Commentary: Facts and values in competency assessment

Dr. Mossman's article cogently describes an approach to measuring the accuracy of competency-to-stand-trial assessments in the presence of a gold standard. I argue that a gold standard may not exist. A conclusion as to whether a defendant is fit to proceed requires a trade-off between a range of desired ends. This trade-off is inevitably influenced by the values of the examiner.     

Commentary: two sides to every story--the need for objectivity and evidence

Dr. Thomas Gutheil, in his article, "Boundaries, Blackmail, and Double Binds: A Pattern Observed in Malpractice Consultation," provides readers with some important and useful recommendations regarding the avoidance of real or perceived boundary violations and how to avoid the pitfalls of difficult therapy. However, in doing so, he moved away from the usual even-handedness and objectivity that characterizes his work. Forensic mental health professionals rely on evidence, and always wait until they have carefully considered both (or all) relevant sides of an issue before rendering an opinion.     

Applying evidence to patient care: From population health to individual patient values

What are the health status and health needs of people with epilepsy? How do clinicians and patients choose between alternative interventions for the same condition? Are health interventions used effectively in the community, and do they improve health? How can we translate findings from regulatory clinical trials to the real world? These and similar questions are the subject of applied translational research. This evolving and broad-ranging area of research involves the application of basic sciences such as epidemiology, biostatistics, economics, and behavioral science to the assessment of health, health interventions, and outcomes. However, despite its palpable importance, applied translational research remains underfunded and underutilized. Using their own innovative research as a prototype, two young and promising investigators provide insights not only into the enormous potential but also the gaps and hurdles of two specific areas of applied translational research, i.e., clinical decision analysis and health services research. The message is clear that if we are to understand and improve the health of people with epilepsy in clinics, hospitals, and communities, we must substantially increase research capacity to address the many gaps that thwart our progress in applied research in epilepsy.This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.     

Neural evidence of motivational conflict between social values

Motivational interdependence is an organizing principle in Schwartz’s circumplex model of social values, which has received abundant cross-cultural support. We used fMRI to test whether motivational relations between social values predict different brain responses in a situation of choice between values. We hypothesized that differences in brain responses would become evident when the more important value had to be selected in pairs of congruent (e.g., wealth and success) as opposed to incongruent (e.g., curiosity and stability) values as they are described in Schwartz’s model, because the former serve mutually facilitating motives, whereas the latter serve mutually inhibiting motives. Consistent with the model, choosing between congruent values led to longer response times and more activation in conflict-related brain regions (e.g., the supplementary motor area, dorsolateral prefrontal cortex) than selecting between incongruent values. These results provide novel neural evidence supporting the circumplex model’s predictions about motivational interdependence between social values. In particular, our results show that the neural networks underlying social values are organized in a way that allows activation patterns related to motivational similarity between congruent values to be dissociated from those related to incongruent values.     

Commentary: The romanticists and their contribution to psychiatry

Conclusion This paper has attempted to show the contributions and influence that the German Romanticists had on psychiatric thinking during the first half of the nine-tenth century. The Romanticists wrote in a flowery, poetic language. They did, however, bring forth many ideas and theories which seemed advanced for the time. In fact, some of their concepts may be found sprinkled here and there in present-day psychiatric and psychoanalytic thought, although usually in altered form. The Romanticists established the groundwork for the great discoveries which were to come after 1850.     

Making sense of candidates: partisanship, ideology, and issues as guides to judgment

Citizens employ a range of heuristic devices in reaching judgments and making evaluations regarding political candidates and issues. This paper examines the circumstances that lead to the use of multiple and potentially competing heuristics in making complex decisions. In our analysis, subjects systematically demonstrate evidence of confusion regarding particular combinations of partisan, ideological, and issue-based heuristics--a difficulty in disentangling partisan, ideological, and issue-based criteria in the evaluation of candidates. We argue that the political environment alters both the accessibility of particular heuristic devices, as well as the strength of association in memory among alternative heuristic devices. Hence the ability of citizens to select among heuristics is conditioned on the larger environment of incoming information. As a practical matter, this means that the ability of citizens to employ various judgmental criteria depends on the larger political debate, and accessibility provides the connecting link between environmentally supplied political messages and the terms and criteria of individual political choice.