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Biomedical subjects

L Eisenberg

Publications and source records attributed to L Eisenberg.

At least 19 recordsLinked to original sources
PubMed1996

Infants and young children in orphanages: one view from pediatrics and child psychiatry.

A large body of medical knowledge exists that can inform the public policy debate as to whether the current needs and future life prospects of poor children could better be served in orphanages than by continuing safety net programs, such as Aid to Families with Dependent Children, Medicaid, and Supplemental Social Security Income, which maintain children in families. This special article explores a century of pediatric and child psychiatry research covering five areas of potential biologic and social risk to infants and young children in orphanage care: (1) infectious morbidity, (2) nutrition and growth, (3) cognitive development, (4) socioaffective development, and (5) physical and sexual abuse. These data demonstrate that infants and young children are uniquely vulnerable to the medical and psychosocial hazards of institutional care, negative effects that cannot be reduced to a tolerable level even with massive expenditure. Scientific experience consistently shows that, in the short term, orphanage placement puts young children at increased risk of serious infectious illness and delayed language development. In the long term, institutionalization in early childhood increases the likelihood that impoverished children will grow into psychiatrically impaired and economically unproductive adults.

Child↗
PubMed1995

The social construction of the human brain.

OBJECTIVE: The purpose of this article is to review the development of concepts about the contribution of nature and nurture to brain structure and mental function, and to derive the implications of these changing concepts for clinical practice. METHOD: The literature of the past five decades, as refracted by the author's personal experience in academic psychiatry during that interval, is reviewed. RESULTS: Psychiatric theory has swung through mighty arcs in recent years but has begun to re-equilibrate. Fifty years ago, psychoanalysis dominated the academic scene; for the past two decades, reductionist biological determinism has held the fort. Neither position is tenable. To subscribe to either is possible only by ignoring conflicting evidence. Worse, it means short-changing patients, whose disorders do not come neatly packaged into "organic" and "functional" compartments. Development is neither predestined in the genome nor completely malleable to shaping by the environment. Children inherit, along with their parents' genes, their parents, their peers, and the communities they inhabit. CONCLUSIONS: Contemporary psychiatric research conclusively demonstrates that mind/brain responds to biological and social vectors and is jointly constructed by both. Major brain pathways are specified in the genome; detailed connections are fashioned by, and consequently reflect, socially mediated experience in the world. Just at the time when integration at the level of theory is coming into sight, comprehensive patient care is endangered by for-profit corporate managed care, which is transforming medical visits into commodities on a production line. Physicians and patients must join in a coalition to protect quality, ensure access, and build continuity into all of medical care.

Animals↗
PubMed1994

Social policy and child health.

Under the rubric of social policy and child mental health are two overlapping but conceptually different areas. The first set is the social policy questions with direct relevance to child mental health programs per se; that is, decisions about whether a given child mental health proposal merits the investment of community resources. The second category of social forces is that which has important secondary consequences for child mental health although child mental health per se may never enter the discussion; for example, policy decisions which have a major impact on family life (women's rights, tax policy, divorce law, employment policy, etc.). This paper will review the first category, the overt policy issues, before moving on to the second category, the "convert" child health debate.

Child↗
PubMed1992

Psychiatric morbidity in developing countries and American psychiatry's role in international health.

Economic and social change in the developing countries of Asia, Africa, Latin America, and the Pacific Islands is associated with increased rates of behavior-related illnesses, including psychiatric disorders, alcoholism, and substance abuse. Between 10 and 20 percent of the presenting problems in primary care settings in those countries are psychosocial. The authors provide an overview of the epidemiology of psychiatric and psychosocial morbidity in developing countries and summarize its effect on medical care systems in those settings. They suggest that American psychiatry increase its involvement in improving mental health care in developing countries. Consultation should be directed toward priorities determined locally in those countries, including assessment of current clinical practices, applied epidemiologic research, and training of indigenous researchers.

Adolescent↗
PubMed1992

Child mental health in the Americas: a public health approach.

The systematic, population-wide application of preventive measures based on what is known about the causes and outcomes of psychiatric disorders can markedly reduce morbidity from mental ill health among children in the Americas. The actions proposed here rely partly upon increasing access for all women and their children to thoroughly tested obstetric and pediatric care; in part they depend on improving nutrition and opportunities for cognitive stimulation; and in part they call for enhancing the mental health skills of primary care practitioners by appropriate in-service training. There are limits to our knowledge and to the effectiveness of some of our interventions; nonetheless, the greatest barrier to better child mental health is failure to muster the political will to apply what is known to the care of mothers and children in all sectors of society.

Americas↗