The victim-to-patient process is reconceptualized as an interplay among abuse events, family rela... 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.
Teaching residents in psychiatry to be aware of sexist attitudes in psychiatric theory, training,... 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.
A psychiatrist and a psychiatric nurse interviewed 33 physicians and 94 nurses at a cancer center... 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.
This collection of readings is designed to clarify the relationship between social structures and... 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."
Social science differs from the other basic medical sciences in that its perspective for understa... 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.
ABSTRACT Bone marrow transplantation (BMT), once a highly experimental procedure performed in onl... 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.
Page 1. The Impact of Testicular Cancer on the Work Lives of Survivors. Susan D. Edbril, EdM Patr... more 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. ...
To assess the feasibility of early discharge to home therapy with standard intravenous antibiotic... 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.
Abstract This chapter reviews a growing body of international research that documents a puzzling ... 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.
Encounters with patients who are experiencing a life crisis such as cancer can be profoundly mean... 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.
Although it is evident that working with cancer patients can be stressful, explanations have diff... 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 ...
The victim-to-patient process is reconceptualized as an interplay among abuse events, family rela... 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.
Teaching residents in psychiatry to be aware of sexist attitudes in psychiatric theory, training,... 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.
A psychiatrist and a psychiatric nurse interviewed 33 physicians and 94 nurses at a cancer center... 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.
This collection of readings is designed to clarify the relationship between social structures and... 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."
Social science differs from the other basic medical sciences in that its perspective for understa... 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.
ABSTRACT Bone marrow transplantation (BMT), once a highly experimental procedure performed in onl... 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.
Page 1. The Impact of Testicular Cancer on the Work Lives of Survivors. Susan D. Edbril, EdM Patr... more 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. ...
To assess the feasibility of early discharge to home therapy with standard intravenous antibiotic... 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.
Abstract This chapter reviews a growing body of international research that documents a puzzling ... 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.
Encounters with patients who are experiencing a life crisis such as cancer can be profoundly mean... 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.
Although it is evident that working with cancer patients can be stressful, explanations have diff... 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 ...
Gender and Health is the first book to examine how men’s and women’s lives and their physiology c... more Gender and Health is the first book to examine how men’s and women’s lives and their physiology contribute to differences in their health. In a thoughtful synthesis of diverse literatures, the authors demonstrate that modern societies’ health problems ultimately involve a combination of policies, personal behavior and choice. The book is designed for researchers, policy makers and others who seek to understand how the choices of individuals, families, communities and governments contribute to health. It can inform men and women at each of these levels how to better integrate health implications into their everyday decisions and actions.
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