Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Trauma. Show all posts
Showing posts with label Trauma. Show all posts

Wednesday, January 31, 2024

Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Pan, L., Gao, B., Zhu, J., & Guo, J. (2023).
JAMA network open, 6(12), e2349258.

Key Points

Question

Is an experience of negative wealth shock—a loss of 75% or more in total wealth over a 2-year period—associated with cognitive decline and dementia risks among middle-aged and older US adults?

Findings

In this cohort study of 8082 participants, those with negative wealth shock had faster decline in cognition and elevated risks of dementia when compared with those who had positive wealth without shock.

Meaning

These findings suggest that negative wealth shock is a risk factor for cognitive decline and dementia in middle-aged and older adults.

The research is linked above.
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Key findings:
  • Negative wealth shock, defined as losing 75% or more of total wealth within two years, was associated with accelerated cognitive decline and higher risks of dementia.
  • This association was stronger for younger participants (under 65) and white participants compared to older and non-white participants.
While the study offers valuable insights, it also has limitations:
  • The study is observational, not causal, so it cannot prove cause and effect.
  • Wealth changes after negative wealth shock were not considered, potentially impacting results.
Overall, the study suggests that negative wealth shock may be a risk factor for cognitive decline and dementia, highlighting the potential impacts of financial hardship on brain health. Further research is needed to confirm these findings and explore underlying mechanisms.

Additional points:
  • The study used data from the Health and Retirement Study, which tracked over 8,000 participants for 14 years.
  • Participants with negative wealth shock had a 27% higher risk of developing dementia compared to those without wealth shock.
The study suggests potential social and psychological mechanisms linking financial hardship to cognitive decline, such as stress, depression, and reduced access to healthcare.

Monday, January 29, 2024

Two in three UK doctors suffer ‘moral distress’ due to overstretched NHS, study finds

Denis Campbell
The Guardian
Originally posted 28 Dec 23

Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found.

Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill.

A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS.

Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said.

“There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association.

The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added.

“In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said.


Key points:

The study also found that:
  • Nearly half (47%) of doctors believe the cost of living crisis is contributing to their moral distress.
  • 72% of doctors say being unhappy at work has affected their mental health.
  • 85% of doctors have experienced fatigue as a result of their work.
Causes of moral distress:
  • Doctors are often in situations where they have to make difficult decisions about who to treat first, or whether they can afford to give a patient the treatment they need.
  • They may also feel that they are not able to provide the level of care that they would like to because of the lack of resources in the NHS.
Impact of moral distress:
  • Moral distress can lead to burnout, depression, and anxiety.
  • It can also make it difficult for doctors to continue working in the NHS.

Thursday, September 28, 2023

US prison labor is cruel and pointless legalized slavery.

Dyjuan Tatro
The Guardian
Originally posted 22 Sept 23

Here is an excerpt:

It costs New York around $70,000 a year in taxpayer money to imprison someone. It costs the BPI about $10,000 a year to educate an incarcerated student. New York’s recidivism rate is 40%, while graduates of the BPI and similar programs recidivate at only 4%, a tenfold decrease. Yet, despite its clear positive record, only 300 of New York’s 30,000 incarcerated people are enrolled at the BPI in any given semester. I was one of a lucky few.

Prisons are designed to warehouse, traumatize and exploit people, then send them back home in worse shape than when they entered the system. Despite having worked every day, the vast majority of people are released with no job experience, no references and no hope. Some would take this to mean that the system is failing. And it is with regard to public safety, rehabilitation and justice, but it’s horrifyingly successful at two things: guaranteeing jobs for some and perpetuating slavery for others.

Over the years, I learned that prison officials were not interested in giving us fruitful educational and job opportunities that allowed us to go home and stay home. The reality is much more sinister. Prisons are a job program for officers that requires us to keep coming back.


Here is my summary:

The article is a personal account of the author's experience working in prison. Tatro argues that prison labor is a form of legalized slavery, and that it is cruel and pointless. He writes that his work in prison was meaningless and dehumanizing, and that it did not teach him any skills or prepare him for life outside of prison. He also argues that prison labor undermines the living standards of workers outside of prison, as businesses that use prison labor are able to pay their workers less.

Tatro's article is a powerful indictment of the US prison system, and it raises important questions about the role of labor in the rehabilitation of prisoners.

Saturday, September 23, 2023

Moral injury in post-9/11 combat-experienced military veterans: A qualitative thematic analysis.

