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Appalachia's Children

The Challenge of Mental Health

David H. Looff

This thoughtful, compassionate book makes a major contribution to our understanding of the Southern Appalachian child -- his mental disorders and his adaptive strengths. Drawing upon his extensive fieldwork as a clinical child psychiatrist in Eastern Kentucky, Dr. Looff suggests means by which these children can be helped to bridge the gap between their subculture and the mainstream of American life today.

The children described in this book, the author points out, are in a real sense not "all children." Since no child grows up in a vacuum, the children of Eastern Kentucky cannot be understood apart from the historical, geographic, and socioeconomic characteristics of the area in which they grow. Knowledge of the children requires some knowledge of the lives of parent, teachers, and the many others upon whom they are dependent. That is to say, mental disorder -- or mental health -- is embedded in a social matrix. Dr. Looff therefore examines the milieu of these Southern Appalachian children, their future as adults, and how they can achieve their potential -- whether in their native or an urban setting. In viewing the children within their own cultural framework, Dr. Looff shows how they develop toward mental health or psychopathology, suggesting supportive techniques that build upon the strengths inherent in each child. These strengths, he suggests, rise out of the same culture that burdens the child with handicaps.

Dr. Looff's position is one of guarded optimism, based on the successes of the techniques he has used and observed in seven years of work in Appalachian field clinics. Although he details instances of mental disorder in children, and instances of failure in family functioning, he notes at the same time family strengths and sees these strengths as sources of hope.

Although this book is based on fieldwork techniques within a specific area and culture, it is paradigmatically suggestive of wider application. Dr. Looff demonstrates effectively and clearly the profound need for increased concern about what is happening to the rising generation -- the children of Eastern Kentucky, the children of the Southern Appalachian region, and the children of the rural south.

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Appalachian Health and Well-Being

edited by Robert L. Ludke and Phillip J. Obermiller. foreword by Richard A. Couto

Appalachians have been characterized as a population with numerous disparities in health and limited access to medical services and infrastructures, leading to inaccurate generalizations that inhibit their healthcare progress. Appalachians face significant challenges in obtaining effective care, and the public lacks information about both their healthcare needs and about the resources communities have developed to meet those needs.

In Appalachian Health and Well-Being, editors Robert L. Ludke and Phillip J. Obermiller bring together leading researchers and practitioners to provide a much-needed compilation of data- and research-driven perspectives, broadening our understanding of strategies to decrease the health inequalities affecting both rural and urban Appalachians. The contributors propose specific recommendations for necessary research, suggest practical solutions for health policy, and present best practices models for effective health intervention. This in-depth analysis offers new insights for students, health practitioners, and policy makers, promoting a greater understanding of the factors affecting Appalachian health and effective responses to those needs.

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Appalachian Mental Health

edited by Susan E. Keefe

This volume is the first to explore broadly many important theoretical and applied issues concerning the mental health of Appalachians. The authors -- anthropologists, psychologists, social workers and others -- overturn many assumptions held by earlier writers, who have tended to see Appalachia and its people as being dominated by a culture of poverty.

While the heterogeneity of the region is acknowledged in the diversity of sub-areas and populations discussed, dominant themes emerge concerning Appalachia as a whole. The result of the authors' varied approaches is a cumulative portrait of a strong regional culture with native support systems based on family, community, and religion.

Some of the contributors examine therapeutic approaches, including family therapy, that consider the implications of the cultural context. Others explore the impact of Appalachian culture on the impact of Appalachian culture on the development of mental health problems and coping skills and the resulting potential for conflict between Appalachian clients and non-Appalachian health providers. Still others examine cultural considerations in therapeutic encounters and mental health service delivery. The book is rich in case studies and empirical data. The practical, applied nature of the essays will enhance their value for practitioners seeking ways to improve mental health care in the region.

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Appraising the Human Developmental Sciences

Essays in Honor of Merrill-Palmer Quarterly

Edited by Gary W. Ladd

This volume sets out to celebrate the Quarterly’s significant contribution to developmental research and to highlight the advances made in the field since the early 1950s.

