Patricia Rieker
Boston University, Sociology, Faculty Member
The victim-to-patient process is reconceptualized as an interplay among abuse events, family relationships, and other life contexts, emphasizing the fragmented identity deriving from accommodations to the judgments of others about the... more
The victim-to-patient process is reconceptualized as an interplay among abuse events, family relationships, and other life contexts, emphasizing the fragmented identity deriving from accommodations to the judgments of others about the abuse. Original defenses are seen to form the later core of the survivor's psychopathology. This schema helps clinicians to understand obstacles to treatment and recovery and to recognize the behavior reflecting disconfirmation and transformation of abuse.
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Teaching residents in psychiatry to be aware of sexist attitudes in psychiatric theory, training, and practice is difficult for both the instructors and the trainees. When residents are confronted with the extent to which sex-role... more
Teaching residents in psychiatry to be aware of sexist attitudes in psychiatric theory, training, and practice is difficult for both the instructors and the trainees. When residents are confronted with the extent to which sex-role socialization has shaped not only their own values but also the values and behaviors of their mentors, patients, and intimates, they respond with intense anxiety. The instructors, as the messengers who bring the “bad” news, become the objects of their hostility and frustration. Thus, an important aspect of the instructor role is the ability to remain empathic (and nonviolent) when confronted with the most creative forms of resistance to learning. Until recently, there has been little reinforcement for residents to explore gender attitudes and few rewards for instructors’ efforts to teach in this affect-laden and value-conflicted area.1 In this paper we describe an effective model for teaching and evaluating a one-semester course on gender and psychotherapy, in which a central feature is team teaching by a psychiatrist and a sociologist.
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A psychiatrist and a psychiatric nurse interviewed 33 physicians and 94 nurses at a cancer center about their experience working with oncology patients, including their usual approach to "denial" seen in these patients.... more
A psychiatrist and a psychiatric nurse interviewed 33 physicians and 94 nurses at a cancer center about their experience working with oncology patients, including their usual approach to "denial" seen in these patients. Most respondents viewed denial as a useful, nearly universal defense mechanism, potentially capable of interfering with treatment. Physicians described a pattern in which their patients were presented with the facts one time during diagnosis and formulation of a treatment plan, after which denial was allowed and new facts not offered unless the denial was viewed as interfering with the medical intervention. Nurses more often referred to denial as a phase, stressing the importance of honesty in dealing with patients who are prone to deny. They experienced discomfort when patients who were suffering adverse effects of treatment seemed to need greater honesty from their physicians. Discussion of these differences includes the effect of the contexts in which nurses and physicians encounter denial as well as their complementary roles in patient care, and the differential goals and values of the two professions.
Research Interests: Nursing, Cancer, Medicine, Humans, Medical Oncology, and 14 moreFemale, Cancer Nursing, Oncology Nursing, Male, Cancer Care Facilities, Boston, Questionnaires, Adult, Denial, Public health systems and services research, Neoplasms, Honesty, Guidance and Counseling Intervention Programs, and Psychology of Denial
Research Interests: Psychology, Jurisprudence, Higher Education, Medical Education, Family, and 15 moreSocialization, Medicine, Interpersonal Relationship, Medical Students, Humans, Female, Male, Gender Difference, Role Conflict, Comparative Analysis, Interpersonal Relations, Academic Medicine, Questionnaires, Sex Factors, and Curriculum and Pedagogy
This collection of readings is designed to clarify the relationship between social structures and psychological processes. Our awareness of the need for such a book derives from our extensive experiences in teaching a for mal course for... more
This collection of readings is designed to clarify the relationship between social structures and psychological processes. Our awareness of the need for such a book derives from our extensive experiences in teaching a for mal course for mental health professionals on gender and psychother apy. The material in this anthology emphasizes the clinical implications of the new research and knowledge that has changed our understanding of the psychological development of women and men. Throughout the book, we present ideas that challenge conventional explanations of psy chological distress in women and men and suggest alternative concep tualizations of these processes. As will be evident, our work is informed by and contributes to the growing field of knowledge produced by feminist scholars over the last decade. That this book on gender has more to say about women reflects the existence of a substantial body of research that reconceptualizes women's psychology. The corresponding research on men is still in its formative stages, due in part to the later development of a men's move ment. Although many of the chapters focus on women, we have attempted in our discussion to consider the implications for men. We believe that the fundamental processes explored in this book are relevant to the understanding of both women and men."
