Q. Dimitar. Youngstown State University.

Adoption of a Deceptive Role The simulation of psychosis or of any mental aberration may be considered as a conscious and deliberate attempt to take a specific social role discount zebeta 10mg overnight delivery. According to Sarbin (77) order zebeta on line, the concept of role deals with the organized actions of a person in harmony with a given status or position discount zebeta 5 mg on line. A position may be considered a system of rights and duties exercised by the person who occupies the position. The role expectations, which are learned through direct or indirect experiences, deal with with the behavior expected of the occupant of a particular position, and with the behavior anticipated of the person occupying the reciprocal position in the social interaction situation. Thus the position or status of the mentally ill person is culturally transmitted just as any other role, and consists of a system of expectations about the behavior of the mentally ill person. It also includes the reciprocal expectation that the person dealing with the deranged patient will protect him, consider him not responsible for his actions, prevent him from doing harm, make few if any demands on him to be rational, and institute therapeutic and rehabilitative measures. The organized behavior of the individual, directed toward fulfilling these expectations of the self and other, is called the role. Thus, the person who plays the role of the psychotic is trying to determine the role of the examiner or interrogator, and he expects a certain response from him. How successful he will be in enacting that role seems to be dependent on three factors. The second appears to be related to a generalized skill at taking and -279- enacting roles. Finally, certain enduring or temporary motivational and qualitative characteristics of the self structure are probably influential in determining the choice and adequacy of the role. This possible consonance of basic personality to enacted role is one of the most complicating factors in recognizing malingering, and is one with which almost all workers in this field have wrestled. Although these notions on role behavior may help in understanding malingering in general, there is as yet little empirical work which would aid in the prediction of the persons and the circumstances which might combine to produce simulation of psychosis. It is apparent that almost all individuals play different roles, and the role played is partly dependent upon who the partner is in the social situation. Block (9) and Block and Bennett (11) have demonstrated that a single subject varies his behavior as the interpersonal situation changes. The complexity of this understanding did not appear to be a function of self and ideal-self discrepancy in a homogeneous sample of college students. However, Gough (35) and Cameron (14) have argued that role-taking ability is related to emotional well-being. Studies by Sarbin and Farberow (78), Sarbin and Hardyck (79), and Sarbin and Jones (80) have tended to confirm that adequate role perception and validity of role enactment are positively related to adjustment. However, in a study by Helfand (40), schizophrenics in remission were found to be more adept at taking the role of a standard stimulus person than were either normals or chronic schizophrenics. Thus, there are somewhat contradictory findings concerning the question of adjustment in relation to skill for enacting a variety of roles. The more specific question of the type of person who will attempt to simulate the role of the psychotic has not been investigated experimentally. From role theory comes the suggestion that the role chosen and played well is the one which is congruent with the nature and organization of the self (77). This would tend to support those writers who feel that malingering of psychosis is a symptom of a serious personality defect, if not a psychosis in itself. This position is most clearly taken by Ossipov (69) who feels that the person who simulates a psychosis is accentuating his own latent characteristics. Moreover, several authors have pointed out that malingering may be used to -280- conceal an actual psychosis, and that which was at first considered malingering may show up as a grave disorder later (13, 22, 34, 47, 58). Eissler (22) explains this as an attempt to hold a psychosis in abeyance by acting as if the behavior is under control and not something one is submitting to. Furthermore, on recovery from psychosis, a person may claim he was malingering because it may be too humiliating to have others know that that he was suffering from a psychiatric disorder (22, 58). Thus, regardless of the problem of who is best at taking roles, the disturbed or the integrated individual, there are many who would hold that the choice of a specific role, that of the psychotic, usually indicates serious psychopathology. However, others argue that while the malingerer may be emotionally upset, there are also many normals and near normals who malinger under extreme circumstances (22, 23, 29, 30, 41, 58, 88, 91). As MacDonald (58) and Ossipov (69) indicate, the simulation of mental incompetence is more frequent when there is danger of loss of life. Certainly the