Thomas Szasz' “critical reflections on child psychiatry”: An alternative view through a systemic lens

In “Critical Reflections on Child Psychiatry,” Thomas Szasz (1979) argues that children are without the rights afforded adults, that children are often coerced into therapy, and that most children do not appear to benefit from psychotherapy. Szasz raises many pertinent questions for mental health professionals working with children. However, his arguments appear to be based on literature limited to traditional psychodynamic approaches. His position also neglects to consider literature in the developmental psychology and legal fields. This paper, written from the cognitive developmental and the family systems perspective, provides another examination of the important issues raised by Thomas Szasz.     

Tailor-made planning: Making planning fit the firm

This selective and limited application of the contingency approach to planning is intended to show that the process is a highly flexible set of activities which can be adapted and tailored to the organization's requirements. At each stage of the planning process the manager has a set of choices which enable him to make the best possible fit between the process and the organization. He is not a passive recipient of a pre-ordained sequence of rigidly invariable activities. He is in the position of being able to select specific solutions to specific problems so that the planning process and structure form the best possible fit for the organization in its environment.     

Professional authority and state power

Conclusion The relation between professional authority and state power is not to be found in the political clout of the A.M.A. or the A.B.A. nor in the fact that lawyers work at every level of government and doctors often occupy key policy making positions. The relation between state power and professional authority that I have tried to underline is more diffuse and embedded in the very work doctors and lawyers do. But even this claim can be misleading, because what's at issue here is not how doctors and lawyers use their expert authority to extract consent from and normalize patients and clients. In fact, it is the erosion or deconstitution, as I have called it, of this authority by the commodification of legal and medical services that has brought out more subtle problems and more revealing ties to state power.The HMO doctor who has to advise a patient about emergency service coverage is a good example of the way in which medical service, state administrative power, and economic interests are visibly intertwined in the actual provision of medical care at the ground level. When we take this one step further, the role of the state in the crisis of the professions begins to emerge. State licensing laws and insurance regulations are restructuring the already fragile relations among patient, doctor, HMO, and insurer. The patient in this example, outraged by pseudo-medical advice on emergency coverage, may soon recognize that it is not only the doctor who is incapable of assessing his or her medical needs. The political domain itself is becoming a maze of tort laws and tort reform proposals.What difference does all of this make? Right now, for the professions it may mean slightly more competition among practitioners and, for some, a loss of status. For the state it means a new kind of oversight and intervention. Instead of licensing professional autonomy, state power is now being used to stabilize the process of commodification by encouraging backsliders and disciplining those who would go too far. One reason unethical behavior is drawing closer state scrutiny is its high economic costs. Although these are obviously important consequences, I have tried to emphasize a more theoretical one. At the same time the state is being drawn into the commodification of professional services, the professions are losing their ability to interpret persuasively the origins and scope of human needs. This means that the repoliticization Habermas and Offe anticipate makes even more sense. Not only is the state's role in previously private matters subject to criticism, it seems unable to provide a forum for critical needs interpretation of the pragmatic sort at a time in which the professions are seen as derelict in their traditional duty of needs interpretation.This point can be made more precise by distinguishing two ways in which my analysis of professional authority is related to Habermas's and Offe's work. I have not analyzed professional authority in general, but medical and legal professional authority in the United States in particular. One implication of this study is that the prospects for democratic social movements in the United States along the lines Habermas and Offe sketch may depend upon the commodification of professional services more than simply the general intervention of the state into private economic, educational, and family affairs. This peculiar feature of a strong American social movement would be the result of the traditional popular dichotomy between authority and power, the historical role of the professions in needs interpretation in the United States, and the current radical deconstitution of medical and legal authority. Habermas and Offe seem more concerned with the more mature European social movements than with events in the United States. My analysis applies and amends their legitimation crisis thesis, and the repoliticization hypothesis especially, in the U.S. case.But, like a good case study, it also suggests a way in which the general theoretical framework that guided it in turn can be revised. In my analysis it is the concept of needs interpretation that has general theoretical significance for the legitimation crisis thesis. One problem critics have noted in the legitimation crisis thesis is its inadequate account of what motivates or will motivate such as crisis. Habermas's own treatment of the difference between a legitimation crisis and a motivational crisis is notably weak. The case of the deconstitution of professional authority suggests that the motivational basis for a legitimation crisis cannot be deduced from greater state intervention in private domains but that it nonetheless may have its roots in basic changes in the political economy. The commodification of medical and legal services is part of a larger transformation in capitalist political economies that I have not been able to describe here. Although I have called this commodification an internal process, it most certainly reflects larger trends and changes, both domestically and internationally. What the deconstitution of professional authority suggests is that 1) it may be possible to gain greater clarity about the motivational basis of a potential legitimation crisis through the concept of needs interpretation, 2) this motivational basis is not a simple function of the macroeconomy, but still 3) how effective professional and political needs interpretation are will depend upon the pace and range of commodification.

