bluuebunny/crossref_metadata_2025 huggingface dataset:
Fungal toxin-mediated disease
Authors: Kibbler Christopher C.
Published: December 2017

More than 300 mycotoxins have been described, and increasing numbers have been shown to cause disease in humans. They may cause organ failure, carcinogenesis, mutagenesis, and immunosuppression, or have oestrogenic effects. Exposure may occur through ingestion of preformed toxin in contaminated foodstuffs, ingestion of toxic mushrooms, or inhalation of airborne toxins in damp environments This chapter discusses food-borne mycotoxin disease, mushroom poisoning, and the potential impact on health of environmental exposure to airborne mycotoxins. It is intended to provide a background and understanding of these conditions, about which there is a relative ignorance amongst healthcare professionals. However, their clinical management requires the expertise of mycologists and toxicologists to ensure an optimum outcome.
Serology of fungal disease
Authors: Barton Richard
Published: December 2017

Examination of serum and other body fluids for the presence of antibodies to fungi, or the direct detection of the fungal antigens themselves, can play an important role in the diagnosis of fungal disease. Various methods have been applied, though currently the most commonly used is some form of enzyme-linked immunosorbent assay. Antigen detection has become a standard method for diagnosing cryptococcosis and can play a key role in detecting aspergillosis, and to a lesser extent candidiasis, depending on the underlying disease. Antibody testing is routine for many fungal diseases, including coccidioidomycosis, histoplasmosis, and many forms of aspergillosis. Beta-D-glucan is a generic fungal antigen found in the cell walls of many fungi, and detection of BDG is a test which many find useful when screening the sera of at-risk patients. Increasingly, physicians and scientists are looking to serodiagnostic tests not only to diagnose, but also to monitor treatment outcomes.
Some troubling observations about involuntary treatment
Authors: Szmukler George
Published: December 2017

The huge variations in the rates of the use of detention and involuntary treatment between similar countries, as well as between regions in a country, and even between mental health services within a region, are deeply troubling. Large changes in rates over time, perhaps in different directions at the same time in different places, and between ethnic groups in some societies have also been evident. These findings suggest a significant degree of arbitrariness in the use of compulsion. History offers many examples of abuses and misuses of psychiatric treatment, without consent, sometimes to control threats to the social order, at other times as a result of unwarranted faith in what turn out to be ineffective but harmful treatments. The structure of mental health law may offer a relatively undemanding passage to such abuses and misuses.
Challenges to the orthodoxy
Authors: Szmukler George
Published: December 2017

Two comparatively recent developments in health care ethics and policy further challenge the conventional bases for involuntary treatment in mental health care. First has been the shift in general medicine over the past 50 years from ‘paternalism’ and large medical discretion to patient ‘autonomy’. Interventions require ‘informed consent’; treatment without a patient’s consent can only occur if the person lacks ‘decision-making capacity’ and the treatment is judged to be in the person’s ‘best interests’. The treatment decision of a general medical patient who has decisional capacity is respected even if it appears to be unwise. This shift to respect for patient self-determination has been largely ignored in psychiatry. The second policy development is the extension in mental health care of involuntary treatment into the community, greatly increasing the scope for the exercise of compulsion. What constitutes an appropriate level of risk to justify compulsion in the community is unclear.
How mental health law discriminates against persons with mental illness
Authors: Szmukler George
Published: December 2017

Mental health law discriminates against people with mental illness when it comes to detention and involuntary treatment. This is evident when we compare such law with that applying in the rest of medicine, certainly in countries with well-developed legal systems. Mental health law fails to respect patient ‘autonomy’ (or self-determination) in the same way as it does in the rest of medicine. Furthermore, a confusion between a person’s health interests and the protection of others results in laws permitting the preventive detention of people with mental disorders—probably uniquely so—on the basis of ‘risk’ of harm, without any offence having been committed. Though people with mental illness are responsible for a very small percentage of violent offences, they can be preventively detained—on grounds reserved for them—while people without a mental illness—equally risky to others or even more so—cannot.
A law that does not discriminate against people with mental illness
Authors: Szmukler George
Published: December 2017

To eliminate the discrimination in mental health law, a form of law (‘Fusion Law’) is proposed that is generic, equally applicable across the entire range of medical specialties (and indeed social care), and in all settings—both hospital and community. No distinction is drawn between ‘mental’ and ‘physical’ disorders. The ‘Fusion Law’ proposal is based on ‘decision-making capacity’ and ‘best interests’—notions that are developed later in the book—but also includes detailed provisions for the regulation of detention and the use of force, areas usually absent or insufficiently addressed in capacity-based law but well developed in civil commitment legislation. Involuntary interventions are only justified when a person has impaired ‘decision-making capacity’ and the intervention is in the person’s ‘best interests’. The meanings of ‘capacity’ and ‘best interests’ will require detailed examination.
On being able to make decisions and making decisions for others
Authors: Szmukler George
Published: December 2017

