Male Psychiatrists Research Articles

Perceptions of bias and credibility of male and female clinical psychologist and psychiatrist expert witnesses presenting clinical information in the courtroom

Expert witness credentials and gender have independently been shown to influence jurors' perceptions of expert witness credibility and legal decision-making. This study examined how manipulations of expert witness gender (Male/Female) and profession (Consultant Clinical Psychologist/Consultant Psychiatrist) together affected mock jurors' perceptions of expert witness credibility, judgements, and decision-making. Mock jurors (N = 182; 80.9 % were White) were recruited from England and Wales and were randomly assigned to watch a video-recorded mock expert witness testimony. Participants rated the expert witness using the Witness Credibility Scale and reported the likelihood of assigning the defendant to a guilty verdict. Results showed significant interaction effects of expert witness gender and profession on jurors' perceptions of their likeability, trustworthiness, knowledge, and total credibility. Male psychiatrists, followed by female clinical psychologists, received the highest scores in most credibility variables. Varied main effects of expert witness gender and profession on credibility were also found. Overall, jurors' ratings of expert witness credibility, when controlled by the expert's gender and profession, predicted jurors' determination of guilt. This study provides evidence of a potential interaction effect between profession and gender in expert witness credibility and supports existing research linking credibility with ultimate decision-making. More research is needed to understand jurors' unconscious biases and cognitive processes in making legal decisions.

Attitudes of European psychiatrists on psychedelics: a cross-sectional survey study

Research and public interest in psychedelic-assisted psychotherapy (PAP) are growing. This study investigated attitudes toward psychedelics among a diverse and multinational sample of psychiatrists currently working in Europe. We conducted an anonymous, web-based survey consisting of demographic information, a test of basic knowledge on psychedelics, and the previously validated 20-item Attitudes on Psychedelics Questionnaire (APQ), which was validated for the first time in English within this sample. We included N = 419 participants from 33 countries in the study. One-third of participants (34%) reported past use of psychedelics. The APQ sub-scale with the highest score was Openness to Psychedelics, while Risk Assessment of Psychedelics was rated lowest. Regression modelling, explaining 31.3% of variance in APQ scores, showed that younger male psychiatrists who identified as spiritual, were better at recognizing and classifying substances as psychedelics and had previously used psychedelics had more positive attitudes on psychedelics. No professional variables besides self-reported previous experience with PAP or psychedelic research predicted APQ scores. European psychiatrists, therefore, show a general openness to psychedelics and PAP, but are concerned by the potential risks associated with them. Our findings overall suggest that psychedelics are a subject where it is difficult to remain impartial. Protocol registration: The study was pre-registered at the Open Science Framework (available online at https://osf.io/upkv3).

Intramural Health Care Through Video Consultations and the Need for Referrals and Hospital Admissions: Retrospective Quantitative Subanalysis of an Evaluation Study.

In comparison to the general population, prison inmates are at a higher risk for drug abuse and psychiatric, as well as infectious, diseases. Although intramural health care has to be equivalent to extramural services, prison inmates have less access to primary and secondary care. Furthermore, not every prison is constantly staffed with a physician. Since transportation to the nearest extramural medical facility is often resource-intensive, video consultations may offer cost-effective health care for prison inmates. This study aims to quantify the need for referrals to secondary care services and hospital admissions when video consultations with family physicians and psychiatrists are offered in prison. In 5 German prisons, a mixed methods evaluation study was conducted to assess feasibility, acceptance, and reasons for conducting video consultations with family physicians and psychiatrists. This analysis uses quantitative data from these consultations (June 2018 to February 2019) in addition to data from a sixth prison added in January 2019 focusing on referral and admission rates, as well as reasons for encounters. At the initiation of the project, 2499 prisoners were detained in the 6 prisons. A total of 435 video consultations were conducted by 12 physicians (3 female and 7 male family physicians, and 2 male psychiatrists during the study period). The majority were scheduled consultations (341/435, 78%). In 68% (n=294) of all encounters, the patient was asked to consult a physician again if symptoms persisted or got worse. In 26% (n=115), a follow-up appointment with either the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 4% (n=17) of the cases. Only in 2% (n=8) of the consultations, a hospital admission was needed. Usually, hospital admissions were the result of unscheduled consultations, and the videoconferencing system was the method of communication in 88% (n=7) of these cases, while 12% (n=1) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina or suspected myocardial infarction, or a suspected schizophrenic episode. Most scheduled and unscheduled consultations did not require subsequent patient transport to external health care providers. Using telemedicine services allowed a prompt patient-physician encounter with the possibility to refer patients to other specialties or to admit them to a hospital if necessary.

