A Black and White History of Psychiatry in the United States.

Histories of psychiatry in the United States can shed light on current areas of need in mental health research and treatment. Often, however, these histories fail to represent accurately the distinct trajectories of psychiatric care among black and white populations, not only homogenizing the historical narrative but failing to account for current disparities in mental health care among these populations. The current paper explores two parallel histories of psychiatry in the United States and the way that these have come to influence current mental health practices. Juxtaposing the development of psychiatric care and understanding as it was provided for, and applied to, black and white populations, a picture of the theoretic foundations of mental health emerges, revealing the separate history that led to the current uneven state of psychiatric care.

Drive theory, redux: a history and reconsideration of the drives.

A large and significant portion of contemporary psychoanalytic theory has given up on the drives. The shift toward object relations in the 1940s and 50s, the scepticism about metapsychology in the latter half of the twentieth century, and a general confusion about the coherence of Freud's drive theory have all contributed to their slow decline in prominence. There are legitimate criticisms of the drives that deserve attention but the drives themselves require a careful examination before any successful defence of their place in the metapsychology may be mounted. The current paper provides an account of the drives informed by the intellectual history of German and English thought related to the drives and instincts as they came to Freud. This history allows us to clearly distinguish between "drive" (or Trieb) and its conceptual neighbour "instinct" (or Instinkt).

Harm as a Necessary Component of the Concept of Medical Disorder: Reply to Muckler and Taylor.

Wakefield's harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction (failure of biologically designed functioning) and a value (harm) component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction's harmfulness is best understood in dispositional terms.

Playful but Mindful: How to Best Use Positive Affect in Treating Toddlers With Autism.

The best-tested treatments for toddlers with autism spectrum disorder (ASD) are grounded in the principles of applied behavioral analysis (ABA) and blended with developmental science. Examples include Project ImPACT1 and Early Start Denver Model,2 among others. ABA-based behavioral interventions use conditioned reinforcement of target behaviors by giving the child access to desired objects and activities as a consequence of performing target behaviors. Unlike the original ABA technique, discrete trial training, ABA-based naturalistic developmental-behavioral interventions (NDBIs) occur in natural environments and employ operant conditioned reinforcement of target behaviors by capitalizing on the child's interests in objects and activities.1-3 NDBIs are highly recommended for toddlers and children with autism.3 Clinical manuals for NDBIs emphasize that clinicians should use modulations of voice and exaggerated facial expressions and gestures to engage toddlers.1-4 These behaviors are often referred to as positive affect, increased animation, modulation of child affect, or playfulness. Given the range of clinician behaviors described across these constructs and the commonalities between them, within this article we will henceforth refer to the following behaviors as playfulness: positive affect, increased animation, modulation of child affect, and exaggerated facial expressions and gestures. Most NDBIs indicate that playfulness should be thoughtfully employed throughout NDBI sessions in conjunction with other NDBI strategies (eg, contingent responsiveness, balanced turns, child choice) to maintain engagement and build social reciprocity with the child as the clinician and child work together toward treatment goals. However, our clinical and supervisory experiences suggest that many clinicians do not consistently use playfulness as an intervention tool. Instead, according to our observations, many clinicians largely employ neutral affect when providing treatment to toddlers with ASD, even while employing NDBI strategies such as following the child's lead, contingent responsiveness, and balanced turns. This article presents our clinical perspective on the utility of playfulness for treating toddlers with ASD.

On intellectual and developmental disabilities in the United States: A historical perspective.

The history of intellectual and developmental disabilities (IDD) in the United States is, in many ways, a triumphant story reflecting an increasingly progressive attitude acknowledging the equality of all persons. The law now recognizes people with IDD as citizens, possessing an equal right to education, health care, and employment-each of which represents milestone victories. However, this progression was not a linear development but rather a product of periods of growth and decline, backsliding, and hard-won battles across political, cultural, and legal domains. This article explores the vacillating historical trajectory for people with IDD in the United States from the colonial period to the present. Particular attention is paid to the conceptual understanding of disability itself across time periods as that which informs particular developments in treatment, law, and social status. The capabilities approach, as outlined by Martha Nussbaum, is then brought to bear as a heuristic framework, consonant with current developments in disability studies, and which may guide future social and legislative action.