This paper presents the results of electric aversion therapy in 24 patients with transvestism, fe... more This paper presents the results of electric aversion therapy in 24 patients with transvestism, fetishism, and sado-masochism. Preliminary findings have been reported elsewhere, together with a review of the literature and a discussion of the process of change during treatment (Marks and Gelder, 1967; Bancroft and Marks, 1968; Gelder and Marks, 1969). In these studies the available evidence indicated that the manifestations of the sexual disorder were diminished by treatment, and this appeared to be directly due to aversion rather than to non-specific components of treatment. The present report is concerned with the clinical outcome of these cases, with prognostic variables, and with the part aversion therapy should play in the treatment of these sexual disorders.
This fine book deserves to be read by every psychiatrist and behavioural scientist, indeed by any... more This fine book deserves to be read by every psychiatrist and behavioural scientist, indeed by anyone trying to understand today's world. It grew out ofthe 1991BBC Reith lectures and won major awards. Steve Jones has a rare ability to bridge disparate disciplines. He makes fascinating excursions into genetics, sex, molecular biology, sociobiology, medicine, infectious disease, palaeopathology, history from todayback to the origin of our species and its spread round the world, economics, linguistics, and even surnames (“A surname is rather like a gene; it passes from father to son. Every generation there is a chance that a particu lar father does not have a son.―) These diverse areas are drawn together deceptively simply and clearly. He can hardly write a boring sentence. Jones exposes the frightening ignorance and arrogance of the eugenics movement. Who said “¿ The unnatural and increasingly rapid growth of the feeble minded and insane classes, coupled as it is with steady restriction among all the thrifty, energetic and superior stocks constitutes a national and race danger which it is impossible to exaggerate. I feel that the source from which the stream of madness is fed should be cut off and sealed off before another year has passed―?No, not Adolf Hitler. The rantings came from Winston Churchill as Home Secretary in 1910.They were only allowed to be made public in 1992,half a century after the Holocaust. Which of today's received wisdom will appear as barbarous hubris in 2045? It is refreshing to see Jones's humility in interpret inggeneticdata.Politicians oftenquote†̃¿ science' to justify policy. Biological factors in homosexuality were cited by Nazis for their brutal view and by liberals for their opposing one. The naà ̄vetyof such arguments is exposed. An association between blood pressure and hair colour was shown to be due to an experimental artefact leading dark-haired students to exercise and drink coffee just before their blood pressurewas measured.Genes vary lessbetween races than between individuals; racism is a moral and political issue, nota genetic one.DNA fingerprinting islessconclusive thanwas oncesupposed. Too much is asked of biology. “¿ Although biology may tell us a lot about where we come from, it says nothing about what we are.― A common misconception is that humans can now bypass evolution. How wrong such an idea is stares out from this book. Inadvertent natural selection con tinues. Perhaps nowadays it acts less on survival than on fertility. Nevertheless, fewer conceptuses may reach term as a living baby than those which abort, often without the woman knowing. Limits to how much mass screening can help to reduce the frequency of deleterious genes are openly faced. More important for reducing the effects of recessive genes may be greater outbreeding as humans move increasingly often across the planet. A point rarely made is that the number of children with old mothers and fathers drops as social conditions improve,becausemostpeoplestophaving children soon after starting their families. Even if they begin later on average than in the past, they stop earlier. This may mean a drop in the number of new mutations. An absorbing story is told of applied genetics break ing the sex barrier. Gene trading no longer depends solely on luckofthesexualdraw.Plannedparenthood now allowsgenestobemixednotonlywithinspecies but also across speciesand even across kingdoms. This may help to reduce drug resistance by microorganisms and arthropods against our chemical weapons. How ever, “¿ genetic engineers, unlike those who build bridges, must face the prospect that their new toys will fight back.― A mature understanding of the origins of behav iour requires today's psychiatrists and psychologists to be familiar with relevant evolutionary issues, to whichtherearenow excellent popularintroductions, and with genetic advances such as those sketched by Steve Jones in this splendid volume. His preface expresses “¿ gratitude o thefundingbodieswhose determined refusal to support my work led me... to abandon research, in my case for journalism.― Un intended good came out of adversity. Natural selection at its best.
Reeves JT, Groves BM, Sutton JR, et al. OperationEverestII: preservation of cardiac function at e... more Reeves JT, Groves BM, Sutton JR, et al. OperationEverestII: preservation of cardiac function at extreme altitude.