In this chapter, the meaning of ‘decision-making capacity’ is examined. A ‘procedural’, ‘value-free’ notion of its assessment is inadequate, especially in difficult cases where a consideration of a person’s ‘values’ may be unavoidable. An approach influenced by Davidson’s ‘radical interpretation’ is proposed, in which, under the ‘Principle of Charity’, a person’s system of beliefs and values is presumed to be, by and large, ‘coherent’. It asks how coherent are the present beliefs underlying a person’s apparently unwise treatment decision—how well do they fit with their previously deeply held beliefs and value commitments? A disruption of coherence may suggest an undermining of a person’s decision-making ability. The meaning of ‘best interests’ is also clarified in this context; it may mean giving effect to the person’s deep value commitments. Problematic situations are examined where questions arise concerning whether changes in a person’s values are of a nature that undermine decision-making or not. Dementia is an example.
Can we reduce the need for coercive interventions?
Authors: Szmukler George
Published: December 2017

Sadly, little research has been devoted to developing interventions aimed at reducing the use of coercive measures. A large study in the United States showed that patient perceptions of coercion at admission to psychiatric hospitals are less if they believe their ‘voice’ has been heard, and they have been treated with respect, concern, and in good faith—termed ‘procedural justice’. However, trials of whether training staff in accord with these observations will reduce coercion have yet to be done. The most promising interventions to reduce involuntary admissions have been ‘joint crisis plans’. These offer opportunities for patients to state their treatment preferences in case of future crises, and plans are negotiated in joint meetings with the treatment team. Though randomized controlled trials are lacking, ‘before versus after’ comparisons have suggested a range of complex interventions that may reduce the use of coercive measures, such as restraint and seclusion, on inpatient units.
Emergencies, general medicine, ‘community treatment orders’, and ‘psychiatric advance statements’
Authors: Szmukler George
Published: December 2017

The implications of the Fusion Law for general medicine, especially inpatient care when non-consensual and involuntary treatment is being considered, are examined in this chapter. The new burdens posed by regulation can be minimized by making requirements essentially parallel ‘good practice’. Involuntary psychiatric treatment in the community under the ‘decision-making capability–best interests (will and preferences)’ principles of the Fusion Law would be substantially different from the way it is commonly instituted today. The Fusion Law offers an important place for ‘advance statements’ and ‘advance directives’, supporting respect for a patient’s beliefs and values (or ‘will and preferences’). Illnesses that impair decision-making capacity, but that are relapsing-remitting—such as the majority of mental illnesses—are good candidates for such advance planning, yet such measures have rarely been employed to date.
The Psychiatric and Cognitive Mental Status Examination in the Medical-Legal Context
Authors: Holzer Jacob C.
Published: December 2017

This chapter provides an introduction to and overview of psychiatric and cognitive mental status examination in older adults, particularly within a medical-legal context. A methodical approach to the mental status examination involves assessment of a range of areas, including behavior, alertness, mood state, affect, thought content and process, sensory input and perception, symptom experience and safety variables, and cognitive domains including attention, language, visuospatial, memory and executive cognitive functions. This assessment can be critical in a variety of forensic contexts involving the elderly, including civil commitment, different forms of capacity, end-of-life decision making, assisting in the determination of safe or unsafe driving, risk of victimization and abuse, criminal competency and responsibility evaluations, and need for assisted and structured living. Rating scales and tools can augment, but not replace, the examination.
Neuropsychiatric Aspects Involving the Elderly and the Law
Authors: Granacher Robert P.
Published: December 2017

Neuropsychiatry has generally been concerned with the diagnosis and management of syndromes with productive symptoms (positive symptoms) such as hallucinations, mood changes, and delusions. This chapter focuses on the brain-based forensic issues before the law concerning the neuropsychiatry of the older patient. These include the forensic infinitives of legal cognitive capacity to be competent to be tried, enter a plea, be a witness, consent generally, enter a contract, make a will, resist undue influence, refuse treatment, give informed consent, have general competence, have specific competence, be fit for duty, be criminally responsible, be civilly committable, and resist elder abuse. Fundamentally, the forensic neuropsychiatric question is: does a brain disorder remove the individual capacity to understand, decide or act in a specific circumstance before the law? Thus, a well-planned forensic assessment of a geriatric person usually requires a neuromedical psychiatric examination model. This may include examinations, laboratory testing, structural neuroimaging, cognitive screening, and neuropsychological testing. It also may involve lumbar puncture functional neuroimaging and other neurodiagnostic testing.
Neuropsychological Assessment in Geriatric Forensic Psychiatry
Authors: Frakey Laura L. , Davidoff Donald A.
Published: December 2017

