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Post Vietnam syndrome: neurosis or sociosis?

Recently released figures from the Veterans Administration on the number of Vietnam veterans who have been granted service connection in their claims for post-traumatic stress disorder appear to be astonishingly low, given the publicity that the media and mental health professionals have placed on this diagnosis in recent years. As of the summer of 1984, only slightly more than 7,000 Vietnam veteran cases had been approved by VA rating boards. A conservative popular estimate is that half a million Vietnam veterans are alleged to suffer from this neurosis, which is largely attributable to combat-related experiences. This gross discrepancy raises many serious questions about the appropriate use of the clinical diagnosis of post-traumatic stress disorder. The point of contention is not the legitimacy of the diagnosis, but the abuse and misuse of the term for personal or political purposes to explain the dilemma of the Vietnam veteran in contemporary America. The traditional psychodynamic content of clinical psychology needs to be integrated with an analysis of the impact of social, political, historical, economic, and philosophical forces on individual and group dynamics. The objective of this paper is to examine those forces, the social and historical conditions in particular, which have contributed to the origin, development, and prolongation of readjustment difficulties for Vietnam veterans.

Adult↗

Fatalism and risk of adolescent depression.

This research examined fatalism, the belief in external control over life chances, as a risk factor for adolescent depression. Data were analyzed from a large (N = 5,423) sample of adolescents attending middle school in an ethnically diverse community in the southwest. It was hypothesized that adolescents who demonstrated greater fatalism would have a higher risk for depression. Bivariate associations between fatalism and depression were substantial, with an odds ratio (OR) of nearly 25 for depression with impairment and nearly 13 for depression without impairment. Adjustment for the effects of 10 covariates drawn from three domains (status attributes, stressors, and personal/social resources) essentially eliminated the association between fatalism and depression with impairment. However, the OR was still 2.6. The significant association between fatalism and depression without impairment (OR = 2.7) remained after adjustment for covariates. The results provide further support for models of depression which emphasize the role of psychosocial deficits. In this case, we found depression was associated not only with greater fatalism but also greater pessimism, lower self-esteem, more passive coping, and less social support.

Adaptation, Psychological↗

Impoverished counterfactual thinking is associated with schizophrenia.

Counterfactual thoughts are mental representations of alternatives to past events. Recent research has shown counterfactual thinking to be a pervasive cognitive process in normal populations and has linked it to effective problem-solving and decision-making. The present research demonstrates that counterfactual thinking is impaired in schizophrenia patients relative to normal control subjects; this impairment was evident using measures of counterfactual thoughts as well as counterfactual-derived inferences. Furthermore, this impoverished counterfactual thinking partly mediated impaired social functioning experienced by schizophrenia patients. Given the convergence of neuropsychological evidence showing counterfactual deficits in frontal lobe patients and the documented frontal deficits in schizophrenia patients, future studies investigating a specific relationship between counterfactual thinking and frontal lobe function in schizophrenia patients would be a logical next step in this line of research.

Adult↗

What is love anyway?

This essay explores seven interlocking meanings of the term love. These meanings are the author's synthesis based on years of trying to understand what people mean by the word and why they are not more explicit in explaining themselves during psychotherapy. The meanings may help clinicians better grasp what seems to be the most basic context for understanding a person's sexual life. Love may be: a complex emotion--it is never a single feeling; an ambition; moral commitment; a private dynamic struggle; a deal; a stop sign to psychological inquiry. Many forces in culture and within individuals resist careful scrutiny of what we mean by love.

Female↗

Perceptual accuracy as a variable in marital adjustment.

This study investigated the ability of maritally-adjusted couples, couples attaining a divorce, and couples in counseling to predict the rewarding effects of their behavior on their spouse. Twenty-six couples, five obtaining a divorce, nine in counseling, and twelve adjusted couples completed a Marital Interaction Questionnaire in which they rated how rewarding each of the behaviors depicted was to them. Then each member predicted how rewarding it was to their spouse. Behaviors depicting six areas of marital interaction were included in the questionnaire. The computed perceptual accuracy scores were analyzed by a three-way classification-Analysis of Variance (ANOVA)-for unequal n's. This analysis yielded a significant main effect of marital status and a significant interaction between marital status by sex of spouse and between marital status by area of interaction. The maritally-adjusted group was always more accurate than the other two groups in their predictions, however, they were significantly more accurate only for selected areas of interaction.

Counseling↗

The biological impact of social responses to the AIDS epidemic.

This paper examines the extent to which social responses to the AIDS epidemic contribute to the continued transmission of the virus, thereby exacerbating the biological impact of the epidemic. Following the model of McGrath (1991), social responses to AIDS are examined in terms of their impact on potential transmission of HIV. Responses are evaluated using established criteria for decreasing disease transmission: eliminating the source of infection, eliminating contact necessary for infection, decreasing susceptibility of hosts, or decreasing the infectivity of infectious persons. The most frequent responses to AIDS have been scapegoating, resulting in ostracism, stigma, and blame; resignation; use of alternative therapies; political mobilization; and research. With the exception of political mobilization in some communities, the social responses to AIDS have not decreased the biological impact of the epidemic, and, therefore, may not be "biologically appropriate".

Acquired Immunodeficiency Syndrome↗

Stigma and rejection: living with AIDS in villages in southern Thailand.

The problems that face HIV/AIDS patients are now fairly well documented. These include experiences of guilt, anger, grief, fear of abandonment, and potential economic hardship and marginalization due to others' fear of infection and associated stigma. However, limited attention has been paid to the effects of AIDS-related stigma on access to, and the provision of, health services. Understanding how the stigma of AIDS affects the processes and experiences of diagnosis, treatment, prevention, and care is critical to effective public health policy and the delivery of health care programs and medical services. In this article, we examine stigma as experienced by people with HIV and AIDS, and by their families, in village Thailand. We also identify areas for improvement pertaining to people with HIV/AIDS and other stigmatizing diseases.

