Self-destructive Actions Research Articles

The High Place Phenomenon: Associations With Markers of Positive and Negative Mental Health in Individuals Suffering From Specific Phobia or Agoraphobia.

The Call of the Void phenomenon describes an inexplicable urge to consider dangerous or self-destructive actions in certain situations. Previous studies have focused on the high place phenomenon (HPP), which is the sudden urge to jump from high places. One aim of this study is to replicate the previously found associations of HPP with suicidality and anxiety in a larger sample of patients suffering from flight phobia or agoraphobia. Furthermore, the influence of personality traits and protective factors, such as self-efficacy and self-esteem, will be examined to identify associations between the HPP and potential markers of both positive and negative mental health. The study sample comprised 612 patients (76% female; Mage = 43.77, SDage = 12.82) suffering from clinically relevant fear of flying. Participants filled out questionnaires on experiences with the high place phenomenon, depression, personality traits, anxiety sensitivity, suicidal ideation, insecurity in social contact, flight phobia symptoms, positive mental health, self-efficacy expectations, self-esteem and satisfaction with life. Consistent with previous findings, the high place phenomenon was known to nearly 43% of the patient sample. Multiple regression analysis showed that openness to experiences, neuroticism, suicidal ideation and insecurity in social contacts were positively related to the high place phenomenon, whereas agreeableness, self-efficacy and self-esteem were negatively related. The high place phenomenon is a common experience in individuals, whether or not they suffer from suicidal ideation. It is therefore cautioned not to interpret such experiences as an expression of a hidden death wish. Nevertheless, the occurrence of the HPP is influenced by the presence of negative and positive mental health markers. Future studies should examine the association between HPP and intrusions in the context of obsessive-compulsive disorders.

Capital game: male athletes’ rationalisation of playing hurt and reproduction of the risk, pain, and injury custom in professional combat sports

ABSTRACT As the phenomenon of playing hurt persists in sports, extant literature has explored the risk, pain, and injury custom (RPIC) from diverse angles. However, academic endeavours revealing the agency–structure continuum between individual agents’ willingness to play hurt and the capital structure related to the RPIC remain limited. This study aims to investigate professional athletes’ health-compromising practice and its underlying mechanism through capital games. Drawing on Bourdieu’s theory of practice, we examined two research questions: (a) how does individual athletes’ desire for capital justify playing hurt? and (b) how are their capital games connected to the RPIC? Empirical data were collected through semi-structured and photo-elicitation interviews with eight athletes and six coaches (ex-athletes) from three combat sports. The data were interpreted using reflexive thematic analysis. The findings were categorised into two narratives: (a) rationalisation of playing hurt and (b) reproduction of the RPIC. First, our participants continued playing hurt, expecting certain rewards (cultural, social, economic, and performance capital); this profit-seeking aspiration rationalised self-destructive action as an investment to garner social energy in the field. Second, the more athletes immersed themselves in capital games using health as a token, the more prominent the habitus of playing hurt became in the field. This RPIC reproduction mechanism drove former/present athletes’ choices to converge into an identical career trajectory, uni-taste, and limited subversion strategy, trapping them in a cycle where the victim becomes another perpetrator of playing hurt. These results are expected to provide sport institutions with insights into building safer sporting environments.

