Loss Of Self-determination Research Articles

Die Politik von Caligari: Totalitarian Anxieties in Adaptations of Robert Weine’s Das Cabinet des Dr. Caligari

Contemporary politics is filled with anxiety about the survival of democracy—particularly within a framework pitting liberal representative democracy against authoritarianism. In times of anxiety about authoritarianism, Western artists repeatedly return to a masterpiece of relatively early cinema: Robert Weine’s silent film Das Cabinet des Dr. Caligari, or The Cabinet of Dr. Caligari. This essay examines three twenty-first century adaptations: David Lee Fisher’s 2005 remake of the film; James Morrow’s 2017 novel, The Asylum of Dr. Caligari; and Georgie Bailey’s 2022 play Caligari. I argue that while the direct politico-cultural anxieties of Weine’s film have often been overstated, the emergence of adaptations during periods of heightened concern about authoritarianism reflects a deep-seated reception of the film as anticipating autocratic governance. However, for all its fears about power, control, and the loss of self-determination, Weine’s movie also contains the seeds of liberation. Cesare ultimately sacrifices his own life rather than murdering Jane. And it is this gesture that the adaptations examined here seek—a gesture of resistance. The sleepwalker can awaken and assert a form of just resistance in the world, even if the penalties are steep.

Association of duration of treatment on post-discharge mortality in forensic psychiatric patients in Finland.

Longer treatment time has been shown to be associated with lower crime recidivism among forensic psychiatric patients, but it is not known if this applies also to mortality. In this study, we aim to research whether treatment time is associated with risk of post-discharge mortality in Finnish forensic psychiatric patients. The study population consisted of 989 patients committed to compulsory forensic psychiatric hospital treatment in Finland from 1980 to 2009 who were released from care by the end of 2018. Each patient included in the cohort was linked with the Statistics Finland register, which includes all data on dates and causes of deaths in Finland. Crude cumulative rate of mortality were estimated using Kaplan-Meier method and compared using logrank-test. Adjusted cumulative rate analyzed using Cox regression model. A possible nonlinear relationship between the treatment time and the hazard of death was assessed by using 3-knot-restricted cubic spline regression. Adjusted models included age, sex, and SUD (substance use disorder) as covariates. The mean duration of care was 7.1 (SD 6) years. The duration of treatment variable was divided into tertiles of treatment duration less than 3.5 years, 3.5-7.9 years and equal or more than 8 years. The risk of mortality was highest in the first tertile, and lowest in the last tertile. The risk of mortality was higher for patients suffering from SUD, for patients of male sex and for those released at younger age. Longer treatment time is associated with reduced post-discharge mortality in forensic psychiatric patients in Finland. Especially males and individuals with SUD are at higher mortality risk after release, but longer treatment duration may mitigate these risks. Longer periods of hospitalization have to be, however, viewed against the backdrop of institutionalization and loss of self-determination.

Dene, métis and inuvialuit peoples’ voices on the impact of Canada’s perinatal transport and non-medical escort policy in their communities: an outcome assessment approach and narrative literature review

ABSTRACT Historically, there is a documented lack of support for women leaving their communities to give birth. Due to an over-emphasis on risk discourse (no distinction between low- or high-risk pregnancies with options to birth at home, the large geographical distances to regional centres within circumpolar regions, remoteness of communities, lack of qualified staff, and limited resources), women are forced to travel great distances to give birth. In Canada until 2017, women travelled alone or bore the burden of paying out of pocket for someone to travel with them for support with the births of their babies. A recent policy change has allowed for one paid escort to accompany a pregnant woman. The purpose of this paper is to provide an outcome assessment of the perinatal transport and non-medical escort policy implemented by the federal government in Canada. The paper utilises a narrative literature review along with preliminary Indigenous photovoice results to illuminate the perspectives of Indigenous families. There are numerous challenges women face when travelling for birth including feelings of loneliness and fear, stress and separation from their children, lack of community connection, financial concerns, and a loss of self-determination. Women are given an opportunity in decision-making about who will travel with them as an escort. This does little to address the disparity of delivering their babies away from their families and communities, the burden of figuring out who cares for the children at home, and the impact their absences have on health of their families. Although, additional support has been provided for birthing women in northern Canada, there continues to be little effort to return to community birthing creating safety for Indigenous families through traditional practices, Indigenous midwifery, and community ceremonies and changing the disproportionate burden of poor outcomes experienced by Indigenous women.

