Chapter in JM Mezzich, M Botbel, G Christadoulou, R Cloninger and I Salloum (eds): Person Centered Psychiatry, Springer Verlag, 2017
The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.
Background: Person- and people-centered medicine (PCM) underscores the importance of accounting f... more Background: Person- and people-centered medicine (PCM) underscores the importance of accounting for culture and cultural values. Objective: The objective of this article is to clarify the concept of culture and describe misleading or faulty ways of understanding this concept in averting blind-spots for culture in person- and people-centered health care. Method: Drawing on the conceptualization of PCM, the philosophy of values, values-based Practice, and principles of anthropology, misleading or faulty ways of understanding the concept of culture are identified by meeting criteria of conflation, confusing contingency as if necessity, being too narrow, or contracting blind-spots. Results: Six ways of understanding the concept of culture are identified that may undermine person-centered practice. These may be corrected by understanding culture as necessarily constituted by a set of shared practices underpinned by values. So understood, this clarifies the distinction between culture and...
International Perspectives in Values-Based Mental Health Practice, 2021
The book is now Open Access. The link is: https://link.springer.com/book/10.1007%2F978-3-030-4785... more The book is now Open Access. The link is: https://link.springer.com/book/10.1007%2F978-3-030-47852-0 This book off ers essential information on values-based practice (VBP): the clinical skills involved, teamwork and person-centered care, links between values and evidence, and the importance of partnerships in shared decision-making. Diff erent cultures have diff erent values; for example, partnership in decision-making looks very diff erent, from the highly individualized perspective of European and North American cultures to the collective and family-oriented perspectives common in South East Asia. In turn, African cultures off er yet another perspective, one that falls between these two extremes (called batho pele). Th e book will benefi t everyone concerned with the practical challenges of delivering mental health services. Accordingly, all contributions are developed on the basis of case vignettes, and cover a range of situations in which values underlie tensions or uncertainties regarding how to proceed in clinical practice. Examples include the patient's autonomy and best interest, the physician's commitment to establishing high standards of clinical governance, clinical versus community best interest, institutional versus clinical interests, patients insisting on medically unsound but legal treatments etc. Th us far, VBP publications have mainly dealt with clinical scenarios involving individual values (of clinicians and patients). Our objective with this book is to develop a model of VBP that is culturally much broader in scope. As such, it off ers a vital resource for mental health stakeholders in an increasingly interconnected world. It also off ers opportunities for cross-learning in values-based practice between cultures with very diff erent clinical care traditions.
Objectives: Amidst calls for improved professionalism, this study examined the professionalism of... more Objectives: Amidst calls for improved professionalism, this study examined the professionalism of psychiatry registrars at Weskoppies Hospital as evaluated by their patients, themselves, their consultants and other health practitioners. The second objective was to examine the perceived importance of aspects of professionalism and compare these descriptively among the various health practitioners and patients.Method: Participants completed the Professionalism Mini-Evaluation Exercise Questionnaire in evaluating the professionalism of the registrar. The number of questionnaires completed by patients, allied health practitioners, consultant psychiatrists and psychiatry registrars were, respectively, 100, 50, 25 and 20; thus, 195 in total. This previously validated questionnaire consists of 21 items that enquire about doctor-patient relationship skills, reflective skills, time management and interprofessional relationship skills. Participants also ranked the three items of the questionn...
The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.
Background: In the Life Esidimeni tragedy, crucial voices of mental healthcare users and practiti... more Background: In the Life Esidimeni tragedy, crucial voices of mental healthcare users and practitioners were silenced, captured in the Ombud’s report as a ‘failure to listen’. Working against this kind of failure, various therapeutic interventions listen deliberately and uncover the voice of the patient, that is, what matters from his or her subjective perspective in his or her particular circumstances. Amongst these interventions, music therapy provides for this sensitive listening by expanding the scope and means of expression from the verbal to the musical.Aim: This article reports on a qualitative exploration of patients’ lived experiences both during and after their course of individual music therapy, expressed both verbally and in the language of active music-making.Setting: A tertiary public psychiatric hospital in South Africa.Methods: Audio-video recordings of 131 music therapy sessions and 15 post-therapy interviews were analysed thematically. From three sets of themes acco...