Self-Destructive Dermatosis Mimicking Pyoderma Gangrenosum: A Clinical Case

Background. Polymorphism of clinical manifestations of mental pathology in dermatology often leads to diagnostic errors and severe social exclusion of patients.Clinical case description. The presented clinical case demonstrated the similarity of the clinical picture of self-destructive dermatosis with the symptoms of pyoderma gangrenosum, which determined our differential diagnostic search. Ulcerous defects in the patient were localized in places accessible for self-destruction and did not cause severe pain characteristic of pyoderma gangrenosum. In addition, lack of association with systemic diseases, unsuccessful long-term dermatological treatment, uniformity of skin lesions, and rapid healing of skin manifestations resulting in a scar were more characteristic of self-destructive dermatosis. A pathomorphological examination of the skin revealed morphological data typical of artificial dermatitis in combination with sclerotic changes, and excluded the presence of granulomatous diseases, vasculitis, and deep purulent inflammation of the dermis (neutrophilic dermal abscesses). Thus, histological changes in the biopsy material did not correspond to the clinical skin manifestations. The constant self-destructive actions of the patient resulted in excoriations, ulcerations, with the subsequent secondary infection and conspicuous cicatricial skin changes.Conclusion. The presented clinical case demonstrated the complexity of the diagnostic search for a psychodermatological disorder due to the similarity of the clinical picture of self-destructive dermatosis with the symptoms of pyoderma gangrenosum, which led to a delayed diagnosis.

Vulnerability of personality disorder during COVID-19 crises: a multicenter survey of mental and social distress among patients referred to treatment

Background Relational and emotional problems, dysregulation, self-harming or substance abuse often characterize personality disorders (PD). In Norway, COVID-19 restrictions led to an abrupt shutdown of services from 12 March 2020 also including specialized PD treatments. Aims The objective of this study was to investigate social and mental distress among patients with PDs during the first COVID-19 wave. Design A survey was distributed after the first COVID-19 wave (June–October 2020) among 1120 patients from 12 PD treatment units. Results The response rate was 12% (N = 133). The survey reflected impairment of occupational activity (53% <50% activity last 6 months), life quality (EQ-5D-VAS: 56, SD 19), and personality functioning (LPFS-BF ≥12: 81%, 35% avoidant PD, 44% borderline PD) and high levels of depression and anxiety (PHQ-9 ≥ 10: 84%, GAD-7 ≥ 10: 68%), 49% with health-related anxiety. Problem increase was reported for anxiety (28%), depression (24%), aggression (23%), substance use (14%), and 70% of parents had more child-care difficulties. Self-destructive behaviors (26%) did not increase. The majority (78%) reported increased or unchanged social isolation and loneliness. Occupational activity declined with negative effects on part-time jobs/rehabilitation. Therapist contact was mainly telephone-based (63% ≥ weekly contact). More severe personality problems, current depressive symptoms, and self-harming before 12 March were associated with more frequent consultations. Conclusion The survey confirms severe, enhanced levels of mental distress among patients receiving telephone-based consultations as the main alternative to specialized PD treatment during the COVID-19 shutdown. The most vulnerable patients received more frequent consultations and self-destructive actions did not increase.

Relationship Between Big Five Personality Traits to Compliance of Site Operational Procedure (SOP) of Grinding Machine in Maintenance Contractor PT. X

Site Operational Procedure (SOP) is implementationwork procedures that are more focused on the work are a at PT.X. Initial review mentions that grinding workersdo not apply the SOP correctly on their work steps. The behavior of workers was unsafe which could lead to accidents. The behavior was a manifestation of the worker personality. Different worker personalities will produce different behaviors. The purpose of this study was to analyze the relationship of big five personality traits to compliancedof SOP for grinding machine. This research was observational with a cross sectional design. Respondent research was 54 grinder. Big five personality traits were independent variables. The dependent variable was complianced of SOP for grinding. The results showed that 50 % of 54 respondents did not complied the SOP and analysis of multiple logistic regression showed about independent variabel that significantly effected to SOP complianced was neuroticism traits (p = 0.006).An assessment of the traits of workers personalities, both openness, conscientiousness, extraversion, agreeableness, and neuroticism, shows a high category for each assessment of traits. The assessment shows that only neuroticism traits were related to SOP compliance with unidirectional values, it cause by workers whom easily worried and anxious tend to careless and self-destructive actions. It is recommended to paying attention for the dominant personality background of workers while recruitment, especially the mechanical field. Personality can be used as anassessing predictor in compliance behavior with work procedures.

