Incomprehensibility: The role of the concept in DSM-IV definition of schizophrenic delusions

In this paper the role of incomprehensibility in the conceptualization of the DSM-IV definition of delusion is discussed. According to the analysis, the conceptual dependence of DSM-IV definition of delusion on “incomprehensibility” is manifested in several ways and infested with ambiguity. Definition of “bizarre” delusions is contradictory and gives room for two incompatible readings. Also the definition of delusion manifests internal inconsistencies and its tendency to account for delusions in terms of misinterpretation is bound to miss the content of the traditional comprehension of delusionality. It is suggested that the ambiguities in defining delusions has to do with the question whether psychiatric practice is better accounted for in terms of the grammar of “incorrectness” or of “incomprehensibility”. This revised version was published online in July 2006 with corrections to the Cover Date.     

Cancer Pain in Children: The Selection of a Model to Guide Research

Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.     

Using administrative databases to evaluate the quality of medical care: A conceptual framework

Health care is consuming an ever larger share of national resources in the United States. Measures to contain costs and evidence of unexplained variation in patient outcomes have led to concern about inadequacy in the quality of health care. As a measure of quality, the evaluation of hospitals through analysis of their discharge databases has been suggested because of the scope and economy offered by this methodology. However, the value of the information obtained through these analyses has been questioned because of the inadequacy of the clinical data contained in administrative databases and the resultant inability to control accurately for patient variation. We suggest, however, that the major shortcoming of prior attempts to use large databases to perform across-facility evaluation has resulted from the lack of a conceptual framework to guide the analysis. We propose a framework which identifies component areas and clarifies the underlying assumptions of the analytic process. For each area, criteria are identified which will maximize the validity of the results. Hospitals identified as having unexpectedly high unfavorable outcomes when our framework is applied will be those where poor quality will most likely be found by primary review of the process of care. We outline the following criteria for the selection of disease-outcome pairs to be studied in large administrative database analysis: (1) disease entities or clinical states selected should be well defined and easily diagnosed; (2) if diagnostic classification systems are used, disease groups should be homogeneous as to the clinical states they contain; (3) the disease entities should be prevalent; (4) a plausible link should exist between the quality (process) of care and the frequency of the outcome; (5) types of care which conform to acceptable practice standards but still lead to variation in the outcome of interest should be excluded from the analysis; (6) the outcomes should be prevalent; (7) constraints of the ICD-9 coding system should be understood such that only those disease-outcome pairs least affected by these limitations are selected for analysis; (8) constraints of the structure of the database should be considered when the analysis is performed; and (9) disease-outcome pairs should be chosen where there is agreement on the processes of care that affect the outcome of interest, either favorably or unfavorably.     

Putting Wilson and Cleary to the Test: Analysis of a HRQOL Conceptual Model using Structural Equation Modeling

Wilson and Cleary (1995) proposed a conceptual model of health-related quality of life (HRQOL) that integrates both biological and psychological aspects of health outcomes. There are five different levels in their model, namely, physiological factors, symptom status, functional health, general health perceptions, and overall quality of life. Their model has been widely applied to different populations, including patients living with cancer, Parkinson’s disease, arthritis, and HIV+/AIDS. However, their conceptual model has only been partially examined. That is, the five major concepts have not been examined simultaneously. Using structural equation modeling (SEM), the Wilson and Cleary HRQOL model was validated in patients living with HIV from the AIDS Time-Oriented Health Outcomes Study. The results showed that the HRQOL model fit the data adequately, and the relationships between the constructs were all significant (at p<0.05 level). Based on the modification indexes, an alternative model linking symptom status directly with general health perceptions and overall quality of life was specified. Implication and limitation of the findings are discussed.     

我国中医药创新发展的机遇——从发达国家迈向“概念时代”谈起

经济全球化、信息网络化使世界变得平坦,发达国家正在由“信息时代”迈进“概念时代”。在全新思维中,以形象思维为基础,崇尚“高概念”、“高感性”,提倡“概念整合”及“模式识别能力”。我国中医药素以形象思维和整体概念为核心。中医对生命的理念所用的术语（形、气、神）与现代科学的“物质、信息、概念”融会相通。中医诊断及辨证施治和美国风行的“口述诊疗学”、“结合医学”、“整体医学”有众多联系。中医已经引起了西方的关注,如“现代舌诊学”。继承中医长期形成的学术成果,结合我国在系统科学、思维科学、复杂性科学及模式识别领域所获得与中医有关的研究与结果,进入“概念时代”的21世纪,是我国的中医药创新发展的大好时机。     

