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  Mens Sana Monographs
A Monograph Series Devoted To The Understanding Of Medicine, Mental Health, Man, Mind, Music And Their Matrix
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   2008| January-December  | Volume 6 | Issue 1  
    Online since April 26, 2008

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Dual Psychological Processes Underlying Public Stigma and the Implications for Reducing Stigma
Glenn D Reeder, John B Pryor
January-December 2008, 6(1):175-186
DOI:10.4103/0973-1229.36546  PMID:22013358
People with serious illness or disability are often burdened with social stigma that promotes a cycle of poverty via unemployment, inadequate housing and threats to mental health. Stigma may be conceptualized in terms of self-stigma (e.g., shame and lowered self-esteem) or public stigma (e.g., the general public's prejudice towards the stigmatized). This article examines two psychological processes that underlie public stigma: associative processes and rule-based processes. Associative processes are quick and relatively automatic whereas rule-based processes take longer to manifest themselves and involve deliberate thinking. Associative and rule-based thinking require different assessment instruments, follow a different time course and lead to different effects (e.g., stigma-by-association vs attributional processing that results in blame). Of greatest importance is the fact that each process may require a different stigma-prevention strategy.
  11 16,563 384
Medical Ghost-Writing
Elise Langdon-Neuner
January-December 2008, 6(1):257-273
DOI:10.4103/0973-1229.33006  PMID:22013363
Any assistance an author receives with writing a scientific article that is not acknowledged in the article is described as ghost-writing. Articles ghost-written by medical writers engaged by pharmaceutical companies who have a vested interest in the content have caused concern after scandals revealed misleading content in some articles. A key criterion of authorship in medical journals is final approval of the article submitted for publication. Authors are responsible for the content of their articles and for acknowledging any assistance they receive. Action taken by some journals and medical writer associations to encourage acknowledgement is an uphill task in the light of disinterest from the pharmaceutical industry and ignorance or similar lack of interest by those who agree to be named authors. However, acknowledgment alone is not sufficient to resolve medical ghost-writing; issues of how the acknowledgement is formulated, permission to acknowledge and access to raw data also need to be tackled.
  9 12,516 363
Diseases of Poverty and Lifestyle, Well-Being and Human Development
Ajai R Singh, Shakuntala A Singh
January-December 2008, 6(1):187-225
DOI:10.4103/0973-1229.40567  PMID:22013359
The problems of the haves differ substantially from those of the have-nots. Individuals in developing societies have to fight mainly against infectious and communicable diseases, while in the developed world the battles are mainly against lifestyle diseases. Yet, at a very fundamental level, the problems are the same-the fight is against distress, disability, and premature death; against human exploitation and for human development and self-actualisation; against the callousness to critical concerns in regimes and scientific power centres. While there has been great progress in the treatment of individual diseases, human pathology continues to increase. Sicknesses are not decreasing in number, they are only changing in type. The primary diseases of poverty like TB, malaria, and HIV/AIDS-and the often co-morbid and ubiquitous malnutrition-take their toll on helpless populations in developing countries. Poverty is not just income deprivation but capability deprivation and optimism deprivation as well. While life expectancy may have increased in the haves, and infant and maternal mortality reduced, these gains have not necessarily ensured that well-being results. There are ever-multiplying numbers of individuals whose well-being is compromised due to lifestyle diseases. These diseases are the result of faulty lifestyles and the consequent crippling stress. But it serves no one's purpose to understand them as such. So, the prescription pad continues to prevail over lifestyle-change counselling or research. The struggle to achieve well-being and positive health, to ensure longevity, to combat lifestyle stress and professional burnout, and to reduce psychosomatic ailments continues unabated, with hardly an end in sight. We thus realise that morbidity, disability, and death assail all three societies: the ones with infectious diseases, the ones with diseases of poverty, and the ones with lifestyle diseases. If it is bacteria in their various forms that are the culprit in infectious diseases, it is poverty/deprivation in its various manifestations that is the culprit in poverty-related diseases, and it is lifestyle stress in its various avatars that is the culprit in lifestyle diseases. It is as though poverty and lifestyle stress have become the modern "bacteria" of developing and developed societies, respectively. For those societies afflicted with diseases of poverty, of course, the prime concern is to escape from the deadly grip of poverty-disease-deprivation-helplessness; but, while so