1. Tan'gun sinhwa ŭi wŏnhyŏngjŏk segyegwan kwa p'ungnyu chŏngsin -- 2. Wŏnhyo ŭi hwajaeng sasang kwa muaehaeng ŭi silch'ŏn -- 3. Ŭisang ŭi 'Hwaŏm ilsŭng pŏpkyedo' e nat'anan Hwaŏm sasang -- 4. Chinul ŭi Tono chŏmsu wa Chŏnghye ssangsu sasang -- 5. Sambong Chŏng To-jŏn ŭi Pulgyo paech'ŏk ŭi naeyong kwa sŏngkyŏk -- 6. T'oegye Yi Hwang ŭi ch'ŏrhakchŏk ipchang kwa 'Kyŏng' sasang -- 7. Kobong Ki Tae-sŭng ŭi hangmun chŏngsin kwa ch'ŏrhak sasang -- 8. Ugye Sŏng Hon ŭi Tohakchŏk (...) sam kwa hangmun yŏnwŏn -- 9. Yulgok Yi I ŭi Taedong sahoeron kwa ch'ŏrhakchŏk chihyang -- 10. Sŏgye Pak Se-dang ŭi Sirhakchŏk sayu ŭi kich'o -- 11. Namdang Han Wŏn-jin ŭi yŏksa insik kwa Chosŏn chunghwajuŭi -- 12. Sŏngdam Song Hwan-gi ŭi 'T'aegŭk tosŏl' haesŏk ŭi kibon ipchang -- 13. Kanjŏng Yi Nŭng-hwa 'Chosŏn Togyosa' ŭi haksulsachŏk ŭiŭi wa han'gye -- 14. Manhae Han Yong-un i pon chuch'e ŭi munje wa minjok chagyŏl ŭi wŏnch'ik -- purok. T'algyŏnggye sidae ŭi Han'guk ch'ŏrhak ŭi inmunhakchŏk ŭiŭi wa chŏnmang: Yulgok ŭi ch'ŏrhak. (shrink)

덜그럭 덜그럭 소란한 우리네 마음 살림살이를 깨끗하게 청소해주는 산중 큰스님을 만나다 “쩔쩔 맬 것 없이, 집착할 것도 없이, 한세상 훨훨 살아라!” ‘집안 살림’이 아무리 풍족해도 ‘마음 살림’ 부족하면 다 헛인생이다. 진짜 잘사는 사람은 쩔쩔 맬 일도 없이, 집착할 것도 없이 트인 마음으로 훨훨 살아가는 사람이 아닐까? 그런 길로 안내하는 스물일곱 산중 선승들을 만났다.“우리는 누구인가”, “어떻게 살아야 하는가”, “마음과 몸이 힘들고 어려울 때는 어떻게 해야 할까”. 저자는 오래전부터 팍팍한 세상에 필요한 ‘마음 살림살이’를 탁발하러 선승들을 찾아다녔다. 때로는 시대와 역사와 사회에 대한 촌철의 (...) 말씀을 청했고, 때로는 노스님의 살아온 이야기를 듣고 일상을 엿보기도 했다. 모든 스님들이 무더운 여름날 한줄기 시원한 소나기였다. 이 책에는 ‘염화실의 향기’라는 이름으로 경향신문에 연재한 글을 보완해 다시 쓴 것과 이후 만난 큰스님까지 모두 스물일곱 분의 이야기를 담았다. 그사이 이 세상을 떠나가신 큰스님들은 2부에 따로 모셨다. 스님들 몸은 산중에 있어서도 그 말씀은 속세를 떠나지 않았다. 어지럽고 어려운 이 세상을 향한 한 말씀 한 말씀은 송곳처럼 정곡을 찌르며 우리네 눈과 귀, 마음을 환하게 밝혀준다. 깨끗하게 비질 된 큰스님들의 ‘마음 마당’을 거닐다보면, 누구나 잃었던 마음의 본래 밝음을 되찾고, 저마다 ‘마음을 살리는 화두’ 하나씩 가슴에 품게 된다. (shrink)

1. Yugyo chŏnt'ong kwa taedong inyŏm -- 2. Yugyo chŏnt'ong, Han'guk minjujuŭi, taedong minjujuŭi -- 3. Taedong minjujuŭi wa pip'an iron ŭi pangbŏp -- 4. Munmyŏng chŏnhwan ŭi sidae wa saengt'ae, taedong minjujuŭi ŭi kanŭngsŏng.

