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

Wednesday, February 8, 2012

Marine Fights Conviction for Suicide Attempt

Pvt. Lazzaric T. Caldwell
Associated Press
Originally Published February 3, 2012

HAGERSTOWN, Md. - A discharged Marine private who slit his wrists in a suicide attempt is fighting his military conviction for deliberately injuring himself, arguing the punishment is inconsistent with the armed forces' efforts to battle a rise in suicides during the wars in Iraq and Afghanistan.

It's not clear how often the Marines or any other service branch prosecute active duty members for trying to kill themselves. But the defense lawyer for Pvt. Lazzaric T. Caldwell says it's wrong to punish service members with mental health problems for genuine suicide attempts. Suicide prevention has become a priority across the military as numbers climbed in the past decade with the increasing stress of combat and multiple deployments in the wars.

Caldwell, 25, of Camp Pendleton, Calif., never deployed to a war zone but was diagnosed in 2009 with post-traumatic stress disorder and a personality disorder, according to court records. In 2010, he slashed his wrists in his barracks at Camp Schwab in Okinawa, Japan.

He pleaded guilty at a court-martial that year to "intentional self-injury without intent to avoid service," a criminal charge that the government says helps maintain good order and discipline in the armed forces. The charge is sometimes used in self-injury cases when there isn't enough evidence to prove malingering, military justice experts say.

Caldwell was sentenced to 180 days in jail and a bad conduct discharge. Military rules allow an appeal after a guilty plea in some cases, but Caldwell's initial appeal to the Navy-Marine Corps Court of Criminal Appeals was denied in December. His lawyer, Navy Lt. Mike Hanzel, said this week he will ask the military's highest court, the U.S. Court of Appeals for the Armed Forces in Washington, to hear the case.

"I think it definitely touches important issues which are affecting all the branches of the armed forces right now," Hanzel said in a telephone interview from Bremerton, Wash.

Military prosecutors didn't immediately respond to requests for comment on the case. In an appellate brief, the government stated that Caldwell "was not charged with, or convicted of, attempting suicide. He was charged with, and properly convicted of, intentionally injuring himself to the prejudice of good order and discipline or the discredit of the service."

The entire story is here.

Tuesday, February 7, 2012

As Journal Boycott Grows, Elsevier Defends Its Practices

By Josh Fischman
The Chronicle of Higher Education
Originally Published January 31, 2012

A protest against Elsevier, the world's largest scientific journal publisher, is rapidly gaining momentum since it began as an irate blog post at the end of January. By Tuesday evening, about 2,400 scholars had put their names to an online pledge not to publish or do any editorial work for the company's journals, including refereeing papers.

The boycott is growing so quickly—it had about 1,800 signers on Monday—that Elsevier officials on Tuesday broke their official silence to respond to protesters' accusations that they charge too much and support laws that will keep research findings bottled up behind a company paywall.

"Over the past 10 years, our prices have been in the lowest quartile in the publishing industry," said Alicia Wise, Elsevier's director of universal access. "Last year our prices were lower than our competitors'. I'm not sure why we are the focus of this boycott, but I'm very concerned about one dissatisfied scientist, and I'm concerned about 2,000."

She added that her company improves access rather than impeding it, and said that Internet downloads from some journals increased by as much as 40 percent when Elsevier added them to collections it sells to libraries.

Protesters disagree, and say Elsevier is emblematic of an abusive publishing industry. "The government pays me and other scientists to produce work, and we give it away to private entities," says Brett S. Abrahams, an assistant professor of genetics at the Albert Einstein College of Medicine. "Then they charge us to read it." Mr. Abrahams signed the pledge on Tuesday after reading about it on Facebook.

Those views highlight a split that could spell serious trouble for journal publishers, and for researchers. Price complaints are not new, but some observers say this is the first time that the suppliers of journal content—the scientists—are upset enough to cut the supply line. But, if publishers are correct, those scientists could cut themselves off from valuable research tools.

The Boycotters' Complaints


According to the boycotters, Elsevier, which publishes over 2,000 journals including the prestigious Cell and The Lancet, is abusing academic researchers in three areas. First there are the prices. Then the company bundles subscriptions to lesser journals together with valuable ones, forcing libraries to spend money to buy things they don't want in order to get a few things they do want. And, most recently, Elsevier has supported a proposed federal law, the Research Works Act (HR 3699), that could prevent agencies like the National Institutes of Health from making all articles written by grant recipients freely available.

The entire story is here.

Monday, February 6, 2012

Jonathan Haidt Decodes the Tribal Psychology of Politics

By Marc Perry
The Chronicle of Higher Education

Jonathan Haidt
Jonathan Haidt is occupying Wall Street. Sort of. It's a damp and bone-chilling January night in lower Manhattan's Zuccotti Park. The 48-year-old psychologist, tall and youthful-looking despite his silvered hair, is lecturing the occupiers about how conservatives would view their ideas.

