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PubMed2006

The death of a mind: a study of Shakespeare's Richard III.

Some of the most difficult aspects of our work involve our encounters with states of mind which are steeped in and spread violence. In these circumstances, we experience our best efforts to offer empathic presence and thought to avoid being assaulted and obliterated. In these instances, a figure from literature depicting the details in question may come to our aid. In the play popularly known as Richard III,William Shakespeare depicts how the state of mind which is etched by grievance and committed to revenge may impose the 'winter of (its) discontent' upon the sunny dispositions of others' healthy, integrated functioning. Shakespeare masterfully depicts Richard's cunning and malice, but he also illustrates how this vengeful state uses guile and 'changes of shape' to seduce its way past protective boundaries, utilizing the human qualities of trust, open-heartedness and longing as pathways for invasion, betrayal and emotional devastation. This paper will view excerpts of the play's text from a psychoanalytic perspective which suggests that several clear lessons about this obliterative state of mind may be gleaned: that grievance can only operate to spread grievance and destruction; that our open-hearted and trusting qualities do make us vulnerable to such invasion and betrayal, but that our humanity is also the only avenue for rescue from this plight. In addition a clear lesson is offered about the value of protected 'sanctuary', that is, mental space where our most potent tool in these circumstances, our discerning minds, might find residence.

Drama↗
PubMed2006

What drives referral from primary care physicians to mental health specialists? A randomized trial using actors portraying depressive symptoms.

BACKGROUND: Referral from primary care to the mental health specialty sector is important but poorly understood. OBJECTIVE: Identify physician characteristics influencing mental health referral. DESIGN: Randomized controlled trial using Standardized Patients (SPs). SETTING: Offices of primary care physicians in 3 cities. PARTICIPANTS: One hundred fifty-two family physicians and general internists recruited from 4 broad practice settings; 18 middle aged Caucasian female actors. INTERVENTION: Two hundred and ninety-eight unannounced SP visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. MEASUREMENTS: Mental health referrals via SP written reports; physician and system characteristics through a self-administered physician questionnaire. RESULTS: Among 298 SP visits, 107 (36%) resulted in mental health referral. Referrals were less likely among physicians with greater self-confidence in their ability to manage antidepressant therapy (adjusted odds ratio [AOR] 0.39, 95% confidence interval [CI] 0.17 to 0.86) and were more likely if physicians typically spent > or =10% of professional time on nonclinical activities (AOR 3.42, 95% CI 1.45 to 8.07), had personal life experience with psychotherapy for depression (AOR 2.74, 95% CI 1.15 to 6.52), or usually had access to mental health consultation within 2 weeks (AOR 2.94, 95% CI 1.26 to 6.92). LIMITATION: The roles portrayed by SPs may not reflect the experience of a typical panel of primary care patients. CONCLUSIONS: Controlling for patient and health system factors, physicians' therapeutic confidence and personal experience were important influences on mental health referral. Research is needed to determine if addressing these factors can facilitate more appropriate care.

Adult↗
PubMed1983

Ibsen's truth, family secrets, and family therapy.

In certain Ibsen plays a character (would-be family therapist) enters during a crisis revolving around family secrets. Taking two such plays as models, this paper examines family processes and clinical issues surrounding secrets and myths. In Ghosts, Ibsen demonstrates the tragic foreclosure visited upon the Alvings' lives by a generation of secrecy. For contrast, in The Wild Duck the would-be reformer Gregers brings out the truth, to expose and correct consequences of his father's past machinations. The biographical roots of Ibsen's obsession with truth and illusion are explored. Lastly, the notion that Ibsen and early family therapist were reformers is viewed in historical perspective.

Adolescent↗
PubMed1990

Six characters in search of an author: a constructivist view.

The investigation of imaginative literature has been one of psychotherapy's most useful tools for the explication of its theories and the general dissemination of psychotherapeutic concepts. Using this idea, I examine Luigi Pirandello's play Six Characters in Search of an Author from a constructivist, family therapy, point of view.

Drama↗
PubMed1997

Believing in make-believe: looking at theater as a metaphor for psychotherapy.

In this essay, I explore the theatrical dimensions of psychotherapy. I argue that many of the historical, practice-related, and conceptual connections between theater and therapy often are only alluded to in the literature, but rarely made explicit. In doing so, however, it seems apparent that, as a metaphor for psychotherapy, theater perhaps offers a more appropriate fit than those narrative and conversational metaphors that have been employed so far. Proposing that theater is, in fact, the metaphor on which psychotherapy bases itself, I briefly examine some of its implications for how therapy might be conceptualized and performed. I conclude by inviting other therapists to consider--by openly acknowledging theater as a metaphor for psychotherapy--if they might then become more engaging, creative, and imaginative in their work.

Acting Out↗
PubMed1999

Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania.

An entertainment-education radio soap opera introduced in Tanzania in 1993 was evaluated by means of a field experimental design in which the radio program was broadcast by seven mainland stations of Radio Tanzania. An eighth station broadcast alternative programming from 1993 to 1995, its listenership serving as a comparison area in which contemporaneous changes in family planning adoption were measured. The soap opera was subsequently broadcast nationwide from 1995 to 1997. Data about the effects of the radio soap opera were gathered in five annual surveys of about 2,750 households in the comparison and the treatment areas and from a sample of new family planning adopters in 79 health clinics. The soap opera had strong behavioral effects on family planning adoption; it increased listeners' self-efficacy regarding family planning adoption and influenced listeners to talk with their spouses and peers about contraception.

Adult↗
PubMed2002

Evaluation of a theater production about eating behavior of children.

This study evaluated "All's Well That Eats Well," a theater production performed in 20 schools in the Twin Cities, Minn., metropolitan area in winter 2000. The production sought to change food-related knowledge and food choices concerning fruits and vegetables among children in grades 1-6. The study used a pretest-posttest design with two randomly-assigned, sequential intervention-control groups (N = 4,093). All students completed surveys prior to and then following the theater production and the classroom and home activities. No differences existed between the groups at pretest. Significant differences occurred in food-related knowledge, food choices, and food recall from pretest to posttest for all students. Significant differences also occurred between intervention groups in food-related knowledge and food choices. The study indicates that professional theater productions in schools can create at least a short-term effect on children's nutrition knowledge and behavior.

Child↗