FENOMENA AKSI MENYAKITI DIRI BAGI REMAJA DALAM MEDIA ONLINE TIRTO.ID Analisis Teori Konstruksi Sosial dalam Fenomena Aksi Menyakiti Diri bagi Remaja dalam Media Online Tirto.id

The act of self-injury is an action that will have fatal consequences if left unchecked to occur among teenagers today. Recently, the author saw the proliferation of mass media coverage of cases of depression which led to suicide. Anyone can experience it, especially adolescents who in fact are in a period of emotional development, so even this attracts public attention to examine the main root causes of these actions. But in this article, the author wants to highlight one of the news in Tirto.id's online media which discusses the phenomenon of self-injury for junior high school students that occurred in Riau. In the non-participant observations carried out, the authors see that the online media Tirto.id illustrates the existence of self-injury as a form of depression experienced by junior high school students. The self-destructive actions taken were in the form of slashing one's own hand, slapping himself, hitting the wall, banging his head against the wall, and other acts of self-injury. This phenomenon is relevant to the assumptions contained in social construction theory of reality. Tirto.id said that the phenomenon of self-injury has been widespread, both through social media, videos circulating among junior high school students, that it became viral and constructed as a natural reality carried out by these teenagers, as a form of diversion from depression experienced. Keywords: Phenomenon, Social Construction, Self-Suffering Action, Online Media, Tirto id. DOI: https://doi.org/10.26905/nomosleca.v5i2.3226

“Efficacy of Buprenorphine in the Treatment of Suicide”

Background: Buprenorphine is currently used for the treatment of opioid use disorder and pain disorder. It could be an effective alternative option for the treatment of anxiety symptoms, depressive symptoms, self-destructive actions and suicidal ideations. However, it has a major potential for abuse and diversion that limits its application in these disorders. Objective: To explain the efficacy of buprenorphine in the treatment of Suicidal ideations. Conclusion: Buprenorphine can be an effective alternative option for the treatment of suicidal ideation.

S127. “HOW COULD THIS HAPPEN?”: PSYCHOSIS OR DEPRESSION AS A FACTOR IN DEATH BY SUICIDE

BackgroundNumerous factors play a role in the path of self-destruction that ends in suicide. The risk of suicidal behavior is increased when a depressed patient is also struggling with psychotic symptoms. Likewise, among adults with a psychotic disorder, suicide risk is related to depression, hopelessness, low self-esteem, social isolation and stressful life events. The present study was designed to examine the differential impact of major depression versus psychotic thinking on suicide risk in adults.MethodsSubjects:The present study evaluated 104 adults who had died by suicide. Among these suicidal adults, 81 met diagnostic criteria for a Major Depressive Disorder at the time of their death, 10 met criteria for a psychotic disorder and 13 met criteria for the presence of both depression and psychosis.Measures:Structured Clinical Interview for DSM-Disorders (SCID: First et al., 1994) used informant interviews to evaluate the presence of major mental illness in the adult who died by suicide. Interviews were conducted with family members, gathering detailed information about the duration and severity of major mental illness.Suicidal Actions Checklist (Dejong, Overholser, & Stockmeier, 2010) was used to gather information about recent stressors, previous suicide attempts and past hospitalizations for psychiatric problems. Prior research (Dejong & Overholser, 2009) has documented an adequate level of agreement for the Suicidal Actions Checklist when collected from suicide attempters as compared to family member informants.Procedures:Assessment procedures followed the guidelines for psychological autopsy research (Hawton et al., 1998), whereby family members were interviewed two months after the death of their loved one. In order to determine the most accurate diagnosis for each case, all records were reviewed by a psychiatrist, a clinical psychologist, a social worker, and a neuroscientist.ResultsBecause of the small number of patients with a psychotic disorder (with or without depression), these cases were combined into one group, and several non-significant trends are reported. As compared to suicide completers with a depressive disorder, the psychotic cases were more likely to be younger (t = 2.18, p < .05), unmarried (χ2 = 3.13, p < .08), unemployed at the time of their death (χ2 = 9.75, p < .01), and more likely to meet criteria for cannabis abuse (χ2 = 3.75, p < .06). Suicide completers with nonpsychotic depression were more likely to meet criteria for a comorbid diagnosis of alcohol abuse (χ2 = 4.36, p < .05) and often had alcohol in their system at the time of their death (χ2 = 4.35, p < .04). Despite the higher rate of personality disorders among the depressed completers (χ2 = 3.14, p < .08), the psychotic cases of suicide were more likely to have a chronic course to their symptoms (χ2 = 3.11, p < .08) with a history of prior psychiatric hospitalization (χ2 = 18.22, p < .01). Although not significant, when the three groups were examined separately, the depressed psychotic cases were more likely to have attempted suicide prior to the actual death by suicide (62%) compared to the depressed non-psychotic patients (37%) as well as the psychotic non-depressed cases (40%). Qualitative analyses will examine various patterns that may have direct links to suicidal urges.DiscussionAdults with a psychotic disorder have a more chronic condition that appears difficult to treat and tends to impair work or home functioning. The psychotic patients were less likely to rely on alcohol to lower their inhibitions about committing a suicidal act, suggesting other factors need to be addressed in prevention efforts. Patients may allow their psychotic thinking to guide their behavior, and when combined with depression can result in self-destructive actions.