doing, they must be careful not to land in the lap of lifestyle diseases. For the haves, the need is to seek well-being, positive health, and inner rootedness; to ask science not only to give them new pills for new ills, but to define and study how negative emotions hamper health and how positive ones promote it; to find out what is inner peace, what is the connection between spirituality and health, what is well-being, what is self-actualisation, what prevents disease, what leads to longevity, how simplicity impacts health, what attitudes help cope with chronic sicknesses, how sicknesses can be reversed (not just treated), etc. Studies on well-being, longevity, and simplicity need the concerted attention of researchers. The task ahead is cut out for each one of us: physician, patient, caregiver, biomedical researcher, writer/journalist, science administrator, policy maker, ethicist, man of religion, practitioner of alternate/complementary medicine, citizen of a world community, etc. Each one must do his or her bit to ensure freedom from disease and achieve well-being. Those in the developed world have the means to make life meaningful but, often, have lost the meaning of life itself; those in the developing world are fighting for survival but, often, have recipes to make life meaningful. This is especially true of a society like India, which is rapidly emerging from its underdeveloped status. It is an ancient civilization, with a philosophical outlook based on a robust mix of the temporal and the spiritual, with vibrant indigenous biomedical and related disciplines, for example, Ayurveda, Yoga, etc. It also has a burgeoning corpus of modern biomedical knowledge in active conversation with the rest of the world. It should be especially careful that, while it does not negate the fruits of economic development and scientific/biomedical advance that seem to beckon it in this century, it does not also forget the values that have added meaning and purpose to life; values that the ancients bequeathed it, drawn from their experiential knowledge down the centuries. The means that the developed have could combine with the recipes to make them meaningful that the developing have. That is the challenge ahead for mankind as it gropes its way out of poverty, disease, despair, alienation, anomie, and the ubiquitous all-devouring lifestyle stresses, and takes halting steps towards well-being and the glory of human development.
  9 30,223 543
Covert Treatment in Psychiatry: Do No Harm, True, But Also Dare to Care
Ajai R Singh
January-December 2008, 6(1):81-109
DOI:10.4103/0973-1229.40566  PMID:22013352
Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from some sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent.
  8 13,071 299
On Well-Being: Current Research Trends And Future Directions
C Robert Cloninger
January-December 2008, 6(1):3-9
DOI:10.4103/0973-1229.40564  PMID:22013345
  7 11,502 596
What Medical Journal Editing Means to Me
Harvey Marcovitch
January-December 2008, 6(1):237-243
DOI:10.4103/0973-1229.33004  PMID:22013361
Papers in medical journals are often difficult to understand and tedious to read. An editor's first loyalty should be to readers, by prioritising readability over merely producing a repository of data for the scientific community generally. The web now provides infinite repository space so there is even less excuse for journals to be unreadable. I give examples of how I attempted to improve one journal, despite external pressures and regardless of how it might affect the Impact Factor. As a postscript I outline increasing involvement in promoting honesty and integrity in publishing through the auspices of the Committee on Publication Ethics (COPE).
  6 7,229 246
Our Censored Journals
David Healy
January-December 2008, 6(1):244-256
DOI:10.4103/0973-1229.39302  PMID:22013362
When an article is rejected by a medical journal, the standard assumption is that the article is unsound or there is something wrong with the author. Alternatively, it may have been because the journal editor was concerned about the consequences should the article be published. This article seeks to inform discussion by providing a series of instances in which editorial concerns about the consequences to journals may have counted for more than any assessment about the truth-value of the article or the motives of its authors. This claim is based on the fact that different journals may treat exactly the same article in an entirely different fashion; some issues appear to be taboo in certain journals, no matter who the author, and there is a series of explicit communications from editors that publication has been held up by their legal departments.
  6 11,879 328
Positive Emotions, Spirituality and the Practice of Psychiatry
George E Vaillant
January-December 2008, 6(1):48-62
DOI:10.4103/0973-1229.36504  PMID:22013350
This paper proposes that eight positive emotions: awe, love (attachment), trust (faith), compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology; rather, spirituality is all about emotion and social connection. Specific religions, for all their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change if clinicians set about enhancing positive emotions rather than focusing only on negative emotions.
  6 24,949 721
Values-Based Practice: A New Partner to Evidence-Based Practice and A First for Psychiatry?