While memory complaints are ubiquitous among elders, and memory impairment is one of the most significant aspects of cognitive dysfunction in elderly persons, deficits in other cognitive domains can also negatively impact the ability of elderly individuals to function independently and can have marked consequences in the forensic arena. Neuropsychological assessment is a critical element in identifying cognitive changes that can have a negative impact on legal capacity. Information about cognitive vulnerabilities, combined with data concerning day-to-day functioning, provides critical information to identify what specific areas of capacity may be impaired, and wherever possible, identify the least restrictive accommodations to preserve the individual’s dignity and autonomy. This chapter outlines the components and procedures associated with forensic neuropsychological assessments to help the practitioner understand the potential utility of these types of assessments and how to critically evaluate and interpret the neuropsychological findings regarding the geriatric client within the forensic setting.
The Elderly Veteran, Service, Benefits, and the Community
Authors: Skoble Luisa , Rogers Jamison E. , Kohn Robert
Published: December 2017

The U.S. veteran population is aging, with 47.3% being age 65 or older in 2013. This chapter addresses the mental health of older veterans and the services and benefits available to them. Among older veterans, posttraumatic stress disorder (PTSD) is the most commonly diagnosed disorder, followed by alcohol use disorders and major depression. Cognitive disorders also place increased demands on services. The Veterans Health Administration (VHA) provides a broad array of mental health services across the full continuum of care. Older veterans, however, often do not connect with the VA (Veterans Administration) system until after retirement to take advantage of financial assistance offered by the VA, including service-connected disability pensions and healthcare. While the VA does not provide routine legal services to veterans, three elements of the justice system are available: (1) the Veterans Justice Outreach Program, (2) the Veterans Treatment Court, and (3) the Veterans Adjudication Process of Tort Claims. Also discussed in the chapter are goals identified by the Office of Geriatrics and Extended Care at the Department of Veterans Affairs to improve care for older veterans.
Civil Commitment of Older Persons
Authors: Brady Sara J. , Drogin Eric Y.
Published: December 2017

Older persons experience higher rates of psychiatric illness than the general population. Consequently, they are disproportionately affected by issues at the intersection of psychiatry and law. Case law, statutes, and regulations that address involuntary hospitalization do not typically address the unique challenges faced by this population in terms of available resources, cognitive styles, or manifestations of age-related or other psychiatric disorders. This chapter reviews the scope of civil commitment issues, legal standards for due process and compelled treatment criteria, forensic assessment techniques, cognitive screening, and opportunities for finding common ground with representatives of the legal community. Maintaining currency with requirements of each of the stakeholder professions will provide the best means of advancing practice in this critical and expanding area.
Capacity in the Life Course of the Elder
Authors: Haq Yaser , Anfang Stuart A. , Liptzin Benjamin
Published: December 2017

Over the next few decades, there will likely be an increase in the frequency of will challenges related to testamentary capacity and undue influence, given a U.S. elderly population with a disproportionate amount of wealth. Psychiatric clinicians are likely to be called upon to advise the courts about a person’s capacity to make a will or susceptibility to undue influence. This chapter reviews the important legal and psychiatric issues involved in determinations of testamentary capacity and undue influence. It also touches on the policy considerations of promoting liberty and autonomy which set a low threshold for testamentary capacity while allowing for the doctrine of undue influence as a mechanism to protect those who are vulnerable. The complex interplay between cognition, a potentially conflictual milieu, and the extent of the assets at stake is also discussed. This chapter also provides guidance with respect to some of the challenges faced by clinicians conducting a contemporaneous versus retrospective assessment. Finally, mechanisms to avoid estate litigation, such as power of attorney and estate planning, are also discussed.
Forensic Issues and Caregivers of the Elderly
Authors: Epstein-Lubow Gary , Tobin-Tyler Elizabeth
Published: December 2017

Providing patient-centered care for an elderly individual with a mental health condition requires clinicians and family caregivers to work together. This chapter provides a description of a mental health treatment model, the triadic model of caregiving, in which service delivery for a patient includes clinicians communicating with family members or caregivers. Description of the mental health workforce to support patient-centered care is provided along with laws and policies that support family caregivers in their aid of patients. The associated legal responsibilities and ethical issues related to working with patients who have impaired decision-making capacity due to a mental health or substance use condition are explained, including capacity, competence, informed consent, advance care planning, guardianship, fiduciary responsibilities, and ethical concerns.
Forensic Issues in the Geriatric Psychiatry Consult Liaison Service and the Right to Accept and Refuse Treatment
Authors: Metzger Eran D. , Holzer Jacob C. , Brendel Rebecca W.
Published: December 2017