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Social science differs from the other basic medical sciences in that its perspective for understanding illness is not centered on processes within the individual. For this reason the relevance of social science knowledge to clinical... more
Social science differs from the other basic medical sciences in that its perspective for understanding illness is not centered on processes within the individual. For this reason the relevance of social science knowledge to clinical practice is not obvious to many medical educators and students. Initial efforts at the University of North Carolina to develop a social science curriculum that is obviously relevant are described. Strategies include the use of small-group seminars taught by social-scientist/clinician teams and an organizing framework which links social science knowledge to clinical practice. Response to the curriculum from faculty and students has been encouraging.
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ABSTRACT Bone marrow transplantation (BMT), once a highly experimental procedure performed in only a handful of medical centers, has become increasingly common and is now considered to be the treatment of choice for some diseases.... more
ABSTRACT Bone marrow transplantation (BMT), once a highly experimental procedure performed in only a handful of medical centers, has become increasingly common and is now considered to be the treatment of choice for some diseases. Although a growing number of pediatric patients undergo this life-saving procedure, psychosocial research has focused primarily on adult BMT patients. This article presents data from an exploratory study of 73 parents whose children successfully completed the transplant. The study identified the major concerns and needs of this unique population as they coped with life after a child's transplant. The results indicated that although most parents coped adequately, certain problems such as financial strains and fears of relapse remained.
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Page 1. The Impact of Testicular Cancer on the Work Lives of Survivors. Susan D. Edbril, EdM Patricia P. Rieker, PhD ABSTRACT. This study examines the impact of cancer on work among adult male survivors of testicular cancer. ...
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To assess the feasibility of early discharge to home therapy with standard intravenous antibiotics in 30 patients with fever and neutropenia at low risk by a validated clinical decision rule. Newly admitted outpatients with fever and... more
To assess the feasibility of early discharge to home therapy with standard intravenous antibiotics in 30 patients with fever and neutropenia at low risk by a validated clinical decision rule. Newly admitted outpatients with fever and neutropenia were evaluated for home therapy during 2 days of inpatient observation. To evaluate enrolled patients' acceptance of home care, we assessed patient attitudes and quality of life before and after home therapy. To assess economic effects, we compared the medical charges of patients treated at home with those of medically eligible patients who remained in the hospital. Of the first 84 patients, 50 (60%) were medically ineligible, and neutropenia was resolved in another eight (10%) during the observation period. Only nine patients of the remaining 26 who were medically eligible (35%) were enrolled in the home-therapy trial. Thereafter, 21 of 31 medically eligible patients (68%) were enrolled. The 30 patients treated at home were neutropenic for a median of 6 days (mean, 8.2). Four had medical complications, and five others were readmitted for observation. Patients' quality of life improved during home therapy, and favorable attitudes toward home care persisted after treatment. Medically eligible patients not enrolled had briefer neutropenia than patients treated at home, but had 44% higher daily medical charges and equivalent overall charges despite treatment half as long. We conclude that early discharge of low-risk patients to home intravenous antibiotic therapy is feasible, is well received by patients, and may prove to be cost-saving. However, these conclusions must be validated in a large randomized trial.
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Abstract This chapter reviews a growing body of international research that documents a puzzling pattern of gender differences in health and considers the limitations of current explanations. Such limitations derive from a failure to... more
Abstract This chapter reviews a growing body of international research that documents a puzzling pattern of gender differences in health and considers the limitations of current explanations. Such limitations derive from a failure to capture the complexity of men's and women's lives because much of the research focuses either on differences in their social and economic status or biology. We argue that an integrated model is needed to enable researchers to understand more fully the health connections between gendered lives and physiological processes. We elaborate the framework of constrained choice (CC) as one approach to address this conundrum. Constrained choice provides an innovative multilevel model for examining how the social environment differentially shapes men's and women's agency and health-related opportunities and choices. We provide examples of studies in the United States and Qatar that employ the framework and highlight ways in which it can be used more effectively in future research.
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Encounters with patients who are experiencing a life crisis such as cancer can be profoundly meaningful to both patients and those caring for them. Intense emotional involvement with patients can also lead to difficulties including... more
Encounters with patients who are experiencing a life crisis such as cancer can be profoundly meaningful to both patients and those caring for them. Intense emotional involvement with patients can also lead to difficulties including "burnout" (Davitz and Davitz 1975), interstaff conflict (Burnham 1966; Pollack and Battle 1963; Robinson 1984; Weintraub 1964), and violation of professional boundaries (Applebaum 1990; Gartrell et al. 1986; Gutheil 1989a, 1989b). Nicholi (1988) has reviewed the challenges that psychotherapists face in maintaining relationships with patients that are both close and therapeutic. However, there has been little research into the relationships that clinicians in other medical disciplines have with their patients. This report describes both the stresses and rewards of relationships with oncology patients in a comprehensive sample of 192 staff members at a regional cancer center, interviewed about factors affecting their job satisfaction.