the International Journal of Person-Centered Medicine, Jul 27, 2021
This issue features the third set of articles in the volume on work–life balance and burnout. It ... more This issue features the third set of articles in the volume on work–life balance and burnout. It focuses on burnout among physicians and an intervention pursuing well-being by which to prevent or recover from burnout. Burnout among physicians is addressed from perspectives from the United Kingdom (UK), Nordic countries, Japan and Germany [4]. Different from the focus on burnout among physicians in these four articles, another article [7] focuses on interventions that pursue well-being by which one may prevent or recover from burnout. Burnout is a global problem adversely affecting physicians and patient care. In the UK, the first article shows, burnout among about a third of physician puts their national health service at risk. Burnout is linked to working conditions leading to emotional exhaustion and impediments to a good work–life balance. Working conditions brought about by regulatory changes in Japan and Germany feature respectively in the third and fifth articles. The fourth article drawing on Nordic studies underscores the person-centered point that burnout among physicians is adversely affecting the very foundation of the physician’s work, that is, the relationship with the patient. This issue, furthermore, features an article on the quantitative effects that well-being interventions had on the personality and health of a sample of refugees living in Sweden.
International Perspectives in Values-Based Mental Health Practice, 2020
This chapter reflects on the Life-Esidimeni tragedy in which more than 140 mental healthcare user... more This chapter reflects on the Life-Esidimeni tragedy in which more than 140 mental healthcare users died as a consequence of a policy decision. The main finding of an official investigation into these events was a “failure to listen or take advice”, but how this failure may be averted in the future did not feature among the recommendations of the Ombud’s report, this being mostly about further legal, regulatory and rights-based actions. To avert similar tragedies in the future, this chapter adds another recommendation. This is a practical decision-making process by which to listen properly in policy-making. Specifically, a policy-making indaba in an African version of values-based practice generates a space in which all stakeholders implied in the formulation and execution of a health policy may listen properly to each other about what matters to them in that context over and above the values captured in regulations and rights. The resulting policy may thus creatively account for the...
A few items of existing schizophrenia scales measure avolition, but no research has been reported... more A few items of existing schizophrenia scales measure avolition, but no research has been reported on vigour in schizophrenia, including whether avolition would be more or less the inverse of vigour. Such research requires a valid and reliable measure of vigour. In the absence of this, this study developed and examined the validity and the reliability of the Vigour Assessment Scale (VAS) among 242 avolitional schizophrenia outpatients in relation to measures of workplace vigour, behavioral inhibition and activation, procrastination, fatigue, anxiety, depressive features, and active involvement in personal growth. Convergent validity was found in moderate to strong correlations (r = 0.5 to 0.714) between the VAS and measures approximate to vigour. Discriminant validity was found in lower and/or inverse correlations with depression (r = -0.423), anxiety (r = -0.279), behaviour inhibition (r = -0.045), procrastination (r = -0.656), and fatigue (r = -0.684). Internal consistency was good...
International Perspectives in Values-Based Mental Health Practice, 2020
This Chapter presents the case of a Qur’anic healer in the Dakhla Oasis of Egypt. It identifies t... more This Chapter presents the case of a Qur’anic healer in the Dakhla Oasis of Egypt. It identifies the values that the healer is seeking to promote and the cultural influences on his beliefs and practices. The Chapter demonstrates the interplay of traditional practices and scientific concepts and methods, and concludes by considering implications for the development of mental health services in communities such as the Dakhla Oasis.
International Journal of Person Centered Medicine, 2021
Background: Person-centered medicine (PCM) broadens the practical scope in health practice beyond... more Background: Person-centered medicine (PCM) broadens the practical scope in health practice beyond patient-centered medicine. Objectives: The objective of this article is to consider what a broadened scope mean in understanding how employment/work relates to the promotion of health and well-being of the patient and the practitioner. Method: The conceptual scope of PCM is applied in considering the connections of work with health and well-being. The scope of occupational health is accordingly expanded in accounting for the work and well-being of the patient and the practitioner. Results: PCM puts the person and people before their work. It recognizes that an employed person, whether patient or practitioner, works in a context that is interpersonal and in which all the role players contribute to a healthy milieu. This means that a healthy work–life balance should not be pursued merely as an attribute of an individual, but as a pursuit to which all role players should actively contribut...