Recent years have seen major developments in psychotherapy research that suggest the need to addr... more Recent years have seen major developments in psychotherapy research that suggest the need to address critical methodological issues. These recommendations, developed by an international group of researchers, do not replace those for randomized controlled trials, but rather supplement strategies that need to be taken into account when considering psychological treatments. The limitations of traditional taxonomy and assessment methods are outlined, with suggestions for consideration of staging methods. Active psychotherapy control groups are recommended, and adaptive and dismantling study designs offer important opportunities. The treatments that are used, and particularly their specific ingredients, need to be described in detail for both the experimental and the control groups. Assessment should be performed blind before and after treatment and at long-term follow-up. A combination of observer- and self-rated measures is recommended. Side effects of psychotherapy should be evaluated...
MARKS, I. AND A. TOBEIqA. Learning and unlearning fear: A clinical and evolutionary perspective. ... more MARKS, I. AND A. TOBEIqA. Learning and unlearning fear: A clinical and evolutionary perspective. NEUROSCI BIOBEHAV REV 14(4) 365-384, 1990.-Many fears, phobias and rituals seem to arise from prepared phylogenetic mechanisms which favor old over new evolutionary dangers and affect the rules of aversive learning which govern the acquisition of fear. Recent developments in several forms of aversive learning (sensitization, conditioning, extinction, observational learning) can improve them as paradigms of the acquisition, spread and maintenance of normal and clinical fears. The most reliable treatment for phobias and rituals is exposure, whose effects closely parallel the habituation of normal defensive responses and the extinction of conditioned fear and avoidance in animals. Habituation during exposure is usually slow and step by step, and generalizes little, but once attained tends to endure. Conditioned fear extinction and fear habituation have similar courses and may depend on similar neural processes. To be reduced, avoidance has to be prevented or the safety intervals that it heralds must be given up. Some phobias may result less from enhanced acquisition than from insufficient exposure to attain habituation. Finally, the review discusses the limits of habituation and the instability of fear extinction in relation to the long-term efficacy of exposure therapy.
Twenty phobic outpatients were treated by 9 weekly “interviews” at the console of a desk computer... more Twenty phobic outpatients were treated by 9 weekly “interviews” at the console of a desk computer. Using a conversational style and multiple choice questions, the computer assessed the symptoms and agreed a hierarchy of self-exposure tasks. Each week the patient was given a diary sheet of tasks to practise daily. At his next visit his progress and motivation were assessed, and if he was succeeding he was encouraged to accept progressively more difficult tasks. This group was compared with a group of 20 patients (matched for age, sex and type of phobia) treated conventionally by a therapist in the preceding year. Progress was measured on standardized scales (both self- and clinician-rated). The two groups showed significant improvement on all the scales, and 75–80% of each group were much improved (scores reduced by 50%). The therapist treated group tended to be more severely ill at entry and to show greater improvement during treatment. Improvement was maintained at 6 month follow-u...
While on a waiting list for treatment by therapist-guided exposure and ritual prevention (ERP), p... more While on a waiting list for treatment by therapist-guided exposure and ritual prevention (ERP), patients with obsessive-compulsive disorder (OCD) did self-treatment at home guided by a manual plus a computer-driven telephone interview system (BT STEPS). Of 21 patients who used the system for at least three weeks while on the waiting list, one improved so much that subsequent therapist-guided ERP was unnecessary. Progress of the rest with the system predicted later progress with therapist-guided ERP. Improvement after using the system was similar to that of 20 matched historical controls who had had therapist-guided ERP without the prior use of BT STEPS. Outpatient users of BT STEPS needed less subsequent clinician-guided time than did their matched controls. In this pilot study, patients with OCD improved nearly as much with home self-treatment guided by a manual plus computer, as with treatment guided by a behaviour therapist.
Journal De Therapie Comportementale Et Cognitive, 1994
Une commission europeenne sur la definition de standards communs pour mesurer le cout et les bene... more Une commission europeenne sur la definition de standards communs pour mesurer le cout et les benefices des soins classiques pratiques en sante mentale va etre organise. Un systeme d'audit performant (CORM) mis sur ordinateur pour mesurer les effets de la pratique clinique quotidienne, et qui a fait ses preuves sur 600 patients, est detaille. De tels instruments peuvent permettre une avancee significative au niveau de la definition de standards moyens de soins et du cout moyen de ces soins en sante mentale.