Kalmbach, K. C., Basinger, E. D.,  et al. (2023). 
Psychological Services. Advance online publication.

Abstract

War zone exposure is associated with enduring negative mental health effects and poorer responses to treatment, in part because this type of trauma can entail crises of conscience or moral injury. Although a great deal of attention has been paid to posttraumatic stress disorder and fear-based physiological aspects of trauma and suffering, comparatively less attention has been given to the morally injurious dimension of trauma. Robust themes of moral injury were identified in interviews with 26 post-9/11 military veterans. Thematic analysis identified 12 themes that were subsumed under four categories reflecting changes, shifts, or ruptures in worldview, meaning making, identity, and relationships. Moral injury is a unique and challenging clinical construct with impacts on the individual as well as at every level of the social ecological system. Recommendations are offered for addressing moral injury in a military population; implications for community public health are noted.

Impact Statement

Military veterans who experienced moral injury—events that violate deeply held moral convictions or beliefs—reported fundamental changes following the morally injurious event (MIE). The MIE ruptured their worldview, or sense of right and wrong, and they struggled to reconcile a prior belief system or identity with their existence post-MIE. Absent a specific evidence-based intervention, clinicians are encouraged to consider adaptations to existing treatment models but to be aware that moral injury often does not respond to treatment as usual for PTSD or adjacent comorbid conditions.

The article is paywalled, with the link noted above.

My addition:

The thematic analysis identified 12 themes related to moral injury, which were grouped into four categories:
  • Changes in worldview: Veterans who experienced moral injury often reported changes in their worldview, such as questioning their beliefs about the world, their place in it, and their own goodness.
  • Changes in meaning making: Veterans who experienced moral injury often struggled to make meaning of their experiences, which could lead to feelings of emptiness, despair, and hopelessness.
  • Changes in identity: Veterans who experienced moral injury often reported changes in their identity, such as feeling like they were no longer the same person they were before the war.
  • Changes in relationships: Veterans who experienced moral injury often reported changes in their relationships with family, friends, and others. They may have felt isolated, misunderstood, or ashamed of their experiences.

Thursday, September 22, 2022

Freezing revisited: coordinated autonomic and central optimization of threat coping

Roelofs, K., Dayan, P. 
Nat Rev Neurosci 23, 568–580 (2022).
https://doi.org/10.1038/s41583-022-00608-2

Abstract

Animals have sophisticated mechanisms for coping with danger. Freezing is a unique state that, upon threat detection, allows evidence to be gathered, response possibilities to be previsioned and preparations to be made for worst-case fight or flight. We propose that — rather than reflecting a passive fear state — the particular somatic and cognitive characteristics of freezing help to conceal overt responses, while optimizing sensory processing and action preparation. Critical for these functions are the neurotransmitters noradrenaline and acetylcholine, which modulate neural information processing and also control the sympathetic and parasympathetic branches of the autonomic nervous system. However, the interactions between autonomic systems and the brain during freezing, and the way in which they jointly coordinate responses, remain incompletely explored. We review the joint actions of these systems and offer a novel computational framework to describe their temporally harmonized integration. This reconceptualization of freezing has implications for its role in decision-making under threat and for psychopathology.

Conclusions and future directions

Considering the post encounter threat state from neural, psychological and computational perspectives has shown how the most obvious external characteristic of this state — a particular form of active freezing arising from co-activation of the normally opposed sympathetic and parasympathetic branches of the ANS — could have various advantages from the viewpoints of both information processing and fast Pavlovian or instrumental action. Descending control of this state is quite well understood, and the potential benefits of expending effort on enhancing unbiased, bottom-up, sensory processing and engaging in planning are easy to observe. However, the roles of ascending neuromodulators in engaging these forms of appropriate information processing are less clear.  Certainly, various of the modes of action of ACh and NA in the CNS are in a position to achieve some of this; but much remains to be discovered by precisely recording and manipulating the candidate circuits within the timeframes of the detection, evaluation and action stages.

One important source of ideas is evolutionary theory. For instance, the polyvagal theory of the phylogeny of the ANS suggests that it progressed in three stages. The first, associated with an unmyelinated vagus nerve, allowed metabolic activity to be depressed in response to threat and also controlled aspects of digestion. The second stage was associated with the sympathetic nervous system, which organized energized behaviour for fight or flight. The third stage was associated with a myelinated vagus nerve and allowed for more flexible and sophisticated responding. It has been suggested that the last stage is particularly involved in the evolution of somatic regulation in a social context; but the evolutionary layering of the competition and cooperation between the inhibitory and activating aspects of the different branches of the ANS is notable. It would be interesting to understand the parallel evolution of cholinergic and noradrenergic neuromodulation in the CNS. 