The consultation liaison psychiatrist frequently encounters questions of decision-making capacity for hospitalized geriatric patients. This trend will only continue as the population ages and questions about the ability of aging patients to make medical decisions and broader life decisions arise more and more frequently. Consultation liaison psychiatrists tasked with determining these capacities may be faced with a duality of roles: responsibility to the patient but also protective obligations imposed by laws and regulations. Consultation liaison psychiatrists should engage these evaluations carefully and be forthright with patients. An approach focusing on the nature and cause of incapacity, the potential for reversibility of incapacity, adequately informing the patient, relying on colleagues in occupational and physical therapy as well as speech and language pathology for functional assessment, and understanding the patient’s life history and story can lead to results respectful of both the patient’s well-being and dignity. This chapter presents forensic issues relevant to the geriatric psychiatry consultation-liaison service through an illustrative clinical vignette.
Psychopharmacological Agents, Side Effects, and Black Box Warnings
Authors: Fozdar Manish A. , Holzer Jacob C.
Published: December 2017

From a medical-legal viewpoint, psychopharmacological management in the elderly population requires a multifaceted, comprehensive approach, involving a detailed clinical diagnostic assessment, an awareness of a patient’s current medical status, risk factors, and an understanding of the risks and benefits of various treatment options. Several risk management strategies can be employed as part of the treatment process, which are reviewed in this chapter. Special attention is needed in the pharmacological management of the elderly population with respect to efficacy and risk as well as polypharmacy. It is important that clinicians have a broad understanding of the different medication classes, including antidepressants, antipsychotics, mood stabilizers, cognitive-enhancing medications, benzodiazepines, sedative-hypnotics, and stimulants; specific agents; indications; kinetics; and side effects in both the clinical management of elderly patients and in medical-legal consultation.
Ethics in Geriatric Forensic Assessment
Authors: Candilis Philip J. , Leong Gregory B. , Weinstock Robert
Published: December 2017

The ethics of geriatric forensic practice are governed by frameworks that help guide common elder activities, such as medical and financial decision-making, self-care, driving, and making choices at the end of life. Practitioners must be aware of countervailing and often contradictory considerations among older patients and forensic evaluees, including their empowerment and protection and the protection of others. As in most decision-making, families, communities, and other citizens may be affected by decisions taken by older persons, whether to plead guilty, drive, make a will, or participate in physician-assisted dying. Consequently, clinical and forensic practitioners may need to be aware of the principles, professional guidelines, habits, and skills that apply to their work. This chapter offers a number of ethical models for informing evaluations of geriatric populations and applies them to an array of activities scrutinized in older persons.
Substance Use Disorders in the Elderly
Authors: Burgard Michael , Kohn Robert
Published: December 2017

Substance use disorders in older adults remains lower than in younger adults; however, the prevalence is rising in the elderly population. In the United States, the lifetime prevalence of an alcohol use disorder among persons age 65 and older is 16.1%. Studies of Veteran’s Administration nursing home residents have found that 29% to 49% of those admitted have a lifetime diagnosis of alcohol use disorder. A sizable proportion of the elderly acknowledge driving under the influence. In 2013, 1.5% of the elderly had used illicit drugs. The number requiring treatment for substance abuse is expected to double by 2020. The populations with the fastest increase in opiate mortality are those age 55 and older, including those 65 and older. This chapter presents the epidemiology of substance use among older adults and discusses issues related to elders’ substance use, including use in nursing homes, impaired driving and arrests, use of non-prescription medications, screening for substance use, and treatment.
The Traumatized Older Individual and Society
Authors: Tanaka Gen , Soonsawat Anothai , Haque Omar Sultan , Kohn Robert , Bursztajn Harold J.
Published: December 2017

As life expectancy increases and the baby-boom generation ages, clinicians will see a growing aging population, many of whom have experienced individual or mass psychic trauma. In these individuals, a personal history of trauma can compound the expected traumas of aging. This chapter provides the epidemiology of older adults who have experienced trauma and discusses issues such individuals face, as well as measures clinicians can use to avoid retraumatization. There is a relatively high prevalence of posttraumatic stress disorder (PTSD) among older persons generally. Fragile elders with a history of helplessness, trauma, and massive loss are vulnerable to reactivation of posttraumatic symptomatology through the experience of pain, fear, or helplessness that can accompany even ordinary aging, especially in nursing homes. Aging persons show varying levels of resilience in the face of trauma due to genetic factors and/or life experience. Clinicians and researchers need to take into account individual, family, and communal histories of trauma and respect patients’ autonomy in order to implement an informed-consent process within a trusting patient–family–clinician alliance.
Issues in Medicare Billing, Documentation, and Coding
Authors: Martins Linda , Nicholson Ruby , Kohn Robert
Published: December 2017