"Conservatives believe in equality before the law," he tells the young activists, who are here in the "canyons of wealth" to talk people power over vegan stew. "They just don't care about equality of outcome."

Explaining conservatism at a left-wing occupation? The moment tells you a lot about the evolution of Jonathan Haidt, moral psychologist, happiness guru, and liberal scold.

Haidt (pronounced like "height") made his name arguing that intuition, not reason, drives moral judgments. People are more like lawyers building a case for their gut feelings than judges reasoning toward truth. He later theorized a series of innate moral foundations that evolution etched into our brains like the taste buds on our tongues—psychological bases that underlie both the individual-protecting qualities that liberals value, like care and fairness, as well as the group-binding virtues favored by conservatives, like loyalty and authority.

"He, over the last decade or so, has substantially changed how people think about moral psychology," says Paul Bloom, a psychologist at Yale University.

Now Haidt wants to change how people think about the culture wars. He first plunged into political research out of frustration with John Kerry's failure to connect with voters in 2004. A partisan liberal, the University of Virginia professor hoped a better grasp of moral psychology could help Democrats sharpen their knives. But a funny thing happened. Haidt, now a visiting professor at New York University, emerged as a centrist who believes that "conservatives have a more accurate understanding of human nature than do liberals."

In March, Haidt will publish The Righteous Mind: Why Good People Are Divided by Politics and Religion (Pantheon). By laying out the science of morality—how it binds people into "groupish righteousness" and blinds them to their own biases—he hopes to drain some vitriol from public debate and enable conversations across ideological divides.

The entire story is here.

Sunday, February 5, 2012

US Health Breach Tally Hits 19 Million

385 Major Incidents Reported Since 2009
Govinfosecurity.com
By Howard Anderson, January 23, 2012

With the tardy addition of the Sutter Health breach, the U.S. tally of major healthcare information breaches now includes 385 incidents affecting more than 19 million individuals since September 2009.

The Department of Health and Human Services' Office for Civil Rights recently added the Sutter Health breach, which occurred in October, to its official tally of breaches affecting 500 or more individuals. It adds incidents once it confirms the details.

Healthcare information on 943,000 individuals was on an unencrypted desktop computer that was stolen in October from a Sutter facility in California; that total is reflected in the official federal healthcare breach tally. But in announcing the breach, Sutter Health noted that two databases with information on 4.2 million patients were on the device.

A database for Sutter Physician Services, which provides billing and other administrative services for 21 Sutter units, held only limited demographic information on about 3.3 million patients collected from 1995 through January 2011. The device also contained a database with more extensive information on 943,000 Sutter Medical Foundation patients, dating from January 2005 to January 2011. This smaller database included the same demographic information as the larger database, plus dates of service and a description of diagnoses and/or procedures.

Sutter Health faces two class action lawsuits in the wake of the breach.

Breach List Update

In addition to adding the Sutter Health incident, federal officials added five much smaller incidents to the official breach tally in the past month.

Of the 385 incidents affecting 500 or more individuals that are now included in the official tally after being reported to authorities as required under the HIPAA breach notification rule, roughly 55 percent have involved lost or stolen unencrypted electronic devices or media. About 22 percent have involved a business associate.

The entire story is here.

Saturday, February 4, 2012

Not Diseases, but Categories of Suffering

By GARY GREENBERG
The New York Times - Opinion
Published: January 29, 2012

YOU’VE got to feel sorry for the American Psychiatric Association, at least for a moment. Its members proposed a change to the definition of autism in the fifth edition of their Diagnostic and Statistical Manual of Mental Disorders, one that would eliminate the separate category of Asperger syndrome in 2013. And the next thing they knew, a prominent psychiatrist was quoted in a front-page article in this paper saying the result would be fewer diagnoses, which would mean fewer troubled children eligible for services like special education and disability payments.

Then, just a few days later, another front-pager featured a pair of equally prominent experts explaining their smackdown of the A.P.A.’s proposal to eliminate the “bereavement exclusion” — the two months granted the grieving before their mourning can be classified as “major” depression. This time, the problem was that the move would raise the numbers of people with the diagnosis, increasing health care costs and the use of already pervasive mind-altering drugs, as well as pathologizing a normal life experience.

Fewer patients, more patients: the A.P.A. just can’t win. Someone is always mad at it for its diagnostic manual.

It’s not the current A.P.A.’s fault. The fault lies with its predecessors. The D.S.M. is the offspring of odd bedfellows: the medical industry, with its focus on germs and other biochemical causes of disease, and psychoanalysis, the now-largely-discredited discipline that attributes our psychological suffering to our individual and collective history.

The entire story is here.