Note: We are primates subject to the principles of biology and evolution.

Tuesday, April 20, 2021

State Medical Board Recommendations for Stronger Approaches to Sexual Misconduct by Physicians

King PA, Chaudhry HJ, Staz ML. 
JAMA. 
Published online March 29, 2021. 
doi:10.1001/jama.2020.25775

The Federation of State Medical Boards (FSMB) recently engaged with its member boards and investigators, trauma experts, physicians, resident physicians, medical students, survivors of physician abuse, and the public to critically review practices related to the handling of reports of sexual misconduct (including harassment and abuse) toward patients by physicians. The review was undertaken as part of a core responsibility of boards to protect the public and motivated by concerning reports of unacceptable behavior by physicians. Specific recommendations from the review were adopted by the FSMB’s House of Delegates on May 2, 2020, and are highlighted in this Viewpoint.

Sexual misconduct by physicians exists along a spectrum of severity that may begin with “grooming” behaviors and end with sexual assault. Behaviors at any point on this spectrum should be of concern because unreported minor violations (including sexually suggestive comments or inappropriate physical contact) may lead to greater misconduct. In 2018, the National Academies of Science, Engineering, and Medicine identified sexual harassment as an important problem in scientific communities and medicine, finding that greater than 50% of women faculty and staff and 20% to 50% of women students reportedly have encountered or experienced sexually harassing conduct in academia. Data from state medical boards indicate that 251 disciplinary actions were taken against physicians in 2019 for “sexual misconduct” violations (Table). The actual number may be higher because boards often use a variety of terms, including unprofessional conduct, physician-patient boundary issues, or moral unfitness, to describe such actions. The FSMB has begun a project to encourage boards to align their categorization of all disciplinary actions to better understand the scope of misconduct.

Wednesday, December 23, 2020

Beyond burnout: For health care workers, this surge of Covid-19 is bringing burnover

Wendy Dean & Simon G. Talbot
statnews.com
Originally posted 25 Nov 20

Covid-19 is roaring back for a third wave. The first two substantially increased feelings of moral injury and burnout among health care workers. This one is bringing burnover.

Health care systems are scrambling anew. The crises of ICU beds at capacity, shortages of personal protective equipment, emergency rooms turning away ambulances, and staff shortages are happening this time not in isolated hot spots but in almost every state. Clinicians again face work that is risky, heart-rending, physically exhausting, and demoralizing, all the elements of burnout. They have seen this before and are intensely frustrated it is happening again.

Too many of them are leaving health care long before retirement. The disconnect between what health care workers know and how the public is behaving, driven by relentless disinformation, is unbearable. Paraphrasing a colleague, “How can they call us essential and then treat us like we are disposable?”

It is time for leaders of hospitals and health care systems to add another, deeper layer of support for their staff by speaking out publicly and collectively in defense of science, safety, and public health, even if it risks estranging patients and politicians.

Long before the pandemic emerged, the relationships between health care organizations and their staffs were already strained by years of cost-cutting that trimmed staffing levels, supplies, and space to the bone. Driven by changes in health care reimbursement structures, systems were “optimized” to the point that they were continually running at what felt like full capacity, with precious little slack to accommodate minor surges, much less one the magnitude of a global pandemic.

Friday, November 6, 2020

Deluded, with reason

Huw Green
aeon.co
Originally published 31 Aug 20

Here is an excerpt:

Of course, beliefs don’t exist only in a private mental context, but can also be held in place by our relationships and social commitments. Consider how political identities often involve a cluster of commitments to various beliefs, even where there is no logical connection between them – for instance, how a person who advocates for say, trans rights, is also more likely to endorse Left-wing economic policies. As the British clinical psychologist Vaughan Bell and his colleagues note in their preprint, ‘De-rationalising Delusions’ (2019), beliefs facilitate affiliation and intragroup trust. They cite earlier philosophical work by others that suggests ‘reasoning is not for the refinement of personal knowledge … but for argumentation, social communication and persuasion’. Indeed, our relationships usually ground our beliefs in a beneficial way, preventing us from developing ideas too disparate from those of our peers, and helping us to maintain a set of ‘healthy’ beliefs that promote our basic wellbeing and continuity in our sense of self.