Gender differences in income among psychiatrists in China: Findings from a national survey.

Gender income disparity in healthcare settings is a longstanding issue around the globe, but such evidence among Chinese psychiatrists is scarce. This study investigated whether gender income differences exist among physicians in China. Data came from the 2019 national survey data of 4,520 psychiatrists in major public psychiatric hospitals across China. Self-reported monthly income after tax (in Chinese Yuan, CNY) by participants at all professional ranks was assessed. Average monthly income by gender was reported. Adjusted income differences between male and female psychiatrists were examined using multivariable regression models, adjusting with inverse probability of treatment weights and controlling for psychiatrist demographics (e.g., gender, professional rank, marital status, educational level, and work hours) and hospital fixed effects. The unadjusted mean difference in monthly income after tax by gender was 555 CNY (about $86; 95% CI, -825 to -284; mean [SD] for men: 8,652 [4,783] CNY and for women: 8,097 [4,350] CNY) in all psychiatrists. After regression adjustments, the income difference by gender among all psychiatrists reduced substantially and became insignificant. However, gender income difference was still observed among senior-level psychiatrists, where female psychiatrists earned 453 CNY (about $70; 95% CI, -810 to -95) significantly less than male psychiatrists. China achieved gender equity in income for psychiatrists overall, the observed income differences among senior level psychiatrists, however, reveal the persistence of gender inequity at the highest level of professional hierarchy. These findings call for policy attention to the issue of gender income disparity among psychiatrists in China's healthcare system.

Do Women have More Barriers for Professional Development?

Women consistently fare worse than men in different professional metrics in terms of salary, promotions, grant money, and scholarly publishing. In clinical and management leadership roles, a similar trend of underrepresentation for women exists. It has been shown in academic publishing that women progressed to senior author positions at a slower pace, resulting in their ongoing underrepresentation as senior writers. Previous literature has shown that one of the most effective strategies for promoting women to leadership positions is the collaboration with men to identify attitudinal and institutional barriers, since gender equality is not only a “women’s concern.” To address this, a cross-sectional, multinational survey was disseminated in English (SurveyMonkey) to psychiatric trainees and psychiatrists across Europe. This study aims to explore the perspectives of female and male psychiatrists on the obstacles they face in their careers. The survey covered items on self-promotion, current institutional environment, and networking along with contextual information- age, gender, professional degree, current field, and years of professional experience in the current field. We hope that the presentation of these findings will serve as a springboard for future educational activities to address concerns connected to the gender gap. The speaker will present the comparison of female and male psychiatrists’ barriers and challenges they face during their professional development. This talk is hoped to elicit discussion in preparation for future action and inform a roadmap for addressing issues related to the gender gap with subsequent educational events.DisclosureNo significant relationships.

