The Narrative Structure of Transcripts and the Psychoanalytic Self

Psychoanalytic publications often contain the patient’s discourse in the form of transcripts in the context of a clinical vignette. These transcripts are productions that result from a set of operations and technologies put at play by the psychoanalytic author, in the process of transmission and dissemination of the psychoanalytic discipline. The focus of our study was to investigate these transcripts and to determine first, if their narrative structure was affected by four factors (diagnosis, psychoanalytic school, gender and source of the transcript), and second, to articulate what type of self was promoted by such narratives. For this purpose, 93 clinical vignettes with transcripts, published in a recognized psychoanalytic journal, were analyzed and the effects of those factors upon the narrative structure of these transcripts, studied. Anova´s results showed that the produced transcripts were affected in their narrative structure by the studied factors. At the same time, the studied factors tended to promote certain forms of selfhood over others through the transcripts. &nbsp

Moral judgements as organizational accomplishments : insights from a focused ethnography in the English healthcare sector

In this chapter, we aim to deepen our understanding of judgments in organizations. Whilst previous studies have underscored the situated nature of individual judgments exercised by e.g. leaders or managers, our research focuses on how judgments emerge as organizational responses to recurrently emerging moral dilemmas. Accordingly, we study a setting—decision practices in the English healthcare sector—where moral puzzles (to fund or not to fund healthcare for apparently atypical patients) demand ongoing attention and systemic handling. We conducted (and present findings of) a focused ethnography of the ways expert decision-making panels in three health authorities confronted, engaged, and coped with morally perplexed situations. The moral perplexity there lay in that panels were called upon to prudently and demonstrably determine whether a particular patient deserved or not exceptional investment; and do so by taking into consideration the healthcare needs and rights of all patients under the same health system. By adopting a practice perspective (Schatzki, 2002), we develop an analytical account of the effortful accomplishments (sociomaterial activities or intertwined “projects” in practice theory terms), which enabled the recurrent collective exercise of judgments in accordance with publicly recognizable moral expectations—namely notions of fairness. Our main contribution lies in conceptualizing the work of rendering moral judgments as organized pursuits possible and meaningful and hence in complementing current “ecological understandings” of individual judgment-making in organizations

Diminishing Stigma Sentiments in Individuals with Depression: Sociopsychological Predictors of Deflecting and Challenging Coping Orientations

Individuals who suffer from depression can be stigmatized by labeling and resort to negative stigma coping orientations such as secrecy and withdrawal, resulting in internalized self-stigma. Self-stigma can have negative effects such as low self-esteem, low self-efficacy, isolation, and feeling like a failure. Guided by modified labeling theory, the purpose of this study was to fill a gap in the literature on predictors of two orientations (challenging and deflecting) of positive stigma coping. Challenging stigma involves taking action, and deflecting is a cognitive strategy; both are used to positively cope with the stigma of mental illness. Predictors included symptom severity, depression literacy, stereotype awareness, treatment seeking, social support, and stigma sentiments in a sample of undergraduates (N = 195). Results from a canonical correlation found that individuals with high scores on deflecting and, simultaneously, low scores on challenging tended to have high scores on stigma sentiments and low scores on both symptom severity and treatment seeking. Analyzed in independent regressions, challenging was significantly predicted only by symptom severity (+), while deflecting was predicted by symptom severity (-), depression literacy (+), and stigma sentiments (+). These findings reinforce the potential for individuals who suffer from depression to address stigma using healthier and more affirming coping orientations. Implications for positive social change include a decrease in self-stigma regarding depression, less negative stigma coping, an increased awareness of how depression stigma affects individuals who suffer from the disorder, and a decrease in the social stigma of depression. Educators and practitioners can apply this information in academia, counseling, and clinical practice

