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PubMed2003

Beyond Dusky and Godinez: competency before and after trial.

Scholars have carefully considered all aspects of the incompetency to stand trial process, questions involving incompetency to confess, questions involving incompetency to be executed, and, to a lesser extent, questions related to incompetency to plead guilty or to waive counsel, but little attention has been paid to the relationship between incompetency and the full range of other criminal procedure issues: sentencing, appeals, consent to searches, and others. This article discusses this range of issues, assesses the factors relied upon by courts in deciding these cases and attempts to offer an agenda for future scholarly developments in this area.

Crime↗
PubMed2003

Pre-adjudicative and adjudicative competence in juveniles and young adults.

There are several different types of legal competence, such as competence to waive Miranda rights, competence to confess, and competence to stand trial. Although it can be surmised that many of the underlying factors that influence the different legal competencies are similar, little research has been conducted to empirically test this hypothesis. In the present study, juveniles' and young adults' understanding and appreciation of their Miranda rights and their ability to stand trial were measured. Age, suggestibility, average grades in school, and frequency of previous police involvement were also examined as possible factors that influence both types of legal knowledge. Results indicated that Miranda competence and adjudicative competence are indeed strongly related, especially for juveniles. Also, age and suggestibility were found to predict Miranda competence, whereas suggestibility and average school grades predicted competence to stand trial. Patterns of findings often diverged for juveniles and young adults. Implications for legal policy are discussed.

Adolescent↗
PubMed2006

Fatal outcome from extreme acute gastric dilation after an eating binge.

OBJECTIVE: A 22-year-old woman is presented with acute gastric dilation after an eating binge, who died of complications of acute reperfusion syndrome. METHOD: A young patient was admitted in our clinic with critical condition without any significant previous medical history. Her initial complaints--diarrhea, vomiting and abdominal pain--began after an enormous food intake. There was no history of medications or toxic substances. Physical examination showed a normally-developed, well-nourished female in severe distress with an extremely distended abdomen. Femoral pulses were absent. The US and CT scan showed a dilated stomach, extended into the pelvis, dislocating the intestinal organs and compressed the aorta and mesenteric veins. RESULTS: Urgent laparotomy was performed. An enormously distended stomach was encountered without volvulus, obstruction or adhesions. About 11 liters of gastric content was removed gastrotomy and nasogastric tube. Following the gastric decompression, the mesenteric and femoral pulses reappeared. During the operation, the cardio-respiratory status was stabilized, but in the following 24 hours irreversible shock developed, possibly due to the reperfusion of the retroperitoneal organs and the lower extremities. In the postoperative period disseminated intravascular coagulopathy developed. In an uncontrollable state of diffuse bleeding, 36 hours post-operation, the patient died. In retrospective investigation, the family confessed that previous psychological treatments which aimed at her bulimic attacks. CONCLUSION: Acute gastric dilatation is very uncommon and is of various etiologies, two of these being anorexia nervosa and bulimia. Several cases documenting complications of gastric dilatation were published; however, such severe complications, involving gastric infarction and compression of the aorta with ischemic injury of the bowels and lower extremities, are rare.

Acute Disease↗
PubMed2004

Epiphany in autobiography: the quantum changes of Dostoevsky and Tolstoy.

The quantum changes of Dostoevsky and Tolstoy are clarified by the partly overlapping concept of a literary epiphany. The qualities of an epiphany-intensity, resonance, and mystery-are much like the vividness and surprise of a quantum change (which also is felt to be beneficent and permanent). Epiphanic intensity and mystery reinforce the quantum attributes of love and lasting transformation in Dostoevsky's sudden memory of the motherlike tenderness of the peasant Marey. Tolstoy underlines the quantum effects of the embracing light seen in A Confession, but this epiphany is more abstract and attenuated than Dostoevsky's Diary episode. Tolstoy's earlier memoir shows how the shock of identity questioning introduces a complicating factor: the trauma of remorse. Clinical implications of the two authors' quantum-change accounts are discussed.

