[Bodies and Political Orders. On the Role of Bodies in Modern Western Political Theory]. / Körper und politische (An­)Ordnungen. Zur Bedeutung von Körpern in der modernen westlichen Politischen Theorie.

At first glance, it can be stated that bodies do not play an important role in modern Western political theory. They are mostly privatized and set as natural or prepolitical. This article argues, however, that bodies are not absent in modern political theory but that they play a crucial political role. They legitimize political orders in a subtle way. Through an examination of central arguments in the work of Thomas Hobbes, John Locke, Jean-Jacques Rousseau, Immanuel Kant, Hannah Arendt, John Rawls, and Jürgen Habermas, three ways are identified in which bodies shape modern Western political theory. First, bodies are used to legitimize the political order; second, they serve to determine political subjectivity; and third, body politics define politics. The text aims to highlight how a body-theoretical perspective that does not define the body as prepolitical but rather as a political construct is able to expand the scope of political theory.

Psychodynamic interventions in cancer care II: a qualitative analysis of the therapists' reports.

BACKGROUND: To investigate the focus of psychodynamic-oriented interventions in cancer patients by means of a qualitative analysis of the therapists' reports. METHODS: One hundred thirty-five reports collected within a controlled psychotherapy trial were analyzed; the themes addressed during the intervention were classified in categories reflecting the focus of the intervention and correlated with sociodemographic and medical data and type of intervention. RESULTS: Twenty main themes were identified and classified in two categories: category 1 corresponded to interventions based on expression and support, and category 2 to interventions based on introspection, with subcategory 2.1 focusing on the patient's psychological functioning and subcategory 2.2 focusing on his way to engage and communicate in relationships. While the most frequently addressed theme was related to the diagnosis of cancer (N = 102/576; 22.6%), the majority of themes were related to other concerns (N = 446/576; 77.4%). Half of the interventions (50.4%) were classified in category 1, 27.4% in category 2.1, and 9.6% in category 2.2. Patients of category 1 entered less often brief psychotherapy (step 2 of the intervention) and more frequently suffered from advances disease. CONCLUSIONS: A wide variety of themes are addressed in psychodynamic interventions in the oncology setting, illustrating that cancer is not the only focus of therapy. Other themes reflect different psychological difficulties triggered by the disease. This study illustrates that cancer patients have different needs, which surpass the event of the disease. Early clarification and comprehension of the demand may therefore be beneficial to adjust the therapeutic approach.

Assessing psychosocial vulnerability and care needs of pretransplant patients by means of the INTERMED.

OBJECTIVE: We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation. METHOD: One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Åsberg Depression Rating Scale (MADRS), and Hospital Anxiety & Depression Scale (HADS). RESULTS: We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS,MADRS, and mental and physical health scores of the SF-36 Health Survey. CONCLUSIONS: The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.

Care complexity, mood, and quality of life in liver pre-transplant patients.

RATIONALE: This study was intended to document the frequency of care complexity in liver transplant candidates, and its association with mood disturbance and poor health-related quality of life (HRQoL). METHODS: Consecutive patients fulfilling inclusion criteria, recruited in three European hospitals, were assessed with INTERMED, a reliable and valid method for the early assessment of bio-psychosocial health risks and needs. Blind to the results, they were also assessed with the Hospital Anxiety and Depression Scale (HADS). HRQoL was documented with the EuroQol and the SF36. Statistical analysis included multivariate and multilevel techniques. RESULTS: Among patients fulfilling inclusion criteria, 60 patients (75.9%) completed the protocol and 38.3% of them were identified as "complex" by INTERMED, but significant between-center differences were found. In support of the working hypothesis, INTERMED scores were significantly associated with all measures of both the SF36 and the EuroQol, and also with the HADS. A one point increase in the INTERMED score results in a reduction in 0.93 points in EuroQol and a 20% increase in HADS score. CONCLUSIONS: INTERMED-measured case complexity is frequent in liver transplant candidates but varies widely between centers. The use of this method captures in one instrument multiple domains of patient status, including mood disturbances and reduced HRQoL.

Differences Between Centers in Psychosocial Evaluations for Living Kidney Donors Do Not Influence Outcome: Results From an Observational Multicenter Study.

Rather little is known about how psychosocial evaluations for living kidney donation (LKD) are performed. We aimed to explore whether Swiss transplant centers (STCs) vary regarding the rate of living kidney donors refused for psychosocial reasons, the psychosocial evaluation process, and the characteristics of the donors. Methods: We investigated 310 consecutive candidates for LKD in 4 of 6 existing STC during mandatory psychosocial evaluations. We registered (i) sociodemographic data, (ii) the type of the decision-making process regarding LKD (ie, snap decision, postponed, deliberate, other), (iii) the evaluator's perception of the donor's emotional bonding and his/her conflicts with the recipient, (iv) the donor's prognosis from a psychosocial perspective, (v) time taken for the psychosocial evaluation, and (vi) its result (eligible, eligible with additional requirements, not eligible). Results: Centers had comparable proportions of noneligible donors (2.9%-6.0%) but differed significantly in the percentage of donors accepted with additional requirements (3.4%-66%, P < 0.001). Significant differences emerged between centers regarding the time needed for evaluation (75-160 min [interquartile range (IQR) 75-180 min] per single exploration, P < 0.001), the perception of the donor's emotional bonding (visual analogue scale [VAS] 8-9 [IQR 6-10], P < 0.001), his/her conflicts with the recipient (VAS 1.5-2 [IQR 0-3], P = 0.006), the donor's psychosocial prognosis (VAS 8-9 [IQR 7-10], P < 0.001), and the type of decision concerning LKD (59%-82% with snap decision "yes," P = 0.008). However, despite differences in the psychosocial evaluation process, the rates of patients accepted for transplantation (eligible and eligible with additional requirements versus noneligible) were comparable across STC (P = 0.72). Conclusions: Our results emphasize that it is more important to establish clear guidelines to identify potential psychosocial risks than to stringently standardize the procedure for psychosocial evaluation of living kidney donors.

Desiring Neoliberalism.

The paper is based on the premise that neoliberalism is a political rationality that is not only anti-social but also requires an anti-democratic and violent form of statehood. However, neoliberalism is not solely based on coercion and force, but paradoxically also on consensus. This consensus is not least organized through its flexibilized and pluralized sexual politics. By focussing on sexual politics in Germany's capital Berlin, the paper highlights that the flexibilization of the apparatus of sexuality is not merely a side effect of neoliberalism but a constitutive element of neoliberal governmentality that is deployed to legitimate an anti-democratic and violent neoliberal state. Neoliberalism uses the promise of sexual tolerance, flexibility, and pluralism in order to fulfill its anti-social, anti-democratic, and violent agenda. Furthermore, it is argued that neoliberal sexual politics require a rethinking of the concept of heteronormativity. Here, I propose to recast heteronormativity as heteronormalization.

Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?

BACKGROUND: Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. OBJECTIVE: This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). METHODS: Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). RESULTS: Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. CONCLUSION: Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.