Sea: An Exploration of Figurability Through the Triad of Training Clinician-Supervisee-Analysand

Using the work of the Botellas (2005), Laplanche (1999), and Levine (2012), I aim to examine unconscious communications between patient and clinician and the transformational process that moves intersubjectively from unrepresented toward represented mental states. During my work with Sea, sessions from my own analysis revealed content that I failed to recognize as my own; unconscious untranslatable messages given to me by her that were half understood during my supervision, and crystalized only during my own analysis. Using my own changes in representational states that became available to me during this shifting of positions, I worked as Sea's “double,” sharing with her my ability to consolidate her internal representations, while strengthening her ability to reflect in the face of potentially self-destructive actions. Weaving in my own analysis with our therapy sessions, I show how regressive states from the clinician create the potential place from which the patient can form his or her own representations of that which had formerly remained un-representable because of traumatic origins. I discuss the ways in which this process might be multi-directional.

The psychodynamics of hope in suicidal despair

ABSTRACTFor suicidal individuals, crushing hopelessness correlates more strongly than depression with suicidal intent. Ambivalence is recognized as a principal aspect of suicidality – wanting to die and wanting to be rescued at the same time. Hope is the mental state in which the desire of a positive outcome in one’s life is directed toward the future, and supports a positive resolution to psychic pain, thereby playing an important role in suicide prevention by delaying self-destructive action. This paper explores the psychodynamics of hope in suicidal distress, as it functions to support the suicidal patient’s sense of connection over abandonment and rescue over the wish to die. Three pathways that instill and support hope in suicidal patients are examined through the use of clinical examples.

Book review: The Logic of Madness: A New Theory of Mental Illness

Book review: The Logic of Madness: A New Theory of Mental Illness

Addiction Trajectories ed. by Eugene Raikhel and William Garriott (review)