K.W.M Fulford
January-December 2008, 6(1):10-21
DOI:10.4103/0973-1229.40565  PMID:22013346
  5 13,831 565
Neurobiology of Spirituality
E Mohandas
January-December 2008, 6(1):63-80
DOI:10.4103/0973-1229.33001  PMID:22013351
Spiritual practices have been proposed to have many beneficial effects as far as mental health is concerned. The exact neural basis of these effects is slowly coming to light and different imaging techniques have elucidated the neural basis of meditative practices. The evidence though preliminary and based on studies replete with methodological constraints, points toward the involvement of the prefrontal and parietal cortices. The available data on meditation focus on activated frontal attentional network. Neuroimaging studies have shown that meditation results in an activation of the prefrontal cortex, activation of the thalamus and the inhibitory thalamic reticular nucleus and a resultant functional deafferentation of the parietal lobe. The neurochemical change as a result of meditative practices involves all the major neurotransmitter systems. The neurotransmitter changes contribute to the amelioration of anxiety and depressive symptomatology and in part explain the psychotogenic property of meditation. This overview highlights the involvement of multiple neural structures, the neurophysiological and neurochemical alterations observed in meditative practices.
  5 23,907 770
Biomedical Research and Corporate Interests: A Question of Academic Freedom
Leemon McHenry
January-December 2008, 6(1):146-156
DOI:10.4103/0973-1229.37086  PMID:22013356
The current situation in medicine has been described as a crisis of credibility, as the profit motive of industry has taken control of clinical trials and the dissemination of data. Pharmaceutical companies maintain a stranglehold over the content of medical journals in three ways: (1) by ghostwriting articles that bias the results of clinical trials, (2) by the sheer economic power they exert on journals due to the purchase of drug advertisements and journal reprints, and (3) by the threat of legal action against those researchers who seek to correct the misrepresentation of study results. This paper argues that Karl Popper's critical rationalism provides a corrective to the failure of academic freedom in biomedical research.
  4 9,623 268
Focus on Performance: The 21 st Century Revolution in Medical Education
Frank Davidoff
January-December 2008, 6(1):29-40
DOI:10.4103/0973-1229.37085  PMID:22013348
For centuries medicine was predominantly a tradition-based "trade" until the introduction of science transformed it into an intellectually rigorous discipline. That transformation contributed heavily to the dominance in medical education of the learning of biomedical concepts ("knowing that") over learning how to translate that knowledge into clinical performance ("knowing how"). The recent emergence of performance-oriented educational initiatives suggests, however, that the balance between these two complementary approaches is changing, a change that has been referred to as "the Flexnerian revolution of the 21 st century." Problem-based learning, learning the practice of evidence-based medicine, and learning to use clinical guidelines are among the important initiatives designed to develop high-level performance in the care of individual patients. Initiatives in which learners acquire skill in changing the performance of care systems are also being widely implemented. These trends have received important formal support through recent changes in residency training accreditation standards. Although it is too early to assess the impact of these initiatives or to know whether they will develop further, medical education is unlikely to reach its full potential unless it successfully comes to grips with the challenges of understanding, teaching, and measuring performance.
  4 10,874 442
Editorial Independence in the Electronic Age: New Threats, Old Owners?
John Hoey
January-December 2008, 6(1):226-236
DOI:10.4103/0973-1229.40568  PMID:22013360
Editorial independence is crucial for the intellectual life of a scientific journal.A journal exists only as an idea created by authors and readers, with some editorial orchestration. Editorial independence can be compromised by pressure put on editors by their owners-whether commercial publishers or professional organizations. Both types of owners rely heavily on income from paid advertising in their print journals. Yet, the massive expansion of journal readership that has resulted due to the development of the Web has effected a marked shift in the readership of the journal, both geographically and intellectually, producing a new community of users who see only electronic versions of the journal. Commercial pressures on owners to satisfy the interests of the (mainly national and professional) print readership conflict with the editorial independence needed to respond to the vast Web constituency. This is a major source for compromise of editorial independence. Reduction of commercial pressures by transferring editorial costs to authors and by other cost-reducing models are discussed in this article.
  3 7,078 251
Medicine as a Corporate Enterprise: A Welcome Step?