1. T'oegye wa Hip'ok'ŭrat'esŭ ka mannagi kkaji -- 2. Taehwa e ch'amyŏ hasin pundŭl -- 3. Che 1-il. 'Kojŏn muksang' : kijon ŭi palgyŏndŭl ŭl ch'ulbalchŏm ŭro samaya -- 4. Che 2-il. 'Chonjaeron': mom an ŭi param ŭn hohŭp, mom pak ŭi param ŭn konggi -- 5. Che 3-il. 'Chŏngsŏ haengdongnon': chari ŭi ch'ai ro inhae sŏro tarŭda -- 6. Che 4-il. 'Kongburon': chonjae haji annŭn ŭisul ŭn ŏpta -- 7. Che 5-il. 'Chihaengnon': maŭm i p'yŏnhaji anŭl ttae nŭn han (...) kŏrŭm kŏrŏra -- 8. Che 6-il. 'Yulliron': kajang hullyunghan ŭihak ŭn ŭihak ŭl p'iryo ro haji ank'e hanŭn kŏt -- 9. Che 7-il. 'Chilli nŭn kat'ŭn kot e': modŭn kŏt ŭi sijak kwa kkŭt ŭn hana ida -- 10. Hip'ok'ŭrat'esŭ myŏngŏndŭl. (shrink)

Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy (...) of a 4-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after four weeks of treatment as usual. Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. Jumping to conclusions and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to treatment as usual, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. Jumping to conclusions bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approach. (shrink)

BackgroundIn the 1970s, the Federal Trade Commission declared that allowing medical providers to advertise directly to consumers would be “providing the public with truthful information about the price, quality or other aspects of their service.” However, our understanding of the advertising content is highly limited.ObjectiveTo assess whether direct-to-consumer medical service advertisements provide relevant information on access, quality and cost of care, a content analysis was conducted.MethodTelevision and online advertisements for medical services directly targeting consumers were collected in two major urban (...) centres in Nevada, USA, identifying 313 television advertisements and 200 non-duplicate online advertisements.ResultsBoth television and online advertisements reliably conveyed information about the services provided and how to make an appointment. At the same time, less than half of the advertisements featured insurance information and hours of operation and less than a quarter of them contained information regarding the quality and price of care. The claims of quality were substantiated in even fewer advertisements. The scarcity of quality and cost information was more severe in television advertisements.ConclusionThere is little evidence that medical service advertising, in its current form, would contribute to lower prices or improved quality of care by providing valuable information to consumers. (shrink)