Reviewed by: Addiction Trajectories ed. by Eugene Raikhel and William Garriott J. Bryan Page Eugene Raikhel and William Garriott, eds. Addiction Trajectories. Durham, N.C.: Duke University Press, 2013. 338 pp. Ill. $25.95 (978-0-8223-5364-5). Accomplishment of a book’s stated goals becomes especially difficult when different authors have written the book’s component chapters. Addiction Trajectories largely succeeds in keeping its overall thrust together throughout the introduction, ten chapters, and afterword contained between its covers. Eugene Raikhel and William Garriott, the two editors, conceived of an apt image in furtherance of the volume’s intentions—the trajectory. It has often been the wont of anthropologists who study drug users to focus on the life histories of the participants in their research, and the single most evocative metaphor for drug users’ histories of drug use is some sort of curvilinear tracing of drug use, remission, recidivism, nadir, or “hitting bottom,” and resurgence, among other features. The book’s introduction for its concept of the trajectory familiarizes the reader with its key aspects, emphasizing movement, therapy, and experience. Each of the chapters addresses parts of the human trajectory of addiction, from hopelessness engendered by the nexus between personal tragedy and recidivism, as in Angela Garcia’s narrative about Alma, to the “pharmaceutical optimism” (p. 238) described in Nancy Campbell’s chapter on neuroimaging and popular perception. Some of the most edifying perspectives in any of the book’s chapters appear in Natasha Dow Schüll’s analysis of machine-based gambling in Nevada. The duality of meditation and medication, serving as both a treatment and as a trigger for going into “the zone” in which addicted gamblers go out of control, provides a cautionary tale for those who would intervene among machine gamblers. Molly, one of Schüll’s study participants, contributes a cognitive map of her day that succinctly points out the key features of daily routine that present risk of recidivism. This kind of concrete illustration of the addict’s human circumstances shows the reader just how risk laden the addict’s personal environment may be. Todd Meyers’s chapter on adolescent addicts in Baltimore succeeds somewhat less than other chapters, although to his credit, he points out that addicts in circumstances of pharmaceutic treatment occupy a kind of liminal space that neither they nor the public media completely comprehend. Helena Hansen’s chapter deals with buprenorphine treatment and likens the role of Pentecostal Christianity in the recruitment and ongoing participation of recovering addicts into roles of [End Page 847] religious leadership to the adoption of buprenorphine therapy. Two communities, one in Puerto Rico and the other in New York, exemplify these processes. Narcology, as presented by Anne Lovell, comes under comparative scrutiny, but it needs more material like the chapter’s striking final pages that describe the contrasts between Marseillaise and Russian clientele of French treatment centers. E. Summerson Carr’s chapter on denial and self-talk as therapeutic tools adroitly brings the reader into the philosophy and goals of psychotherapy as they are practiced in drug treatment centers, raising important questions about the nature of denial, and the potential of encouraging positive self-talk to achieve the goals of drug treatment. Eugene Raikhel’s discussion of deceptive placebo use in the Russian tradition of kimzashchita constitutes some of the most lucid and revelatory narratives on the practice of narcology ever seen in the literature. His likening of the disulfiram deception to the creation of a “prosthesis for the will” (p. 190) in a system that does not require treatment patients to take responsibility for their self-destructive actions is inspired. Based on West Virginia’s methamphetamine using population and their institutional criminalization by local constabulary and other authorities, Garriott brings the reader into a difficult community-wide dilemma and the inhabitants’ adaptation to it. The chapter’s final quotes of key informants, who make assertions that the addict population is impossible to control, add a tone of pessimism that seems appropriate for most of the rest of the book. In her final chapter on the disciplinary stakes in current approaches to addiction and the “war on drugs,” A. Jamie Saris invokes the issue...

ISIL, insurgent strategies for statehood, and the challenge for security studies

What do we know about the US-led coalition's chance of defeating the Islamic State in Iraq and the Levant (ISIL)? Exploring a number of past wars between state and non-state forces, I argue that while the war with ISIL may become protracted and last long, ISIL's chance of winning is after all slim. Primary reasons for this optimism lie in the combination of ISIL's self-destructive actions, which are likely to alienate much of its popular and financial base, and the transformation of US-led military operations in Iraq and Syria.

Analysis of psychological functioning of patients after their suicide attempts

Suicide is a serious psychiatric problem. A deliberate act of taking their own lives by patients is a difficult and dramatic move. There has been ongoing discussion about causes of this phenomenon and they still have not been established unequivocally. There are numerous theories on the etiology of suicidal behaviors including a sociological theory, cognitive-behavioral theory and neurobiological theories. Material and methods. The research is based on the survey of the control group that consisted of 76 persons including 48 of those who had already attempted suicide. Among the group were also Lodz Babinski Hospital patients who attempted suicide recently or in the more distant past. Each patient did psychological CISS and IPSA-II tests. Results. A statistical analysis shows that patients attempting suicide differ in psychological traits from the rest of the control group. They have greater aggressive tendencies and difficulties in controlling emotions. They also tend to be less trusting. Conclusions. It is possible to attempt to prevent suicide. A psychological profile of those who attempt suicide could lead to a better understanding of mechanisms that underlie self-destructive actions and help identify a group of persons with a significantly greater suicidal behavior risk and apply preventive measures to those persons.