Friday, February 3, 2012

Ritalin Gone Wrong

By L. ALAN SROUFE
The New York Times
Opinion
Published: January 28, 2012

The molecular model of Ritalin
THREE million children in this country take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage ofdrugs like Ritalin and Adderall that they considered absolutely essential to their children’s functioning.

But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled?

In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder.

As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs.

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.

What gets publicized are short-term results and studies on brain differences among children. Indeed, there are a number of incontrovertible facts that seem at first glance to support medication. It is because of this partial foundation in reality that the problem with the current approach to treating children has been so difficult to see.

Back in the 1960s I, like most psychologists, believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.

The entire story is here.

Thursday, February 2, 2012

I Had Asperger Syndrome. Briefly.

By Benjamin Nugent
The New York Times
The Opinion Pages
Originally Published January 31, 2012

FOR a brief, heady period in the history of autism spectrum diagnosis, in the late ’90s, I had Asperger syndrome.

There’s an educational video from that time, called “Understanding Asperger’s,” in which I appear. I am the affected 20-year-old in the wannabe-hipster vintage polo shirt talking about how keen his understanding of literature is and how misunderstood he was in fifth grade. The film was a research project directed by my mother, a psychology professor and Asperger specialist, and another expert in her department. It presents me as a young man living a full, meaningful life, despite his mental abnormality.

“Understanding Asperger’s” was no act of fraud. Both my mother and her colleague believed I met the diagnostic criteria laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The manual, still the authoritative text for American therapists, hospitals and insurers, listed the symptoms exhibited by people with Asperger disorder, and, when I was 17, I was judged to fit the bill.

I exhibited a “qualified impairment in social interaction,” specifically “failure to develop peer relationships appropriate to developmental level” (I had few friends) and a “lack of spontaneous seeking to share enjoyment, interests, or achievements with other people” (I spent a lot of time by myself in my room reading novels and listening to music, and when I did hang out with other kids I often tried to speak like an E. M. Forster narrator, annoying them). I exhibited an “encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus” (I memorized poems and spent a lot of time playing the guitar and writing terrible poems and novels).

The general idea with a psychological diagnosis is that it applies when the tendencies involved inhibit a person’s ability to experience a happy, normal life. And in my case, the tendencies seemed to do just that. My high school G.P.A. would have been higher if I had been less intensely focused on books and music. If I had been well-rounded enough to attain basic competence at a few sports, I wouldn’t have provoked rage and contempt in other kids during gym and recess.

The thing is, after college I moved to New York City and became a writer and met some people who shared my obsessions, and I ditched the Forsterian narrator thing, and then I wasn’t that awkward or isolated anymore. According to the diagnostic manual, Asperger syndrome is “a continuous and lifelong disorder,” but my symptoms had vanished.

The entire story is here.

Supervising the Countertransference Reactions of Case Managers

Supervising the Counter Transference of Case Managers

This chapter is found in the public domain.

Wednesday, February 1, 2012

Need to heal thyself?

Up to a third of all graduate students are coping with mental health problems alongside the demands of school. To whom can they turn for help?

By Cassandra Willyard
gradPSYCH
Print version: page 28

The last six years of graduate school haven't been easy for Gretchen Foster (not her real name), who describes herself as a "high-achiever who wants to do everything right." Her clinical psychology program was exceedingly competitive, and she had trouble figuring out the complex politics of her department. Foster often had more work than she could handle, so she had to let some assignments go unfinished. And being new to the area, she had few friends outside of the department.

Those issues might sound familiar to many graduate students, but they were especially trying for Foster, who was diagnosed with an anxiety disorder at age 17. "I would push myself really hard and feel sort of like I had exhausted my supply of energy," she says. Medication helped her cope, but some days the anxiety overwhelmed her. "I would just have to go home and give up the day and know that there was no way I would be able to get work done," she says. Foster feared that those lost days would cause her to fall behind her peers, and she felt frustrated with herself.

Trying to handle grad school's heavy workload while still having a social life and maintaining a healthy lifestyle can be enough to stress anyone out, says John C. Norcross, PhD, a psychology professor at the University of Scranton in Pennsylvania who studies self-care and personal therapy among psychologists. These challenges can be especially daunting for students suffering from a mental illness, he notes.

"Most studies of full-time doctoral students show they are routinely working 60-plus hours [a week]," he says. "And when you're working that many hours, self-care tends to plummet."

Just how prevalent mental health problems are among graduate students is an open question. Only a few surveys have been conducted, and the magnitude of the problem appears to vary from school to school, depending in part on how they define mental health issues.

A 2008 survey at the University of California–Irvine, for example, found 17 percent of students reported having a serious mental disorder and nearly 30 percent reported having a mental health concern that affected their well-being or academic performance. A survey from 2006 at Berkeley found that 45 percent of graduate students polled said they had a mental health issue that affected their well-being or academic performance, and almost 10 percent of respondents reported they had considered suicide in the past year.

The entire article is here.