Given the social function of beliefs, it’s little surprise that delusions usually contain social themes. Might delusion then be a problem of social affiliation, rather than a purely cognitive issue? Bell’s team make just this claim, proposing that there is a broader dysfunction to what they call ‘coalitional cognition’ (important for handling social relationships) involved in the generation of delusions. Harmful social relationships and experiences could play a role here. It is now widely acknowledged that there is a connection between traumatic experiences and symptoms of psychosis. It’s easy to see how trauma could have a pervasive impact on a person’s sense of how safe and trustworthy the world feels, in turn affecting their belief systems.

The British philosopher Matthew Ratcliffe and his colleagues made this point in their 2014 paper, observing how ‘traumatic events are often said to “shatter” a way of experiencing the world and other people that was previously taken for granted’. They add that a ‘loss of trust in the world involves a pronounced and widespread sense of unpredictability’ that could make people liable to delusions because the ideas we entertain are likely to be shaped by what feels plausible in the context of our subjective experience. Loss of trust is not the same as the absence of a grounding belief, but I would argue that it bears an important similarity. When we lose trust in something, we might say that we find it hard to believe in it. Perhaps loss of certain forms of ordinary belief, especially around close social relationships, makes it possible to acquire beliefs of a different sort altogether.

Thursday, October 15, 2020

Active shooter drills may do more harm than good, study shows

Katie Camero
Miami Herald
Originally posted 3 September 20

Here is an except:

The research team discovered that social media posts alone displayed a 42% increase in anxiety and stress from the 90 days before active shooter drills to the 90 days after them. The frequent use of words such as “afraid, struggling and nervous” served as evidence, according to the report.

Signs of depression increased by 39% based on posts that featured the words “therapy, cope, irritability and suicidal” following drill events. Concerns about friends grew by 33%, concerns about social situations rose by 14% and concerns about work soared by 108%, the researchers found.

“I can tell you personally, just as an educator, we were not okay [after drills]. We were in bathrooms crying, shaking, not sleeping for months. The consensus from my friends and peers is that we are not okay,” one anonymous K-12 teacher wrote on social media, according to the report.

Worries over health also jumped by 23% while fears about death rose by 22%. “The analysis revealed words like blood, pain, clinics, and pills came up with jarring frequency, suggesting that drills may have a direct impact on participants’ physical health or, at the very least, made it a persistent topic of concern,” the researchers wrote.

An anonymous parent tweeted, “my kindergartener was stuck in the bathroom, alone, during a drill and spent a year in therapy for extreme anxiety. in a new school even, she still has to use the bathroom in the nurses office because she has ptsd from that event.”

Monday, July 6, 2020

Reframing Clinician Distress: Moral Injury Not Burnout

W. Dean, S. Talbot, and A. Dean
Fed Pract. 2019 Sep; 36(9): 400–402.

For more than a decade, the term burnout has been used to describe clinician distress. Although some clinicians in federal health care systems may be protected from some of the drivers of burnout, other federal practitioners suffer from rule-driven health care practices and distant, top-down administration. The demand for health care is expanding, driven by the aging of the US population. Massive information technology investments, which promised efficiency for health care providers, have instead delivered a triple blow: They have diverted capital resources that might have been used to hire additional caregivers, diverted the time and attention of those already engaged in patient care, and done little to improve patient outcomes. Reimbursements are falling, and the only way for health systems to maintain their revenue is to increase the number of patients each clinician sees per day. As the resources of time and attention shrink, and as spending continues with no improvement in patient outcomes, clinician distress is on the rise. It will be important to understand exactly what the drivers of the problem are for federal clinicians so that solutions can be appropriately targeted. The first step in addressing the epidemic of physician distress is using the most accurate terminology to describe it.

Freudenberger defined burnout in 1975 as a constellation of symptoms—malaise, fatigue, frustration, cynicism, and inefficacy—that arise from “making excessive demands on energy, strength, or resources” in the workplace. The term was borrowed from other fields and applied to health care in the hopes of readily transferring the solutions that had worked in other industries to address a growing crisis among physicians. Unfortunately, the crisis in health care has proven resistant to solutions that have worked elsewhere, and many clinicians have resisted being characterized as burned out, citing a subtle, elusive disconnect between what they have experienced and what burnout encapsulates.