Employment of the Pregnant Anaesthesiologist According to Maternity Protection Act

With the onset of pregnancy, female physicians face a conflict of interest between the protection of the unborn child and the loss of self-determination in their professional lives. The Maternity Protection Act provides guidelines for the continued employment of pregnant and breastfeeding women. This review focusses on legal basics, employment ban, individual risk assessment, implementation in clinical practice, and pitfalls. We suggest that each hospital should define safe workplaces for the pregnant anesthesiologist.

TECHNOLOGY VERSUS INDIVIDUAL: AN ANALYSIS ON INTERACTIVE FILM BLACK MIRROR: BANDERSNATCH

One of the basic themes of technology-based dystopian narratives appears as the problem of self- determination. In these narratives that proceed through concepts such as surveillance and control; there are descriptions of a dark future in which the individual becomes an object. Netflix production Black Mirror: Bandersnatch (David Slade, 2018) examines the loss of individuality and the loss of self-determination. The film, as a technology-based narrative, connects these concepts to the impact of technology. In the narrative, a critical discourse has been developed over the possible impacts of technology by removing the self-determination of the protagonist by giving the audience the ability to choose instead. This study aims to examine the effects of technology on individuals and their freedom through the science fiction anthology Black Mirror. In this study, the issue of self-determination of an individual through the concepts of surveillance and technology is discussed within the interactive movie Bandersnatch, a part of the anthology. In this study, thematic content analysis is applied to the movie. It is concluded that the messages include technology will increase surveillance and control, and affect the loss of individuality in the postmodern society are predicted by Bandersnatch as in other Black Mirror episodes. Another result is that the Black Mirror anthology gives a critique of the present while narrating the future.

Refugees’ loss of self-determination in UNHCR operations through the gaining of identity in blockchain technology

ABSTRACT Through the experimental use of blockchain technology with biometric enrollment, the United Nations High Commissioner for Refugees (UNHCR) is seeking ways to give refugees control over their own individual identities and greater forms of self-determination within contexts of assistance and protection. The point is to empower refugees with identity-sovereignty that may greatly enhance their autonomy and dignity as persons. In this regard, UNHCR addresses core problems in refugee identification that have always undermined its institutional objectives. However, regardless of its successes in this regard, UNHCR's use of blockchain with these aims demonstrates a great misunderstanding of identity, as if identity were a mere property and disregards the social and political relational contexts in which identity is effectively mobilized with autonomy. Moreover, UNHCR ignores how refugees’ identities are already richly formed for them. UNHCR's development of blockchain systems of identification have the effect of displacing the relational and social qualities of identity with a system of fixed coding over which refugees have no actual control. The uses of blockchain in this context serve the function of rendering the identities of persons seeking assistance and protection as refugees merely as “refugees” within a manageable system over which UNHCR maintains sovereignty.

Saving or Subordinating Life? Popular Views in Israel and Germany of Donor Siblings Created through PGD.

To explore how cultural beliefs are reflected in different popular views of pre-implantation genetic diagnosis for human leukocyte antigen match (popularly known as "savior siblings"), we compare the reception and interpretations, in Germany and Israel, of the novel/film My Sister's Keeper. Qualitative analysis of reviews, commentaries and posts is used to classify and compare normative assessments of PGD for HLA and how they reproduce, negotiate or oppose the national policy and its underlying cultural and ethical premises. Four major themes emanated from the comparison: loss of self-determination and autonomy; loss of dignity through instrumentalization; eugenics and euthanasia; and saving life. In both countries, most commentaries represented a dominant position, with a few negotiated positions. We also highlight the decoding of a relatively less explored bioethical aspect of My Sister's Keeper's narrative, namely the meaning of euthanasia. We conclude by discussing how the findings relate to attempts of providing cultural explanations for the regulation of HLA-PGD.

