In this groundbreaking book, psychiatrist and ethicist Mona Gupta analyzes the basic assumptions of Evidence-based medicine (EBM), and critically examines their applicability to psychiatry. Highlighting ethical tensions between psychiatry and EBM, she asks the controversial question - should psychiatrists practice evidence-based medicine at all?

Spirituality in the workplace is gaining recognition and value among researchers, academicians, and business professionals. The aim of this paper is to examine the impact of spirituality in the workplace on job satisfaction by measuring four dimensions of spirituality in the workplace: meaningful work, sense of community, organizational values, and compassion. The impact of each dimension on job satisfaction is hypothesized. A cross-sectional survey was used to collect data from 100 payroll employees in private insurance companies in Punjab. A correlation (...) analysis showed a positive relationship between all the dimensions of spirituality in the workplace and job satisfaction. A regression analysis revealed that although all the dimensions of spirituality in the workplace are important, organizational values and a sense of community are the most important in terms of the job satisfaction level of employees. This work will help insurance companies to better understand the concept of spirituality in the workplace and its importance. Insurance companies can improve their functioning by encouraging employee spirituality in the workplace. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a shift (...) in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric (...) knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs. (shrink)

Acts of intimate partner violence and abuse of nonhuman animals are common, harmful, and co-occurring phenomena. The aim of the present study was to identify perpetrator subtypes based on variable paths hypothesized to influence physical violence toward both partners and nonhuman animals: callousness and instrumental representations of aggression and rejection-sensitivity and expressive representations of aggression. Strong associations emerged between callousness and instrumental representations and between rejection-sensitivity and expressive representations. For males, callousness directly predicted both IPV and animal abuse. For females, (...) rejection-sensitivity predicted IPV. Instrumental representations mediated the relationship between callousness and animal abuse for females but not for males. Results suggest that IPV and animal abuse functionally interconnect, that perpetration of animal abuse may differ in function across gender, and that identifying distinct pathways to violence may facilitate violence prediction and prevention. (shrink)

This study offers a feminist analysis of the dominant sociological theories of ethnicity that restrict understandings of immigrant identity formation within the boundaries of the United States. These scholars have, for the most part, been preoccupied with the loss or persistence of ethnicity. By using a transnational approach to interpret data, this article argues that questions of identity have to be linked to what gets designated as ethnic culture and tradition by immigrant communities. These designations often hierarchically reorganize difference, with (...) immigrant women bearing the weight of signifying their communities' ethnic identity. An examination of what counts as culture is necessary if feminist scholarship on immigrant identities is to pose an alternative to depoliticized notions of multiculturalism. (shrink)

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)

Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed (...) to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics. (shrink)

Evidence-based medicine (EBM) made its first appearance in the medical lexicon in 1990 and since then has enjoyed widespread support from within the medical profession, including among psychiatrists. Proponents of evidence-based psychiatry (EBP) point to its ability to demonstrate the efficacy of various psychiatric treatments, promising improved mental health outcomes and more efficient use of healthcare resources as a result. Policymakers and insurers have embraced EBP in hopes that these goals will be realized. However, the question of whether EBM is (...) even applicable to psychiatry remains largely unaddressed, even though it is an urgent one, given the various corporate, professional, and governmental pressures .. (shrink)

North American psychiatric literature describes the current method of psychiatric diagnostic assessment as "phenomenological"; however, it is unclear what phenomenology 1 means in this context. This paper investigates the meaning and impact of some of the major philosophical and psychiatric definitions of phenomenology on contemporary psychiatric assessment. Employing a comparative analysis of selected definitions of phenomenology, this paper argues that North American psychiatric assessment does not reflect any of these definitions of phenomenology. Instead, within the context of psychiatric assessment, phenomenology (...) has taken on an idiosyncratic, clinical meaning of signs and symptoms. However, this does not mean that phenomenology has had no impact on North American psychiatry. This paper contends that phenomenology has made contributions to psychiatry, particularly in the area of psychotherapy and especially in self-psychological psychotherapy. The importance of the concept of empathy within psychotherapy is evidence of the continuing influence of philosophical phenomenology on psychiatry. This paper concludes that phenomenology can provide an important complementary perspective to the dominant methods of North American psychiatric practice. (shrink)

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)