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The Arabic Freud

Psychoanalysis and Islam in Modern Egypt

Omnia El Shakry

The first in-depth look at how postwar thinkers in Egypt mapped the intersections between Islamic discourses and psychoanalytic thought

In 1945, psychologist Yusuf Murad introduced an Arabic term borrowed from the medieval Sufi philosopher and mystic Ibn ‘Arabi—al-la-shu‘ur—as a translation for Sigmund Freud’s concept of the unconscious. By the late 1950s, Freud’s Interpretation of Dreams had been translated into Arabic for an eager Egyptian public. In The Arabic Freud, Omnia El Shakry challenges the notion of a strict divide between psychoanalysis and Islam by tracing how postwar thinkers in Egypt blended psychoanalytic theories with concepts from classical Islamic thought in a creative encounter of ethical engagement.

Drawing on scholarly writings as well as popular literature on self-healing, El Shakry provides the first in-depth examination of psychoanalysis in Egypt and reveals how a new science of psychology—or “science of the soul,” as it came to be called—was inextricably linked to Islam and mysticism. She explores how Freudian ideas of the unconscious were crucial to the formation of modern discourses of subjectivity in areas as diverse as psychology, Islamic philosophy, and the law. Founding figures of Egyptian psychoanalysis, she shows, debated the temporality of the psyche, mystical states, the sexual drive, and the Oedipus complex, while offering startling insights into the nature of psychic life, ethics, and eros.

This provocative and insightful book invites us to rethink the relationship between psychoanalysis and religion in the modern era. Mapping the points of intersection between Islamic discourses and psychoanalytic thought, it illustrates how the Arabic Freud, like psychoanalysis itself, was elaborated across the space of human difference.

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Archetype and Allegory in the "Dream of the Red Chamber"

Andrew H. Plaks

Surprisingly little has been written in Western languages about the eighteenth- century Chinese novel Dream of the Red Chamber, perhaps the supreme masterpiece of its entire tradition. In this study, Andrew H. Plaks has used the conceptual tools of comparative literature to focus on the novel's allegorical elements and narrative structure. He thereby succeeds in accounting for the work's greatness in terms that do justice to its own narrative tradition and as well to recent advances in general literary theory.

A close textual reading of the novel leads to discussion of a wide range of topics: ancient Chinese mythology, Chinese garden aesthetics, and the logic of alternation and recurrence. The detailed study of European allegorical texts clarifies the directions taken by comparable works of Chinese literature, and the critical tool of the literary archetype helps to locate the novel within the Chinese narrative tradition from ancient mythology to the more recent "novel" form. Professor Plaks' innovative use of traditional criticism suggests the levels of meaning the eighteenth-century author might have expected to convey to his immediate audience.

This book provides not only an illuminating analysis of this important novel, but also a significant demonstration that critical concepts derived primarily from Western literary models may be fruitfully applied to Chinese narrative works.

Originally published in 1976.

The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

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The Architecture of Madness

Insane Asylums in the United States

Carla Yanni

Elaborately conceived, grandly constructed insane asylums—ranging in appearance from classical temples to Gothic castles—were once a common sight looming on the outskirts of American towns and cities. Many of these buildings were razed long ago, and those that remain stand as grim reminders of an often cruel system. For much of the nineteenth century, however, these asylums epitomized the widely held belief among doctors and social reformers that insanity was a curable disease and that environment—architecture in particular—was the most effective means of treatment.

 

In The Architecture of Madness, Carla Yanni tells a compelling story of therapeutic design, from America’s earliest purpose—built institutions for the insane to the asylum construction frenzy in the second half of the century. At the center of Yanni’s inquiry is Dr. Thomas Kirkbride, a Pennsylvania-born Quaker, who in the 1840s devised a novel way to house the mentally diseased that emphasized segregation by severity of illness, ease of treatment and surveillance, and ventilation. After the Civil War, American architects designed Kirkbride-plan hospitals across the country.