Practitioners working with geriatric patients need to be aware of Center for Medicare and Medicaid Services regulatory requirements, the definitions of fraud and abuse, and rules and criteria for billing and documentation. This chapter discusses these and other issues related Medicare billing, documentation, and coding. Denials for reimbursement and paybacks for audits are usually due to incomplete elements in documentation and incorrect coding. Although psychotherapy is appropriate for many elderly individuals, including those with neurocognitive disorders, it must be clear that the service is medically beneficial. A recent Department of Justice lawsuit qualifies that the patient has to have the capacity to recall what occurred in therapy from one session to the next. The changes created by DSM-5 diagnostic criteria and utilization of ICD-10 codes have had a particular impact on geriatric psychiatry. These changes in DSM-5 also have an implication in geriatric forensic psychiatry practice and are discussed in detail in the chapter.
Leadership [Is] Organizational Citizenship Behavior: Review of a Self-Evident Link
Authors: Piccolo Ronald F. , Buengeler Claudia , Judge Timothy A.
Published: December 2017

In this chapter, we focus on the theoretical and empirical relationship between leadership and organizational citizenship behavior (OCB), arguing that leadership, at its conceptual core, is extra-role behavior (i.e., leadership [is] OCB). Updating and extending Organ, Podsakoff, and MacKenzie’s (2006) chapter, we review both traditional (e.g., transformational leadership, transactional leadership, initiating structure, and consideration behaviors) and contemporary models of leader behavior (e.g., ethical, authentic, and servant leadership behaviors). In doing so, we report meta-analytic results comparing leadership models and the activities that underlie those models. We close by discussing three potential avenues for continued research in this domain.
Getting Underneath the Power of “Contact”: Revisiting the Fundamental Lever of Stigma as a Social Network Phenomenon
Authors: Pescosolido Bernice A. , Manago Bianca
Published: December 2017

Physical conditions, such as body size, physical deformity, and deafness, elicit stigma, which has emotional, social, and health consequences. Researchers have consistently found that contact with a stigmatized individual can be one of the most powerful tools for dismantling this stigma. Specifically, the contact hypothesis argues that a lack of knowledge about stigmatized others makes it easier to stereotype and discriminate against them. Although the contact hypothesis has been supported in research, this chapter argues that network science offers relevant theory and research that may be instructive for further understanding and contextualizing the contact hypothesis. This chapter suggests that the structure and content of social networks affect stigmatizing attitudes and provide a theoretical basis to examine how individuals who are routinely in “contact” with stigmatized persons (e.g., family members, co-workers, and health professionals) may influence stigma. Finally, the chapter discusses the importance of these insights for anti-stigma campaigns.
Perceived Racial Discrimination and Health Behavior: Mediation and Moderation
Authors: Gibbons Frederick X. , Stock Michelle L.
Published: December 2017

Research has documented a strong link between perceived racial discrimination and various health outcomes among African Americans. These outcomes include health status and health-relevant behavior. This chapter focuses on the relation between the stress associated with perceived racial discrimination and health-risk behavior, primarily substance use and abuse. The chapter examines a variety of factors thought to mediate this relation, the two primary ones being negative affect and self-control. Research has shown that discrimination has an impact on both factors, and these in turn directly affect substance use. The chapter also examines several factors that have been shown to moderate the discrimination–health relationship. In addition, the chapter reviews research examining moderators that can be either risk-promoting or protective. Some research identifying individuals who appear to respond in a favorable or healthy manner to perceived discrimination is also reviewed. The chapter concludes with recommendations for future research.
Social Identity, Stigma, and Health
Authors: Jetten Jolanda , Haslam S. Alexander , Cruwys Tegan , Branscombe Nyla R.
Published: December 2017

This chapter argues that an understanding of social identity processes is critical to understand when and how stigma affects health. This chapter presents a social identity analysis of the relationship between stigma and health and starts from the premise that it is particularly difficult for individuals who belong to stigmatized groups to derive a positive identity from their social group memberships. However, when individuals turn to the stigmatized group, identify with it, and draw social support from others within it, their health will be buffered against some of the negative consequences of discrimination because group memberships—and the social identities that are derived from them—act as psychological resources. Perceptions of the broader sociostructural context that affect appraisals of discrimination and coping with stigma play an important role in determining whether the curing properties of group memberships are unlocked, turning the curse of belonging to a stigmatized group into a cure.
Physical Health Disparities and Stigma: Race, Sexual Orientation, and Body Weight
Authors: Dovidio John F. , Penner Louis A. , Calabrese Sarah K. , Pearl Rebecca L.
Published: December 2017