Autobiographies as Topic↗
PubMed2003

The modern confessional: Anglo-American religious groups and the emergence of lay psychotherapy.

This article reconceives of secularization as a gradual process of increasing interaction between the (social) scientific and spiritual realms by examining the influence of Christian ideas of group confession on lay psychotherapeutic groups in Britain, Canada, and the U.S. in the early twentieth century. This article focuses on three religious group leaders of the interwar period: Frank Buchman (1878-1961), Gerald Heard (1889-1971), and Henry Burton Sharman (1865-1953). Influenced by Natural Theology and the holiness movement, they placed sin and its redemption within the world, reconceiving it as psychological individualism and its redemption as self-sacrifice to the group. This reconception endorsed the moral power of groups and influenced Alcoholics Anonymous and various groups within the Human Potential Movement.

Alcoholics Anonymous↗
PubMed2004

"La manie d'ecrire": psychology, auto-observation, and case history.

This essay examines the modern psychiatric case study as a scientific method and as a genre of writing about the self. As psychological discourse became a privileged language of selfhood at the fin de siècle, the penultimate signifier of the self came to be found in the realm of sexuality, in the particular contours of an individual's sexual desire. The investigative tool used to uncover these secrets of identity was the case history. This article concerns an influential project of sexual research based on "auto-observations"-autobiographical patient narratives-conducted by Dr. Georges Saint-Paul, who published under the inverted pseudonym "Laupts." The article focuses on the central autobiography of his collection, the "roman d'un inverti," and related sexological literature to suggest how this emphasis on patient stories in psychiatric writing engendered new narrative possibilities for doctors and patients alike. Putting patient stories at the center of psychiatric investigation created a new relationship between patient and doctor, observation and diagnosis, subject and discourse. The tools of psychological observation simultaneously placed a subject's confession more firmly at the center of the investigation and made it more open to interpretation by nonspecialists. Rather than simply confirming the authority of the trained observer, the story of Laupts's enquête suggests that the method actually authorized inquiry by others.

History, 19th Century↗
PubMed1989

Moral medicine: symbolic content in 19th century Shaker therapeutics.

This paper presents an analysis of the symbolic meanings implicit in an ostensibly empirical therapeutic system. The Shakers, a celibate communal religious order founded in New York State in the mid 1770s, were practitioners of botanic medicine, as were many other Americans in the nineteenth century. This study analyzes the therapeutic properties of the herbs they produced (such as diuretic, stimulant, narcotic, emetic, astringent), using a classification scheme based on the location of the botanical substance's effect vis-à-vis body boundaries and surfaces. The Shakers' beliefs about the therapeutic properties of their herbs are compared with similar analyses of the properties given by two contemporary nineteenth century New England proponents of herbal medicine, botanist Constantine Rafinesque and sectarian practitioner Samuel Thomson. The comparison shows systematic variation in emphasis given to herbs which regulate internal body processes, or act through the openings of the body or on its surface. In this context Shaker medicine can be characterized as quickening, internal, and purifying in its effects on body processes, effects which are highly consistent with Shaker religious beliefs in active, physical worship, selflessness and spiritual purification by confession.

Body Image↗
PubMed1985

[Student tragedy. Forensic-psychiatric and legal medicine aspects of an unusual crime].

The unusual circumstances of the violent killing of an 18-year-old girl by her 18.8-years-old schoolfriend led us to undertake a forensic-psychiatric analysis of the offence action as well as a presentation of legal-medical points of view. The crime, which can be classified as a collective lover crime for which there is no parallel in the literature, was only solved 9 months later when one of the two delinquents confessed a further offence. The killing was planned and prepared, the victim being buried hurriedly in a previously made hole in a wood after she had been strangled.

Adolescent↗
PubMed1993

The use of antidepressant drugs in general practice. A questionnaire survey.

