Study: Don't implement CIWA protocol (benzodiazepines) unnecessarily

In an article published April 27 in JAMA Internal Medicine, “Challenges in Prediction, Diagnosis, and Treatment of Alcohol Withdrawal in Medically Ill Hospitalized Patients: A Teachable Moment,” Thomas D. Brothers, M.D., and Paxton Bach, M.D., write about the case of a man admitted to the hospital for planned bowel resection. The patient said he drank 8 to 10 ounces of whiskey a day but that his last drink was three days prior to admission. There were no symptoms of alcohol withdrawal during the first week. But he required an urgent reoperation on day 6, and on day 9, he became disoriented and inattentive, with large intra‐abdominal abscesses. On day 13, he became more agitated and confused, and clinicians implemented withdrawal treatment protocol using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale. He scored high — anxiety, agitation, hallucinations and disorientation — and was given 10 mg of diazepam, with improvement in his symptoms requiring no further medication. However, the next day he was even more confused and agitated, again scoring high. After another 10‐mg dose of diazepam, he became sedated and had to be transferred to a monitored unit. “In this case, poor understanding of the natural history of alcohol withdrawal led the inpatient team to misdiagnose alcohol withdrawal and inappropriately implement a CIWA protocol,” the researchers wrote. “Alcohol withdrawal symptoms generally begin 6 to 12 hours after the last drink and peak at 24 to 72 hours. Although withdrawal‐related seizures can occur at any time during this course, delirium tremens tends to occur three to seven days after the last drink, and only after progressing through more mild symptoms. For this patient, acute onset of severe alcohol withdrawal more than 1 week after the last drink would be highly unusual, especially without first demonstrating mild withdrawal.” Patients do become agitated under certain medical conditions, including pain and intubation. In this case, the patient was unnecessarily given high doses of benzodiazepines. He was not in alcohol withdrawal.     

In the Right Place at The Right Time: An Interview with Brian Stagoll

Few in Australia have done more than Brian Stagoll to develop and critique a local family therapy within an international context, to define its political and intellectual challenges, and to give the field organisational substance. He has been at the centre of Australian family therapy for more than two decades, as both creator and iconoclast. Brian is a psychiatrist who has always pursued social justice and community health initiatives along with a busy life as a therapist, and is a keen reader of history, politics, philosophy and literature. He was a co‐founder of our annual conferences. He co‐founded and organised the Williams Road Summer Schools in the 1980s. He was a co‐founder of this journal, its first Associate Editor and book review editor. He has contributed some of our most significant papers, as well as publishing elsewhere nationally and internationally. He was influential as a Board member and later as President. He is an Honorary Life Member of VAFT, which he co‐founded, and in 2001 he received — in his home city of Melbourne — the Journal Award for outstanding contributions to family therapy.     

TMZ shifts blame from police to drugs in Floyd death coverage

Last week, the Hennepin County Medical Examiner released the cause of death report of George Floyd, and when celebrity website TMZ got hold of it, it started what seemed like blaming the victim. Floyd's murder by the police was followed by days of protests around the country. The Minneapolis police officers involved — one choked him to death with a knee on his throat while the others watched — were fired. But TMZ's headline said “M.E. says he died from heart attack, had fentanyl…,” and the article went on to interpret the death certificate as follows: “In other words … he suffered a heart attack while they were arresting him, and that complicated their efforts to subdue him. The report says George had fentanyl in his system, and they also found signs of recent methamphetamine use. It also says his manner of death is homicide.”     

Ibn Khaldun and Philosophy: Causality in History

Ibn Khaldun was a statesman, diplomat, scholar and judge. His masterpiece Muqaddimah bears testimony to his skills in some other fields like economy and poetry too. As an intellectual of his time, he was naturally interested in philosophy as well. He had an education in philosophy and had a considerable knowledge in both Greek and Islamic philosophy. In fact, he is considered a philosopher of history and even the first one. This article will display an aspect of Ibn Khaldun's interest and relation to philosophy. It will discuss his conception of causation and analyze how it works in his history.     

Family therapy: An orientation

Conclusion The family therapist is an active, involved therapist. He must be emotionally lithe and resilient, prepared to deal with, or deal out, the unexpected. His challenge is to learn to use his own impulses and reactions in a way that the family can use to understand themselves better. He makes use also of any people and resources in the family's environment which might be of help to them. There are some basic techniques and orienting principles available to the family therapist, and it is these which it has been the task of this paper to set forth. Beyond these, the responsibility rests with each family therapist to comprehend himself and his place in his own family, and then to use his creativity to transform what he knows and what he feels into a form which can be used by the families he treats in their development.     