Acquired Immunodeficiency Syndrome↗

Cognitive rehabilitation two and one-half years post right temporal lobectomy.

A 45-year old radiologist, who underwent a right temporal lobectomy to remove a tumor, sought treatment for difficulties with attention/scanning, sustained concentration, leisure reading, driving, and self-monitoring in social situations. A neuropsychological evaluation conducted 2.5 years postsurgery revealed impaired visual-spatial memory, inefficiency in general visual scanning, a mild left-sided neglect, and diminished social perception. The patient subsequently underwent a 4-month cognitive retraining program, which was tailored to his specific neuropsychological deficits. At the termination of treatment, improvements were observed on follow-up neuropsychological data, behavioral observations made by the patient's wife, and efficiency on work-related tasks. This case illustrates the ecological validity of cognitive rehabilitation procedures and emphasizes the need to tailor the procedures to specific cognitive deficits revealed on neuropsychological testing.

Attention↗

Women living with environmental illness.

We used a case study approach to explore the experiences of 4 women who live with environmental illness (EI). From the unstructured interviews we found a variety of themes that pointed to the complexity of EI and its severe impact on the lives of these women, their families, and their significant others. The methodology was guided by an ecofeminist approach, which enabled a critical analysis of the data to move beyond the personal to the broader sociopolitical forces shaping society. We identified the following themes from the women's stories: indirect exposure to incitants through people with whom these women come in close physical contact; the phenomenon of burden of proof, meaning that these women are forced to explain and legitimize their illness on a continuous basis; taking refuge from a hostile environment in social isolation to a more controlled environment, not as a matter of choice, but because of the severity of the illness; and, finally, a change in value system was integral to the entire process of living with EI.

Environmental Illness↗

Grieving a loss from AIDS.

The determinants of the nature of an AIDS death and their likely effects on the survivors are identified. Specifically discussed with illustrative case examples are stigma, lack of social support, contagion, untimely death, protracted illness and disfigurement, and neurological complications. Strategies for intervention are suggested.

Acquired Immunodeficiency Syndrome↗

Psychosocial support and marginalization of youth-headed households in Rwanda.

This research aims to characterize the psychosocial aspects of well-being among youth-headed households (YHH) in Gikongoro, Rwanda, through examination of social support and marginalization. Data is presented on perceived availability of support from relatives, an unidentified adult, peers, and other community members and an index of social marginalization. A total of 692 interviews were completed with YHH age 13-24 who are beneficiaries of a basic needs program. Sixteen percent of youth reported there was no one they felt they could go to with a problem. In times of need, only 24% felt relatives would help them, while 57% felt neighbors would offer assistance. Most youth reported significant caring relationships: 73% reported access to trusted adult who offers them advice and guidance, and most indicated close peer relationships. However, many youth also perceived a lack of community support, with 86% feeling rejected by the community and 57% feeling the community would rather hurt them than help them. Social support is a low-cost critical resource for the care of vulnerable youth and an understanding of existing social support networks would enhance the design and implementation of psychosocial and community-based care initiatives.

Adolescent↗

Psychiatric and substance use disorders in late adolescence: the role of risk and perceived social support.

This article explores how measures of risk and perceived social support relate to different configurations of adolescent psychopathology using data from a community-based, longitudinal investigation of 284 individuals interviewed in 1982 at age 5 and again at age 19. Discriminant analysis was used to assess differences in risk and social support variables among eight clusters of youth: anxious, anxious drinkers, depressed, depressed drug abusers, antisocial, antisocial drinkers, drug abusers, problem drinkers, and a ninth group representing those participants without a diagnosis. The results indicated that one function, defined by loadings for (low) family support and (high) early cumulative risk, accounted for the majority of between-group associations. Two groups of drug-abusing youth with multiple adjustment problems were highest on this function, while non-disordered youth and a group of participants with substance abuse alone were lowest. Findings are discussed in terms of the need to consider comorbidity when examining risk factors for later disorder.

Adolescent↗

Educational environment in traditional and innovative medical schools: a study in four undergraduate medical schools.

INTRODUCTION: The undergraduate curricula of medical schools in King Abdul Aziz University, Saudi Arabia, Umm Al-Qura University, Saudi Arabia and Sana'a University, Republic of Yemen are traditional, like most of the medical schools in the Middle East region. The curriculum in Dundee University Medical School, UK, claims to follow the prescriptions of the UK General Medical Council to be outcome based with three interlocking phases and students encouraged to take responsibility for their own learning. The aim of this study is to measure the educational environment, using the 50-item Dundee Ready Education Environment Measure (DREEM), in each medical school and to compare the educational environment as perceived by the responding students of the traditional medical schools in developing countries with that of the "modernised" medical school in Dundee University, UK. METHODS: The DREEM was administered to 1072 medical students in the four different universities. Using SPSS, data were expressed as means of scores. Comparisons between schools, years of study and gender were made using non-parametric tests. RESULTS: For all three traditional medical schools, the mean scores of the inventory were lower compared with Dundee Medical School. Students from traditional schools rated their learning and teaching environment significantly lower than their counterparts in Dundee Medical School. Similarly, they rated their academic self-perceptions, social-self perceptions and their atmosphere more poorly than the Dundee students. CONCLUSION: The DREEM provides useful diagnostic information about medical schools, whether it is in developing or western developed countries.

Adult↗