malingerer does not expect to be punished more severely for having committed a murder and feigning psychosis than for having committed a murder without feigning psychosis, if through simulation there may be a chance of avoiding punishment. The person may see himself in a role conflict, and failure to resolve the conflict may cost him his life. He is occupying two positions simultaneously, and the role expectations of the one are not compatible with the other. As a loyal soldier he is expected by his country to withhold information which would aid the enemy. As shown by Gullahorn (38), a person who is placed in a situation where incompatible demands are placed upon him because of his role relationships in two groups will try to retain both positions and find a way of satisfying them both. Toby (84) in his analysis of role conflict situations suggests that illness is an excuse by which a person in role conflict may avoid performing an obligation or duty of a role, without relinquishing the position and without suffering sanctions for failing to perform the duty. Thus illness, and particularly mental illness, would allow the prisoner to escape the role dilemma, and since illness is such a widespread excuse, special personality characteristics may not be necessary for selecting this role under extreme circumstances. Furthermore, if one conceives of malin- -281- gering as antisocial behavior (Szasz, 83), then there is much evidence to indicate that many people are dishonest at one time or another (15, 17, 39, 51, 59). This is one way of interpreting the rather consistent finding that poor students who are having difficulty maintaining their roles as students are more likely to cheat (15, 17, 39). This also seems to be congruent with the finding that a person will take a particular role if it is seen as satisfying an important need (66). As pointed out by several writers, the person who simulates is an actor who portrays an illness as he understands it (8, 58, 69). It would appear that the characteristics and behaviors which are perceived as crucial to the role are acquired through experience and observation. Personal experiences may have occurred with friends or relatives who were psychotic. In the two cases described by Atkin (4), the role perceptions necessary for the malingering were built up by confinement in mental hospitals at eariler times. The cultural stereotype of the deranged person also seems to be used as a basis for role enactment. Observations made of criminal cases being psychiatrically evaluated prior to trial tend to support this. Many Negro patients who are thought to be malingering tend to play the part of a slow, somewhat confused and defective person who understands little of what is going on around him. Like members of other oppressed minorities, some Negroes have adopted a mask of dullness and unawareness when interacting with the Caucasian majority (5). The cultural determination of the ingredients Which are perceived as comprising the psychotic -282- role is also evident in the work of Benedict (6).

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The standard toxin was now made and defned by Behring and Ehrlich cheap 10 mg zebeta with mastercard, and they asserted that no one had the right to reference their „titer“ without express permission discount zebeta 5 mg. Secondly cheap zebeta 5 mg overnight delivery, a network of strategic cooperation between bacteriological research, clinicians, pharmaceutical enterprises, and state authorities developed around the serum: the concept of the serum’s „value” bridged the differences between these diverse interest groups because it was broad and fexible enough to be translated from a laboratory to a therapeutic measure and because it assumed an economic and a public health value. Indeed, Behring was enough of a businessman to recognize the advantages of having a metric for the „value” of the serum and of course the Farbwerke Hoechst were eager to have such a useful accounting tool. Thus, it was probably no accident that Behring redefned the evaluation method at the same time that Wernicke and Aronson were presenting their dog-sera. Aronson in particular threatened Behring’s ambitious plans because he too was aiming to enter the private sector. Considering Wernicke’s publication on dog-sera, it’s noteworthy that he felt obliged to reassess the value of his sera based on the newly developed method, because it was viewed as being more rational and exact. See the report of Laubenheimer to the board of Hoechst („Bericht an Aufsichtsrat“, 0. On the basis of his evaluation method, Behring tried to denigrate the serum and to call Aronson’s scientifc credentials into question, alleging that he had provided unreliable specifcations for the „therapeutic value” of Schering’s serum and was motivated only by its potential „monetary value”. In addition, their method became institutionalized once a central state institute was established in the German Reich in 1895. Unlike his German colleagues, Roux was under no pressure to maneuver through such a point of passage, primarily because in France value comparison was of less eminent importance: there it did not serve to control competing providers because the Pasteur Institute in Paris held a monopoly