Fraudster’s and victims’ profiles and loss predictors’ hierarchy in the mental healthcare industry in the US

Background Fraud- or theft-related crimes account for the highest number of crimes in the mental health industry in the US. Aim This exploratory study aims to demonstrate a fraudster’s and respective victims’ profiles as well as to identify the loss predictors’ hierarchy in the mental health industry in the US. Materials and methods The Psychiatric Crime database and mixed-effects models are utilized for this purpose. Results A typical fraudster’s profile is defined as a 53-year old male psychiatrist who victimizes one or two of the largest federal insurance programs in states with high property crime ratios. The results revealed the year and state where the fraud is prosecuted explain the largest portion of the variance in loss size. Predictably, case-specific factors also have a significant impact on the loss. Specifically, Medicaid, the existence of collusion, and fraudster’s age are associated with the fraud loss. Conclusions This study empirically justifies considering loss, due to healthcare fraud, from a multi-level perspective. Identified typical fraudster’s and respective victim’s profiles helped to elaborate on specific practical recommendations aimed at fraud prevention in the mental healthcare system in the US.

Sous-représentation des femmes intervenant dans les congrès de psychiatrie en France

First, the main objective was to describe the evolution of the representation of women at the two main conferences of psychiatry in France-Encephale and French Congress of Psychiatry-from 2009 to 2018, and to compare it to the evolution of the representation of women among French psychiatrists. Second, we aimed to describe this evolution within the themes of general psychiatry, child psychiatry and addictology and compare it to the evolution of the number of adult psychiatrists, child psychiatrists and addictologists in France, and likewise to describe this evolution within the organizing and scientific committees, chairpersons and symposia of pharmaceutical companies at these conferences. We hypothesized that women are underrepresented at French speaking psychiatry conferences and sought to quantify this. Programs from the 2009-2018 meetings of the Encephale and the French Congress of Psychiatry were included in analysis. We collected for each intervention information about the sex of the participant, the type of the intervention (i.e., speaker, moderator, chairperson) and its main theme (i.e., general psychiatry, child psychiatry, addictology, pharmaceutical company symposium). We also collected from the National Council of the French Medical Association the number of male and female psychiatrists active in France from 2009 to 2018, and the number of male and female psychiatrists who have validated a specific competence in child psychiatry and addictology. The average proportion of women at the two conferences per year was obtained by weighting the average by the different numbers of speakers at the two conferences. À Chi-squared test was used to compare the evolution of the proportion gap over time. The proportion of women speaking at these conferences ranged from 25% in 2009 to 32% in 2018. Among French psychiatrists, the proportion of female psychiatrists increased from 46% to 51%, with a higher proportion of women since 2016. In that ten year span, the difference between the proportion of females amongst the French psychiatrists and the speakers at these French conferences varied between 21% in 2009 and 17% in 2016, with a higher proportion of female psychiatrists registered at the National Council of the French Medical Association than female speakers at these conferences. The proportion of female speakers at these conferences tends to increase more quickly than the proportion of active female psychiatrists. The proportion of women speaking on child psychiatry topics (41-59%) is much higher for each year than those of women speaking on general psychiatry topics (24-33%) or on addictology topics (10-39%). Also, the proportion of women speaking on child psychiatry and addictology topics tends to increase more quickly than the proportion of active female child psychiatrists and addictologists in France, while the proportion of women speaking on general psychiatry topics tends to increase more slowly than the proportion of active female psychiatrists for adults in France. The proportion of female speakers is very low in symposia of pharmaceutical companies (7-24%), members of organizing and scientific committees (13-33%) and chairpersons (19-28%), although it increases sfrom 2009 to 2018. This observation of the underrepresentation of women at French psychiatry conferences could make it possible to achieve greater equity. This count could be continued in the next few years and could raise the question of the inclusion of parity in the policy of psychiatric conferences, both among the speakers and among the scientific and organizational committees. Higher exposure of women to conferences would reduce the Matilda effect, defined by minimizing women's contribution to research.

Factors Associated with Psychiatrist Opt-out from US Medicare: an Observational Study.