The Heart of Human Rights by Allen E. Buchanan (review)

Reviewed by: The Heart of Human Rights by Allen E. Buchanan Jill Stauffer, Asst Prof. (bio) Allen E. Buchanan, The Heart of Human Rights ( New York, Oxford University Press, 2013), ISBN 9780-19-932538-2, 320 pages. This is a massive book that covers so much ground that nothing of review length could do it justice, so I’ll focus on what I believe is the most interesting and fruitful aspect of the book—its assessment of whether the legal order of international human rights is, at present, capable of anything more than a diagnosis of global problems. Put otherwise, can this system to which so many look for remedies actually offer remedies, or is something more needed to fix the world’s more entrenched forms of injustice? Before we dive into that question, let us glance at the book’s broader ambitions. Allen Buchanan does a good job taking the reader through many of the dominant schools of philosophical thought about human rights, asking whether any offer adequate justification for their positions. He does justice to what each position asserts but ultimately argues for taking international human rights as a legal practice to be viewed instrumentally for its usefulness rather than as a “mirror” to any one set of original principles. Concerns that rights discourse is too individualistic are overstated, Buchanan insists, because human rights always focus on the social setting in which conditions for leading a good life must transpire. We just do live with others, and rights discourse is one way we have found to manage conflicts that inevitably arise between persons and groups. Many who argue for rights for individuals on a priori grounds of human dignity worry that any other approach threatens to sacrifice individuals to consequentialism, but Buchanan contends that one can recognize the importance of securing public goods without denying protection to individuals. He also reminds us that protecting individuals does not solve every problem of injustice, as rights regimes can coincide with systemic discrimination. One must look at the small and large pictures simultaneously in order to do justice. That is why Buchanan argues for an “ecological” view of the legitimacy of human rights legal institutions: “it is often not possible to determine the legitimacy of an institution in isolation; instead, its legitimacy may be a function of how it fits into a network of institutions.”1 If we think of the legitimacy of international human rights law in this way, the question is not only whether the United Nations Security Council, treaty-making bodies, or the International Criminal Court are legitimate, but how all these parts of the larger whole operate together to provide what constituents need and expect. And if that is how legitimacy is created, then there is also room for nongovernmental organizations (NGOs) in international human rights law, even though they are, as Buchanan puts it, “reliable external agents to gather and integrate the information and make it available in understandable form to relevant stakeholders.”2 So, though NGOs are external to states, and must be in order to be legitimate, that legitimacy also depends on how their [End Page 240] work serves the legitimacy of states by offering neutral judgments about states’ human rights records. The worry remains that a robust international system is not compatible with individual states’ constitutional democracies. Buchanan visits both sides of the problem and argues that, though international human rights law may modify constitutional democracies’ policies, at times without democratic authorization, the risk may not be more weighty than that posed by the kind of indeterminacy that always is part of law. He adds, however, that one should not blithely dismiss concerns about loss of self-determination when international law is not treated carefully by domestic jurisdictions. Instead of posing the problem as a false dilemma—international rights or domestic constitution—Buchanan recommends judgment: the common practice of balancing competing values. That leads us back to his main idea: human rights as they are practiced at present are largely a legal phenomenon (which means we escape the need to agree on a moral foundation for them), and the legal system created to express them may not be up to some of the...

Exploring psychosis and bipolar disorder in women: a critical review of the qualitative literature.

BackgroundThe experiences of women with severe mental illness warrant particular consideration to identify the strategies they use to facilitate recovery. This review systematically examined women’s experiences of psychosis and bipolar disorder.MethodsFollowing an extensive database search, 13 studies met inclusion criteria. Noblit and Hare’s metasynthesis approach was used to synthesise these qualitative studies exploring the experiences of 250 women, of which 78 (31.2%) were also mothers.ResultsTwelve sub-ordinate themes were identified and categorised into three overarching themes: 1) women’s beliefs about illness, 2) perceived consequences of illness, and 3) strategies used to cope with illness. Contextual factors and spiritual beliefs were found to be important in these women’s illness appraisals. Women incorporated diagnosis-related information into illness models if it was concordant with their existing beliefs.ConclusionsWomen reported negative illness consequences relating to stigma, loss of self-determination and changes to relationships. They employed various strategies in order to cope with illness. Barriers to strategy use and clinical recommendations are presented.

