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PubMed2003

Evidence-based practice in mental health: practical weaknesses meet political strengths.

UNLABELLED: RATIONALE, AIMS, AND OBJECTIVES: Evidence-based medicine (EBM) has given rise to evidence-based practice (EBP) in the field of mental health. EBP too is predicated on an evidence hierarchy and has the goal of using the "best evidence" (usually randomized controlled trials) to improve practice. EBP is increasingly influential in mental health care in the U.S. Growing numbers of researchers and public officials endorse its claims and pursue its benefits. The rationale for this paper is to examine the potential of EBP for the field of mental health-and public mental health care specifically. Is it likely to contribute to improved lives for mentally ill people? If so, how? METHODS: This qualitative study relies on archival, and to a much lesser extent, informant interview data. Informants were mostly public mental health officials because they are in a position to implement EBP on a large scale and their policies are a matter of public record. Interviews were semi-structured, held in person and on the telephone, and lasted one to two hours. Archival research included the substantial literature on EBM and EBP plus studies and articles on the practice and policy of U.S. public mental health care. RESULTS: The results of this study were that there exists an extensive, coherent literature critical of EBM and of EBP specifically. Attempts to implement EBP will falter on epistemological and organizational barriers. Still, as a public idea--that more science will bring about better mental health practice--EBP may well serve political purposes, especially in the U.S. public mental health system, where more overtly ideological policies have been inadequate in the past. EBP, as a public idea, has the advantage of ambiguity, accountability, quantifiability, etc. CONCLUSIONS: This paper concludes that EBP is growing more influential in public mental health care in the U.S. Its practical strengths, i.e., its improvement of mental health practice, may turn out to be less than its strengths as a public idea in the formulation and dissemination of mental health policy.

Biomedical Research↗
PubMed2003

Identity, difference and the ethical politics of prenatal testing.

This paper explores the role of identity in relation to the ethics of prenatal testing for conditions that cause intellectual disabilities. Specifically, it considers the question of identity and the moral status of the fetus. It argues that both the arguments in favour and opposed to prenatal testing mistakenly presuppose that there is no moral status attached to the fetus. That status is grounded in an identity-constituting characteristic, such as 'intellectual disability', which is brought about by the purpose of genetic testing, and the meaning of which is culturally constructed. This paper examines the implications this has for the debate around both prenatal testing and termination in general and considers the nature of the ethical politics which follows from this position with regard to prenatal testing related to intellectual disability.

Abortion, Induced↗
PubMed2003

Not an innocent pursuit: the politics of a 'Jewish' genetic signature.

This commentary questions the presumption in genetic research that a biological connection exists between populations identified as Jewish. The author emphasises that identifying individuals as Jewish based on biological criteria is a sociological process that can draw attention away from other social mechanisms affecting identity construction. She also encourages critical consideration of the possible racialised thinking behind genetic anthropology studies, and the language used to express genetic findings. In conclusion, she calls for a radical cultural shift in the kind of knowledge valued as significant, relevant, and beneficial to the people on whom genetic ancestry studies are carried out and she asks for attention to the political contexts surrounding all such research.

Black People↗
PubMed1993

[Psychological disorders after political imprisonment in East Germany--attitude of victims].

In an exploratory study we examined 55 patients who had been politically imprisoned in the GDR for at least six weeks and suffered from enduring mental sequelae of that imprisonment. Views of the patients were assessed by means of standardized open questions and rating scales. Patients reported on stressful conditions in prison, fears concerning the uncertain end of imprisonment, as well as on helpful aspects during and after imprisonment. In a cluster analysis two groups were separated: one group that found social relationships helpful for coping with their experiences and another one that did not feel helped by anybody in coping, 28% of the patients stated that the symptoms were not mainly due to experiences during imprisonment; 20% saw general positive effects of imprisonment on their life. Views of the patients were correlated with other variables such as psychopathological symptoms. The relevance of the findings is discussed briefly.