Concerns exist about availability and access to psychiatric services in the USA. For Medicare beneficiaries, one impediment to psychiatric services is the extent to which psychiatrists have opted out of the Medicare program. This study describes geographic variation in rates that psychiatrists opt out of Medicare, and assesses physician-level and geographic-level predictors of opt-out. Retrospective cross-sectional analysis of data describing psychiatrists' opt-out status as of March 2017 linked to data on psychiatrist location, psychiatrist characteristics (obtained from a comprehensive US physician database), and market area-level characteristics. 27,838 psychiatrists in the USA MAIN MEASURES: Whether a psychiatrist had opted out of Medicare as of March 2017. Overall, 7.0% of psychiatrists (1940/27,838) opted out of Medicare as of March 2017. Opt-out rates varied substantially across states and within states. Physician-level factors independently associated with opt-out included: older age (psychiatrists > 65years were 2.6 percentage points more likely to opt vs. psychiatrists < 35years old, p = 0.03), greater years of experience, female gender (female psychiatrists were 2.6 percentage points more likely to opt out than male psychiatrists, p < 0.001), graduation from a top-20 ranked medical school (1.7 percentage points more likely to opt out of Medicare, p < 0.001), and domestic medical graduate (domestic graduates were 7.3 percentage points more likely to opt out of Medicare vs. foreign graduates, p < 0.001). Adjusting for other individual- and geographic-level factors, psychiatrists who practiced in areas with more psychiatrists per Medicare beneficiary were less likely to opt out (p < 0.001). The overall likelihood that psychiatrists opt out of Medicare is significant and varies considerably across regions and by characteristics of psychiatrists.

Dress and address in hospital psychiatry: an issue?

Background and aims: To assess the preferences of Dutch psychiatric patients in three general hospital psychiatric settings for the dress of psychiatrists and patients preference to be addressed by psychiatrists. To assess the associations concerning different clothing styles and the attributes of the patient–doctor relationship.Methods: One hundred and seventy-three adults, in and outpatients (aged 18–89 years) attending the psychiatry departments of three general hospitals, were included during the period June 2015 to May 2016. In these hospitals, the psychiatrist staff has different clothing policies. Data were analyzed with SPSS21.Results: Divided over the three hospitals, 173 patients were included, 96 inpatients and 77 outpatients. The patients’ opinions on the psychiatrists' dress differed significantly between the hospitals in line with the local hospital clothing policy (p = 0.002 for the male psychiatrists, p = 0.000 for the female psychiatrists). The patients’ ethnicity significantly influenced their preferences for dress and address, as a majority of the patients with a non-Dutch ethnic background expressed a preference for white coats, and address by surname (RR = 2.0, p = 0.003 for male and RR = 2.1 p = 0.002 for female psychiatrists). A significant difference in preference for being addressed by their first names by the psychiatrist was found between Dutch and non-native Dutch patients (RR = 2.6, p = 0.005). According to patients, the male psychiatrist in trousers and a long sleeve shirt and female psychiatrist in casual clothing were most often associated as being the friendliest, a white coat as being the most competent, and wearing smart attire as being the most accessible.Conclusion: Patients’ preferences are in line with current local clothing habits. Ethnicity, setting and country influence a patient’s preferences. Casual clothing for psychiatrists is assessed as being the friendliest but as the least competent, and white coats are assessed as being the most competent but as being less friendly and less accessible.

Sociodemographic Characteristics and Job Satisfaction of Psychiatrists in China: Results From the First Nationwide Survey.

The aim of the study was to establish a comprehensive understanding of the sociodemographic characteristics of psychiatrists in China and their working environment and job satisfaction. As part of a national survey, the authors conducted China's first survey in 32 tertiary psychiatric hospitals, including administration of a structured questionnaire for psychiatrists. Participants also completed the Minnesota Satisfaction Questionnaire (MSQ). Of 3,363 surveyed psychiatrists, 2,715 (81%) responded, and 2,602 (77%) completed the survey. Among completers, 58% were women, and 83% were ages 30-49. Significant differences were found in actual and expected monthly income between male and female psychiatrists and across various regions. The mean±SD MSQ score was 71.6±14.3, suggesting moderate job satisfaction. The top three reasons for dissatisfaction were low pay, contentious doctor-patient relationships, and a heavy workload. One-fifth (20%) of participants reported an intention to quit their jobs. MSQ score was significantly associated with younger age, shorter working hours, higher monthly pay, and a smaller gap between expected and actual pay. Being in an administrative position, having medical liability insurance, and not having experienced medical disputes appeared to have a positive impact on job satisfaction. Compared with their international counterparts, psychiatrists in China have a low level of the job satisfaction, especially those in West China. Given China's increasing demand for psychiatric services, policy makers in China urgently need to find ways to improve the job satisfaction of working psychiatrists and should consider enhancements in financial compensation, the working environment, and malpractice insurance coverage.