Unearthed: the economic roots of our environmental crisis

In Unearthed: The Economic Roots of Our Environmental Crisis, Kenneth M. Sayre argues that the only way to resolve our current environmental crisis is to reduce our energy consumption to a level where the entropy (degraded energy and organization) produced by that consumption no longer exceeds the biosphere s ability to dispose of it. Tangible illustrations of this entropy buildup include global warming, ozone depletion, loss of species diversity, and unmanageable amounts of nonbiodegradable waste. Degradation of the biosphere is tied directly to human energy use, which has been increasing exponentially since the Industrial Revolution. Energy use, in turn, is directly correlated with economic production. Sayre shows how these three factors are invariably bound together. The unavoidable conclusion is that the only way to resolve our environmental crisis is to reverse the present pattern of growth in the world economy. Economic growth is motivated by social values. Key among them are the desire for wealth and consumer values including gratification, convenience, and acquisition of goods. Sayre maintains that economic growth can be reversed only by eliminating these social values in favor of others more conducive to environmental health. Eliminating these values will involve major changes in lifestyle within industrial societies generally. Only with such changes in lifestyle, he argues, does human society as we know it have a chance of survival. Clearly written and thoroughly documented, this book provides a comprehensive overview of our complex environmental predicament. With unerring logic and science, Kenneth Sayre dissects the origins of the ecological crisis and points to the necessary recalibration of industrial societies with the laws of thermodynamics and ecology. It is a radical book in that he gets to the heart of what ails us, and it charts a course toward a future grounded in authentic hope. David W. Orr, Oberlin College Sayre s assessment forces all seeking a sustainable future to reexamine the preeminence accorded to clean energy. Unearthed uniquely combines thermodynamics and ethics to challenge and broaden readers understandings of the systemic issues we face. Assembled and presented with piercing clarity, Unearthed constructs a brilliant framework for making sense of our quiet, but growing crises. Felipe Witchger, IHS Cambridge Energy Research Associates Kenneth M. Sayre s Unearthed: The Economic Roots of Our Environmental Crisis constitutes a major and significant contribution to our understanding of the grave ecological crisis facing humanity. It covers the complete picture, from the basic physical causes of the destruction of our environment to the sociological or anthropological forces that condition our self-destructive actions. The work not only is a brilliant and mind-sweeping piece of diagnosis and prognosis, but it goes all the way to point towards possible solutions. Fernando del Rio Haza, Laboratorio de Termodinamica, Universidad Autonoma Metropolitana, Iztapalapa, Mexico

Movie Star Suicide, Hollywood Gossip, and Popular Psychology in the 1950s and 1960s