Leo Bogart, 1921-2005

Leo Bogart, who died October 15, 2005, in New York City, calledhimself an "applied sociologist" because he spent his careerin marketing rather than academic research. But his contributionsto knowledge filled 14 books, three of them published afterhe turned 80. His appreciation for the nuances of opinion measurementand contributions to question design would have earned him distinctionon any faculty, and so his career embodied the commercial-academicblend that has characterized the American Association for PublicOpinion Research (AAPOR). Born in Lvov, Poland, he moved with his family to New York atthe age of 2. He was a high school newspaper editor in     

Joshua A. Fishman 1926–2015

Joshua Fishman died in March this year. He was founder‐editor of the International Journal of the Sociology of Language, one of the early and central journals of sociolinguistics. Alongside this major editorial involvement, which he maintained to the end, he also edited several of the field‐defining book collections which helped shape the growing field in the 1960s and 70s. He might well have viewed the founding of the Journal of Sociolinguistics in 1997 as unfortunate or competitive, the more so since our opening manifesto questioned the role of traditional sociology in our field. But Fishman responded graciously and positively to the invitation from me and Nikolas Coupland to join our inaugural Editorial Board. He remained on the Board, and was warm in his support and advice. The one piece he published with us was in 2000, a very personal obituary for Charles Ferguson which was notable for the respect and warmth it displayed. The editorial team is indebted to Fishman's longtime collaborator, Ofelia García, for this memoir on him and his significance in sociolinguistics. The Editors     

New variable-population paradoxes for resource allocation

We identify previously unnoticed ways in which agents can strategically distort allocation rules, by affecting the set of “active” agents. (i) An agent withdraws with his endowment. (ii) He gives control of his endowment to someone else and withdraws. (iii) He invites someone in and let him use some of his endowment. (iv) He pre-delivers to some other agent the net trade that the rule would assign to that second agent if that second agent had participated. In (i) and (ii), he and his co-conspirator may end up controlling resources that allow them to reach higher welfare levels than they otherwise would. In (iii) and (iv), he may end up with a bundle that he prefers to the one he would have been assigned had he not engaged in the manipulation. We show that (i) the Walrasian rule is not “withdrawing-proof”, nor “endowments-merging-proof, nor “endowments-splitting-proof”, but that it is “pre-delivery-proof”, and that (ii) canonical selections from the egalitarian-equivalence-in-trades solutions satisfy none of the properties.     

What’s disability got to do with it? Changing constructions of Oscar Pistorius before and after the death of Reeva Steenkamp

Traditionally disability has been viewed in the popular imagination as either a highly positive or highly negative phenomenon. Disability and disabled people deserve to be seen in an integrated, holistic way and to have recognised as much diversity as characterises the human condition. The recent case of Oscar Pistorius fatally shooting Reeva Steenkamp has highlighted this tendency. Before this incident, Pistorius’ disability was viewed in a predominantly positive light. He had been described as a ‘supercrip’ who had, despite his physical impairments, ‘overcome’ his mobility limitations and was consequently attributed heroic status by some. However, after this fatal incident, the portrayal of Pistorius’ disability has, perhaps inevitably, shifted. This paper will offer possible psychosocial reasons for this tendency to view disability in a binary way.     

War and the contest over national identity

This paper looks at a recent historical moment in which the American national identity was defined and contested in the public arena. The Persian Gulf crisis of 1990‐91 presents a case in point in which official actors attempted to define the American character and in so doing prescribed particular actions necessary to fulfill what it means to be an American confidence. He described Americans as unique in esteemed values and America as the only country capable of leading the world. In so doing, he invited American participation in support for US military intervention. On the other side, the peace movement chose to emphasize American weaknesses, domestic problems, and the gullible nature of the American people. In so doing it attempted to shame Americans into supporting the anti‐war movement.     