Surveying Psychiatrists' Psychopharmacology Practices Across Common Clinical Scenarios.

The practice of psychopharmacology has become increasingly complex with the expansion of medication options across psychiatric conditions. The level of variability among psychiatrists in their application of medication treatments has received little attention to date. We surveyed 111 psychiatrists attending one of two annual psychiatry meetings in 2017, asking whether they agreed or disagreed with statements about psychopharmacological approaches to 14 common clinical scenarios. High consistency was found for six scenarios, which generally reflected published treatment guidelines, and in recommending that their patients avoid using marijuana. However, low consistency was found for seven scenarios, particularly for statements addressing the use of benzodiazepines and antipsychotic medications. These statements of low consistency generally reflected contradictions or ambiguity across treatment guidelines. In comparison with male psychiatrists, female psychiatrists' responses revealed greater caution around use of medications with addictive potential. Responses to statements were not associated with psychiatrists' perceived adequacy of psychopharmacology training received during residency. Although psychiatrists have high consistency in some aspects of psychopharmacological practice, significant variability exists in important areas of medication use. The consistency of psychotropic medication prescribing may be improved through conducting practical clinical trials that address the existing evidence gaps and by developing educational materials targeting areas of prescriber disagreement.

Changes in Characteristics and Practice Patterns of Ontario Psychiatrists.

The objective of this study was to evaluate the changes in demographic, geographic, and practice characteristics of all Ontario psychiatrists between 2003 and 2013 and their implication for access to psychiatrists. We included all psychiatrists who were clinically active in Ontario in any year from 2003 to 2013. For each psychiatrist, we reported age, sex, years since medical school graduation, geographic practice region, and practice characteristics such as total number of inpatients, outpatients, and outpatient visit frequencies. In 2013, there were 2070 psychiatrists, with nearly half (47%) more than 30 years since medical school graduation. Female psychiatrists comprised 41% of all psychiatrists in 2013 but 56% of all psychiatrists within 15 years of medical school graduation. Between 2003 and 2013, there was a 17% increase in the total number of psychiatrists, with the largest growth in psychiatrists occurring in the group more than 30 years from medical school graduation. Over these 11 years, the mean (SD) number of unique outpatients seen by a psychiatrist annually increased from 208 (228) to 249 (275) (19.5%; P = 0.001), with male psychiatrists, on average, seeing more outpatients annually than female psychiatrists. The number of outpatients seen by psychiatrists is slowly increasing. However, the large proportion of aging psychiatrists, the high concentration of psychiatrists in urban settings, and the increase in the number of female psychiatrists with smaller practices suggest that without radical changes to the way psychiatrists practice, access to psychiatrists will remain a challenge in Ontario.

The Role of Clinical Psychologist as Perceived by Psychiatrists at the National Center for Mental Health

The present study aims at finding out the role of the clinical psychologist as perceived by the psychiatrists at the National Center for Mental Health in Jordan. The study sample consisted of (33) male and female working psychiatrists at NCMH. The researcher has designed an instrument to measure the main functions of the clinical psychologist represented by diagnosis, psychotherapy, and psychological counseling. The instrument was applied to the current study sample. The results of the study show differences between male and female psychiatrists. Results indicate that there are differences in the role of the clinical psychologist as perceived by the psychiatrists, the differences are in favor of experienced psychiatrists, besides indicating that the experience(over 10 years) obtains the highest rate for the role of the clinical psychologist. The results show that the age (greater than 45 years ) is the highest rated for the role of the clinical psychologist. The results show no statistically significant differences at the level of significance (α ≤ 0.05) in the role of clinical psychologist as perceived by the psychiatrists at the National Center for Mental Health attributed to the rank of career where the value (V) = 0.314. In light of these results the researcher put forward a number of recommendations and suggestions.

