Assessing Impairment: From Theory to Practice - download pdf or read online

ISBN-10: 0387875425

ISBN-13: 9780387875422

The 1st in-depth therapy of the speculation, definition, and review of this middle inspiration, this publication cuts during the cross-talk. major students and clinicians argue for a reconceptualization of impairment in the context of prognosis and incapacity.

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Sample text

How were we to r~concile what Prozac did for Tess with our notion of the continuous, autobiographical human self? And always there was the question of how society would be affected by our access ro drugs that alter personality in desirable ways. l wondered what I would have made of Tess had she been referred tO me just before] im broke up with her, before she had experienced acute depression. I might have recognized her as a woman with skills in many areas, one who had managed to make friends and sustain a career, and who had never suffered a mental illness; l might have seen her as a person who had examined her life with some thoroughness and made progress on many fronts but who remained frustrated socially.

Sociobiologists have speculated that compulsiveness survived in the human species because it was a competitive advantage for our ancestors' tribes to contain one or two members who were 'prudent and driven in the extreme. Certainly Tess's family survived because of her inability to tolerate failure. I am morally certain that I would not have had these ruminations if Prozac did not exist. Because an antidepressant likely to be useful for compulsive patients was available, it made sense to ask whether Tess's strength of character could be a manifestation of the same biological constellation that in other people shows itself as compulsiveness.

Here is one place where the favorable side-effect profile of Prozac makes a difference: if a doctor thinks there is even a modest chance of quickly liberating a chronically stymied patient, and if the risk ro the patient is slight, then the doctor will rake rhe gamble repeatedly. And of course Prozac had phenomenal word of mouth, as "good responders" like Tess told their friends about it. I saw this effect in the second patient I put on Prozac. She was a habitually withdrawn, reticent woman whose cautious behavior had handicapped her at work and in courtship.

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Assessing Impairment: From Theory to Practice


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