The aim of this study was to examine the anti-depressant drug prescribing preferences and habits of a population of general practitioners. The method used was that of a questionnaire survey, including case vignettes. The response rate exceeded 70% Data are presented out-lining the attitudes of the respondents to the use of antidepressant drugs in the management of common psychiatric presentations in the primary care setting. The majority of general practitioners (G.P.'s) had received little or no post-graduate education in psychiatry. The antidepressants most frequently prescribed were amitriptyline, clomipramine, trazodone and lofepramine. Despite recognition of the alarming frequency of serious self-poisoning incidents with some of these compounds, 26% of respondents confessed to an inability to make an informed choice of antidepressant drug, with 14% using the same drug with every patient with no attempt to select according to individual patient requirements. The management of depressive neurosis generates considerable clinical confusion with a variety of interventions favoured. The use of a sedating antidepressant is popular. There is greater accord for the management of endogenomorphic depression. The use of the benzodiazepine drugs in the management of anxiety disorders is infrequent, with appropriate recognition of the merits of behavioural approaches. However, the role for antidepressant drugs in the management of anxiety disorders is under-recognized. We conclude that general practitioners are required to undertake a significant body of work for which they may be inadequately trained.

Adult↗
PubMed1976

[Changes in delusional psychoses. A historical transcultural comparison (author's transl)].

A historical transcultural comparison of paranoid psychoses (ICD 295.3, 297. 0-9) was done by evaluating the data of 200 case histories (I: 100 from 1911, II: 100 from 1973). An interrater reliability test was performed. 1. Stable delusions were: delusions of reference, religious delusions, delusions of persecution. 2. There was a significant increase in hypochondriacal delusions. 3. Megalomania and erotomania decreased. 4. There is in the "old" and "new" group a significant correlation between megalomania and the male sex. 5. The significant correlation between erotomania and the female sex found in the "old" group could not be found in the "new" group. 6. Constancy and change of delusion is due to both sexes, differing in degree, in part contrarotating. 7. The decrease of "sex-specific" delusions (megalomania and erotomania) is due to the sex concerned. 8. With increasing age there is a reduction of delusion themes in group II: delusions of special descent, paranoid identity change, erotomania were not found after age 30. Querulant paranoia did not occur. In group I querulant paranoia did not appear before age 30. 9. There was a significant correlation between megalomania and the item "development in rural country". 10. In our material there was no correlation between delusion and intelligence and religious confession. 11. Paranoid ideas of hypochondriasis and persecution show changes in the thematics (organs, disease, means of persecution) subject to time. 12. A tendency to change of content of the main delusion is discussed.

Age Factors↗
PubMed1981

Partnership in transsexualism. Part I. Paired and nonpaired groups.

In a group of 72 transsexuals, 26 out of 55 male-to-female transsexuals had partners and 9 out of 17 female-to-male transsexuals had partners. Forty percent of the group of 35 paired transsexuals had been married, but most of these marriages had ended in divorce or separation. Six male patients were still married at the time of the enquiry. The two groups differed significantly in several respects. Those with partners (the paired group) had more fathers or heads of family in social classes I-III, while those without partners (the nonpaired group) were more often without their father in the first decade of life. Significantly more of the paired group received psychiatrists' rating of stable social adjustment. There was a tendency for the paired group to have a more successful employment history since leaving school and to change their National Insurance cards more often in order to obtain employment in their adopted gender. The groups did not differ in the amount of social drift, self-confessed criminal behavior, age at referral, history of prostitution, or incidence of rejecting parents. There were also no significant differences on the following psychological tests: Wechsler Bellevue, Progressive Matrices, Mill Hill Vocabulary Scale, Maudsley Personality Inventory, Slater Selective Vocabulary--except that the nonpaired group knew fewer male words. Any differences between the two groups are perhaps best described in terms of social adjustment rather than any background social factors, personality, or clinical differences.

Adult↗
PubMed1993

Nature in the laboratory--nature as a laboratory. Considerations about the ethics of release experiments.