Staff and caregiver attitude to coercion in India.

Objectives:The objective of this study was to assess attitudes of Indian psychiatrists and caregivers toward coercion.Materials andMethods: The study was conducted at the Department of Psychiatry, Krishna Rajendra Hospital, Mysore, India. Staff Attitude to Coercion Scale (SACS), a 15-item questionnaire, was administered to self-selected psychiatrists across India and caregivers from Mysore to measure attitudes on coercion. Data were analyzed using descriptive statistics and investigating differences in subgroups by means of Chi-square test, Student's t–test, and analysis of variance. Reliability of the SACS was tested in this Indian sample.Results:A total of 210 psychiatrists and 210 caregivers participated in the study. Both groups agreed that coercion was related to scarce resources, security concerns, and harm reduction. Both groups agreed that coercion is necessary, but not as treatment. Older caregivers and male experienced psychiatrists considered coercion related to scarce resources to violate patient integrity. All participants considered coercion necessary for protection in dangerous situations. Professionals and caregivers significantly disagreed on most items. The reliability of the SACS was reasonable to good among the psychiatrists group, but not in the caregiver group (alpha 0.58 vs. 0.07).Conclusion:Caregivers and psychiatrists felt that the lack of resources is one of the reasons for coercion. Furthermore, they felt that the need on early identification of aggressive behavior, interventions to reduce aggressiveness, empowering patients, improving hospital resources, staff training in verbal de-escalation techniques is essential. There is an urgent need in the standardized operating procedure in the use of coercive measure in Indian mental health setting.

How should Child Psychiatrists Get Dressed? Children's Perspective

Abstract Objectives. The aim of the present study was to investigate the patients’ preference regarding psychiatrists’ attire and whether attire styles were important for patients in child and adolescent mental health services. It was additionally sought to examine the influence of doctors’ attire on patients’ confidence in their psychiatrists. Methods. Sixty-four participants between the ages of six and eighteen were recruited from a child and adolescent mental health service within Turkey. Participants were asked to report their preferences for five types of doctor attires (white coat, formal, semi-formal, casual wear and relaxed attire) in both male and female psychiatrists. Participants were additionally asked whether they considered psychiatrist dress important and whether their psychiatrists’ attire influenced their confidence. Results. A large proportion of our sample (N=49) reported doctors’ attire as important. For both male and female psychiatrists, white coat was determined to be the most preferred style of attire, whereas relaxed attire was the least preferred attire in children’s psychiatrists. Around 67% of our respondents reported that doctors’ attire has an influence on the confidence and trustwortiness they will hold for their psychiatrists. Conclusions. The present study confirms that psychiatrists’ attire is considered as important by the children and adolescent patients, and white coat is the most preffered type of attire by children and adolescents. Psychiatrists’ attires can additionally be suggested as influencial on children and young people’s confidence in their doctors.