 

Before the end of the century, interest in the Kirkbride plan had begun to decline. Many of the asylums had deteriorated into human warehouses, strengthening arguments against the monolithic structures advocated by Kirkbride. At the same time, the medical profession began embracing a more neurological approach to mental disease that considered architecture as largely irrelevant to its treatment.

 

Generously illustrated, The Architecture of Madness is a fresh and original look at the American medical establishment’s century-long preoccupation with therapeutic architecture as a way to cure social ills.

 

Carla Yanni is associate professor of art history at Rutgers University and the author of Nature’s Museums: Victorian Science and the Architecture of Display.

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Are We Ready?

Public Health since 9/11

David Rosner

A contemporary history of a critical period, Are We Ready? analyzes the impact of 9/11, the anthrax attacks that followed, and preparations for a possible smallpox attack on the nation's public health infrastructure. David Rosner and Gerald Markowitz interviewed local, state, and federal officials to determine the immediate reactions of key participants in these events. The authors explore the extent to which these emergencies permanently altered the political, cultural, and organizational life of the country and consider whether the nation is now better prepared to withstand another potentially devastating attack. This well-reasoned and well-researched book presents compelling evidence that few with hands-on experience with disease and emergency preparedness believe that an adequate response to terrorism—whether biological, chemical, or radiological—is possible without a strong and vibrant infrastructure to provide everyday services as well as emergency responses.

Are We Ready? begins with an examination of the experiences of local New York officials who were the first responders to 9/11 and follows them as events unfolded and as state and national authorities arrived. It goes on to analyze how various states dealt with changing federal funding for a variety of public health services. Using oral histories of CDC and other federal officials, the book then focuses on the federal reaction to 9/11 and anthrax. What emerges is a picture of dedicated public servants who were overcome by the emotions of the moment yet who were able to react in ways that significantly reduced the public anxiety and public health threat. Despite the extraordinary opportunity to revitalize and reinvigorate the nation’s public health infrastructure, the growing federal and state budget deficits, the refocusing of national attention on the war in Iraq, and the passage of time all combined to undermine many of the needed reforms to the nation’s public health defenses.

Copub: Milbank Memorial Fund

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Artificial Hearts

The Allure and Ambivalence of a Controversial Medical Technology

Shelley McKellar

Artificial hearts are seductive devices. Their promissory nature as a cure for heart failure aligned neatly with the twentieth-century American medical community’s view of the body as an entity of replacement parts. In Artificial Hearts, Shelley McKellar traces the controversial history of this imperfect technology beginning in the 1950s and leading up to the present day.

McKellar profiles generations of researchers and devices as she traces the heart’s development and clinical use. She situates the events of Dr. Michael DeBakey and Dr. Denton Cooley’s professional fall-out after the first artificial heart implant case in 1969, as well as the 1982–83 Jarvik-7 heart implant case of Barney Clark, within a larger historical trajectory. She explores how some individuals—like former US Vice President Dick Cheney—affected the public profile of this technology by choosing to be implanted with artificial hearts. Finally, she explains the varied physical experiences, both negative and positive, of numerous artificial heart recipients.

McKellar argues that desirability—rather than the feasibility or practicality of artificial hearts—drove the invention of the device. Technical challenges and unsettling clinical experiences produced an ambivalence toward its continued development by many researchers, clinicians, politicians, bioethicists, and the public. But the potential and promise of the artificial heart offset this ambivalence, influencing how success was characterized and by whom. Packed with larger-than-life characters—from dedicated and ardent scientists to feuding Texas surgeons and brave patients—this book is a fascinating case study that speaks to questions of expectations, limitations, and uncertainty in a high-technology medical world.

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Artificial Nutrition and Hydration and the Permanently Unconscious Patient

The Catholic Debate

Ronald P. Hamel and James J. Walter, Editors

During the past few decades, high-profile cases like that of Terry Schiavo have fueled the public debate over forgoing or withdrawing artificial nutrition and hydration from patients in a persistent vegetative state (PVS). These cases, whether involving a

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