This chapter reviews evidence of stigma and differences in physical health between members of dominant social groups and select disadvantaged social groups (defined by race, sexual orientation, and weight) and considers the direct and indirect ways that stigma can contribute to these differences in health. The goal of this chapter is to provide a deeper understanding of the relationship between stigma and health disparities for members of these groups. It considers how enacted, anticipated, and internalized stigmas influence, to varying degrees, health and health disparities experienced by Blacks, sexual minorities, and people with overweight or obesity. The chapter concludes by suggesting promising future directions for research. The new insights provided by this theoretical understanding can lead to interventions that reduce stigma as well as help members of these (and other) stigmatized groups better cope with the stigma they confront in their lives and thus realize better psychological and physical health.
Stigma, Health, and Individual Differences
Authors: Mendoza-Denton Rodolfo , Leitner Jordan B.
Published: December 2017

This chapter discusses how within-group variability is as important a component to understanding the relationship between stigma and health outcomes as between-group variability. The chapter offers a framework that proposes that people’s expectations, beliefs, attitudes, goals, and self-regulatory competencies interact with one another, as well as with people’s cultural environment, to yield individual differences in response to perceived discrimination. The chapter reviews a set of individual difference constructs that have been shown to affect physical and psychological health-related outcomes. Throughout the chapter, we emphasize that individual differences can arise not only through differences in how much a given construct characterizes a person but also through differences in the relationships among the constructs themselves as well as differences in the environment. The broad goal is to reconcile individual variability with group-level differences.
Parenting as a Buffer That Deters Discrimination and Race-Related Stressors from “Getting Under the Skin”: Theories, Findings, and Future Directions
Authors: Barton Allen W. , Brody Gene H.
Published: December 2017

In this chapter, the hypothesis is explored that parenting processes buffer children’s physical health from the deleterious effects of discrimination. First, the existing empirical literature is reviewed on the stress-buffering effects of parenting on children’s physical health outcomes, with respect to the stress of general childhood adversity and the specific stressor of discrimination. Next, theoretical approaches are considered that account for the capacity of parenting to buffer contextual stressors, including discrimination, from compromising mental and physical health outcomes. Particular emphasis is given to the putative mechanisms potentially responsible for protective-stabilizing effects. Then, a critique of the extant research and theory on this topic highlights particular qualifications and considerations for the research community. Finally, suggestions are offered for future research directions, including the use of randomized prevention trials to test hypotheses about the protective functions of parenting in preventing discrimination from “getting under the skin.”
Mental and Physical Health Consequences of the Stigma Associated with Mental Illnesses
Authors: Link Bruce G. , Phelan Jo C. , Sullivan Greer
Published: December 2017

People with mental illnesses experience physical illness and premature mortality at much higher rates compared to people without such illnesses. This chapter proposes that the stigma of mental illness comprises an important set of causes of this physical health disparity. It draws on classical and modified labeling theory from sociology for insights and propositions as to why mental illness stigma might affect physical health. The chapter proposes that the stigma of mental illness might affect not only the future experience of mental illness but also a broad range of physical illnesses, thereby contributing to the substantial physical health disparity that people with mental illnesses experience. The chapter develops a conceptual model that places at its center stigma processes including structural, interpersonal, social psychological, and internalized processes. Stigma processes at these levels induce stress and reduce resources, which in turn compromise physical health to produce large physical health disparities.
Neural and Cardiovascular Pathways from Stigma to Suboptimal Health
Authors: Derks Belle , Scheepers Daan
Published: December 2017

This chapter reviews research from the emerging field of social neuroscience to examine the underlying mechanisms that explain why stigma and discrimination lead to suboptimal health outcomes. The review is structured around three pathways through which stigmatization has negative effects on physical health, and it discusses neural and cardiovascular processes associated with (1) the stress that being a target of discrimination elicits, (2) impaired self-regulation of health behavior among targets of discrimination, and (3) how intergroup dynamics during interactions between health care provider and patient can result in suboptimal health care for stigmatized individuals. The insights offered by the neuroscience perspective provide crucial information on how to interrupt the downward stigma–health spiral and can inform policy to reduce the impact of stigma and discrimination on the physical health of its targets.
Budgeting for National Security
Authors: Bent Rodney
Published: December 2017