In two shocking developments in post-World War II Hollywood, actress-singer Judy Garland attempted suicide in 1950, and, in 1962, actress Marilyn Monroe died, apparently from suicide. Movie star suicide had occurred in earlier years - at least eight incidents preceded Garland's attempt?but these postwar incidents occurred as old studio system was in sharp decline and exerted less control over stars, publicity, and audiences. Thus, Garland's attempt and Monroe's death sparked enormous news coverage and controversy, as well as discussion and debate inside and outside about causes, meanings, and significance of these tragic events. Concerned Americans sought explanations, asking where responsibility lay. Were these events result of problems internal to two actresses or due to external pressures they felt? One prominent place for such a discussion was column of famed gossip Hopper, whose readers joined her in offering their views about unstable mental health and selfdestructive actions of these troubled stars. In columns and letters, Hopper and her readers raised a range of issues and concerns, but most strikingly majority drew on concepts originating and identified with Sigmund Freud to explain problems of Garland and Monroe. Their use of the psychological to understand emotional lives of two actresses demonstrated reach of popular psychology and its saturation of popular culture and everyday experience after World War II (Rose 264). Yet, Hopper and her readers' adoption of explanations coexisted with skepticism, deeply held religious convictions, and criticisms of psychiatrists. Moreover, a significant number of Hopper's readers rejected psychology's emphasis on interior self and life, and located source of problem not within Garland and Monroe but with external factors, including studio bosses, overwork, celebrity culture, and even Hopper herself. While one of popular sites of diffusion of therapeutic knowledge in postwar America, Hopper's gossip column also provided a forum for those who remained uneasy with the psychiatric persuasion, revealing cultural change as always messy and incomplete (Illouz 7, 23; Lunbeck). Hopper's Hopper remained a powerful, if aging, figure in movie industry in 1950s and 1960s. Born in 1885 (she always claimed 1890) to strict Quaker and Republican parents in Hollidaysburg, Pennsylvania, married and divorced once, Hopper was a struggling, underemployed supporting actress when her fledging movie gossip column Hedda Hopper's Hollywood was picked up by Los Angeles Times in 1938. Following in footsteps of her soon-to-be archrival Louella Parsons, Hopper soon became a powerful figure in movie industry. Syndicated in eighty-five metropolitan newspapers during 1940s, Hopper's column had an estimated daily readership of thirty-two million by mid-1950s (out of a national population of 160 million) (Eells). By middle of last century, Hopper in her famous hats had become a icon, and, like other gossip columnists, movie critics, and fan magazine writers, she fulfilled an important function within motion picture industry by helping to publicize movies and stars, and forging a relationship with movie-going public. And she fulfilled this function until her death in early 1966. Yet, Hopper was more than a movie gossip. She also saw herself as a conservative political figure and activist. She was a strident Cold War antiCommunist and a highly partisan member of Republican Party. She positioned herself as voice of conservative, small-town America, and used her column to express what she saw as proper social mores and political values. Gossip is private talk? true or false talk about life? voiced, often illegitimately, in public realm. …

Efficacité des antidépresseurs inhibiteurs sélectifs de la recapture de la sérotonine chez l’enfant et l’adolescent

Efficacité des antidépresseurs inhibiteurs sélectifs de la recapture de la sérotonine chez l’enfant et l’adolescent

War, Society, and Enlightenment: The Works of General Lloyd (review)