Adaptation, Psychological↗
PubMed1975

Politics in the development of a migrant health center. A pilgrim's progress from idealism to pragmatism.

New methods of health-care delivery have been recommended to correct the inequities in the distribution of health services to rural and urban poor. A migrant health center developed in 1970 to accomplish this aim illustrated the many attendant problems. The award of the grant to an outside consumer group rather than to the country health department resulted in political pressures during the center's development. Other factors isolated the center. These included categorical funding specifically directed to a community's ethnic minority and the lack of a regional network of health care. Confusion was created when legitimate spokesmen of the target group, other segments of the local community or interested private and governmental agencies were not defined. Although a program for curative and preventive medicine was established for a minority, the center was less successful in becoming self-supporting and in affecting the social and economic determinants of health.

Agriculture↗
PubMed2004

Data, circumstance and politics: reflections on regional mental health planning.

We use our experience as consultants to a regional mental health planning project in South Australia to describe three practical aspects of regional health planning. First, we systematically summarised various data on socio-demographic indicators, health status and health service use along with qualitative opinion about needs and services from consultations with over 200 stakeholders. In addition to these data, we found that attention to two other aspects of planning, circumstance and politics, were of critical importance, particularly if the plan was to be implemented and as a way of turning thinking into action.

Community Participation↗
PubMed1999

The case for managed care: reappraising medical and socio-political ideals.

The arguments against managed care can be divided into two general clusters. One cluster concerns the way managed care undermines the ethical ideals of medical professionalism. Since those ideals largely focus on the physician-patient relation, the first cluster comes under the rubric of micro-ethics; namely, the ethics of individual-individual relations. The second cluster of criticisms focuses on macro-ethical issues, primarily on issues of justice and policy. By reviewing these arguments, it becomes clear that managed care does not easily fit within traditional modes of ethical analysis. It poses a radical challenge to current medical and socio-political norms, and even resists the distinction between micro- and macro-ethical domains, a distinction that reflects the private/public distinction. Managed care organizations call for a third way, an inter-ethic for middle level organizations. The essays in this Journal provide a first step in this radical reassessment, laying the foundation for an organizational ethic that is responsive to the realities and promise of managed care.

Ethical Analysis↗
PubMed1998

[On the origins of university psychology in France (1870-1900): intellectual stakes, political context, networks and strategies].

The university study of psychology originated in France in the 1880's. The first practitioners conceived of it as psychophysiology, a natural science, as opposed to an aspect of spiritual philosophy, which needed to be understood in a specific political context. This paper analyses this seminal period through the militant activity of its main architect, Theodule Ribot (1839-1916). It particularly questions the orientations of the Revue philosophique, founded in 1876, which proved a rally-point for the young philosophers and physicians who derived from Ribot their alliance strategy within the medical milieu. The inquiry is continued to the turn of the century, when psychology became firmly institutionalized.

Education↗
PubMed2001

Social mobility and constitutional and political preferences in Northern Ireland.

During the past thirty years Catholics in Northern Ireland have experienced unprecedented upward social mobility. Some commentators have suggested that this has led Catholics not merely to adopt the lifestyles of the middle class but also to modify their constitutional preferences, leading to a decline in nationalism. In this paper I examine the relationship between social mobility, on the one hand, and, on the other, both constitutional preferences and political (left or right wing) preferences among Catholics and Protestants in Northern Ireland, using survey data collected in 1996. There is no evidence that Catholics' constitutional preferences are related to their mobility experiences.

Choice Behavior↗
PubMed2000

Culture, politics and ergonomics.

The beginning of a new century is an appropriate moment to consider the role of ergonomics in relation to the problems facing society. To help solve these serious global problems, ergonomics needs to be open to new disciplines, particularly those in the social sciences. Also, it may be difficult to generalize research on human-centred sociotechnical design without taking into account national characteristics, economics and political constraints. Currently there is more interest than ever in what ergonomics has to offer, but to deliver its promise requires a much broader approach than is usual. By adopting such new approaches one may help solve both the problems of the overdeveloped postindustrial societies and those of the societies of the Third World, where a new approach to work and economics may provide an improved chance for development given the recent changes in global economic policy.