This chapter explains basic concepts used by the executive branch and Congress in requesting and allocating federal budget resources for national security. It provides a context for mandatory and discretionary budgeting and also defines some basic budget terms, such as “budget authority” and “outlays.” The chapter briefly explains the budgeting process, first within the executive branch (e.g., the White House and Departments of Defense and State) and then within the Congress, both the House of Representatives and the Senate. In addition, the chapter highlights some of the trade-offs that the executive branch and Congress must make in allocating federal budget resources to national security.
Diplomacy, the State Department, and National Security
Authors: Cloud John A. , Leader Damian
Published: December 2017

This chapter explains the history and role of diplomacy in advancing U.S. interests. The State Department is discussed as the primary actor in American diplomacy. The rise of multilateral diplomacy in the 20th century is examined along with the continued applicability of bilateral approaches. The State Department’s role in forming and implementing policy, in coordination with other government agencies, is outlined as well as its role in development assistance, consular affairs, and public diplomacy. The increased role of transnational issues, including human rights, religious freedom, arms control, and nonproliferation is outlined. The structure, funding and career paths of Foreign Service officers is examined, and the increasing use of diplomats alongside the U.S. military in combat zones in recent decades. The chapter highlights the limited resources that the United States commits to diplomacy when compared with military activities.
Military Operations and the Defense Department
Authors: Clark J. P.
Published: December 2017

This article examines the U.S. military’s plans for carrying out combined joint operations across multiple theaters and domains in the twenty-first century. It summarizes the most likely strategic and operational approaches available to future adversaries, such as anti-access/area denial (A2/AD), gray zone warfare, and other asymmetric methods. The article also considers the respective challenges posed by the two likely catalysts for military operations: contested norms and persistent disorder. The U.S. military response to this strategic context is still forming, but there are common themes among the services: the recognition that future operations will entail greater risk; the need to disperse forces to survive on a more lethal battlefield; a desire to create networked forces attacking with a combination of physical and nonphysical (cyber and electronic warfare); and a rebalancing of force structure in terms of both weapon sophistication and mission type.
National Interests and Grand Strategy
Authors: Reveron Derek S. , Gvosdev Nikolas K.
Published: December 2017

It is axiomatic that the foreign policy decisions of any country, including those of the United States, should be derived and based upon an understanding of the “national interest.” Yet there is no single, overarching conception of what constitutes the national interest or what should be considered as national interests. We see the idea of the national interest as an important starting point—a concept that enables national security policymakers to articulate what matters to the country and how a nation should set its priorities. National interests are enduring, such as protecting the integrity of the state and promoting economic prosperity. The domestic political system, international system, and organizational interests within the national security bureaucracy also shape national interests.
Interstate Rivalry in East Asia
Authors: Khoo Nicholas
Published: December 2017

It is difficult to overstate the importance of East Asia to U.S. national security policy. East Asia was an important venue of contestation for the United States during World War II and the Cold War. Presently, the United States has multiple regional alliances and partnerships and is deeply integrated with the region’s political economy. The region is also the site of a number of critical interstate rivalries that directly impinge on U.S. interests. This chapter evaluates the literature on the U.S.-China relationship and territorial disputes in the South China Sea and East China Sea. This chapter contends that neorealist theory offers a particularly illuminating lens in which to understand interstate rivalry in East Asia.
Human (In)Security
Authors: Hayes Anna
Published: December 2017

The 1990s was host to a range of conflicts emerging from weak or failed states. These conflicts typically involved significant humanitarian crises and widespread human rights abuses. Within this changing global environment, new security thinking started to engage “people” as the referent of security, moving away from the previous privileged status granted to the state as the only referent of security. The end of the Cold War enabled the human security paradigm to provide a significant challenge to the primacy of the state in security thinking. On the other hand, human security has been subject to much criticism and there has been heated debate over its applicability within the security agenda. This chapter argues that despite earlier concerns over its efficacy, human security has made inroads into security thinking and is mutually reinforcing to national security.
Climate Change and Environmental Security
Authors: Mahoney-Norris Kathleen A. , Reveron Derek S.
Published: December 2017

We now find an increasingly strong worldwide consensus that the phenomenon of climate change is real, fostered at least in part by human activities. This trend will have profound effects not only on local communities, societies, and regions but also on U.S. national security. Whereas the United States may have the resources to at least mitigate the effects of climate change within its own territory, most developing countries and their populations do not, and climate change will inevitably worsen already existing problems such as rising sea levels, desertification, and access to scarce water resources. This enhances the potential for conflict between societies and an unstable world order. The chapter defines and assesses the scope of environmental security concerns, focusing on important events, issues, and actors with implications for national and international security.
Threats and Dangers in the Twenty-First Century
Authors: Fettweis Christopher J.
Published: December 2017