我国中医药的创新发展——从"信息时代"迈向"概念时代"谈起

当前,发达国家从以微电子、信息、网络为基础的信息时代(Information Age)迈向概念时代(Conceptual Age),进入全新思维。此外,近代的一些与思维科学、复杂性科学紧密联系的技术如模式识别、以人为中心的综合集成技术等,可以用于中医的辨别施治。这对我国素以形象思维和整体观念为核心的中医药创新发展带来新的机遇。     

The Case for Shorter Residential Alcohol and Other Drug Abuse Treatment of Adolescents

Abstract

During the last ten years, there has been an increased demand for culturally relevant drug abuse treatment that is responsive to the unique needs of international populations, each with its own special culture and taboos. This article explores the assumptions that these distinct cultural characteristics require different treatment approaches to be effective, and presents both curriculum content and training designs used in educating diverse cultures in drug abuse treatment strategies. The authors discuss their training experiences in Central Europe, the Mediterranean, China, and Southeast Asian countries and conclude that, while cultural uniqueness certainly exists, it may be greatly exaggerated in terms of the need for special treatment modalities in the field of drug abuse treatment.     

Combining Alcohol with Benzodiazepines or Psychostimulants. Metaphoric Meanings and the Concept of Control in the Online Talk of Polydrug Use

ABSTRACT

The co-administration of different substances is a widespread practice in the context of hard drug use. Among others, alcohol combined with certain substances produces potentially dangerous interactions. This article explores how people who combine alcohol with benzodiazepines or psychostimulants perceive these practices and how they share their perceptions in Finnish and Swedish online discussions. This is carried out by analyzing discussants’ use of metaphoric expressions. We found that the metaphors given to the use of these substance combinations reflect their pharmacological characteristics. Through that, the metaphors and meanings were different depending on the substance alcohol was combined with. Moreover, we found that, in the realities the metaphors create, the control of use was differently conceptualized. The different aspects of control could be divided into three categories that, however, were not related to any specific substances but overarched all metaphors: 1) controlling pharmacological risks, 2) controlling social appearance and 3) ignoring control. As our findings bring out, often the actual health dangers and risks of the studied substance combinations were bypassed, and the control was rather understood either as a form of socially appropriate behavior or wholly ignored.     

An appropriate research paradigm for evaluating psychoanalytically-informed practices

Abstract

Psychoanalytically-informed practices are under pressure to evaluate their effectiveness via research. This article argues that some of the principles and assumptions of scientific research, qualitative as well as quantitative, are inappropriate for this purpose. A brief critique of the positivist paradigm as applied to human and social sciences research focuses on its incapacity to address meaning and experience in the context of the research relationship. The article goes on to discuss the inadequacy of statistical generalisation for the kinds of research questions relevant to psychoanalytically-informed practices and outlines an alternative set of principles for extrapolation from qualitative data and case studies. It uses examples from attachment research and the Hampstead Index project. An alternative approach involves an understanding of the production and analysis of research data informed both epistemologically and ontologically by psychoanalysis. Such an approach is discussed in relation to the ‘defended’ research subject, the idea of objectivity in Winnicott and Bion, transference and counteriransference in the research relationship and the exemplary supports provided for practitioners of infant observation to foster learning by experience.     

The Heroic Supervisor: Using the Hero's Journey to Facilitate Development in Supervisors-in-Training

This qualitative study explored the perspectives of nine supervisors-in-training to understand how they used metaphoric stories containing the hero's/heroine's journey to conceptualize their process of transitioning from counselor to supervisor. Analysis revealed a three-phase process of counselor supervisor development similar to the process of development and transformation described in both the constructivist model of change (Mahoney, 2006 Mahoney, M. J. (2006). Constructive psychotherapy: Theory and practice. New York, NY: The Guilford Press. [Google Scholar]) and the hero's journey (Campbell, 1988 Campbell, J. (1988). The power of myth. New York, NY: Doubleday. [Google Scholar]). Results also indicated that conceptualizing their development as supervisors using the stories provided students with a valuable opportunity for critical self-reflection and meaning making. Suggestions for clinical supervision practice, training, and future research are discussed.