In 20141 and 2016,2 respectively, Québec and Canada adopted legislation permitting medical assistance in dying (MAID). In this context, the question of whether persons with mental disorders should be able to access MAID has received considerable scrutiny.Over the last 5 years, I have been involved in the academic and policy debates about assisted dying for persons with mental disorders. Policymakers and clinicians alike demand that public policy be based on 'evidence' by which they tend to mean empirical, usually quantitative, data. (...) There is little acknowledgement that some questions are not empirical and that facts require interpretation.The debate about whether a request for assistance in dying by a person with a... Read More. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 93-96 [Access article in PDF] Phenomenological Methods in Psychiatry:A Necessary First Step M. Gupta and L. Rex Kay Keywords: behavior, empathy, human science, methodology, natural science, phenomenology. WE ARE GRATEFUL to the journal for prviding the opportunity for exchange and discussion of some of the themes raised in our paper, "The impact of phenomenology on North American psychiatric assessment" and we are pleased (...) to be able to reply to the two excellent commentaries by McMillan and Morley. Both McMillan and Morley question the prospect of employing phenomenology and its methods in psychiatric assessment, and in psychiatric practice more generally. McMillan questions the utility of such a step, and Morley is pessimistic about its feasibility. We shall address each author's concerns in turn.Initially, let us restate the aims of our paper to contextualize our arguments and those made in the commentaries. First, we sought an understanding of what is meant by North American psychiatrists, working within the DSM framework, when they refer to the phenomenological approach to psychiatric assessment. To elucidate this meaning, we compared the contemporary North American usage to a small number of definitions of phenomenology, particularly those definitions that were, and are now, applied to clinical psychiatric work. Contrary to McMillan's suggestion, we did not intend to state definitively what should or should not count as phenomenological, but rather to compare North American psychiatric assessment to what typically has counted as phenomenological. Second, we sought to examine phenomenology's influence on North American psychiatric practice, particularly psychotherapy.Morley argues that such influences usually exemplify the inappropriate appending of phenomenology to psychiatric practice rather than true integration of different paradigms. Although we do not disagree with this general contention, we will argue that the deployment of phenomenological methods in psychiatric assessment is a necessary first step toward the kind of integration he proposes.McMillan makes two related but unintegrated points. First, he argues that objective, behavioral data are phenomenological, according to his broad definition of the term. Second, he proposes that, if the behavioral and the phenomenological are different, we are better off staying with the behavioral when it comes to psychiatric nosology. Let us consider these two points in succession.McMillan seeks to broaden Jasper's definition of phenomenology to include objective observations [End Page 93] as phenomenological. To this end, he distinguishes methods from aims. He summarizes Jasper's definition of phenomenology as "an empirical method for investigating 'individual psychic experience (p 55)" and claims that this is a statement of aim or objectives. He then urges us to "consider the merits of different phenomenological methodologies in terms of their success in achieving this objective" whether or not they utilize "all the methods" of phenomenology. This is much like saying that if we treat waving one's hand as a method for greeting someone, we are then free to treat the objective of the wave as one of greeting someone, and then say that anything that serves as a greeting is, by definition, a "wave." Whatever else McMillan's objective observations are, he has not convinced us that they are phenomenological, anymore than we are likely to convince you that a kiss on the lips is really just a wave.Nonetheless, it is worthwhile seeing what McMillan does with this argument. He tells us that we can "read the first-person experience from behavior in a fairly accurate and informative way." He uses the example of a father gazing at his young child and notes that it is not unreasonable to infer that he is experiencing loving and nurturing feelings. It is, indeed, not unreasonable to draw such an inference. But it is far more reasonable to infer that the father is experiencing a cacophony of feelings, including, but not limited to, love, concern, anxiety, pride, envy, hope, and sadness (Stern 1995, 18-58). If we are able to distinguish which of these feelings is dominant at any given moment—which we are—and if we are also able to track subtle shifts in such feelings... (shrink)

Vāda, the classical name for the act of discussion/debate in the Indian tradition, forms the basis of every conversation undertaken to reach correct knowledge. The paper explores the Indian tradition of Vāda and its subcategories with the intention of highlighting the all-encompassing and holistic nature of this Indian tool of cultural studies in both theory and praxis. It checks into its evolution through contemporary times, wherein it has lost its essence to accommodate the corrupted interests of modern individuals as well (...) as leaders and debaters. Through the analysis of various examples, the paper endeavours to establish Vāda as a comprehensive way to attain correct knowledge. Examples from day-to-day life as well as the historic-literary world help to explicitly comprehend these tools that have been used for establishing the nearest truth from ancient times in India. These tools are potent to all aspects of research across spatial-temporal limits as they are innate and immutable to all disciplines of knowledge and education. (shrink)

This is a broad overview of how the prevalent family systems in the developing world influence sex preference for children. Son preference is evident in the data in East Asia and South Asia, and in the Middle East and North Africa, where patriarchal family systems make sons more valuable than daughters to parents in terms of economic, physical, and emotional sustenance. In sub-Saharan Africa, Latin America and Southeast Asia, there is little difference between the levels of support parents can expect (...) from sons and daughters—and little revealed sex preference in the data. (shrink)

Scott Waterman's reflection on his experience with chronic pain and alternative treatments raises a fundamental question in medical epistemology: How can we know that an intervention will help people who are suffering?Waterman's details his trial of an alternative therapy with a dubious pathophysiological rationale. Despite the lack of research demonstrating its efficacy, and a lack of therapeutic benefit for him in particular, he acknowledges its benefit to others who were more attitudinally predisposed to it. This leads him to conclude that (...) one's personal beliefs and explanatory hypotheses play a role in the healing process. From this he concludes that data from clinical studies conducted according to... (shrink)