This paper presents the results of electric aversion therapy in 24 patients with transvestism, fe... more This paper presents the results of electric aversion therapy in 24 patients with transvestism, fetishism, and sado-masochism. Preliminary findings have been reported elsewhere, together with a review of the literature and a discussion of the process of change during treatment (Marks and Gelder, 1967; Bancroft and Marks, 1968; Gelder and Marks, 1969). In these studies the available evidence indicated that the manifestations of the sexual disorder were diminished by treatment, and this appeared to be directly due to aversion rather than to non-specific components of treatment. The present report is concerned with the clinical outcome of these cases, with prognostic variables, and with the part aversion therapy should play in the treatment of these sexual disorders.
This fine book deserves to be read by every psychiatrist and behavioural scientist, indeed by any... more This fine book deserves to be read by every psychiatrist and behavioural scientist, indeed by anyone trying to understand today's world. It grew out ofthe 1991BBC Reith lectures and won major awards. Steve Jones has a rare ability to bridge disparate disciplines. He makes fascinating excursions into genetics, sex, molecular biology, sociobiology, medicine, infectious disease, palaeopathology, history from todayback to the origin of our species and its spread round the world, economics, linguistics, and even surnames (“A surname is rather like a gene; it passes from father to son. Every generation there is a chance that a particu lar father does not have a son.―) These diverse areas are drawn together deceptively simply and clearly. He can hardly write a boring sentence. Jones exposes the frightening ignorance and arrogance of the eugenics movement. Who said “¿ The unnatural and increasingly rapid growth of the feeble minded and insane classes, coupled as it is with steady restriction among all the thrifty, energetic and superior stocks constitutes a national and race danger which it is impossible to exaggerate. I feel that the source from which the stream of madness is fed should be cut off and sealed off before another year has passed―?No, not Adolf Hitler. The rantings came from Winston Churchill as Home Secretary in 1910.They were only allowed to be made public in 1992,half a century after the Holocaust. Which of today's received wisdom will appear as barbarous hubris in 2045? It is refreshing to see Jones's humility in interpret inggeneticdata.Politicians oftenquote†̃¿ science' to justify policy. Biological factors in homosexuality were cited by Nazis for their brutal view and by liberals for their opposing one. The naà ̄vetyof such arguments is exposed. An association between blood pressure and hair colour was shown to be due to an experimental artefact leading dark-haired students to exercise and drink coffee just before their blood pressurewas measured.Genes vary lessbetween races than between individuals; racism is a moral and political issue, nota genetic one.DNA fingerprinting islessconclusive thanwas oncesupposed. Too much is asked of biology. “¿ Although biology may tell us a lot about where we come from, it says nothing about what we are.― A common misconception is that humans can now bypass evolution. How wrong such an idea is stares out from this book. Inadvertent natural selection con tinues. Perhaps nowadays it acts less on survival than on fertility. Nevertheless, fewer conceptuses may reach term as a living baby than those which abort, often without the woman knowing. Limits to how much mass screening can help to reduce the frequency of deleterious genes are openly faced. More important for reducing the effects of recessive genes may be greater outbreeding as humans move increasingly often across the planet. A point rarely made is that the number of children with old mothers and fathers drops as social conditions improve,becausemostpeoplestophaving children soon after starting their families. Even if they begin later on average than in the past, they stop earlier. This may mean a drop in the number of new mutations. An absorbing story is told of applied genetics break ing the sex barrier. Gene trading no longer depends solely on luckofthesexualdraw.Plannedparenthood now allowsgenestobemixednotonlywithinspecies but also across speciesand even across kingdoms. This may help to reduce drug resistance by microorganisms and arthropods against our chemical weapons. How ever, “¿ genetic engineers, unlike those who build bridges, must face the prospect that their new toys will fight back.― A mature understanding of the origins of behav iour requires today's psychiatrists and psychologists to be familiar with relevant evolutionary issues, to whichtherearenow excellent popularintroductions, and with genetic advances such as those sketched by Steve Jones in this splendid volume. His preface expresses “¿ gratitude o thefundingbodieswhose determined refusal to support my work led me... to abandon research, in my case for journalism.― Un intended good came out of adversity. Natural selection at its best.
Reeves JT, Groves BM, Sutton JR, et al. OperationEverestII: preservation of cardiac function at e... more Reeves JT, Groves BM, Sutton JR, et al. OperationEverestII: preservation of cardiac function at extreme altitude.
