Schuyler W. Henderson

The Psychology of Suicide Terrorism

This paper reviews current understandings of the psychology of suicide terrorism for psychiatrists and other mental health professionals to help them better understand this terrifying phenomenon. After discussing key concepts and definitions, the paper reviews both group and individual models for explaining the development of suicide terrorists, with an emphasis on “collective identity.” Stressing the importance of social psychology, it emphasizes the “normality” and absence of individual psychopathology of the suicide bombers. It will discuss the broad range of terrorisms, but will particularly emphasize terrorism associated with militant Islam. The article emphasizes that comprehending suicide terrorism requires a multidisciplinary approach that includes anthropological, economic, historical, and political factors as well as psychological ones. The paper concludes with a discussion of implications for research, policy, and prevention, reviewing the manner in which social psychiatric knowledge and understandings applied to this phenomenon in an interdisciplinary framework can assist in developing approaches to counter this deadly strategy.

When Parenting Becomes Unthinkable: Intervening With Traumatized Parents and Their Toddlers

Intervention with infants, preschoolers, and their families requires that the child and adolescent psychiatrist shift perspective from a one-person psychology to a multiperson or Brelational[ psychology. Assessment and intervention with children younger than 5 years therefore necessitate that the clinician pay close attention to the unique characteristics of the parentYchild relationship. These characteristics include adaptation to each other’s temperaments, developmental capacities, and biological and psychological needs and desires, and to the demands of the particular environment with which the parentYchild relationship contends. Central to this work is the observation of parentY child interactionVholding, communicating, feeding, grooming/diapering, dressing, and, of course, playing. For those who practice in clinics or private offices, these observations occur during free and unstructured interactions in an environment where age-appropriate toys are available for the child. The content of the child’s spontaneous play; the parent’s affective, behavioral, and verbal responses to the child and their play; the child’s response during play while the parent speaks with the therapist; and the child’s direct response to the parentVall are key sources of information regarding the nature of the interaction. The child and adolescent psychiatrist alternately considers the child’s and parent’s perspectives, while also stepping outside of both individual perspectives to view the childYparent relationship. Thus, in addition to developmental and psychiatric vantage points, a relational vantage point is adopted. In an effort to maximize the potential for adaptive socialYemotional functioning of parent and child, particular attention is paid to both protective and risk factors within the relationship. One such factor, the presence of which is considered a protective element and the absence of which implies risk, is that of Bmentalization.[ Mentalization is the capacity to reflect on, and hold in mind, the mental states (i.e., feelings, thoughts, beliefs) of oneself and others. Empirical research suggests that this capacity is a parental trait that forms in the first years of life within the context of the attachment relationship with the parent’s own caregivers. The parent’s mentalization capacity affects the parent’s caregiving behavior with her own child and, in turn, the child’s attachment behavior with the parent. The processes involved in mentalization have been operationalized as a range of Bself-reflective functioning[ or BRF.[ Reflective functioning was originally developed as a codification of verbal examples of mentalization ranging from examples of low RF to high RF. It was used to code narrative content from the Adult Attachment Interview (C. George et al., unpublished, 1984). High RF was found to correlate significantly with secure adult attachment and subsequently with the Assistant Editors

Motivational Interviewing and Adolescent Psychopharmacology

In the comprehensive mental health care of an adolescent, psychiatric medication often plays a vital role in addressing debilitating symptoms and improving social functioning. However, although estimates specific to adolescents are limited, psychiatric patients frequently do not adhere to prescribed medications over time. In turn, medication nonadherence predicts psychiatric hospitalization, treatment failure, and other poor outcomes. A growing literature attests to the quality of the therapeutic alliance as a central influence on patient adherence to psychiatric medication and other recommended therapies. A prescription’s effectiveness can depend significantly on the relationship in which it is made. Descriptions of effective Bpsychopharmacotherapy[ with children and adolescents emphasize forming empathic alliances with both patients and parents, early introduction of medication as a possible treatment option, assessment of family, school and social contexts, promoting self-acceptance and hope for the future, and ongoing attention to the particular meanings assigned to medication by the developing child. Such descriptions highlight the importance of devoting adequate time with patients and families to these psychosocial aspects of prescribing medication. Likewise, some warn that patients’ wishes for quick gratification, Bheroic[ physician tendencies, and economic factors such as brief Bmedcheck[ appointments may limit medication treatment effectiveness and promote polypharmacy. Motivational interviewing (MI) is an efficient and collaborative style of clinical interaction that can boost the effectiveness of the therapeutic alliance by enhancing three major elements: empathy that is accurate to the patient’s experience, patient confidence in his or her ability to improve, and positive expectations regarding the recommended treatment. This clinical perspective will describe the use of MI strategies in the practice of adolescent psychopharmacology. Among patients in our academic day program, MI has appeared anecdotally to increase adherence to medication and to strengthen participation in other treatment components. Furthermore, by fostering autonomy and personal insight, MI has helped our adolescent patients to integrate their psychiatric difficulties into a more independent and resilient identity.

Psychiatry and terrorism

Terrorism has dominated the domestic and international landscape since 9/11. Like other fields, psychiatry was not well prepared. With the 10th anniversary of the 9/11 attack approaching, it is timely to consider what can be done to prepare before the next event. Much has been learned to provide knowledge and resources. The roles of psychiatrists are challenged by what is known of the causes of, consequences of, and responses to terrorism. Reflecting on knowledge from before and since 9/11 introduces concepts, how individuals become terrorists, how to evaluate the psychiatric and behavioral effects of terrorism, and how to expand treatments, behavioral health interventions, public policy initiatives, and other responses for its victims. New research, clinical approaches, and policy perspectives inform strategies to reduce fear and cope with the aftermath. This article identifies the psychiatric training, skills and services, and ethical considerations necessary to prevent or reduce terrorism and its tragic consequences and to enhance resilience.

Reporting Iraqi civilian fatalities in a time of war

BackgroundIn February, 2007, the Associated Press (AP) conducted a poll of 1,002 adults in the United States about their attitudes towards the war in Iraq. Respondents were remarkably accurate estimating the current death toll of US soldiers, yet were grossly inaccurate in estimating the current death toll of Iraqi civilians. We conducted a search of newspapers reports to determine the extent of the discrepancy between reporting Coalition and Iraqi civilian deaths, hypothesizing that there would be an over-representation of Coalition deaths compared to Iraqi civilian deaths.MethodsWe examined 11 U.S. newspapers and 5 non-U.S. newspapers using electronic databases or newspaper web-archives, to record any reports between March 2003 and March 2008 of Coalition and Iraqi deaths that included a numeric indicator. Reports were described as events where they described a specific occurrence involving fatalities and tallies when they mentioned the number of deaths over a period of time. We recorded the number of events and tallies related to Coalition deaths, Iraqi civilian deaths, and Iraqi combatant deathsResultsU.S. newspapers report more events and tallies related to Coalition deaths than Iraqi civilian deaths, although there are substantially different proportions amongst the different U.S. newspapers. In four of the five non-US newspapers, the pattern was reversed.ConclusionThis difference in reporting trends may partly explain the discrepancy in how well people are informed about U.S. and Iraqi civilian fatalities in Iraq. Furthermore, this calls into question the role of the media in reporting and sustaining armed conflict, and the extent to which newspaper and other media reports can be used as data to assess fatalities or trends in the time of war.