Security is relative. No state is ever fully safe, just as no individual is ever completely free from danger. However, when U.S. security is considered next to that of any other state, it is hard to reach the conclusion that Washington faces much serious danger. The United States is simultaneously the safest and most fearful of all the great powers of the twenty-first century. This chapter discusses some of the structural and psychological factors that led to the overestimation of danger so common among U.S. analysts and policymakers. Why is it that many serious observers continue to believe that the current era is so dangerous, and even look to the past with a sense of nostalgia? Why do we fear so much?
Women’s Participation in Political Violence
Authors: Thomas Jakana L.
Published: December 2017

Women have a complicated relationship with violence. While they are affected by conflict disproportionately, they are also perpetrators and enablers of violence. These female militants are not rare nor are they aberrations. Countless women have contributed to wars fought from antiquity to the present. Yet, their impact on the security realm is often overlooked or underestimated. This oversight is consequential as it is impossible to truly understand international relations without considering women’s diverse contributions to global politics. This chapter examines female participation in the execution of political violence across time and space and discusses how gender diversity in conflicts across the world affects U.S. national security.
Civil-Military Relations
Authors: Brooks Risa
Published: December 2017

Civil-military relations are fundamental to the fabric of American politics. Throughout the country’s history, relations among military institutions, the civilian leadership, and American society have experienced periodic challenges and frictions. Since the late 1950s, sociologists, historians, and political scientists have sought to document and analyze these tensions. The issues include the perennial topic of how best to assure civilian control of the military; the nature and consequences of the gaps between American society and the military; the military’s involvement in politics; and the appropriate roles of civilian and military leaders in strategic assessment. This chapter explores these scholarly debates and discusses their practical implications for contemporary American civil-military relations.
Values and Values-based Practice
Authors: Fulford K. W. M. , Stanghellini Giovanni
Published: December 2017

This article describes the contribution of phenomenology to values-based practice in mental health through two case studies, respectively of delusion and anorexia. Taken together these case studies show the need in psychopathology for a combined values-based practice drawing equally on the resources of phenomenology and of analytic philosophy of values. The essay outlines the resources for further development of such a combined values-based practice respectively from phenomenological psychopathology (illustrated by research on schizophrenia) and the phenomenology of values (illustrated by the work of Husserl, Scheler, and Ricouer). The article concludes with an indication of the extent to which analytic philosophy of values and phenomenology are natural partners in the development of a combined analytic/phenomenological, values-based practice fit for purpose in meeting the particular values challenges of psychopathology.
Complementarity as a Catalyst for Gender Justice in National Prosecutions
Authors: Kapur Amrita
Published: December 2017

This chapter explores the opportunities present in the Rome Statute to promote justice for victims of sexual and gender-based violence in the International Criminal Court (ICC). It focuses on the concept of complementarity to show the ICC’s potential for reform and to catalyze the prosecution of international crimes (genocide, crimes against humanity and war crimes). It then describes the ICC’s broader approach to sexual violence and gender, as well as the domestic impact of this jurisprudence. The chapter concludes by suggesting that the Rome Statute’s standards should be introduced into national law. This could create broader benefits for women and victims of sexual and gender-based violence beyond the prosecution of criminal perpetrators.
Forced Marriage during Conflict and Mass Atrocity
Authors: Oosterveld Valerie
Published: December 2017

This chapter describes how forced marriage has been treated by international human rights law. It shows how non-consensual marriage has been overlooked in refugee law, even when evaluating claims by refugees fleeing conflict. The chapter also analyzes forced marriage in international criminal law, focusing on the Special Court for Sierra Leone and the Extraordinary Chambers in the Courts of Cambodia. It demonstrates how international criminal law has introduced confusion over how to define and how to charge forced marriage. The chapter suggests that the lack of coherent analysis calls for more consideration of whether and how human rights, refugee, and criminal conceptions of forced marriage fit together, and advocates greater synergy and coherency.
From Women and War to Gender and Conflict?
Authors: Zarkov Dubravka
Published: December 2017

This chapter charts a brief history of the conceptual tools used to understand gender relations with respect to wars and armed conflicts. The chapter begins by summarizing some of the dominant theories of second wave feminism, including radical feminism, liberal feminism, black, lesbian and Third World feminism. It explores critiques of feminist theory, as well as the roles of equality and agency in feminist studies on women and war, the tensions between Western feminism and feminism outside of the West, and the impact of a constructivist analytical lens on feminist scholarship. It depicts how specific violent conflicts influenced feminist thinking in the 1990s and the early 2000s, tracing a genealogy from genocide in Rwanda and the war in the Socialist Federal Republic of Yugoslavia to 9/11 and the War on Terror.