over serum-production. However, for the sake of comparability with the German sera, Roux made the effort to measure the serum using one of the accepted evaluation methods. He decided on the method published by Behring and Wernicke in 189 ,108 which he and Vaillard had already used in a modifed form for measuring tetanus serum. This meant that for Roux and his collaborators the living body and its ability to respond was an obligatory point of passage between the injection of the serum and the infection. On the other side of the Franco-Prussian border, Behring and his antitoxin hypothesis could basically rationalize away the vital variability of the guinea pigs. His ideal test animal was not regarded as an organism which reacted individually, but merely as a standardized indexing device. Roux and his collaborators varied the method by injecting pure toxin instead of diphtheria culture (Roux and Martin 1894, p. Analogously, Gradmann has pointed to the instrumentalization of animals as „cultural media“ in the experimental system of Robert Koch (Christoph Gradmann, „Das Maß der Krankheit - das pathologische Tierexperiment in der medizinischen Bakteriologie Robert 92 French and German Diphtheria Serum Research and the Reconfguration of Cultural Boundaries Conclusion The history of diphtheria serum research in Berlin and Paris tells us much about the differences between the two research cultures. In this article I have described the methods of chemical weakening versus biological attenuation of the diphtheria bacteria (or toxin) that comprised an important technical basis for immunization. I have also discussed the humoral versus cellular or phagocytic theories of immunity, and fnally the in vitro- versus „vital response” method of evaluating the serum. These differences were effected by the respective research traditions in Berlin and Paris, but they were also reconfgured in the interplay of the protagonists on both sides of the Franco-Prussian border in efforts to demarcate and profle their concepts and theories. These dynamic interrelations were at the same time also bridging the research activities of Roux/ Metschnikoff and Behring: Thus, I have shown how the researchers developed a considerable scientifc interest in each other and how both Roux and Behring drew on each other’s basic experimental techniques. Conceptualizing the relationship as dynamic interplay between the „two cultures of bacteriology“ in Paris and Berlin takes us away from the well-worn dichotomies of „national“ or „personal rivalry“ versus „cooperation“. Of course, the present article treats only a very short timeframe and cannot serve as a basis for generalizations about the history of Koch’s and Pasteur’s research schools as a whole. But this micro-study at least suggests that a shift in focus could lead to a subtler picture of the story than one based on the notion of essentially separate cultural worlds of science that only occasionally cooperate. Instead it shows the value of closely analyzing the multi-layered forms of interactions that not only demarcate research schools from one another, but also bind them together. Studien im Anschluß an Georges Canghuilhem, edited by Cornelius Borck, Volker Hess and Henning Schmidgen, 71-90. Jonathan Simon Abstract1 While it would be reassuring to believe that state regulation of drugs refects the best available response to any given public health problem, it is clearly wishful thinking. Indeed, much recent research points to the complex interactions and often intense negotiations that lie behind legislation in this feld, both in the past and today. In the present paper, I argue in the same sense, although in an arena where explicit debate was (apparently) limited. Retracing the history of serum regulation in France in 1895, I will present the context of suspicion and trust that framed a series of (largely silent) negotiations around the manner to ensure the safety of the French people while giving them access to what was seen as a valuable ‘scientifc’ treatment for a deadly disease. To analyse the emergence and functioning of the resulting serum regulation in France, I will make use of Herbert Simon’s concept of ‘satisfcing’, examining how the constraints and possibilities were ftted to one another over the course of parliamentary debates as well as the application of the offcial legislation. Thus, I will argue that while not ideal, this legislation was nonetheless satisfactory with respect to the immediate goals as conceived by the government and its partners, primarily the Pasteur Institute in Paris. In order to understand these developments, we need, therefore to examine all the constraints that entered into the discussion, such as the perception of the serum itself, its proposed use, the perception of diphtheria as a disease, the place of the local doctor in treatment, the status of bacteriology, etc. The heroic narrative of serotherapy I want to start my paper with a piece of French melodrama drawn from the experience of Paul Persy, a local doctor practicing in the Le Mans region of France at the end of the nineteenth century: On Saturday the nineteenth of January 1895, at around fve o’clock in the evening, a farmer from the Le Mans region introduced himself into my surgery, saying: ‘I have come, sir, in order to beg you to examine a child with a sore throat as soon as possible’ and, he added, now in tears ‘you see we are very worried; we lost one to croup four days ago, we only have this one left and “he is going the same way as the frst”: and we do believe it is the same illness’ ‘The child that you lost, was he treated by the new method, was he vaccinated? This modern miracle of medical science inspired the most sublime emotions in our hero’s breast, which he also valiantly struggled to put into words. Did I not think of my loved ones, all those who are dear to me and who might, one day, be affected by this cruel disease? Did I not think of the glory of France, my beautiful country, which I love and which I always want to see among the greatest of nations, for it is the blessed land of all devotions? This circular, dating from 14 January 1895, informed the Prefects of how to obtain the serum from the Pasteur Institute in Paris. Hence, at a moment when the Pasteur Institute was just beginning to produce suffcient serum to supply the whole of France, an emergency system was in place with the Prefect of each department distributing the still scarce medicine. This system by-passed the local pharmacies, which had hitherto constituted the standard channel for supplying medicaments to the French population. Indeed, the fact of leaving the pharmacist out of the circuit of distribution meant that the legal status of the serum under the legislation in force at the beginning of 1895 was unclear. If it was a medicament, then, according to legislation dating from 180 , only a qualifed pharmacist could supply it for medical use, which, as we have seen, was not the case. Nevertheless, as the serum represented a new therapeutic hope, widely acclaimed for its effectiveness in a deadly disease (particularly for young children), it is unsurprising that the Pasteur Institute was not pursued in court under the pharmaceutical legislation. Something else that is clear from the circular and the episode of the provincial doctor’s experience with 2 Paul Persy, Ma première application du sérum antidiphtérique. Morange (ed), L’Institut Pasteur: contributions à son histoire, Paris: La Découverte, 1991, pp. Another intriguing feature of Persy’s story is his repeated reference to the serum as a ‘vaccine’. As Louis Pasteur’s best-known innovation in human medicine was the rabies vaccine, it is perhaps not surprising that people, even doctors, should consider this new treatment for diphtheria to be another vaccine, even though this was not the case. It is interesting to note that Pasteur’s vaccine against rabies (which was used as a post-exposure treatment) occupied a similar precarious legal position to the serum, a situation famously compounded by the fact that Pasteur himself was not a qualifed physician.

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Thus zebeta 10mg for sale, despite failure to confirm their own previous findings cheap 10 mg zebeta visa, this study did not support the deterioration finding of the McGill group order zebeta pills in toronto. Goldberger and Holt (32) studied fourteen paid volunteer male college students under perceptual deprivation conditions similar to those of the McGill experiments. Subjects lay on a bed in a cubicie for eight hours and were encouraged to talk during their time in isolation. The following tests were administered at the end under the experimental conditions: arithmetic reasoning, digit span, and story recall. Subjects were then taken out of the isolation and a test of logical deductions was given. Comparison of the performance of the experimental subjects pre- and postconfinement (without a control group) showed that only the last of these, logical deductions, reflect significant impairment. Davis, McCourt, and Solomon (21) utilizing a modification of the polio tank- respirator procedure initially described by Wexler et al. Although they could talk to each other, they were confined separately and could not see each other. In comparing scores before and after isolation they found no change in performance on a block design task. These authors considered the possibility of procedural variables causing failure to confirm Bexton et al. Subjects were seated individually for one hour in an isolation chamber in a comfortable chair. They wore goggles which were either blacked out or else permitted diffuse light perception. Audition was minimized through car plugs, padded earphones, and the masking sound of a fan motor. Their fingers were wrapped in elastic bandages and they wore elbow- length gloves. Subjects were also told that they would perceive sensations ordinarily below conscious awareness. These experimenters report that there was no "gross cognitive deterioration" under these conditions as measured by the number of word associations produced in two minutes. The small sample size, the brief period of isolation, and the limited measure employed in this study suggests caution in interpreting this result. Cohen, Silverman, Bressler, and Shmavonian (18) reported an exploratory investigation on four subjects exposed singly to four hours of confinement and deprivation while seated in an anechoic chamber, with instructions to keep awake and to