In July 2018, the conversation about clinician distress shifted with an article we wrote in STAT that described the moral injury of health care. The concept of moral injury was first described in service members who returned from the Vietnam War with symptoms that loosely fit a diagnosis of posttraumatic stress disorder (PTSD), but which did not respond to standard PTSD treatment and contained symptoms outside the PTSD constellation. On closer assessment, what these service members were experiencing had a different driver. Whereas those with PTSD experienced a real and imminent threat to their mortality and had come back deeply concerned for their individual, physical safety, those with this different presentation experienced repeated insults to their morality and had returned questioning whether they were still, at their core, moral beings. They had been forced, in some way, to act contrary to what their beliefs dictated was right by killing civilians on orders from their superiors, for example. This was a different category of psychological injury that required different treatment.

The article is here.

Wednesday, May 27, 2020

'A coronavirus depression could be the great leveller'

Kyrill Hartog
The Guardian
Originally published 30 April 2020

Here is an excerpt:

So could the pandemic of our era, already considered the greatest global crisis since the second world war, turn out to be a great societal leveller?

Scheidel’s short answer is that the longer the pandemic wreaks havoc on the global economy, the greater the potential for radical equalising change. “It depends on how severe the crisis is going to be, how long it’s going to last and how much it’s ultimately going to interrupt supply chains.”

The pandemic has already exposed the limits of the market and highlighted the importance of effective state intervention and strong public healthcare provision. In the future this may well create a tolerance for higher and more progressive taxation. Governments have had to intervene to prop up businesses and jobs in ways that only months ago would have seemed unimaginable. The viability of a universal basic income — a dream for egalitarians worldwide — is once again part of the mainstream debate in many countries.

The response at EU level also shows a willingness for strong public intervention and an end to the fiscal restraint approach of the last decade — at least, temporarily.

As people start to believe in government intervention again, the post-corona political landscape may well provide fertile soil for reversing a situation where, since 1980, the richest 1% in the UK have tripled their share of household income and the wealth of the European top 1% grew twice as fast as the bottom 50%.

But Scheidel cautions that, while disasters are not uncommon, tectonic shifts are historical anomalies. In other words, it may take a disaster to usher in more equality, but not every disaster does.

The info is here.

Friday, April 24, 2020

COVID-19 Is Making Moral Injury to Physicians Much Worse

Wendy Dean
Medscape.com
Originally published 1 April 20

Here is an excerpt:

Moral injury is also coming to the forefront as physicians consider rationing scarce resources with too little guidance. Which surgeries truly justify use of increasingly scarce PPE? A cardiac valve replacement? A lumpectomy? Repairing a torn ligament?

Each denial has profound impact on both the patients whose surgeries are delayed and the clinicians who decide their fates. Yet worse decisions may await clinicians. If, for example, New York City needs an additional 30,000 ventilators but receives only 500, physicians will be responsible for deciding which 29,500 patients will not be ventilated, virtually assuring their demise.

How will physicians make those decisions? How will they cope? The situation of finite resources will force an immediate pivot to assessing patients according to not only their individual needs but also to society's need for that patient's contribution. It will be a wrenching restructuring.

Here are the essential principles for mitigating the impact of moral injury in the context of COVID-19. (They are the same as recommendations in the time before COVID-19.)

1. Value physicians

a. Physicians are putting everything on the line. They're walking into a wildfire of a pandemic, wearing pajamas, with a peashooter in their holster. That takes a monumental amount of courage and deserves profound respect.

The info is here.

Friday, April 3, 2020

Treating “Moral” Injuries

Anna Harwood-Gross
Scientific American
Originally posted 24 March 20

Here is an excerpt:

Though PTSD symptoms such as avoidance of reminders of the traumatic event and intrusive thought patterns may also be present in moral injury, they appear to serve different purposes, with PTSD sufferers avoiding fear and moral injury sufferers avoiding shame triggers. Few comparison studies of PTSD and moral injury exist, yet there has been research that indirectly compares the two conditions by differentiating between fear-based and non-fear-based (i.e., moral injury) forms of PTSD, which have been demonstrated to have different neurobiological markers. In the context of the military, there are countless examples of potentially morally injurious events (PMIEs), which can include killing or wounding others, engaging in retribution or disproportionate violence, or failing to save the life of a comrade, child or civilian. The experience of PMIEs has been demonstrated to lead to a larger range of psychological distress symptoms, including higher levels of guilt, anger, shame, depression and social isolation, than those seen in traditional PTSD profiles.

