Warren Kinston

Disaster: Effects on mental and physical state

Abstract Although there is an extensive literature on various aspects of disaster, there has been no comprehensive review of its psychiatric consequences. This article brings together the phenomenological and dynamic descriptions of the immediate and longer term mental effects of disaster as observed in the individual and in groups. Present knowledge on management of these effects is summarized and some conclusions are reached on the implications for future planning of disaster relief services.

Interaction in families with obese children

In a controlled study using recently developed and validated methods for eliciting and describing family interactions, a characteristic dysfunctional pattern of interaction was found in families with an obese child. The pattern differed from patterns predicted by previous workers on the basis of indirect evidence or non-systematic study. The pattern was present in all the families studied, but was more marked in the sub-group recruited from a local school, than from subgroups recruited through medical sources. This sub-group had a more positive attitude to obesity and a slightly lower degree of obesity. No common or characteristic interactional pattern was found in the controls. The results were not explainable in terms of demographic criteria, family structure or composition variables, or family emotional health. The findings are discussed in relation to a model of obesity as a family syndrome and a manifestation of psychosocial identity.

Emotional health of families and their members where a child is obese

A controlled study of families with an obese child showed a small but significantly greater impairment in family functioning when this was elicited and rated using clinical methods. However no significant impairment was found when functioning was elicited with standardized objective methods. Mothers of obese children rated their families as more dysfunctional than mothers of control children. Although the emotional health of individual members in obese families was not worse than in control families, significant differences in the family patterning of emotional health were found. The more overweight the obese child, the healthier the mother rated the family, and the better her own mental health as assessed by a self-report method; and in families of obese girls, the greater the degree of overweight, the worse the rated family functioning. The findings are integrated with the literature and a theoretical explanation in which obesity is seen as an identity disturbance is offered.

Hospital organisation and structure and its effect on inter-professional behaviour and the delivery of care

Some form of organisation within and between hospitals is necessary to provide effective and integrated care to patients, to ensure that medical, nursing and paramedical services develop efficiently and coherently, and to ensure that needs of the community are met. However research into the design of structures for the provision of hospital services has been remarkably limited considering the transformation of hospital work in recent decades. The absence of clearly articulated models of organisation and lack of consensus on the relevant data make needed comparative studies difficult to mount. Nevertheless systematic empirical and evaluative studies of matters like appropriate limits to authority, working of intraprofessional hierarchies, management of clinical autonomy, and the effects of interprofessional rivalry on patient-care seem both feasible and desirable. Many studies bearing directly on these topics take the form of inquiries mounted within government departments or by professional groups with an interest in the outcome.

Pluralism in the organisation of health services research

The variety of methods used in health services research (HSR) embody categorically different epistemological assumptions. These are examined in an effort to contribute to a usable framework for the evaluation of HSR projects, and in the light of a need in the U.K. for adequate institutional arrangements for the promotion and funding of HSR. Research into organisation has revealed that if desired values are not explicitly built into the structure, other values may appear unbidden. The adequate institutional base is one which embodies, espouses and funds a meaningful and practical scientific pluralism. A possible classification is outlined and illustrated and its implications for competition amongst scientists and the social responsibility of scientists are briefly discussed.

Resource consumption and future organisation of medical work in the national health service

Medical expenditure within the National Health Service (NHS) is based upon an arrangement whereby doctors share in common resources provided by the Health Authority. This arrangement is unsatisfactory when resources are contracting and leads to social regulation of medical activity. If doctors within the district work-group do not response to the challenge of cost-containment by internal organisation, more and more externally imposed regulations will result to the detriment of patients and doctors. The continual redevelopment of organisation to permit the optimal mix of internal and external regulation should be a subject of long-term enquiry and action for doctors in each district.

A framework for family description

A hierarchical framework for family description is presented which consists of seven levels. These are, in order, conceptions of interaction, items of interaction, episodes of interaction, patterns of meaning, holistic formulation, type formulation, and requisite formulation. The framework is used to clarify intrinsic differences between the different schools of therapy. Implications of this framework for the epistemological debate within family therapy are discussed.