Reviewed by: War, Society, and Enlightenment: The Works of General Lloyd Armstrong Starkey War, Society, and Enlightenment: The Works of General Lloyd. Edited by Patrick J. Speelman. Leiden, The Netherlands: Brill, 2005. ISBN 90-04-14410-2. Maps. Illustrations. Notes. Index. Pp. xvi, 747. $285.00. Students of eighteenth-century military thought will welcome this publication of the collected works of Major General Henry Lloyd (c. 1729–83). This volume follows editor Patrick Speelman's 2002 biography of Lloyd, reviewed in the October 2005 issue of this journal. In his biography, Speelman made a strong case for Lloyd as perhaps the most creative military intellectual of his time. Now it will be possible for readers to decide for themselves, for all of Lloyd's published works have been brought together for the first time. Some have not been published since the eighteenth century and most have languished in obscurity in special collections. Speelman observes that Lloyd is relatively unknown today because of the general unavailability of his works. This is no longer the case. Lloyd was a soldier of fortune of wide experience, serving Prince Charles Edward Stuart in the '45 rising and in the armies of France, Austria, Brunswick, and Russia, in which he participated in many celebrated actions of the War of the Austrian Succession, the Seven Years' War, and the Russo-Turkish War. He was also absorbed in the era's intellectual currents, which spurred his reflections on military, political, and economic subjects. The result was his "History of the Late War in Germany," which appeared in three parts in 1766, 1781, and posthumously in 1790. Part operational history and part reflections on the principles of war, these segments allow the reader to observe the evolution of Lloyd's military thought. Christopher Duffy has dismissed the value of Lloyd's operational history as not representative of Austrian military thought and, indeed, to a modern reader, this aspect of Lloyd's writing may appear turgid and uninspired. Nevertheless, Lloyd was present at many of the actions that he described and had access to official accounts on both sides. In his "History" Lloyd offered valuable lessons on the influence of geography on warfare that led to his theory of lines of operations. He maintained that skillful exploitation of such lines by a general on the defensive could eliminate the necessity for battle. His criticism of Frederick the Great seems persuasive in this regard. Confined to the defensive, the king was too fond of battle and fought too many self-destructive actions that might have been avoided if he had moved against the enemy's line of communication. On the other hand, the Austrians' failure to develop a comprehensive plan of operations with their allies rendered their [End Page 499] efforts futile. Finally, it is clear that Lloyd's Russian experience led him to value mobility above mass in war. Three other works in this collection demonstrate the variety and richness of Lloyd's contribution to the Enlightenment: "An Essay on the English Constitution" (1770), written in support of John Wilkes and constitutional reform, and providing a critique of Britain's colonial policy; "An Essay on the Theory of Money" (1771), espousing liberal economic ideas; and "A Rhapsody on the Present System of French Politics; on the Projected Invasion, and the Means to Defeat It" (1779). The latter reveals Lloyd's application of his ideas based upon a detailed knowledge of Britain's coastal defenses gained from his experience as a Jacobite agent. Lloyd believed that an invasion was logistically impossible if prudent precautions were taken. The government found his detailed exposition so compelling that it suppressed the pamphlet as a military secret. A brief review cannot do justice to the significance of Lloyd's work. The editor has offered brief, excellent introductions to each work as well as informative footnotes. Speelman's biography of Lloyd should be a compulsory prerequisite for anyone using this volume. Its hefty price will no doubt restrict its purchase to libraries, but scholars owe Speelman a great debt for rendering accessible the work of one of the eighteenth century's most interesting minds. Armstrong Starkey Adelphi University Garden City, New York Copyright © 2006 Society...

Pediatricians and Antidepressant Medications: Black Box or Black Hole?

The intent of this commentary on the article by Leslie and colleagues1 is to describe ongoing efforts by the American Academy of Pediatrics (AAP) and other pediatric professional organizations to support pediatricians and other pediatric clinicians as they attempt to provide care for their patients who have mental health disorders. The article by Leslie et al is extremely important to primary pediatric medical providers and provides an important framework for this commentary for several reasons. The AAP recognizes the critical importance of providing pediatricians with assistance in the pharmacological management of children and adolescents with mental health disorders. The FDA Pediatric Advisory Committee’s vote in September 2004 to advise the FDA to require a “black-box warning” sounded an alarm extending from the examination rooms of tertiary child psychiatry clinics in Boston, Massachusetts, to solo primary care providers in the Oklahoma panhandle and rural Montana. Pediatricians were left wondering what to do about their patients already taking antidepressants (for a variety of conditions, … Address correspondence to Lynn Mowbray Wegner, MD, Learning and Development Associates, 3500 Gateway Centre Blvd, Suite 140, Morrisville, NC 27560. E-mail: lwegner{at}learningfirst.com

Strength of Will

that Baumeister and Heatherton point out (e.g., failures of monitoring, although I think that most drinkers know the limits of their own monitoring capability) and the special case of acute psychosis may be argued. Apart from these, even the case of action that seems self-destructive in its result need not be considered a failure of control. Of course, there are gamblers who lose, criminals who get caught, and addicts and drinkers who ruin their lives. They are people, often demoralized people, for whom talk of transcendence or delay of gratification is meaningless and for whom therefore the immediate relief or the short-term gain is what counts. In any case, it is a mistake to imagine, when we talk of so-called self-destructive action, that short-term gains and longterm consequences are always calculated. They are not. In fact, such calculations are often avoided: A few drinks, an abruptness of action with a quick completion, a rationalization that emphasizes the single and relatively safe instance of a general and risky pattern-all these diminish one's sensation of making a risky choice. They are ways in which people (some people particularly but all of us sometimes) can avoid asking themselves questions to which, they dimly suspect, the answers will be unpleasant.