Culture↗
PubMed1994

Political perception among young Australians: affective versus cognitive appraisal.

We investigated the role of affect in the political perceptions of a sample of Australian university students (N = 185). Following the procedure of Abelson, Kinder, Peters, and Fiske (1982), we compared affective and cognitive appraisals of three Australian politicians (Bob Hawke, John Howard, and John Bjelke-Petersen) and examined their respective influence on favorability judgments. Affective appraisals were less consistent than cognitive appraisals, and affect was a significant predictor of favorability, with certain idiosyncratic exceptions. Bjelke-Petersen elicited comparatively consistent affective reactions. The affective reactions elicited by Hawke were inconsequential to favorability. Two dimensions of negative affect for Hawke revealed a differential impact of negative affect on favorability.

Adolescent↗
PubMed2000

The future of psychotherapy outcome research: science or political rhetoric?

Although the relationship between research and clinical psychology has at times been conflicted, it has also been productive. Psychologists from both specialties have benefited from each others' work. The area of psychotherapy outcome research represents an important interface between the fields of clinical and research psychology. In an era of scarce resources and demands for accountability, there is pressure for researchers to justify the value of clinical practices. Recently, numerous articles have appeared recommending changes to the way psychotherapy research is conducted. The authors of these articles emphasize with urgency the importance of conducting and reporting research in a manner that will influence the decisions of policymakers and sanction funding for psychotherapy services. This article is an exploration of the impact of these recommendations, whose objective appears to be the promotion of psychological techniques for inclusion in clinical practice guidelines. It is argued that such recommendations may be in conflict with the philosophy and methods of science and may adversely affect public perception, perhaps leading psychologists to be seen as political lobbyists rather than clinicians and researchers.

Forecasting↗
PubMed1993

Toward a model of family and political victimization: implications for treatment and recovery.

Political violence, in any of its ugly guises, has a devastating and long-lasting effect on its victims. This effect derives, in my view, from the concurrence of two factors: (1) the physical and emotional violence is perpetrated by the very agencies of society (such as the police and the armed forces) entrusted with the care and protection of individuals, with maintaining order in their world, with enforcing stability, and predictability; and (2) a context or a discourse that destroys or mystifies meanings so that recognition of that shift from protection to violence is blurred.

Adaptation, Psychological↗
PubMedDate not supplied

Group work is political work: a feminist perspective of interpersonal group psychotherapy.

When practicing as group leaders, mental health nurses often incorporate Irvin Yalom's (1995, 1998) concepts of social microcosm and here-and-now. This article examines these concepts from a feminist perspective and offers an approach to group psychotherapy that processes gender issues and fosters collective consciousness-raising. A feminist perspective in group therapy challenges us to view the social microcosm as a reenactment of sociopolitical contexts and the here-and-now as a medium for developing personal and social responsibility. Therapy is not only about individual and interpersonal change in group members, but is an opportunity for healthy social change. Therapy becomes political work, raising the social consciousness of each participant as well as the group as a whole.

Adult↗
PubMed2002

Multinational corporations, the politics of the world economy, and their effects on women's health in the developing world: a review.

Presently, globalization and the world economy maintain power relations that hamper the economic integrity and the political autonomy of the developing world. My paper addresses specific economic conditions that perpetuate poverty and poor health. I examine multinational corporations and their effects on women's health, particularly in Mexico and parts of Asia. The advent of multinational corporate business in Mexico, Malaysia, Philippines, India, and Indonesia has led to increased poverty and human rights abuses. Women bear the brunt of this because of specific international economic arrangements and their low social status, both locally and globally. As a result, their physical, mental, and emotional health is suffering. Solutions to these health problems have been proposed on multiple levels: international top-down approaches (i.e., employing international protectionist regulatory standards, exposing multinationals who infringe on their workers' human rights), as well as local grassroots organizational campaigns (i.e., conducting informational human rights workshops for factory workers). Ultimately, the answers lie in holding corporations accountable to their laborers while developing countries maintain their comparative advantage; this is the only way women's health will improve and the developing world can entice corporate investment.