In his paper, A Logic in Madness, Aaron Hauptman describes the evolving clinical picture of Mr. A, a patient with Asperger’s syndrome who presents with symptoms consistent with a major depressive episode. In his case discussion, Hauptman describes the difficulties, both conceptual and practical, faced by the clinical team in trying to help this man recover from his depression. Among these he identifies: ‘the ethics of mandated treatment, definitions of mental illness, rationality in the context of psychiatric disorders, and the (...) limitations on patient autonomy in a psychiatric inpatient setting’. In this response to Hauptman’s paper, I discuss the first and last concerns with emphasis on... (shrink)

As the title suggests, this paper looks at the Deleuzian concept of body without organs and compares it with Indian Philosophy. In the Indian context, the concept of moksha/nirvana comes near to it as both are practices that aim at liberation; here, ‘liberation’ is never the awaited end of the process but the process itself. The traditional western substantialism rests on things whereas Deleuze, like Indian Philosophy, celebrates ‘experience’ and the ‘incorporeal’. Thus, body without organs plays a role in individuation. (...) It hints at a journey beyond ‘the self’ which is full of ecstasy or the ananda of the Indian thought system. The question of Being, which not only is conceptual identification, is presented in terms of the virtual and the actual. For Deleuze and Guattari, every actual body has a virtual dimension, a vast reservoir of potentials, and this is the body without organs. The actual emerges from it and carries it with it. Further, the plane of immanence is a field in which concepts are produced. It is neither external to the Self nor forms an external self or a non-self. It is ‘an absolute outside’, very much like Brahman. The pragmatics of Deleuzian theory is that it explains life to be ‘immanence of immanence, absolute immanence’ – an utter beatitude – which has a Vedantic counterpart where the essential Brahman is a combination of three attributes – sat, chit and ananda. Thus, this paper aims at the interesting comparison between Deleuzian theory and Indian Philosophy. (shrink)

This book explores the integral vision of human development contained in the original works of Sri Aurobindo and The Mother. It delves into multiple layers of the human personality as envisaged by Sri Aurobindo and The Mother and explores a new developmental science of consciousness based on the practice of Integral Yoga. The book examines the major metatheoretical conceptions that shape the contemporary discipline of developmental psychology and discusses the ways in which Sri Aurobindo's philosophical and psychological perspective can help (...) break fresh ground for developmental theorisation and research by extending the current understanding of the human evolutionary potential. The author proposes a new agenda for human development which brings together the key ideas of integral individual and collective development and informs practices in the areas of counselling, education, parenting, and self-development. This book will be of special interest for researchers of developmental psychology, human development, counselling psychology, philosophy, social work, and education. (shrink)

The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within all postgraduate (...) specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation. (shrink)

In her paper, “Evidence-based medicine in context: A pragmatist approach to psychiatric practice,” Jorid Moen sets out to advance the debate about role of evidence-based medicine in psychiatric practice. She views this debate as dichotomous and unproductive. It is dichotomous in the sense that EBM is linked to foundationalist theories of knowledge, whereas critiques of EBM are often based in anti-foundationalist theory. It is unproductive because neither position offers a way forward. Moen draws on the philosophical tradition of pragmatism in (...) hopes that ‘opposing positions of EBM might be brought to agree that the different perspectives they represent are both relevant and important for psychiatric. (shrink)

Developing country efforts to enforce basic public health standards are often hindered by limited agency resources and poorly designed enforcement mechanisms, including excessive reliance on slow and erratic judicial systems. Traditional public health regulation can therefore be difficult to implement. This article examines innovative approaches to the implementation of public health regulations that have emerged in recent years within the OECD countries. These approaches aim to improve compliance with health standards among the different actors while reducing dependence on the legal (...) system and the administrative resources of public health agencies in developing countries. Developing countries may find some useful lessons from these approaches that can be adapted for use in their own institutional settings. (shrink)

Public health agencies undertake a broad range of health promotion and injury and disease prevention activities in collaboration with an array of actors, such as the community, businesses, and non-profit organizations. These activities are “multisectoral” in nature and centered on public health agencies that oversee and engage with the other actors. Public health agencies can influence the hazardous activities in the private sector in a variety of ways, “ranging from prohibition and regulation to volunteerism, and from cooperation to cooption.” Hence, (...) a public health agency that possesses the necessary administrative resources and authority is vital to the effective implementation of health policies and regulations.In the developing world, however, many state health agencies lack these basic capacities in dealing with critical health threats, including their ability to avert epidemics of communicable diseases arising from poor sanitary conditions. A serious constraint is the shortage of public health funding for health agencies in the developing world for typical agency functions. This is often aggravated by the transaction-intensive demands entailed in enforcing regulations among an array of private and public sector actors including individuals, businesses, and local bodies responsible for providing civic services. (shrink)