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Although it is evident that working with cancer patients can be stressful, explanations have differed as to why this is so and little attention has been paid to the rewards of this work. One hundred ninety clinical staff members at a... more
Although it is evident that working with cancer patients can be stressful, explanations have differed as to why this is so and little attention has been paid to the rewards of this work. One hundred ninety clinical staff members at a comprehensive cancer center representing 91% of eight ...
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The authors describe an effective model for teaching and evaluating a one-semester course on gender and psychotherapy for psychiatry residents. Clarification of values and attitudes about gender involves learning at both intellectual and... more
The authors describe an effective model for teaching and evaluating a one-semester course on gender and psychotherapy for psychiatry residents. Clarification of values and attitudes about gender involves learning at both intellectual and affective levels. The authors conceptualize this cognitive-affective interplay as a series of stages or turning points in the process of value change and professional resocialization. The process may also be viewed as a microcosm of the inevitable gender-based conflicts that occur in the daily lives of the participants and in the wider social context. The course evaluation demonstrates that residents are able to translate the new knowledge into clinical practices. (Am J
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In 2006, our Institution changed the treatment strategy for small volume primary oropharyngeal tumours to transoral laser microsurgery (TOLM). The main aim of this cohort study was to report the health related quality of life (HRQOL) at... more
In 2006, our Institution changed the treatment strategy for small volume primary oropharyngeal tumours to transoral laser microsurgery (TOLM). The main aim of this cohort study was to report the health related quality of life (HRQOL) at around 2 years following TOLM in consecutive patients treated from July 2006 through April 2013. The University of Washington Quality of Life (UW-QOL) questionnaire was administered annually up to Spring 2014 and adjusting for mortality the overall response rate was 71 % (108/153). Tonsil primary site characterised 60 % (98) of patients, base of tongue 25 % (40), soft palate 13 % (21) and others 2 %, (3). Most patients had TOLM, neck dissection and adjuvant radiotherapy, with 21 % (34) of tumours at stage 1 or 2, 25 % (40) at stage 3 and 54 % (88) at stage 4. Kaplan-Meier estimates of overall survival were 94 % at 1 year, 88 % at 2 years and 68 % at 5 years after TOLM. Three-quarters (76 %) reported their overall QOL as being good, very good or outst...
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The dictum, ‘women get sicker but men die quicker’ is often treated as an established fact. However, historical demographic data demonstrate that women have not always outlived men. Moreover, current data from developing countries... more
The dictum, ‘women get sicker but men die quicker’ is often treated as an established fact. However, historical demographic data demonstrate that women have not always outlived men. Moreover, current data from developing countries demonstrate that war, epidemic, disease and extreme poverty can diminish, or even reverse, women’s advantage in life expectancy (see National Center for Healthcare Statistics, 2009; World Health Organization, 2008). Thus the apparently paradoxical gender differences in morbidity and mortality are neither universal nor invariant within and across societies (Annandale, 2009).
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... Pagination Specified. Comments on B. Guthrie's review (see record 2009-09232-001 ) of C. Bird and P. Rieker's book, Gender and health: The effects of constrained choices and social policies (see record 2009-01087-000... more
... Pagination Specified. Comments on B. Guthrie's review (see record 2009-09232-001 ) of C. Bird and P. Rieker's book, Gender and health: The effects of constrained choices and social policies (see record 2009-01087-000 ). The ...
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Page 67. 4 Understanding Gender and Health Old Patterns, New Trends, and Future Directions Patricia P. Rieker, Boston University and Harvard Medical School Chloe E. Bird, RAND Corporation Martha E. Lang, Guilford College ...