The hospitalised patients’ experience of being in protective/source isolation: A systematic review of qualitative evidence

The placement of hospitalised patients in isolation is either done to protect the immunocompromised patient from others (reverse or protective isolation) or to protect others from the patient's infectious process (isolation). Both situations require limiting the contact between the patient and others to prevent the spread of pathogens or to protect the immunocompromised patient. Isolating patients remains a primary treatment in the hospital setting. There is no formal meta-aggregation of the qualitative research literature that describes the meaning of this experience. Explication of the meaning will provide valuable information for clinicians as they care for persons in isolation.The aim of this review was to synthesise the best available qualitative evidence on the experience of hospitalised patients being placed in isolation.The participants were adult (> 18 years old) hospitalised patients in isolation.The phenomenon of interest was the meaning of being in isolation from the hospitalised patient's perspective.The studies of interest were qualitative studies that focused on adult hospitalized patients and their experience with being cared for in isolation.The search strategy sought to find both published and unpublished research studies from 1971 to May 2010. This review was limited to papers written in English. A three step search strategy was utilised. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Lastly, a final hand search of the reference lists from included papers was employed.Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using the appropriate Joanna Briggs Institute critical appraisal instrument from the System for the Unified Management, Assessment and Review of Information (SUMARI) package.Data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.Categories were formed based on aggregation of similar findings with like meaning. The categories were analysed to identify synthesised findings that were presented as declamatory and generalisable statements to guide and inform practice.A total of 12 studies were reviewed and, of those, 4 were excluded for methodological concerns and 8 were included in the review. The qualitative studies examined the hospitalised patients' experiences of being in isolation. A total of 56 findings were extracted from included studies. Findings were then synthesised in 11 categories. Two synthesised findings were developed from these categories: (1) The isolation experience causes fractured human connectivity and nurses must provide care that mitigates the negative effects of this; and (2) nurses must attend to the reality that a variety of factors affect the patient's ability to adapt to an artificial environment.The patient in isolation temporarily resides in an artificial environment, removed from the normalcy of their life. The experience of being in isolation causes severe limitation in or loss of self-determination and autonomy, resulting in the patient being caught in a restrictive environment in which they have little control. The isolated patient must relinquish their autonomy and due to limited contact with others there is disjointed and fractured human connection.In order to moderate the detrimental psychosocial effects of isolation, institutional policies need to reflect the higher acuity of care required, allow the patient to have choices, design rooms that consider the long-term patient, and support nursing care that is considerate of the unique needs of the isolated patient.Further exploration of the effects of isolation on the achievement of desired patient outcomes is needed. In-depth comparative studies between nurses' perceptions of the care they provide versus the patients' perception of the care they receive would provide valuable insights. Additionally, studies that explore patients' perception of how helpful they find nursing interventions aimed at meeting their psychosocial care needs would also provide useful data. Lastly, studies that explore the barriers perceived by nursing staff to implementing patient-centered care in the isolation environment would be helpful in informing nursing practice.

The hospitalised patients' experience of being in protective/source isolation: A systematic review of qualitative evidence.