Briefly Noted

Last week, Scott Gottlieb, M.D., abruptly and surprisingly resigned as commissioner of the Food and Drug Administration (FDA). He has pushed to reduce teenage vaping, been a vociferous supporter of medications to treat opioid use disorder and is noted in the field for his recommendation that methadone and buprenorphine patients should not be terminated from care for use of benzodiazepines. After he announced his resignation on March 5, vaping stocks surged. He was viewed as critical to protecting youths against nicotine and e‐cigarettes. “He was remarkably successful at keeping the agency moving forward at a difficult time and really focused on public health challenges, including the opioid epidemic and drug prices,” said Joshua M. Sharfstein, M.D., a former principal deputy commissioner at the FDA during the Obama administration, who is now a professor of health policy at the Johns Hopkins Bloomberg School of Public Health, told The New York Times. “He surprised a lot of people in his willingness to take some risks for public health.”     

Translator's Introduction to Max Weber's Essay on Some Categories of Interpretive Sociology*

The essay on “Some Categories of Interpretive Sociology” is Max Weber's first systematic statement of his own sociology. Weber had written earlier as an economist and as a methodologist of the social sciences. But in this essay, he sets forth the method and indicates the scope of his interpretive sociology. He delineates the boundaries between it and two neighboring disciplines (psychology and law) and defines some basic concepts or categories of social action. The essay first appeared in 1913 in Logos, an interdisciplinary journal of which Weber was an editor.     

A Strategic Approach to an Extreme Feeding Problem

This paper describes the dramatic resolution of a refractory feeding problem of an eighteen month old boy. He had spent 199 days in hospital prior to treatment and none following this, except for a brief period for a tonsillectomy. He has regained his developmental pace. The authors have attempted to isolate their hypotheses and the interventions derived from them. The parents reflection on the therapy, four months after the first session, provides a commentary on our commentary.     

Russian Jews in exile from Bolshevik Russia: the case of Lev Shestov as an example of Russian‐Jewish existential compromise

Lev Shestov (born Leib Jehuda Shvartsman in Kiev in 1866) was a product of his times and entangled cultural roots. His destiny became closely related to the Russian Diaspora in Europe (he fled Bolshevik Russia in 1920). He was also linked to the local (especially French and German) intellectual life. However, being a Jew made Shestov stand out from the purely Russian emigration, for although he connected himself first and foremost with Russian culture, he could not be integrated without reservations into the purely Russian Diaspora. On the other hand mapping him in relation to the diverse Russian‐Jewish émigré milieu in Europe is not a straightforward task because his attitude to his Jewish roots was rather ambivalent. The case of self‐identification, in varying degrees, was similarly ambiguous with many Russian Jews who left Russia after the revolution. Shestov’s activities in emigration were diverse. Apart from teaching he published regularly in the outlets of the émigré press as well as in major French literary journals and gave lectures in Germany (in particular, addressing such different audiences as the Union of Russian Jews and the Nietzschean Society). In brief, his way of coping with the experience of exile was to become a multicultural conductor of sorts. This article aims to analyse Shestov’s life path in the framework of the Russian‐Jewish Diaspora in Europe at the time in the context of both cultural and ethnic repudiation and appropriation. This in turn should shed some new light on the cultural life of this Diaspora.     

In Touch With People,not Paper: An Interview With Doug Sotheren

Doug Sotheren has been conducting well‐regarded training courses in relationship counseling for over 25 years, outside a university setting. In conversation with his former trainee Cathy Zervos, he presents his personal philosophy of counsellor training, emphasising the need for trainees to be ‘in touch with people’ rather than with theory. His whole course is experiential and based on the concept that training (including the way the co‐trainers handle their own relationship in front of the group) should model the counselling process itself. He talks about his way of selecting students, and his views on counselling students out of the course where necessary. A long‐serving member of the AAMFC and former editor of their newsletter, Sotheren praises the AAMFC for requiring demonstrated competence in its members.     

Family Therapy — An Enduring Passion: An Interview With Michael Locke

Michael has been involved in family therapy since 1975. He is a past president of the Queensland Association for Family Therapists (QAFT), and for fifteen years was an assessor for the ANZJFT. During this time he has been steadily training, and conducting his practice. Mike's involvement at Centacare has made him part of one of the longest‐running reflecting team projects in Brisbane. The interview with Michael was playful, unpredictable and free from stifling earnestness. Chris Lobsinger interviewed Michael Locke in late November 2002.     

