of the special problems for psychiatry is that complex consent requirements have been mandated by those who oppose certain somatic therapies. The author discusses the implications of these legal developments. He lists the kinds of informed-consent and refusal-to-consent situatons psychiatrists face and comments briefly on the most troublesome.

Ethics, Medical↗
PubMed1978

Cognitive slippage in children vulnerable to schizophrenia.

Psychological deficit research with adult schizophrenics has been hindered by numerous methodological problems that may be avoided by the prospective study of children vulnerable to the disorder. An object sorting task was administered to 156 children of schizophrenic patients, 102 children of depressed patients, and 139 children of normal parents. The children were between 6 and 15 years old. The children of schizophrenic parents made fewer "superordinate" sorting responses than those of normal parents, and more "complex" sorts (a category of inadequate responses) than children of either normal and depressed parents. Our analyses showed that these deficits could not be explained by differences in intelligence. These deficits in conceptual performance may reflect the genotypic predisposition to schizophrenic and/or represent an early precursor of later maladjustment.

Adolescent↗