The placement of hospitalised patients in isolation is either done to protect the immunocompromised patient from others (reverse or protective isolation) or to protect others from the patient's infectious process (isolation). Both situations require limiting the contact between the patient and others to prevent the spread of pathogens or to protect the immunocompromised patient. Isolating patients remains a primary treatment in the hospital setting. There is no formal meta-aggregation of the qualitative research literature that describes the meaning of this experience. Explication of the meaning will provide valuable information for clinicians as they care for persons in isolation. The aim of this review was to synthesise the best available qualitative evidence on the experience of hospitalised patients being placed in isolation. The participants were adult (> 18 years old) hospitalised patients in isolation.The phenomenon of interest was the meaning of being in isolation from the hospitalised patient's perspective.The studies of interest were qualitative studies that focused on adult hospitalized patients and their experience with being cared for in isolation. The search strategy sought to find both published and unpublished research studies from 1971 to May 2010. This review was limited to papers written in English. A three step search strategy was utilised. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Lastly, a final hand search of the reference lists from included papers was employed. Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using the appropriate Joanna Briggs Institute critical appraisal instrument from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. Data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Categories were formed based on aggregation of similar findings with like meaning. The categories were analysed to identify synthesised findings that were presented as declamatory and generalisable statements to guide and inform practice. A total of 12 studies were reviewed and, of those, 4 were excluded for methodological concerns and 8 were included in the review. The qualitative studies examined the hospitalised patients' experiences of being in isolation. A total of 56 findings were extracted from included studies. Findings were then synthesised in 11 categories. Two synthesised findings were developed from these categories: (1) The isolation experience causes fractured human connectivity and nurses must provide care that mitigates the negative effects of this; and (2) nurses must attend to the reality that a variety of factors affect the patient's ability to adapt to an artificial environment. The patient in isolation temporarily resides in an artificial environment, removed from the normalcy of their life. The experience of being in isolation causes severe limitation in or loss of self-determination and autonomy, resulting in the patient being caught in a restrictive environment in which they have little control. The isolated patient must relinquish their autonomy and due to limited contact with others there is disjointed and fractured human connection. In order to moderate the detrimental psychosocial effects of isolation, institutional policies need to reflect the higher acuity of care required, allow the patient to have choices, design rooms that consider the long-term patient, and support nursing care that is considerate of the unique needs of the isolated patient. Further exploration of the effects of isolation on the achievement of desired patient outcomes is needed. In-depth comparative studies between nurses' perceptions of the care they provide versus the patients' perception of the care they receive would provide valuable insights. Additionally, studies that explore patients' perception of how helpful they find nursing interventions aimed at meeting their psychosocial care needs would also provide useful data. Lastly, studies that explore the barriers perceived by nursing staff to implementing patient-centered care in the isolation environment would be helpful in informing nursing practice.

An Inquiry about Clinical Death

According to a paper published by the International Work Group on Death, Dying and Bereavement, "Each person has a spiritual dimension." That means each person has spiritual energy and spiritual needs. In facing death, a patient suffers spiritual pain and needs spiritual care. This paper describes what spirituality and spiritual pain mean. It identifies nine types of fears and anxieties about death which become a source of spiritual pain: 1. Fear of pain; 2. Fear of loneliness; 3. Fear of unpleasant experiences; 4. Fear of becoming a burden to the family and to society; 5. Anxiety towards the unknown; 6. Fear of death resulting from fear of life; 7. Fear of death as a feeling that one's life task is still incomplete; 8. Fear of death as fear of personal extinction; 9. Fear of death as fear of judgment and punishment after death. Five types of spiritual pain that seem to be frequent among patients facing death are discussed: 1. Loss of self-determination; 2. Loss of meaning; 3. Guilt feelings; 4. Loneliness and isolation; 5. Loss of hope. Three ways of preventing or reducing excessive fear of death and of lowering the various types of spiritual pain are suggested: 1. Death education; 2. Presence at the bedside; 3. Humor as an expression of love.

From Invisibility to Transparency: Identifying the Implications

Turner, N. J., R. Gregory, C. Brooks, L. Failing, and T. Satterfield. 2008. From invisibility to transparency: identifying the implications. Ecology and Society 13(2): 7. https://doi.org/10.5751/ES-02405-130207

From slave to pharaoh: the black experience of ancient Egypt

In From Slave to Pharaoh, noted Egyptologist Donald B. Redford examines over two millennia of complex social and cultural interactions between Egypt and the Nubian and Sudanese civilizations that lay to the south of Egypt. These interactions resulted in the expulsion of the black Kushite pharaohs of the Twenty-fifth Dynasty in 671 B.C. by an invading Assyrian army. Redford traces the development of Egyptian perceptions of race as their dominance over the darker-skinned peoples of Nubia and the Sudan grew, exploring the cultural construction of spatial and spiritual boundaries between Egypt and other African peoples. Redford focuses on the role of racial identity in the formulation of imperial power in Egypt and the legitimization of its sphere of influence, and he highlights the dichotomy between the Egyptians' treatment of the black Africans it deemed enemies and of those living within Egyptian society. He also describes the range of responses-from resistance to assimilation-of subjugated Nubians and Sudanese to their loss of self-determination. Indeed, by the time of the Twenty-fifth Dynasty, the culture of the Kushite kings who conquered Egypt in the late eighth century B.C. was thoroughly Egyptian itself. Moving beyond recent debates between Afrocentrists and their critics over the racial characteristics of Egyptian civilization, From Slave to Pharaoh reveals the true complexity of race, identity, and power in Egypt as documented through surviving texts and artifacts, while at the same time providing a compelling account of war, conquest, and culture in the ancient world.