Guilt is difficult to address in therapy and often lingers following standardized PTSD treatment (that is, if the sufferer is able to access therapy). It may, in fact, be a factor in the more than 49 percent of veterans who drop out of evidence-based PTSD treatment or in why, at times, up to 72% of sufferers, despite meaningful improvement in their symptoms, do not actually recover enough after such treatment for their PTSD diagnosis to be removed. Most often, moral injury symptoms that are present in the clinic are addressed through traditional PTSD treatments, with thoughts of guilt and shame treated similarly to other distorted cognitions. When guilt and the events it relates to are treated as “a feeling and not a fact,” as psychologist Lisa Finlay put it in a 2015 paper, there is an attempt to lessen or relieve such emotions while taking a shortcut to avoid experiencing those that are legitimate and reasonable after-wartime activities. Continuing, Finlay stated that “the idea that we might get good, as a profession, at talking people out of guilt following their involvement in traumatic incidents is frighteningly short-sighted in more ways than one.”

The info is here.

Tuesday, March 17, 2020

Trump's separation of families constitutes torture, doctors find

David Xol-Cholom of Guatemala hugs his son Byron at Los Angeles international airport last month as they reunite after being separated about one and half years ago.Amanda Holpuch
theguardian.com
Originally posted 25 Feb 20

Here is an excerpt:

Legal experts have argued family separation constituted torture, but this is the first time a medical group has reached the determination.

PHR volunteer psychiatrists evaluated 17 adults and nine children who had been separated between 30 to 90 days. Most met the criteria for at least one mental health condition, including post-traumatic stress disorder, major depressive disorder or generalized anxiety disorder “consistent with, and likely linked to, the trauma of family separation”, according to the report.

Not only did the brutal family separation policy create trauma, it was intensified by the families’ previous exposure to violence on their journey to the US and in their home countries of Honduras, Guatemala and El Salvador.

All but two of the adults evaluated by PHR said they had received death threats in their home countries and 14 out of the 17 adults said they were targeted by drug cartels. All were fearful their child would be harmed or killed if they remained at home.

Almost all the children had been drugged, kidnapped, poisoned or threatened by gangs before they left. One mother told investigators she moved her daughter to different schools in El Salvador several times so gang members couldn’t find her and kill her.

The info is here.

Thursday, February 20, 2020

Harvey Weinstein’s ‘false memory’ defense is not backed by science

Anne DePrince & Joan Cook
The Conversation
Originally posted 10 Feb 20

Here is an excerpt:

In 1996, pioneering psychologist Jennifer Freyd introduced the concept of betrayal trauma. She made plain how forgetting, not thinking about and even mis-remembering an assault may be necessary and adaptive for some survivors. She argued that the way in which traumatic events, like sexual violence, are processed and remembered depends on how much betrayal there is. Betrayal happens when the victim depends on the abuser, such as a parent, spouse or boss. The victim has to adapt day-to-day because they are (or feel) stuck in that relationship. One way that victims can survive is by thinking or remembering less about the abuse or telling themselves it wasn’t abuse.

Since 1996, compelling scientific evidence has shown a strong relationship between amnesia and victims’ dependence on abusers. Psychologists and other scientists have also learned much about the nature of memory, including memory for traumas like sexual assault. What gets into memory and later remembered is affected by a host of factors, including characteristics of the person and the situation. For example, some individuals dissociate during or after traumatic events. Dissociation offers a way to escape the inescapable, such that people feel as if they have detached from their bodies or the environment. It is not surprising to us that dissociation is linked with incomplete memories.

Memory can also be affected by what other people do and say. For example, researchers recently looked at what happened when they told participants not to think about some words that they had just studied. Following that instruction, those who had histories of trauma suppressed more memories than their peers did.

The info is here.

Wednesday, February 19, 2020

American Psychological Association Calls for Immediate Halt to Sharing Immigrant Youths' Confidential Psychotherapy Notes with ICE

American Psychological Association
Press Release
Released 17 Feb 20

The American Psychological Association expressed shock and outrage that the federal Office of Refugee Resettlement has been sharing confidential psychotherapy notes with U.S. Immigration and Customs Enforcement to deny asylum to some immigrant youths.

“ORR’s sharing of confidential therapy notes of traumatized children destroys the bond of trust between patient and therapist that is vital to helping the patient,” said APA President Sandra L. Shullman, PhD. “We call on ORR to stop this practice immediately and on the Department of Health and Human Services and Congress to investigate its prevalence. We also call on ICE to release any immigrants who have had their asylum requests denied as a result.”