Asia↗
PubMedDate not supplied

The political evolution of mental health parity.

This article traces the evolution of the mental health parity debate in American politics, with a focus on how interest groups and politicians have attempted to influence perceptions about treatment effectiveness and the cost of benefit expansion. When parity laws are in place, they require health plans operating in the private health insurance market to provide an equivalent level of coverage for mental health and general medical care. Business and insurance industry groups oppose parity due to cost concerns. The mental health community has framed parity as an antidiscrimination measure that would achieve greater insurance equity across disease groups. The role of personal experience with mental illness among lawmakers and others in framing the parity debate is also considered.

Cost-Benefit Analysis↗
PubMed1997

Community development for health and identity politics.

Community development for health (CD4H) is defined as the mobilization of communities actually or potentially suffering from a health problem to eliminate its causes or alleviate its consequences. This paper links this with questions of social identity, focusing on issues of ethnicity and 'race', in health promotion. When combined with notions of ethnicity and 'race'. CD4H is frequently a reaction to inequalities which are communally experienced and believed to increase risk of ill-health for the group. This paper theorizes the link between communal experience and activity to promote health, by drawing on sociological theory linking structure and agency. It examines how discourses of belonging and exclusion are enacted in struggles for health. Via examples from the Caribbean and the UK, instances of 'identity politics' in CD4H are identified, viewed as the use of essentialist, binary notions of self and other in the attempt to gain an advantage over the other. It is argued that such instances should not be considered in isolation, but should be viewed as responses to experience, particularly, in the UK context, the experience of racism in the Health Service.

Community Health Planning↗
PubMedDate not supplied

The social, cultural and political dimensions of contemporary war.

There have been more than 160 wars and armed conflicts since 1945, almost all in the Third World, and more than 50 currently. More than 90% of these are internal rather than between sovereign states. There has been a sixfold increase in the number of war refugees worldwide since 1970, who now number 1% of the global population. Ninety per cent of all casualties are civilians. A key element of modern political violence is the creation of states of terror to penetrate the entire fabric of grassroots social relations as a means of control. The valued institutions and ways of life of whole populations are routinely targeted for destruction. In the 1980s many such wars were played out on a terrain of subsistence economies. The back-drop is of environmental degradation, poverty, embedded social injustice, pressure on the nation-state, a global rise in food insecurity and a widening gulf between the wealthiest 20% and the poorest 20% in the world. The World Health Organization is warning of a health catastrophe, with life expectancy in the world's poorest countries falling by the year 2000 and one-third of the world's children undernourished. Understanding a complex and evolving set of causes and effects surrounding war is a considerable challenge to the international humanitarian field, not least the health professions. In recent years there has been a burgeoning interest in the psychological impact of the atrocities of war, and in trauma programmes based on Western psychological concepts and techniques. This individualistic focus risks neglecting the core issue: the role of a social world, invariably targeted in war and yet still embodying the capacity of survivor populations to manage their suffering, adapt and recover on a collective basis. Using the example of Mozambique, Guatemala and others, this paper will discuss the way in which contemporary war damages social and cultural forms, and the range of traditions, values and understandings which these carry. However, society and culture also engage actively with war, with changes in the social order that may come to outlast the violence itself. This paper will also pinpoint the quest for justice as an issue that may distinguish the subjective experience of war from those that arise after peacetime or natural disasters. The work of anthropologists, sociologists, historians and poets in both West and Third World, allied to the voices of survivors themselves, can help the humanitarian field to acquire a more richly textured understanding of the range of responses to war and atrocity, and outcomes over time.

Altruism↗