The Sexual Politics of Clinical Psychoanalysis and Transgender Mental Health

Perversion is derived from the Latin pervertere which means to turn around and has been broadly conceptualized as that which deviates or wavers from an original course. One could argue that the perverse is fundamentally constructed through difference; its existence is predicated upon being set up against some norm and its eccentricity is maintained through a continued refusal to adhere to the rule. This dissertation explores questions of gender difference and sexual deviance as they relate to the clinical pathologization of transgender peoples mental health. In particular, it considers how psychoanalytic theories of perversion - in their multifaceted definitions and various clinical applications - can be usefully employed to understand transphobia as it emerges throughout psychiatric institutions. In borrowing from Freuds polymorphous perversity, fetishism, perverse defense, and Lacans perverse structure, this study both contributes to and moves beyond a genealogical account of transgender peoples relationship to psychoanalysis. It uniquely considers the psychical provocations behind clinicians anxious descriptions and treatments of gender variance, as they have emerged since transsexuals nosological coinage in the early 20th century. By combining two disparate contemporary fields of study - psychoanalysis and transgender studies - this project also asks how transgender people may re-narrate their relationship to the perverse. To do so, this research investigates many under-considered objects of study, including surrealist transsexual drawings from the mid 1900s, lineages of psychiatric taxonomies, science fiction literature, contemporary transgender art installations, autoethno-pornographic transition narratives, and transgender accounts of undergoing psychoanalytic psychotherapy. Through a combination of critical historiographies, discourse analysis, content analysis, and narrative research, this dissertation contributes to a rapidly emerging non-pathological conversation about the psychic life of gender variance, both for transgender people themselves and the mental health institutions that serve them. Ultimately, it finds perversion to be quite useful as a floating signifier, as its various theoretical containers and clinical meanings are employed to deconstruct institutionalized transphobias tenacity. Furthermore, this research centers an archive of historically neglected transgender narratives on mental health as they emerge in the clinic, through case study, and in art or aesthetics. Keywords: transgender, psychoanalysis, mental health, perversion, sexuality, visual ar

The Gene Ontology Handbook

bioinformatics; biotechnolog

Data Analytics of Codified Patient Data: Identifying Factors Influencing Coding Trends, Productivity, and Quality

Cost containment and quality of care have always been major challenges to the health care delivery system in the United States. Health care organizations utilize coded clinical data for health care monitoring, and reporting that includes a wide range of diseases and clinical conditions along with adverse events that could occur to patients during hospitalization. Furthermore, coded clinical data is utilized for patient safety and quality of care assessment in addition to research, education, resource allocation, and health service planning. Thus, it is critical to maintain high quality standards of clinical data and promote funding of health care research that addresses clinical data quality due to its direct impact on individual health outcomes as well as population health. This dissertation research is aimed at identifying current coding trends and other factors that could influence coding quality and productivity through two major emphases: (1) quality of coded clinical data; and (2) productivity of clinical coding. It has adopted a mix-method approach utilizing varied quantitative and qualitative data analysis techniques. Data analysis includes a wide range of univariate, bivariate, and multivariate analyses. Results of this study have shown that length of stay (LOS), case mix index (CMI) and DRG relative weight were not found to be significant predictors of coding quality. Based on the qualitative analysis, history and physical (H&P), discharge summary, and progress notes were identified as the three most common resources cited by Ciox auditors for coding changes. Also, results have shown that coding productivity in ICD-10 is improving over time. Length of stay, case mix index, DRG weight, and bed size were found to have a significant impact on coding productivity. Data related to coder’s demographics could not be secured for this analysis. However, factors related to coders such as education, credentials, and years of experience are believed to have a significant impact on coding quality as well as productivity. Linking coder’s demographics to coding quality and productivity data represents a promising area for future research

Rhetorical dimensions of 20th century depression memoirs: Sylvia Plath's The Bell Jar, William Styron's Darkness Visible, & Kay Redfield Jamison's An Unquiet Mind

This is a rhetorical analysis of three popular autobiographical acts about depression from the American 20th century: Sylvia Plath’s The Bell Jar, William Styron’s Darkness Visible and Kay Redfield Jamison's An Unquiet Mind. This dissertation explores the question: how do these memoirs of depression work as rhetorical texts? Two distinct, yet interrelated, levels of analysis are undertaken through an orientation of "deep reading" in an effort to illuminate the rhetorical dimensions of these enduring and best selling autobiographical works. First, I review the ways these authors generate identification with readers in the face of a suffering that casts its agents as unreliable narrators. Second, I demonstrate how these texts enter into dialogue with technical and public discourses of their time, shifting the grounds of appeal towards more personal considerations. Both of these analyses work to illuminate how these popular books emerge as rhetorically powerful interventions in 20th century discourses on depression, mental illness, and meaningful living more generally