Chapter in JM Mezzich, M Botbel, G Christadoulou, R Cloninger and I Salloum (eds): Person Centered Psychiatry, Springer Verlag, 2017
The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.
Background: Person- and people-centered medicine (PCM) underscores the importance of accounting f... more Background: Person- and people-centered medicine (PCM) underscores the importance of accounting for culture and cultural values. Objective: The objective of this article is to clarify the concept of culture and describe misleading or faulty ways of understanding this concept in averting blind-spots for culture in person- and people-centered health care. Method: Drawing on the conceptualization of PCM, the philosophy of values, values-based Practice, and principles of anthropology, misleading or faulty ways of understanding the concept of culture are identified by meeting criteria of conflation, confusing contingency as if necessity, being too narrow, or contracting blind-spots. Results: Six ways of understanding the concept of culture are identified that may undermine person-centered practice. These may be corrected by understanding culture as necessarily constituted by a set of shared practices underpinned by values. So understood, this clarifies the distinction between culture and...
International Perspectives in Values-Based Mental Health Practice, 2021
The book is now Open Access. The link is: https://link.springer.com/book/10.1007%2F978-3-030-4785... more The book is now Open Access. The link is: https://link.springer.com/book/10.1007%2F978-3-030-47852-0 This book off ers essential information on values-based practice (VBP): the clinical skills involved, teamwork and person-centered care, links between values and evidence, and the importance of partnerships in shared decision-making. Diff erent cultures have diff erent values; for example, partnership in decision-making looks very diff erent, from the highly individualized perspective of European and North American cultures to the collective and family-oriented perspectives common in South East Asia. In turn, African cultures off er yet another perspective, one that falls between these two extremes (called batho pele). Th e book will benefi t everyone concerned with the practical challenges of delivering mental health services. Accordingly, all contributions are developed on the basis of case vignettes, and cover a range of situations in which values underlie tensions or uncertainties regarding how to proceed in clinical practice. Examples include the patient's autonomy and best interest, the physician's commitment to establishing high standards of clinical governance, clinical versus community best interest, institutional versus clinical interests, patients insisting on medically unsound but legal treatments etc. Th us far, VBP publications have mainly dealt with clinical scenarios involving individual values (of clinicians and patients). Our objective with this book is to develop a model of VBP that is culturally much broader in scope. As such, it off ers a vital resource for mental health stakeholders in an increasingly interconnected world. It also off ers opportunities for cross-learning in values-based practice between cultures with very diff erent clinical care traditions.
Objectives: Amidst calls for improved professionalism, this study examined the professionalism of... more Objectives: Amidst calls for improved professionalism, this study examined the professionalism of psychiatry registrars at Weskoppies Hospital as evaluated by their patients, themselves, their consultants and other health practitioners. The second objective was to examine the perceived importance of aspects of professionalism and compare these descriptively among the various health practitioners and patients.Method: Participants completed the Professionalism Mini-Evaluation Exercise Questionnaire in evaluating the professionalism of the registrar. The number of questionnaires completed by patients, allied health practitioners, consultant psychiatrists and psychiatry registrars were, respectively, 100, 50, 25 and 20; thus, 195 in total. This previously validated questionnaire consists of 21 items that enquire about doctor-patient relationship skills, reflective skills, time management and interprofessional relationship skills. Participants also ranked the three items of the questionn...
The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.
Background: In the Life Esidimeni tragedy, crucial voices of mental healthcare users and practiti... more Background: In the Life Esidimeni tragedy, crucial voices of mental healthcare users and practitioners were silenced, captured in the Ombud’s report as a ‘failure to listen’. Working against this kind of failure, various therapeutic interventions listen deliberately and uncover the voice of the patient, that is, what matters from his or her subjective perspective in his or her particular circumstances. Amongst these interventions, music therapy provides for this sensitive listening by expanding the scope and means of expression from the verbal to the musical.Aim: This article reports on a qualitative exploration of patients’ lived experiences both during and after their course of individual music therapy, expressed both verbally and in the language of active music-making.Setting: A tertiary public psychiatric hospital in South Africa.Methods: Audio-video recordings of 131 music therapy sessions and 15 post-therapy interviews were analysed thematically. From three sets of themes acco...