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In this chapter, we examine how work and family life are related to men's and women's health. Many of the differences in men's and women's lives that we have considered in earlier chapters have their roots in their family... more
In this chapter, we examine how work and family life are related to men's and women's health. Many of the differences in men's and women's lives that we have considered in earlier chapters have their roots in their family roles and in their jobs. Family and work are the two arenas where the constraints on choice are most readily apparent and frequently experienced, because they involve a myriad of routine decisions that occur on a daily basis. Consequently, in these arenas it is clear that individuals are making choices actively or at least by default. Moreover, both work and family roles are associated with some activities, as well as stresses, that tend to occur along gender lines. For example, occupations, careers, and family life each carry with them expectations derived from men's and women's social roles. Thus, as one of the mothers Judith Warner interviewed for her recent book on motherhood aptly noted, “These are choices that don't feel like choices at all. They are the harsh realities of family life in a culture that has no structures in place to allow women – and men – to balance work and child rearing” (Warner, 2005). Many of these choices are forced by time or financial constraints, which as this mother's comment illustrates can often leave individuals with a sense that they had little if any freedom to choose among the competing priorities, tasks, and goals.
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We examined the long-term impact of advanced testis cancer and its curative therapies on emotional states and outlook on life, employment, intimate relationships, and sexual function. The sample consisted of 74 nonseminomatous and... more
We examined the long-term impact of advanced testis cancer and its curative therapies on emotional states and outlook on life, employment, intimate relationships, and sexual function. The sample consisted of 74 nonseminomatous and seminomatous tumor patients who had completed treatment two to ten years ago. The majority of men felt that surviving the debilitating treatment(s) was both an accomplishment and worthwhile trade-off. Neither the rate of unemployment (7%) nor divorce (10%) was remarkable. The most critical outcome was in the area of sexual functioning. One fourth to one half of the men reported some type of sexual impairment. Multiple regression results indicate that ejaculatory dysfunction, a side effect of the retroperitoneal lymph node dissection, is significantly associated with distress about both infertility and sexual impairment. Men with sexual impairment report more psychological symptoms, strained intimate relationships, and negative changes in other areas of life functioning. These data, while not definitive, suggest that there are delayed effects and that the subgroup of men, who are least likely to disclose these problems to physicians, are at greater risk for the deleterious outcomes.
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In a retrospective study of 223 testis cancer survivors and 120 controls matched sociodemographically, we examined the relative impact of sociodemographic and clinical factors on long-term outcomes in the areas of sexual function,... more
In a retrospective study of 223 testis cancer survivors and 120 controls matched sociodemographically, we examined the relative impact of sociodemographic and clinical factors on long-term outcomes in the areas of sexual function, relationships, employment, and mental outlook. For most of the survivors, testis cancer did not lead to unemployment (4.5%), divorce (6.8%), or disabling psychological problems. Multivariate analysis results confirm that cancer survivors report significantly more infertility and sexual performance distress, but not more desire distress, than the control group. Survivors' sexual impairment varied according to treatment received (and therefore histologic factors) and sociodemographic variables. Parental status (not having children) and education (college or less) independently predict infertility distress, whereas education and lower occupational level independently predicted sexual performance distress. Adjusting for socioeconomic status (SES), the men with advanced testis cancer who received chemotherapy and standard retroperitoneal lymph node dissection (RPLND) had significantly more infertility and performance distress than those men who received other treatments. Neither the treatment or SES variables predicted disrupted relationships or a deteriorated mental outlook. However, men with sexual impairment distress were more likely to report strained relationships and a pessimistic mental outlook. These findings have implications for treatment decisions and can be used to identify subgroups of survivors who could benefit from counseling and sexual rehabilitation services.
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The complexity of gender differences in health (ie, men's lower life expectancy and women's greater morbidity) extends beyond notions of either social or biological disadvantage. Gaps remain in understanding the... more
The complexity of gender differences in health (ie, men's lower life expectancy and women's greater morbidity) extends beyond notions of either social or biological disadvantage. Gaps remain in understanding the antecedents of such differences and the issues this paradox raises ...
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Research Interests: Prostate Cancer, Enzyme Inhibitors, Medicine, Erectile dysfunction, Humans, and 15 moreMale, Clinical Sciences, Aged, Middle Aged, Developing nations, Finasteride, Pharmacy and Pharmaceutical Sciences, Pilot Projects, Prostate Specific Antigen, Nadir, Adenocarcinoma, Neoplasm staging, Prostatic neoplasms, Flutamide, and Androgen antagonists
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Skip to section navigation; Skip to page content. RAND Corporation. Welcome; Register; Login; Cart. Site-wide Search. About RAND: RAND at a Glance; FAQs; History & Mission; Contacts & Locations; Leadership;... more
Skip to section navigation; Skip to page content. RAND Corporation. Welcome; Register; Login; Cart. Site-wide Search. About RAND: RAND at a Glance; FAQs; History & Mission; Contacts & Locations; Leadership; Organizational Structure; Our Staff; Quality Standards; ...