estimate the passage of successive thirty-minute intervals. All four subjects showed an increase in performance on digit span, and decrease in arithmetic reasoning, abstraction, and general reasoning. The small sample size and absence of a control group limit the relevance of these findings. The few reports available, their currently sketchy detail, and their limited controls make it difficult to arrive at a firm generalization concerning the effects of deprivation and isolation on cognitive skills. It appears that the skill most severely impaired under these conditions is that of general reasoning and problem solving, whether the situation involves verbal-conceptual materials or numbers. On the other hand, in several studies performance on simple recall tasks or rote learning seems either to improve or else does not decline. Tasks that involve analysis and synthesis of visual materials such as block design show equivocal results; in some studies there is deterioration, in others no change is seen. Some of these equivocal results may be a function of differences in procedure or duration of deprivation and confinement. The sequence in which postisolation tests are administered may be a relevant variable here since the duration of the effects, if any, is as yet unknown. The conceptual analysis of cognitive skills into categories such as reasoning, memory, arithmetic, and manipulation would serve a very useful purpose in these studies. Goldberger and Holt (32) offer a tentative generalization which begins to specify some of the different factors involved in various tasks. They point out that, "Probably any task that can be done satisfactorily in a single brief effort by the use of highly overlearned sets of operations (as in simple arithmetic problems), and any learning or memory performance requiring passive receptivity (cf. For example, are there differences in the types of memory or recall involved in digit span as opposed to remote memory? Although the available results are certainly inconclusive, the Gold- -66- berger and Holt generalization suggests that remote recall would be relatively unimpaired by isolation. This would have implications for one interested in the interrogation problem where, leaving motivational issues aside, it would seem that the information a person might recall when cooperating would be reliable. Furthermore the data suggest a decreased interest in and ability to reason through the complexities of the interrogator-prisoner relationship and thus a decreased ability to cope rationally and effectively with the situation at hand. Despite the more tenuous nature of the findings in the area of cognitive skills, to the extent to which a generalization is possible, it seems that in addition to the decline in internal norms or standards for perceiving reality, under conditions of deprivation and isolation there is a lessened ability to reason closely and solve complex problems. Should such a generalization be supported by subsequent findings, a relevant question remains about the extent of such impairment in quantitative terms. Suggestibility An issue related to that of cognitive functioning in isolation and deprivation is that of suggestibility. The reported success of isolated confinement in modifying beliefs and convictions initially directed interest to the question of suggestibility. After twenty hours of perceptual deprivation, twenty-four subjects were exposed to a recorded propaganda message consisting of a ninetyminute talk read in a boring monotone and arguing for belief in various psychical phenomena. To measure attitude change, a series of attitude scales of the Bogardus type were administered before and after confinement. A control group of twenty-seven subjects received both scales before and after a similar interval. Both groups, experimental and control, showed a significant change in attitude after listening to the records. Similarly, measures of interest in the topic and assessments of its importance showed a greater increase for the subjects exposed to perceptual deprivation. Although follow-up data were not systematically obtained, incidental evidence indicated that for some subjects at least, these effects persisted for as long as three to four days. Vernon and Hoffman (76) tested subjects for degree of body sway suggestibility following varying periods of -67- sensory deprivation. These authors remark cryptically that attempts to measure this phenomenon "proved unsuccessful. Rather than estimate the effects of isolation upon suggestibility, others have sought to establish a relationship between suggestibility as a personality attribute and 1 response to deprivation. Petrie measured body sway suggestibility in a group of nine subjects who had been exposed to the conditions of confinement and perceptual deprivation described by Wexler et al. Her observations revealed a trend toward a negative relationship between amount of body sway and length of time voluntarily spent in deprivation. Camberari (16) studied the response to sensory deprivation of twenty male unpaid volunteer psychology graduate students evenly divided into suggestible and nonsuggestible groups. This division was based on the composite scores of these subjects on several tests of suggestibility.