Social Policy and Rights in AfricaFrom Social Contract to Loss of Self-determination

Summaries The agenda for social development in Africa, and therefore the framework in which social policy is defined, has undergone major shifts over the last forty years. This has partly been the result of the ability of post‐colonial governments to depoliticise poverty and demobilise the movements that brought them to power. But the major reason has been the current phase of the globalisation of capital, which has demanded a major restructuring of the world economy to suit its needs. The primary instruments used in effecting those changes were structural adjustment programmes and associated policies. These have resulted in the few accumulating (on a global as well as national level) immense wealth while the majority were condemned to greater poverty, and a reversal of the social gains of independence. In effect, there has been an increasing disenfranchisement of the majority in determining the goals of social development. With the rise of globalisation, the agenda for social development is being set, largely unilaterally, by undemocratic institutions of globalisation in the interests of multinational corporations.

Psychoanalysis, the Anxiety of Influence, and the Sadomasochism of Everyday Life

After reviewing recent upheavals within psychoanalytic institutions and our diminished status in the worlds of academia, psychiatry, and the media, this essay turns to the historical trends that led to the current state of siege in which psychoanalysis finds itself—trends most clearly manifested on the East Coast institutes of the United States. I hypothesize that a legacy of arrogant entitlement on the part of the founding fathers made for an abiding institutional authoritarianism. This hierarchicalism fostered a loss of self-determination and individuation, negative Oedipal submission, identifications with the aggressor within psychoanalytic organizations, and a pseudospeciation with regard to potential critics in the outside world. Promising in many respects, nonetheless many of the current changes in psychoanalytic education and theory inevitably represent a positive Oedipal rebellion against the generation that had oppressed the one now in ascendancy and, more insidiously, a means of containing the candidates now in our charge. Finally, I argue that our future depends on our ability to embrace unwanted and disavowed truths about the history of our field and thereby to reclaim both our idealism and our credibility.

“Survival in Justice”: An Afrikaner Debate over Apartheid

Within nationalist movements a tension typically exists between group demands for ethnic self-preservation and the more universal demands of religious belief, professional commitment, or academic vocation which confront particularly the intelligentsia in the group. Ethnic politicians tend to argue that decades or centuries of oppression or the anticipated disastrous consequences of a loss of self-determination makes loyalty to the group and its leadership's strategies a matter of overriding importance. It is usually exceptional individuals, often poets or novelists, who in times of crisis issue the challenge that survival be reconciled with universal values and prevailing international political norms.

The Use of Concurrent Schedules to Evaluate the Effects of Extrinsic Rewards on "Intrinsic Motivation"

Althou h extrinsic monetary rewards have been 'shown to increase wor k performance, they have been criticized on the grounds that they may also decrease an employee's intrinsic motivation, leading to decreased quality, creativity, and a loss of selfdetermination. Stated more behav~orally, extrinsic rewards may usurp the control of intrinsic rewards and permanently decrease their reinforcing value. This study, a replication of Mawhinney, Dickinson and Taylor (1989), used concurrent schedules to assess the effects of extrinsic rewards; a procedure that enables an assessment of the degree to which extrinsic rewards usurp control of intrinsic rewards during reward administration. Unlike the results of Mawhinney et at., extrinsic monetary rewards usurped control of the intrinsic rewards for six of eight experimental subjects. Similar to Mawhinney et al., the extrinsic rewards did not weaken the reinforcing value of the intrinsic rewards as indicated by subject performance following extrinsic reward termination...