Murali Poduval, Jayita Poduval
January-December 2008, 6(1):157-174
DOI:10.4103/0973-1229.34714  PMID:22013357
The medical profession is set for a change. It is being redesigned as a corporate enterprise. The health-care industry has proved to be lucrative and therefore has seen the entry of newer players from the corporate field into the market. The "Medical-Industrial complex" has led to the commercialization of health care well beyond what traditional practitioners would consider ideal. Medicine is being treated as a business, with cost curtailment measures and profit margins often dictating physicians' choices. A number of factors decide working environment in a corporate setup, all of which may affect the sacrosanct physician-doctor relationship and "physician" ethics. On the other side, the ability of the corporate sector to bring about a welcome change in the health-care sector in terms of availability of newer modalities of management, implementation of preventive and personalized health-care programme and, at the same time, adding to the comfort of the treating physician cannot be ignored.
  2 9,339 308
In Revered Memory of Prof. N.S. Vahia
Ajai R Singh
January-December 2008, 6(1):0-0
DOI:10.4103/0973-1229.40572  PMID:22013367
  - 3,774 209
Medical Guidelines and Performance Measures: The Need to Keep Them Free of Industry Influence
Peter Q Eichacker, Charles Natanson
January-December 2008, 6(1):22-28
DOI:10.4103/0973-1229.33005  PMID:22013347
  - 9,012 302
Mindmelding: Connected Brains and the Problem of Consciousness
William Hirstein
January-December 2008, 6(1):110-130
DOI:10.4103/0973-1229.38516  PMID:22013353
Contrary to the widely-held view that our conscious states are necessarily private (in that only one person can ever experience them directly), in this paper I argue that it is possible for a person to directly experience the conscious states of another. This possibility removes an obstacle to thinking of conscious states as physical, since their apparent privacy makes them different from all other physical states. A separation can be made in the brain between our conscious mental representations and the other executive processes that manipulate them and are guided by them in planning and executing behaviour. I argue here that these executive processes are also largely responsible for producing our sense of self in the moment. Our conscious perceptual representations themselves reside primarily in the posterior portions of the brain's cortex, in the temporal and parietal lobes, while the executive processes reside primarily in the prefrontal lobes. We can imagine an experiment in which we sever the association fibers that connect the posterior regions with these prefrontal regions and, instead, connect the posterior regions to the prefrontal regions of another person. According to my hypothesis, this would produce in the latter person the direct experience of the conscious perceptual states of the first person.
  - 10,622 289
Oxford Textbook of Philosophy and Psychiatry
Ajit V Bhide
January-December 2008, 6(1):274-276
  - 7,936 214
Haiku: Philosophy, Metaphysics
Kristina Brenner
January-December 2008, 6(1):277-278
  - 4,929 182
The Body of Science
Kristina Brenner
January-December 2008, 6(1):278-279
  - 3,865 168
What Child and Adolescent Psychiatry Means to Me
L Eugene Arnold
January-December 2008, 6(1):131-134
  - 5,991 199
Daya Krishna (1924-2007)
Daniel Raveh
January-December 2008, 6(1):281-284
  - 5,391 179
Editors , Mens Sana Monographs
January-December 2008, 6(1):0-0
  - 2,958 225
Readers Respond
NN Wig
January-December 2008, 6(1):280-280
  - 2,786 160
Scientific Research: What it Means to Me
Jayant V Narlikar
January-December 2008, 6(1):135-145
DOI:10.4103/0973-1229.33003  PMID:22013355
This article gives a personal perception of the author, of what scientific research means. Citing examples from the lives of all time greats like Newton, Kelvin and Maxwell he stresses the agonies of thinking up new ideas, the urge for creativity and the pleasure one derives from the process when it is completed. He then narrates instances from his own life that proved inspirational towards his research career. In his early studenthood, his parents and maternal uncle had widened his intellectual horizons while in later life his interaction with Fred Hoyle made him take up research challenges away from the beaten path. He concludes that taking up an anti-Establishment stand in research can create many logistical difficulties, but the rewards of success are all the more pleasing.
  - 9,079 264
Are Jews Smarter Than Everyone Else?
Sander L Gilman
January-December 2008, 6(1):41-47
DOI:10.4103/0973-1229.34526  PMID:22013349
The debate about "race" and "intelligence" seems to be never ending. The "special nature" of the intelligence ascribed to "Jews" has recently reappeared in an essay by one of the authors of the notorious study of race and intelligence - The Bell Curve . How this debate is constructed and what its implications are for the reappearance of "race" as a category in medical and biological science is at the core of this present essay.
  - 13,439 321
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