Feminist Narratology Revisited

In 1986, in pages of Style, a debate was launched between Susan Lanser and Nelli Diengott on feasibility of a new theory, which Lanser named narratology. Lanser argued that as a textual and structuralist methodology could be very useful to feminist critical inquiry, but only if its principles were fundamentally changed to accommodate materialist issues vital to most feminist critics, including gender of author, psychology of character narrating, and time and place of fiction. In a subsequent issue, Diengott countered that such synthesis, by its own terms, would not be possible because materialist feminism is completely antithetical to as theory; combining two into a single methodology called narratology would cross impenetrable line between narrative poetics and interpretive criticism that in practice strictly observes. The debate was revived by Kathy Mezei a decade later in her Introduction to Ambiguous Discourse: Feminist Narratology and British Women Writers. There she explicitly argues for legitimacy of Lanser's definition over Diengott's opposition, defining narratology as a method of analysis that includes the sexuality and gender of author, narrator, character, and reader (2), elements that transcend narratology's normal structural and textual bounds. In 2002, in Feminist Metafiction and Evolution of British Novel, I argued, in contrast, for a theory of narratology that does not depend on gender of author or qualities of female narrating character as person. My thesis instead focused on structure and discourse of woman's narrating activity on level of text, demonstrating that narratology is feasible as a strict narratological theory and can also be used as critical methodology in that way. Since that time, perhaps because of oxymoronic difficulties inherent in term, narratology has mostly been dropped from critical lexicon and its use in feminist criticism has become almost extinct. The kinds of analyses produced in response to Margaret Atwood's Alias Grace, however, suggest relevance of reexamining narratology as a methodological approach and validity of renegotiating its possibilities to include both sides of theoretical debate. Alias Grace is a novel based on real murder of Thomas Kinnear and Nancy Montgomery in 1843. Each chapter opens with excerpts from actual historical documents relevant to murder case and published around same time as crime. Alongside these excerpts are pieces of canonical English and American poetry, all also written during nineteenth century and all by or on subject of women. The primary narrative, however, is delivered by a fictionalized version of real convicted female killer, Grace Marks, imprisoned for crime and trying to reconstruct, in a mostly linear fashion, events leading up to murder she claims she cannot recall. Also included in narrative text are fictional sections of free indirect discourse attributed to Simon Jordan, male psychiatrist who elicits Grace's first-person story, as well as occasional fictional letter from other official and unofficial sources in connection with his enterprise. Precisely because of this unique structural polyphony of different generic narratives, focus on narration in critical response to this text is almost inevitable; and because primary narrative, one that shapes plot and structurally coordinates all other discourses, is delivered in voice of a woman, complexities of woman's narrating act become central to a number of critical essays on a variety of hermeneutic subjects written in response to book. (1) To date, all critical attention paid directly to complexities of female narration in Alias Grace has concerned itself with credibility of its main narrating character as a person and, consequently, as a story teller. …

Cross-sectional study of attitudes about suicide among psychiatrists in Shanghai

BackgroundAttitudes and knowledge about suicide may influence psychiatrists’ management of suicidal patients but there has been little research about this issue in China.MethodsWe used the Scale of Public Attitudes about Suicide (SPAS) – a 47-item scale developed and validated in China – to assess knowledge about suicide and seven specific attitudes about suicide in a sample of 187 psychiatrists from six psychiatric hospitals in Shanghai. The results were compared to those of 548 urban community members (assessed in a previous study).ResultsCompared to urban community members, psychiatrists were more likely to believe that suicide can be prevented and that suicide is an important social problem but they had more stigmatizing beliefs about suicidal individuals and felt less empathy for them. The belief that suicide can be prevented was more common among female psychiatrists than male psychiatrists but male psychiatrists felt more empathy for suicidal individuals. Only 37% of the psychiatrists correctly agreed that talking about suicide-related issues with an individual would not precipitate suicidal behavior and only 41% correctly agreed that those who state that they intend to kill themselves may actually do so.ConclusionsMany psychiatrists in Shanghai harbor negative attitudes about suicidal individuals and are concerned that directly addressing the issue with patients will increase the risk of suicide. Demographic factors, educational status and work experience are associated with psychiatrists’ attitudes about suicide and, thus, need to be considered when training psychiatrists about suicide prevention.