the International Journal of Person-Centered Medicine, Jul 27, 2021
This issue features the third set of articles in the volume on work–life balance and burnout. It ... more This issue features the third set of articles in the volume on work–life balance and burnout. It focuses on burnout among physicians and an intervention pursuing well-being by which to prevent or recover from burnout. Burnout among physicians is addressed from perspectives from the United Kingdom (UK), Nordic countries, Japan and Germany [4]. Different from the focus on burnout among physicians in these four articles, another article [7] focuses on interventions that pursue well-being by which one may prevent or recover from burnout. Burnout is a global problem adversely affecting physicians and patient care. In the UK, the first article shows, burnout among about a third of physician puts their national health service at risk. Burnout is linked to working conditions leading to emotional exhaustion and impediments to a good work–life balance. Working conditions brought about by regulatory changes in Japan and Germany feature respectively in the third and fifth articles. The fourth article drawing on Nordic studies underscores the person-centered point that burnout among physicians is adversely affecting the very foundation of the physician’s work, that is, the relationship with the patient. This issue, furthermore, features an article on the quantitative effects that well-being interventions had on the personality and health of a sample of refugees living in Sweden.
International Perspectives in Values-Based Mental Health Practice, 2020
This chapter reflects on the Life-Esidimeni tragedy in which more than 140 mental healthcare user... more This chapter reflects on the Life-Esidimeni tragedy in which more than 140 mental healthcare users died as a consequence of a policy decision. The main finding of an official investigation into these events was a “failure to listen or take advice”, but how this failure may be averted in the future did not feature among the recommendations of the Ombud’s report, this being mostly about further legal, regulatory and rights-based actions. To avert similar tragedies in the future, this chapter adds another recommendation. This is a practical decision-making process by which to listen properly in policy-making. Specifically, a policy-making indaba in an African version of values-based practice generates a space in which all stakeholders implied in the formulation and execution of a health policy may listen properly to each other about what matters to them in that context over and above the values captured in regulations and rights. The resulting policy may thus creatively account for the...
A few items of existing schizophrenia scales measure avolition, but no research has been reported... more A few items of existing schizophrenia scales measure avolition, but no research has been reported on vigour in schizophrenia, including whether avolition would be more or less the inverse of vigour. Such research requires a valid and reliable measure of vigour. In the absence of this, this study developed and examined the validity and the reliability of the Vigour Assessment Scale (VAS) among 242 avolitional schizophrenia outpatients in relation to measures of workplace vigour, behavioral inhibition and activation, procrastination, fatigue, anxiety, depressive features, and active involvement in personal growth. Convergent validity was found in moderate to strong correlations (r = 0.5 to 0.714) between the VAS and measures approximate to vigour. Discriminant validity was found in lower and/or inverse correlations with depression (r = -0.423), anxiety (r = -0.279), behaviour inhibition (r = -0.045), procrastination (r = -0.656), and fatigue (r = -0.684). Internal consistency was good...
International Perspectives in Values-Based Mental Health Practice, 2020
This Chapter presents the case of a Qur’anic healer in the Dakhla Oasis of Egypt. It identifies t... more This Chapter presents the case of a Qur’anic healer in the Dakhla Oasis of Egypt. It identifies the values that the healer is seeking to promote and the cultural influences on his beliefs and practices. The Chapter demonstrates the interplay of traditional practices and scientific concepts and methods, and concludes by considering implications for the development of mental health services in communities such as the Dakhla Oasis.
International Journal of Person Centered Medicine, 2021
Background: Person-centered medicine (PCM) broadens the practical scope in health practice beyond... more Background: Person-centered medicine (PCM) broadens the practical scope in health practice beyond patient-centered medicine. Objectives: The objective of this article is to consider what a broadened scope mean in understanding how employment/work relates to the promotion of health and well-being of the patient and the practitioner. Method: The conceptual scope of PCM is applied in considering the connections of work with health and well-being. The scope of occupational health is accordingly expanded in accounting for the work and well-being of the patient and the practitioner. Results: PCM puts the person and people before their work. It recognizes that an employed person, whether patient or practitioner, works in a context that is interpersonal and in which all the role players contribute to a healthy milieu. This means that a healthy work–life balance should not be pursued merely as an attribute of an individual, but as a pursuit to which all role players should actively contribut...
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