A common assumption in the selection of nonhuman animal subjects for research and the approval of research is that, if the risks of a procedure are too great for humans, and if there is a so-called scientific necessity, then it is permissible to use nonhuman animal subjects. I reject the common assumption as neglecting the central ethical issue of the permissibility of using nonhuman animal subjects and as being inconsistent with the principle of justice used in human subjects research ethics. (...) This principle requires that certain classes of individuals not be subjected to a disproportionate share of the burdens or risks of research. I argue for an extension of this principle to nonhuman animal research and show that a prima facie violation of the principle occurs because nonhuman animals bear an overwhelmingly disproportionate share of the risks of research without sufficient justification or reciprocal benefit. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryChong Siow Ann, Associate ProfessorDr. G appears to experiencing symptoms of schizophrenia, which is arguably the most severe mental disorder and which afflicts about one in a hundred people. This is a psychotic disorder that causes disturbances and distortions in thinking, including neurocognitive impairments, perception and behaviour. There is no cure for this often devastating disorder. Current antipsychotic medications can alleviate some of the symptoms but it often (...) comes at a price as these antipsychotics have burdensome side effects.A feature of this disorder is anosognosia, which is a lack of awareness or “insight” that an illness is present. This lack of insight presents a particular challenge because these individuals would, as in the case of Dr. G, refuse needed treatment as they do not perceive that they are ill. This is not necessarily an all-or-none phenomenon but is rather more complex and multidimensional; there might be an unawareness or recognition on behalf of the patient that they are suffering from a mental illness, the failure to appreciate the necessity of treatment; and/or the inability to recognise and define the psychotic symptoms like unusual thoughts and hallucinations as signs of illness1 and in many instances, all three are present. It is also by no means uncommon. Studies have found that between 60% and 80% of people with schizophrenia lack awareness of their illness to varying degrees.2This phenomenon remains an enigma. Some regard it as a form of psychological defence against the harsh reality of a psychotic illness — awareness of having a chronic and devastating illness might lead to demoralisation, hopelessness and suicide.3 Recent research, however, [End Page 250] indicates that this psychological denial plays a small part, if any, and instead has found an association with certain neuropsychological and neurocognitive deficits,4 as well as functional and structural brain abnormalities in the frontal lobe of the brain.5The prevailing clinical view thus is that this is an intrinsic and organic aspect of the schizophrenic illness which has nothing to do with wilfulness but rather the incapacity to perceive the presence of the illness. Edwin Fuller Torrey, an eminent psychiatrist and executive director of the Stanley Medical Research Foundation, calls anosognosia the “single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications”, and he has remarked that “to keep talking about civil liberty is illogical. Patients are anything but free when they’re at the beck and call of their own delusions”.6It is also this view that it is a product of a brain disorder that some — particularly patients — find unacceptable. At one level, it does not take into context the person’s own experiences, and at a deeper level it calls into question the conception of the self with its capacity to exercise judgements and the autonomy to make decisions.This is a perennial ethical issue in psychiatry when people with severe mental illnesses refuse treatment. This becomes a Catch-22 situation where part of the illness that needs treatment is also preventing any treatment to be given: implicit in the principle of informed consent for treatment is that the person should be aware of the nature and course of their illness and acknowledge the need for treatment. While there are laws for involuntary commitment, the bar is usually high in that there must be a clear and present risk of harm to the person or others. Alan Stone, a professor of law and psychiatry at Harvard University proposed a possible justification for involuntary treatment based on his “thank-you theory” which assumes that patients will become well and subsequently agree that the intervention was in their best interests but research suggests that only half of these patients would admit so.7One suggested mechanism is the use of advance directives — psychiatry’s version of the living will in which people can specify what sort of medical care they would like should they become mentally unwell and unable to exercise appropriate judgement. An intrinsic part of this might include a “Ulysses contract” — just as Ulysess instructed his crew to lash him to the mast of the his ship so that he could... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Underplayed Ethics and the Dilemmas of Psychiatric CareChong Siow Ann and Tamra LysaghtThe practice of psychiatry is fraught with uncertainty. The exact causes and the biological substrates underlying mental disorders remain to be elucidated; even the diagnosis of these disorders is descriptive and not based on an etiological understanding and no biological diagnostic markers have been validated. The manifestation of almost all mental disorders results from a complex interaction (...) of biological and environmental factors which encompasses the patient’s unique life history, experiences and relationship with others and the community. In the face of such uncertainties — at times extending to the types of treatment (psychiatry is generally acknowledged not be an exact science) — it has been argued that adopting a pragmatic approach is necessary.1 Accordingly, this approach necessitates high ethical standards among mental health practitioners.Some mental illnesses are associated with varying degrees and types of cognitive impairments. Others have certain symptoms like auditory hallucinations and delusions that might severely compromise the patients’ autonomy, distort their sense of reality, increase the risk of harm to themselves or others and render them incapable of making informed decisions in their treatment and participation in research.Consequently, there are issues that are particular to the provision of mental healthcare. These include the need for enforced involuntary treatment with the corollary of depriving a patient of his personal liberty even [End Page 173] though it is often justified on the grounds that it is in the patient’s best interests. However, at times, it is the legal and societal obligation of mental health practitioners to protect those who might be harmed from the patient’s action that might seem to be more pressing. In this situation of double agency, lies the tension of providing confidential care for patients and acting as “an agent of the state” where that patient’s confidentiality might be breached and his liberty infringed upon. This situation is further aggravated by the stigma that clings ever so tenaciously to those who suffer from mental disorders and where it is the norm to stereotype them as dangerous and unpredictable.Consideration of a patient’s autonomy is also challenged by characteristics that are unique to the practice of psychiatry. The prescription of certain psychotropic medications can alter how people think and feel, while psychotherapy works towards changing the patient’s views and values. The philosopher, Jennifer Radden, describes this process as “re-forming the patient’s whole self or character … akin to the responsibilities of raising children”.2 The psychotherapeutic relationship is thus particularly personal and intimate because patients are asked to provide information that often reveals their innermost feelings, fears and fantasies. This information is provided on the basis of trust and assurance of confidentiality, and with expectation of being helped.Jeremy Holmes and Gwen Adshead have elaborated on the vulnerability of patients seeking psychotherapy: they might be particularly susceptible to exploitation because their past experiences of being exploited have led to their distress and help seeking — their dependency and the extreme privacy of the therapeutic relationship make any transgression difficult to be uncovered.3 There is a calamitous combination of the “unconscious wish in the patient to be used” with the complicity of an unethical therapist seeking to fulfil his own interests.4As in any other doctor-patient relationship, the relationship between the mental healthcare practitioner and the patient is one of unequal power where the former is ascendant. While that power should be exercised to heal and to relieve suffering, it also gives the practitioner tremendous power “to harm, reject, misunderstand, or exploit patients who struggle with the experience of mental illness, which itself may generate helplessness, despair, distress, and exceptional dependence on the clinician”.5 Given the potential of doing good and harm coupled with the likelihood of being so significant in the life of the patient,6 providing care for those with mental disorders and distress is necessarily ethically exacting — arguably more so than in other medical practice settings. [End Page 174]This precariousness has led to the suggestion that ethics in psychiatry should have a special status and that the more general principles of biomedical ethics are too limited in scope to... (shrink)