Social science & medicine. Part E, Medical psychology最新文献

There is a hard-work role in American medicine, known to the public and to the medical profession, at least implicitly, that may be responsible for much of what is both good and bad in American medicine. The name of the role, ‘obsessive-compulsive’, suggests the duality. On the one hand, the physician who follows its dictates is committed to high standards and to the service ideal; on the other hand, his workaholism, combined as it is with a highly technological approach to medical practice, may lead to over-diagnosis, over-treatment, and an inflationary medical bill. The role has implications for the health of the physician, as well as for that of the patient, since the former, in a vain attempt to be the perfect (i.e. omniscient and omnipotent) physician may lapse into alcoholism and drug addiction or so neglect his family that he becomes another divorce statistic. While the physician learns this role as a part of his professional socialization and as a reaction to the work situation, his personality type may predispose him to accept role demands; Type A personalities are particularly susceptible. The obsessive-compulsive role has an uncertain future in the American medical profession. The question is can a new role be constructed from the old that will promise a productive, yet healthy life for the physician, a lesser risk of iatrogenic illness for the patient, and a lower medical bill for society?

A brief, standardised and semi-structured social screening interview, designed to identify and quantify social stresses and supports, is described. This experimental interview covers the domains of occupation, finance, housing, social relationships, marriage and family, and may be given to either the subject or an informant or both. Ratings are made by interviewers standardised in its use. Validity and reliability are assessed and discussed. The use of the interview is described in a prospective study of 100 identified men and women with non-psychotic psychiatric disorders where, in these circumstances, it proved to be a significant predictor and correlate of psychiatric outcome.

This paper analyzes social ideas and prejudices surrounding epilepsy in terms of the theories of two major sociologists: Auguste Comte and Max Weber.

Social conceptions of epilepsy are analyzed in terms of Comte's thesis of the 3 stages of Western culture's interpretation of natural phenomena—a progression from a religious or superstitious method of explaining nature to a naturalistic model of social and physical reality and finally to a scientific model. Changing social conceptions of epilepsy, with their attending prejudices followed such a progression.

This paper follows the transition from the exclusion of epileptics from the cultural life of their people in classical Greece, Rome and the ancient Middle East as demon-possessed, or ritually banned outcasts, to the medieval view of epilepsy as a natural, but a fearful disorder, still surrounded by superstition and beliefs that the epileptic was to be avoided, to the modern, scientific view of epilepsy as a disorder of the brain. Prejudices have been ameliorated, but not eliminated, by this transition: in the modern clinical picture the epileptic, if not ‘possessed’, is still ‘sick’ and therefore barred from various activities and interactions in his society.

Weber's thesis, the core of which is that the Protestant work ethic, with its rationalistic values of deligence, efficiency and rational, goal-directed behavior was an important factor in the development of capitalistic economics in Western cultures is employed here to explain prejudices against epileptics, especially in the form of job discrimination in industrial societies. Because his disorder may prevent him from obtaining maximum efficiency (or because his disorder is believed to preclude maximum efficiency) the epileptic may find it difficult to hold his own in industrial societies.

This paper elucidates the way in which these general social theories impinge upon the treatment of epileptics in society in an attempt to better understand the obstacles which these individuals face on the way to full participation in the life of their society.

How is the use of Valium, an anti-anxiety drug, a form of social control? This paper describes how drug treatment of anxiety is a process which redefines social problems as medical problems and, by providing symptomatic relief from stress, discourages approaches which attempt to make more structural changes in society. A major cause of this ‘medicalization’ of anxiety and tension is attributed to attitudes and beliefs which support the use of Valium. These attitudes and beliefs are presented as: (1) the individualization of anxiety. (2) a reductional view of non-specific or psychosomatic symptoms, and (3) a belief that Valium has a specific effect in reducing anxiety without inducing any significantly undesirable changes in physiology, social interaction or subjective experience. Drug companies and the conditions of modern medical practice are examined as two factors which may promote these beliefs.

The aim was to determine which students had debilitating anxiety associated with oral examinations and whether their performance differed significantly from performance in other cognitive and behavioral evaluations obtained in a junior clerkship. Students with debilitating anxiety had lower interest in the clerkship, less favorable attitudes, less internal locus of control, lower self-esteem, and less favorable evaluations by peers.

Computerized, clinical data, pertaining to 21,000 patients at 4 family health centers, were used to examine possible relationships between psychosocial stress and physically manifested illnesses. Statistical tests revealed a significantly higher age-sex standardized prevalence rate of somatic complaints (e.g. arrythmia, chest pain, cystitis, cellulitis, obesity, abdominal pain, lower back pain, hypertension, headaches, dizziness, malaise, acute bronchitis, osteoarthritis, acute upper respiratory tract infections) in patients diagnosed with 1 of 4 selected indicators of psychosocial stress (i.e. anxiety, depression, couple conflict, child abuse/neglect) compared with the patient population which was not diagnosed as stressed. The findings are discussed in the context of the case-control research design used in the study. Although causal relationships cannot be established as a definitive outcome of the study, the findings lend further support to the mounting evidence that psychosocial stress is a contributing factor in a wide variety of physical complaints encountered by Primary Care physicians.