Field tests with genetically modified organisms go beyond the boundaries of the politically and morally neutralized space that normally surrounds scientific experiments. They enter public areas. As a social process of shaping nature they are political in a fundamental sense. Consequences of this observation concern the legitimacy of decisions and the legitimacy of deciding procedures. The political rights of citizens and their human rights can only be respected if these procedures are democratic. Without a more serious exploration of the specific circumstances of release tests--for example, the precise ecological context, the consequences for the future development of the affected ecosystem, the social consequences, and the possible institutional ways of establishing gene technology in agriculture--we do not really know what we are doing when we release transgenic organisms. Moral judgements today can therefore only be prima facie, not free from shortcomings. As responsible judges we must confess that we are still morally blind.

Containment of Biohazards↗
PubMed1997

Who fired the gun? A casuistic contribution to the differentiation between self-inflicted and non-self-inflicted gunshot wounds.

A fatal gunshot wound to the thorax from a .357 Magnum revolver is reported. The entrance wound was located dorsally at the transition of the right shoulder and the upper arm, the exit wound below the left axilla and a re-entry at the medial aspect of the left upper arm. A friend of the victim, who was present when the gunshot was fired, stated that it was a self-inflicted accident. But the inclusion of both upper arms in the trajectory allowed a comparison between the posture of the upper arms at the moment the gunshot was fired and the posture of the upper arms necessary for a self-inflicted gunshot wound. This reconstruction, which is presented in detail, definitely excluded a self-inflicted wound. The friend then confessed that he had fired the gun accidentally.

Accidents↗
PubMedDate not supplied

A qualitative analysis of emotional effector patterns and their feedback.

This paper is devoted to the study of the relationship between the subjective component (feelings) and the behavioral aspect of emotions. The following emotions were studied: fear-anxiety, anger-aggression, joy-laughter, love-eroticism, love-tenderness, and sadness-tears. The observations were performed with three different groups of people: patients with anxiety neurosis, students under hypnosis, and drama students. Each emotion was characterized by a specific set of reactions in the respiratory pattern, heart activity, muscular activity, and facial expression. The feelings were correlated with the behavioral patterns and each time the behavioral patterns were interfered with a concomitant modification of the subjectivity component was observed. The direct performance of the behavioral emotional patterns in the absence of the emotogenic stimulus produced the feeling corresponding to the mimicked emotion. If the subjects were stimulated with an emotogenic stimulus during the direct performance of the behavioral patterns of another emotion, they confessed to have the feeling corresponding to the mimicked emotion, and not to the emotion belonging to the emotogenic stimulus. The role played by the feedback from the effector organs in the determination of the subjective emotional states is discussed.

Adolescent↗
PubMed2003

Fatality caused by self-bloodletting in a patient with factitious anemia.

Death by bloodletting among patients with factitious anemia has never been reported to our knowledge. We report the first known case. A 25-year-old woman with severe iron deficiency anemia confessed her habit of bloodletting at her first visit to our hospital, in March 1998. We prescribed oral iron and referred her to a psychiatrist. The diagnosis was borderline personality disorder. The psychiatrist began counseling the patient and prescribed a major tranquilizer. The patient's method of bloodletting was to insert an 18-gauge needle without syringe into her vein after inducing congestion in her arm. This method was considered to involve risk of death, because once the patient fell into a faint caused by blood loss, the bloodletting could not be stopped. Although we attempted to persuade the patient to stop bloodletting by this method, she died after self-bloodletting in September 1999. It is not known whether the death was intentional suicide or an accident.

Adult↗
PubMed1999

[Dying through the hand of man or taken by the hand of man? Results of an opinion poll concerning active euthanasia and the Hospice Movement].