APA was reacting to a report in The Washington Post focused largely on the case of then-17-year-old Kevin Euceda, an asylum-seeker from Honduras whose request for asylum was granted by a judge, only to have it overturned when lawyers from ICE revealed information he had given in confidence to a therapist at a U.S. government shelter. According to the article, other unaccompanied minors have been similarly detained as a result of ICE’s use of confidential psychotherapy notes. These situations have also been confirmed by congressional testimony since 2018.

Unaccompanied minors who are detained in U.S. shelters are required to undergo therapy, ostensibly to help them deal with trauma and other issues arising from leaving their home countries. According to the Post, ORR entered into a formal memorandum of agreement with ICE in April 2018 to share details about children in its care. The then-head of ORR testified before Congress that the agency would be asking its therapists to “develop additional information” about children during “weekly counseling sessions where they may self-disclose previous gang or criminal activity to their assigned clinician,” the newspaper reported. The agency added two requirements to its public handbook: that arriving children be informed that while it was essential to be honest with staff, self-disclosures could affect their release and that if a minor mentioned anything having to do with gangs or drug dealing, therapists would file a report within four hours to be passed to ICE within one day, the Post said.

"For this administration to weaponize these therapy sessions by ordering that the psychotherapy notes be passed to ICE is appalling,” Shullman added. “These children have already experienced some unimaginable traumas. Plus, these are scared minors who may not understand that speaking truthfully to therapists about gangs and drugs – possibly the reasons they left home – would be used against them.”

Wednesday, November 27, 2019

The Moral Injury of Pardoning War Crimes

The Editorial Board
The New York Times
Originally posted 22 Nov 19

Here is an excerpt:

That Mr. Trump would pardon men accused or convicted of war crimes should come as little surprise, given that he campaigned on promises to torture the nation’s enemies and kill their families. Mr. Trump in May became the first modern president to pardon a person convicted of war crimes, when he pardoned Michael Behenna, a former Army lieutenant, who had been convicted of killing a prisoner in Iraq.

The president may think he’s supporting men and women in uniform. “When our soldiers have to fight for our country, I want to give them the confidence to fight,” he said in a statement issued by the White House. “We train our boys to be killing machines, then prosecute them when they kill!” he said on Twitter last month.

Whatever the reason, absolving people who commit war crimes does great harm to society in general, and the men and women who served honorably — as far more than “killing machines” — in the wars since the Sept. 11 terrorist attacks in particular.

A nation has to know that military action being taken in its name follows morally defensible rules — that soldiers do not, for instance, kill unarmed civilians or prisoners.

To excuse men who have so flagrantly violated those rules — to treat them as heroes, even — is to cast the idea of just war to the winds. It puts the nation and veterans at risk of moral injury, the shattering of a moral compass.

One of the loudest groups pushing for Mr. Trump’s pardons was United American Patriots, a nonprofit organization that supports numerous soldiers accused of crimes, including Mr. Lorance, Mr. Behenna and Major Golsteyn. Last month, Chief Gallagher sued two of his former lawyers and United American Patriots, alleging that his lawyers tried to delay the case to increase fund-raising for the organization.

Supporters of the pardoned men say the military justice system comes down too hard and too often on honorable soldiers fighting through the fog of war. That wouldn’t explain why United American Patriots has made a cause célèbre of Robert Bales, who pleaded guilty to slaughtering 16 Afghan civilians in their homes during a one-man nighttime rampage in 2012.

The info is here.

Friday, November 22, 2019

What School Shooters Have in Common

Jillian Peterson & James Densley
edweek.org
Originally posted October 8, 2019

Here is an excerpt:

However, school shooters are almost always a student at the school, and they typically have four things in common:

They suffered early-childhood trauma and exposure to violence at a young age. They were angry or despondent over a recent event, resulting in feelings of suicidality. They studied other school shootings, notably Columbine, often online, and found inspiration. And they possessed the means to carry out an attack.

By understanding the traits that school shooters share, schools can do more than just upgrade security or have students rehearse for their near-deaths. They can instead plan to prevent the violence.

To mitigate childhood trauma, for example, school-based mental-health services such as counselors and social workers are needed. Schools can also adopt curriculum focused on teaching positive coping skills, resilience, and social-emotional learning, especially to young boys (According to our data, 98 percent of mass shooters are men.)