Recent years have seen major developments in psychotherapy research that suggest the need to addr... more Recent years have seen major developments in psychotherapy research that suggest the need to address critical methodological issues. These recommendations, developed by an international group of researchers, do not replace those for randomized controlled trials, but rather supplement strategies that need to be taken into account when considering psychological treatments. The limitations of traditional taxonomy and assessment methods are outlined, with suggestions for consideration of staging methods. Active psychotherapy control groups are recommended, and adaptive and dismantling study designs offer important opportunities. The treatments that are used, and particularly their specific ingredients, need to be described in detail for both the experimental and the control groups. Assessment should be performed blind before and after treatment and at long-term follow-up. A combination of observer- and self-rated measures is recommended. Side effects of psychotherapy should be evaluated...
MARKS, I. AND A. TOBEIqA. Learning and unlearning fear: A clinical and evolutionary perspective. ... more MARKS, I. AND A. TOBEIqA. Learning and unlearning fear: A clinical and evolutionary perspective. NEUROSCI BIOBEHAV REV 14(4) 365-384, 1990.-Many fears, phobias and rituals seem to arise from prepared phylogenetic mechanisms which favor old over new evolutionary dangers and affect the rules of aversive learning which govern the acquisition of fear. Recent developments in several forms of aversive learning (sensitization, conditioning, extinction, observational learning) can improve them as paradigms of the acquisition, spread and maintenance of normal and clinical fears. The most reliable treatment for phobias and rituals is exposure, whose effects closely parallel the habituation of normal defensive responses and the extinction of conditioned fear and avoidance in animals. Habituation during exposure is usually slow and step by step, and generalizes little, but once attained tends to endure. Conditioned fear extinction and fear habituation have similar courses and may depend on similar neural processes. To be reduced, avoidance has to be prevented or the safety intervals that it heralds must be given up. Some phobias may result less from enhanced acquisition than from insufficient exposure to attain habituation. Finally, the review discusses the limits of habituation and the instability of fear extinction in relation to the long-term efficacy of exposure therapy.
Twenty phobic outpatients were treated by 9 weekly “interviews” at the console of a desk computer... more Twenty phobic outpatients were treated by 9 weekly “interviews” at the console of a desk computer. Using a conversational style and multiple choice questions, the computer assessed the symptoms and agreed a hierarchy of self-exposure tasks. Each week the patient was given a diary sheet of tasks to practise daily. At his next visit his progress and motivation were assessed, and if he was succeeding he was encouraged to accept progressively more difficult tasks. This group was compared with a group of 20 patients (matched for age, sex and type of phobia) treated conventionally by a therapist in the preceding year. Progress was measured on standardized scales (both self- and clinician-rated). The two groups showed significant improvement on all the scales, and 75–80% of each group were much improved (scores reduced by 50%). The therapist treated group tended to be more severely ill at entry and to show greater improvement during treatment. Improvement was maintained at 6 month follow-u...
While on a waiting list for treatment by therapist-guided exposure and ritual prevention (ERP), p... more While on a waiting list for treatment by therapist-guided exposure and ritual prevention (ERP), patients with obsessive-compulsive disorder (OCD) did self-treatment at home guided by a manual plus a computer-driven telephone interview system (BT STEPS). Of 21 patients who used the system for at least three weeks while on the waiting list, one improved so much that subsequent therapist-guided ERP was unnecessary. Progress of the rest with the system predicted later progress with therapist-guided ERP. Improvement after using the system was similar to that of 20 matched historical controls who had had therapist-guided ERP without the prior use of BT STEPS. Outpatient users of BT STEPS needed less subsequent clinician-guided time than did their matched controls. In this pilot study, patients with OCD improved nearly as much with home self-treatment guided by a manual plus computer, as with treatment guided by a behaviour therapist.
Journal De Therapie Comportementale Et Cognitive, 1994
Une commission europeenne sur la definition de standards communs pour mesurer le cout et les bene... more Une commission europeenne sur la definition de standards communs pour mesurer le cout et les benefices des soins classiques pratiques en sante mentale va etre organise. Un systeme d'audit performant (CORM) mis sur ordinateur pour mesurer les effets de la pratique clinique quotidienne, et qui a fait ses preuves sur 600 patients, est detaille. De tels instruments peuvent permettre une avancee significative au niveau de la definition de standards moyens de soins et du cout moyen de ces soins en sante mentale.
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