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Problems in the evaluation of persons who request sex-change surgery

Not all individuals who seek an evaluation for sex-change surgery are true, primary transsexuals. Evaluations need to be thorough and evaluators need to commit themselves to working with a difficult, demanding client population. Problems are related to the state of imperfection in nosology, diagnosis, and scientific knowledge. There is a great need for controlled research, long-term follow-up and consistency in procedural protocols.     

Cohort Perspectives on Women’s Educational Attainment and the Timing of Parenthood in Ghana

This paper examines the effects of womens educational attainment on the timing of parenthood across successive generations of women in Ghana. Given the more enhanced career opportunities in recent years, we argue that the opportunity cost of parenthood may be higher for contemporary educated women, and as such, they are expected to delay parenthood for longer periods than their counterparts in the past. Using data from the 1998 Ghana Demographic and Health Survey, we found that while higher maternal education associates with delayed parenthood, significant cohort differences were noticeable. Consistent with our expectations, the effect of higher educational attainment was substantially greater among younger women, indicating a longer transition to parenthood. Implications of the findings are discussed.     

Perceptions of health and well-being in transition societies: some results of a qualitative study carried out in the Ukraine

This article reports on research carried out within the scope of the Inco-Copernicus Programme, from 1999 to 2002, on ‘Health and Well-Being in Transition Societies’. In particular, it presents the results of a qualitative study carried out in the Ukraine. On the basis of in-depth interviews and two biographical interviews, data are analysed on the following topics: employment situation, informal economy, perception of health and well-being, perception of social services, perception of social exclusion, crisis and low expectations, coping strategies, and perceptions of citizens’ rights. It concludes that transition has meant important change that has had a significant effect upon the Ukrainian population.     

Collaboration for community-based wildlife management

Perhaps as remarkable as the general upsurge in public interest in wildlife over the last 30 years is the trend toward greater community-based wildlife management since the late 1980s. This paper discusses the challenges and opportunities at the local, community scale of collaboration for wildlife management. We explain how collaborative activity between the professional wildlife manager and community stakeholders can lead to improved identification of human-wildlife interactions and better understanding of wildlife-related impacts that are of primary management concern in the community. Community-based collaborative decision making can also effectively result in the specification of management actions that are acceptable to a community. Furthermore, agency-community collaboration can lead to co-management that goes beyond stakeholder input or involvement in decision making about management objectives and actions, and includes appropriate sharing of responsibility for implementation and evaluation. A growing role for the wildlife agency in such situations is facilitating the development of local capacity by filling information and process needs so that individuals and groups in a community can participate effectively in collaborative efforts appropriate to the necessary level of agency-community engagement. This opportunity for the wildlife profession promises to be rewarding and have lasting positive influence on communities for the benefit of wildlife management. However, most agencies cannot address every issue at a community level. Public wildlife managers need guidelines for judgment about when to engage in community-based wildlife management. They need to assess various risks associated with not engaging in a particular issue and to prioritize the potential situations where various degrees of community engagement may be desirable. This paper highlights these intriguing challenges and opportunities associated with community-based wildlife management. An erratum to this article is available at .     

Admissible estimators in finite population sampling employing various types of prior information

We consider some estimators of the total and variance of a finite population from Bayesian and pseudo-Bayesian perspectives. Recently, Meeden and Ghosh (1982a, 1982b) have provided quite simple but powerful tools for proving admissibility of estimators and estimator-design pairs is finite population sampling problems. We consider what these techniques yield in the way of admissibility results for the estimators discussed.