Empathy in high-tech and high-touch medicine

ObjectiveSurgeons and psychiatrists have been described as two contrary groups, the one healing by hands and the other by words. Empathy is needed in every physician–patient relationship. We tested whether (1) surgeons and psychiatrists show different levels of cognitive and emotional empathy; (2) measurements of cognitive and emotional empathy correlate with physician-specific empathy; and (3) gender, experience, and career choices are influencing factors. Methods56 surgeons and 50 psychiatrists participated. We measured empathy with the Jefferson Scale of Physician Empathy (JSPE), cognitive empathy with the Reading the Mind in the Eyes Test Revised (RME-R6), and emotional empathy with the Balanced Emotional Empathy Scale (BEES). ResultsMale psychiatrists scored significantly higher than that of male surgeons (118.0±9.86 vs. 107.5±13.84; p=0.0006) in the JSPE. Analytically trained psychiatrists scored significantly higher in the JSPE than that of behaviorally trained psychiatrists (p=0.024, F test, adjusted for gender). Both the RME and the BEES correlated positively with the JSPE. ConclusionHigher scores for empathy were found in male psychiatrists than in male surgeons. Practice implicationsFurther research is needed to learn about the effects of general medical training on empathy.

Boundary Violations: Non-Sexual Relationships with Patients

Ms. J is a 24-year-old unmarried woman with borderline personality disorder (BPD) who lives with her parents in a large housing estate in the heartlands of Singapore. She is an only child and was first diagnosed with BPD as a teenager following a number of suicide attempts and self-mutilating episodes. While she received some treatment, which reduced her suicidal thoughts, anxiety and feelings of emptiness, her behaviour continues to be moody and impulsive, and she struggles in holding down employment and maintaining stable relationships. She began seeing a male psychiatrist, Dr. D, for psychotherapy about 18 months ago. However, her parents who are paying for her therapy have now sought help for her from another therapist as she has begun to feel depressed again and has been engaging in self-harming behaviours. Over several sessions, the therapist learns that Ms. J had been undergoing psychodynamic psychotherapy with Dr. D on a regular basis. Ms. J reported that at first she was a little uncomfortable talking to an older man about her feelings but that she felt more comfortable with him after a couple of months. One day after her session was over, heavy downpour prevented her from leaving the clinic to catch the bus. Dr. D, having finished work for the day, offered to drive her home, which she accepted with some apprehension but figured that he was just trying to help her out. During the drive, he told her that he was having some marital problems. This revelation made her feel a little better since it seemed that even doctors can have relationship problems and that no one is perfect. She now felt that she could really trust him. A few weeks later, Dr. D offered to drive Ms. J home again and this soon became a regular occurrence. He would talk about the difficulties he was experiencing at home and say how much he enjoyed talking to her. Soon, she began to feel like his equal and looked forward to seeing him at each session. One day, Dr. D told her that he was upset because his wife had left him. Feeling sorry for him, she gave him a hug and he thanked her for being such a good friend. She began to call his cell phone to see how he was doing and it was not long before she started to think about him as being more than just a friend. The phone calls and car conversations continued for several months. Coming from a traditional Chinese family, she did not tell her parents about her feelings or that Dr. D had been driving her home. Soon, she began to feel frustrated that the relationship was not going anywhere and so she decided to reveal her feelings to Dr. D during one of their sessions. She wanted to know if he felt the same way and was devastated to learn that he did not. He said that he was sorry but still had feelings for his wife and was trying to reconcile with her. Shocked and humiliated, she ran out of the office. She kept these events to herself and refused to go back to see Dr. D. She started feeling depressed and has begun cutting herself again. Her parents eventually convince her to see another therapist, a woman. Ms. J tells the therapist that she is confused and cannot understand why Dr. D would pretend to be her friend only to reject her. She refuses to allow the therapist to contact Dr. D for her treatment records and is thus unable to confirm whether he had in fact been driving Ms. J home or talking to her about his own personal matters. The therapist is nevertheless worried about her emotionally unstable patient and wonders what she should do.

The Evolution of Family Process: Contexts and Transformations1,2

The Evolution of Family Process: Contexts and Transformations1,2