Interview With Michael Kerr

The following article was written by Dr Michael Kerr in response to questions put to him by Barbara Fraser; Linda Mackay and Lu Pease when he visited Australia two years ago. These three family therapists took it upon themselves to prepare this interview in recognition of Dr Kerr's unique vantage point on Bowen Theory and family therapy. Michael Kerr was trained by Murray Bowen in the 1970s and subsequently went on to work as faculty at the Georgetown Family centre. He succeeded Bowen as director of the centre where he has devoted his professional life to the understanding, application and extension of theory. He is the co‐author with Dr Bowen of Family Evaluation: An Approach Based on Bowen Theory (Kerr & Bowen, 1988), which remains the most esteemed text on this theory. He is also the editor of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and The Sciences. Bowen's Family Systems Theory grew out of years of research from the 1950s‐1970s, which included observations of inpatient families with a schizophrenic member and using data from Bowen's own interactions with his family of origin (Bowen, 1978). The theory continues to be influential in family therapy with its most well‐known contributions being the process of triangling, the intergenerational transmission of family patterns and the concept of differentiation of self. (Brown, 1999). The following discussion from Dr Kerr brings a fresh perspective on the current applications and developments of this systems theory     

José Ortega y Gasset (1934), Ibn Khaldūn Reveals the Secret to Us (thoughts on Africa Minor) translated from Spanish by Cynthia Scheopner

José Ortega y Gasset (1883–1955) was puzzled how Melilla remained a Spanish enclave on the North African coast. By 1927, Spain had solidified its hold on Northern Morocco and several books on the history and culture of “Africa minor” had been published; in one Ortega encountered Ibn Khaldūn. Ortega read the Prolegomena to History in the French translation by William MacGuckin de Slane. He found a key to understanding Spain that he explored in this essay, first published in El Espectador journal of Madrid in 1934. It introduced Ibn Khaldun to European audiences as the first philosopher of history three decades before an English translation of his work. Ortega, then, knew of Ibn Khaldun's theory of generations at the time he was developing his own. Ortega noted page numbers in parentheses in the text where he quoted from De Slane. The end notes are from the text as well, documenting Ortega's secondary sources for his impressions of Ibn Khaldūn, Islam, and North African culture.     

The cultural apparatus: C. Wright Mitts’ unfinished work

Conclusion Mills wrote to his Oxford publisher in 1955. “One book grows out of another; the trouble is not only is there no end to it, but after the second is pressing upon you before you can finish the first, for planning is more fun than working.” 78 Indeed, this mode of working was common to all of Mills’ projects. He worked fast and furiously and always juggled a number of different ideas in various stages of formation. This certainly was the case with The Cultural Apparatus. In a 1955 letter to his publisher Mills enthusiastically said of the book “I'm into it.” He predicted, optimistically, that unlike his other books, this book would be easy, a natural for him that “writing it will not involve the anguish that White Collar and Elites have provided.” By 1959, however, Mills had to admit that this optimism was premature. In “The Personal Note to the Reader” he confessed that “I've never had so much trouble writing a book as I have with this one, and I’ve never taken so much pain with the writing of it as I’ve taken to heart the criticism of being repetitious, verbose and prone to jargon.” 79 Mills never completed the project. By the late 1950's he became preoccupied with the political issues of “war and peace” and American foreign policy in Cuba, the latter in particular. His health was poor as a result of a heart attack he suffered in December of 1959 on the eve of a televised debate with an American advisor in Latin America, A.A. Berle. He became embroiled in what he understood as necessary public work from within the media and he remained adamant about the personal significance of The Cultural Apparatus in 1959.     

The contributions of john money: A personal view

John Money has been a dominant voice in sexology in the last part of the 20th century, breaking new ground in a wide variety of areas. In the process, he has been cantankerous, outspoken, and ever willing to do battle, but also original and thought provoking. This paper begins with an examination of science in general, moves on to psychology and sexology, and then examines Money's contributions to sexology in some detail. The latter are many and varied, including the development of the concept of gender, his theory of gender identity based on his work with intersex individuals, the John‐Joan case, and his importance in establishing transsexualism as a diagnostic category and an academic discipline. Also important are his contributions to the development of the nomenclature of sexology, his importance to the sexology movement as a teacher, his significant research on a large variety of sexual topics, his ability to convince government agencies that sex was deserving of funding, and his association with the Erickson Educational Foundation. He also was a significant figure in the development of the Society for the Scientific Study of Sexuality (SSSS) and in raising the standard of its journal (The Journal of Sex Research), and therefore it is only fitting that an award be named after him. Though Money remains controversial, he has contributed significantly to the development of sexology as a discipline.