A crisis is a moment, an inflection point, when things will either become very bad or begin to get better. In 80 percent of cases, school shooters communicated to others that they were in crisis, whether through a marked change in behavior, an expression of suicidal thoughts or plans, or specific threats of violence. For this reason, all adults in schools, from the principal to the custodian, need high-quality training in crisis intervention and suicide prevention and the time and space to connect with a student. At the same time, schools need formal systems in place for students and staff to (anonymously) report a student in crisis.

The info is here.

Thursday, September 19, 2019

Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?

Spiegel P, Kass N, Rubenstein L.
JAMA. Published online August 30, 2019.
doi:10.1001/jama.2019.12567

The modern successor to the Hippocratic oath, called the Declaration of Geneva, was updated and approved by the World Medical Association in 2017. The pledge states that “The health and well-being of my patient will be my first consideration” and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.” Can a physician work in US immigration detention facilities while upholding this pledge?

There is a humanitarian emergency at the US-Mexico border where migrants, including families, adults, or unaccompanied children, are detained and processed by the Department of Homeland Security’s (DHS) Customs and Border Patrol and are held in overcrowded and unsanitary conditions with insufficient medical care.2 Children (persons <18 years), without their parents or guardians, are often being detained in these detention facilities beyond the 72 hours allowed under federal law. Adults and children with a parent or legal guardian are then transferred from Customs and Border Patrol facilities to DHS’ Immigration and Customs Enforcement facilities, which are also overcrowded and where existing standards for conditions of confinement are often not met. Unaccompanied minors are transferred from Customs and Border Patrol detention facilities to Health and Human Services (HHS) facilities run by the Office of Refugee Resettlement (ORR). The majority of these unaccompanied children are then released to the care of community sponsors, while others stay, sometimes for months.

Children should not be detained for immigration reasons at all, according to numerous professional associations, including the American Academy of Pediatrics.3 Detention of children has been associated with increased physical and psychological illness, including posttraumatic stress disorder, as well as developmental delay and subsequent problems in school.

Given the psychological and physical harm to children who are detained, the United Nations Committee on the Rights of the Child stated that the detention of a child “cannot be justified solely on the basis of the child being unaccompanied or separated, or on their migratory or residence status, or lack thereof,” and should in any event only be used “…as a measure of last resort and for the shortest appropriate period of time.”6 The United States is the only country not to have ratified the convention on the Rights of the Child, but the international standard is so widely recognized that it should still apply. Children held in immigration detention should be released into settings where they are safe, protected, and can thrive.

The info is here.

Saturday, August 17, 2019

DC Types Have Been Flocking to Shrinks Ever Since Trump Won.

And a Lot of the Therapists Are Miserable.

Britt Peterson
www.washingtonian.com
Originally published July 14 2019

Here two excerpts:

In Washington, the malaise appears especially pronounced. I spent the last several months talking to nearly two dozen local therapists who described skyrocketing levels of interest in their services. They told me about cases of ordinary stress blossoming into clinical conditions, patients who can’t get through a session without invoking the President’s name, couples and families falling apart over politics—a broad category of concerns that one practitioner, Beth Sperber Richie, says she and her colleagues have come to categorize as “Trump trauma.”

In one sense, that’s been good news for the people who help keep us sane: Their calendars are full. But Trump trauma has also created particular clinical challenges for therapists like Guttman and her students. It’s one thing to listen to a client discuss a horrible personal incident. It’s another when you’re experiencing the same collective trauma.

“I’ve been a therapist for a long time,” says Delishia Pittman, an assistant professor at George Washington University who has been in private practice for 14 years. “And this has been the most taxing two years of my entire career.”

(cut)

For many, in other words, Trump-related anxieties originate from something more serious than mere differences about policy. The therapists I spoke to are equally upset—living through one unnerving news cycle after another, personally experiencing the same issues as their patients in real time while being expected to offer solace and guidance. As Bindeman told her clients the day after Trump’s election, “I’m processing it just as you are, so I’m not sure I can give you the distance that might be useful.”

This is a unique situation in therapy, where you’re normally discussing events in the client’s private life. How do you counsel a sexual-assault victim agitated by the Access Hollywood tape, for example, when the tape has also disturbed you—and when talking about it all day only upsets you further? How about a client who echoes your own fears about climate change or the treatment of minorities or the government shutdown, which had a financial impact on therapists just as it did everyone else?

Again and again, practitioners described different versions of this problem.

The info is here.