BACKGROUND: Opinion polls show a growing support of active euthanasia in Germany. The hospice movement rejects active euthanasia and pleads for a qualified care for the dying. The aim of our study was to evaluate how far the work and the ideas of the hospice movement are known in Germany and to which extend this knowledge influences the attitude towards active euthanasia. METHODS: An interview of 200 people in the pedestrian area of Mainz was undertaken. RESULTS: 73% of all interviewees supported active euthanasia. Significant predictors for opposition to active euthanasia were increasing age and belonging to the roman catholic confession. However, 72% of active euthanasia supporters did not know what a hospice is, and 80% were not aware of the existence of such an establishment in Mainz. Opponents of euthanasia had significantly more knowledge of these items. CONCLUSION: The results of our study indicate that physicians should wherever possible explain the aims and the work of the hospice movement who should be their ally in a qualified commitment for the dying. It can be expected that the hospice movement will find a lot of sympathy in the population as 2 of its major aims--openness in communication and dying at home wherever possible--were shared by the vast majority of all interviewees: in case of incurable disease 92% wanted to be informed on their diagnosis, and 84% wanted to die at home or in their families home.

Euthanasia↗
PubMed2004

[Task and function of the European Food Safety Authority].

In 2002, the European Commission and the European Parliament established the European Food Safety Authority (EFSA). The provisional seat of the new Authority is Brussels and the final seat of the authority will be Parma, Italy. EFSA's main task is to carry out risk assessment and to provide independent scientific advice on all matters linked to food and feed safety. This includes animal health and welfare and plant health-as well as nutrition. Therefore, EFSA's risk assessments provide risk managers with a sound scientific basis for regulatory measures in order to ensure a high level of consumer protection. EFSA is confessed to openness and transparence. The authority keeps good links to all European institutions, particularly to the European Commission and the European Parliament, to national authorities, which have similar tasks to EFSA, and to stakeholders such as consumer and food industry organisations.

Advisory Committees↗
PubMed2001

[Evaluation of subdural hemorrhage in infants after alleged minor trauma].

QUESTIONING: Recently the discussion concerning the causes of infantile subdural bleedings (SDB) has become quite controversial. The wide-spread interpretation that most of these cases are the result of abuse, especially by the shaken-baby-syndrome, was doubted, and the role of (even minor) accidental events was emphasized. METHODS: This situation should be analyzed basing on the official statistics of the causes of death in the city of Berlin (1978-1998) and the autopsy material of our institute (1978-1999). RESULTS: In this period, approximately 440.000 children lived their first year of life in our city. Only 80 violent deaths of infants (up to 1 year old) were recorded in the official statistics, including 27 deaths due to blunt forces, with 24 lethal head injuries as the main group. Only two cases were attributed to "falls under unclear conditions"; all other accidental cases were the results of traffic accidents or falls from a height. No death due to an undoubted minor fall was recorded, nor was any in our autopsy material. We investigated 10 cases of infantile SDB, all without skull fractures and gross brain injuries. Only 1 victim had a SDB of a significant volume; in all other cases only small amounts of blood were present in the subdural space. Bridging vein ruptures were directly demonstrated in 8 cases and were bilaterally in most instances; recently their detection has been simplified by postmortem x-ray using contrast material. All 10 cases were interpreted as typical acceleration-deceleration injuries (as in shaking), although only in 2 cases a confession of this procedure could be obtained. CONCLUSION: Comparing cases of accidental and non-accidental SDB in the literature, infantile SDB obviously cannot be looked at as a homogeneous entity: two quite different types should be kept separate: the patients suffering from an accidental SDB due to a minor fall mostly do not deteriorate immediately after the trauma, develop SDB of some volume, up to a space-occupying mass lesion, and have often a good prognosis. A lethal outcome is extremely uncommon; we have not observed a single case of an infantile lethal SDB resulting from such a minor injury for more than 20 years. The source of the SDB in those cases currently is unknown in most instances. The second group of infantile SDB includes the well-known group of shaken-baby-syndrome: no adequate history, infants dead or nearly dead on clinical presentation, often a poor outcome if the event is survived, typically no significant volume of SDB, and--according to our experiences--in all cases BV ruptures. This combination of several BV ruptures with no significant subdural bleeding is not compatible with a supposition of a minor fall causing this.

Accidents↗