Power in psychiatry. Soviet peer and lay hierarchies in the context of political abuse of psychiatry

Soviet political abuse of psychiatry in the Brezhnevite era offers a rich case study of entanglement between various layers, impact spaces, and actors of power. This article discusses two types of discursive power in Soviet psychiatry. One sprang from the madness-affirmative cultural canon, in which dissidents sought their self-legitimation. More prominently, there was the power of psychiatrists within their own hierarchic system. I analyse how the action scopes for psychiatric power varied, depending on whether the recipient was a patient or fellow professional. Here, the inherent hierarchy structured and regulated the peer community and secured the stability of medical practices – and of the political entanglement of these practices and actors with the state-owned places of power.

The National Health Service (NHS) at 70: Bevan’s double-edged legacy

The paper analyses the achievements and problems stemming from Nye Bevan’s model of a tax funded national health care system, on the assumption that only so could equity be achieved. The evidence shows that indeed the National Health Service (NHS) scores highly on equity, so vindicating Bevan’s vision. The price paid is that fiscal crises are the norm for the NHS, with ever more centralisation, intensive regulation and performance management. Successive reorganisations represent attempts to square the circle – to combine the strengths of Bevan’s model and those of a less hierarchic system – but have so far failed to deliver and can be expected to continue.

Using the Manchester triage system for refusing nonurgent patients in the emergency department: A 30-day outcome study

Objective: To evaluate the long-term outcomes and satisfaction of nonurgent patients who seek care in the emergency department (ED) and are diverted to primary health services (PHS). Methods: Data were collected from 264 nonurgent patients diverted from the ED of a tertiary public university hospital in São Paulo, Brazil. The nonurgent patient definition was performed by Manchester triage system version II (MTS-II) associated to medical interview in the triage service. Satisfaction levels were evaluated by telephone interviews. The outcomes were assessed within 30 days after the ED visit. Results: Based on the MTS-II, 56.4 percent of the diverted patients were classified as green, 34.3 percent as blue, and 9.3 percent as white. Only one patient required a hospital admission and no deaths were registered within 30 days after ED diversion. After diversion, the majority of patients searched for PHS (62.7 percent), 14.4 percent sought out other EDs, and 22.9 percent did not seek out any other health services. Regarding patient satisfaction, 61.9 percent evaluated the triage team as fair, good, or very good. Conclusions: Our study suggests that diverting nonurgent patients from the ED to PHS may be carried out in a hierarchic system like the Brazilian public healthcare system. The MTS-II can be a useful triage system to support physician in the diverting process. In addition, patient satisfaction with the refusing was reasonable. Future studies should be designed to evaluate patient safety outcomes in a larger sample and in different healthcare systems.

A Diagnostic System Created for Evaluation and Maintenance of Building Constructions

The successful diagnostic activity has an important role in the changes of the repair costs and the efficient elimination of the damages. The aim of the general building diagnostics is to determine the various visible or instrumentally observable alterations, to qualify the constructions from the suitability and personal safety (accidence) points of view. Our diagnostic system is primarily based on a visual examination on the spot, its method is suitable for the examination of almost all important structures and structure changes of the buildings. During the operation of the diagnostic system a large number of data–valuable for the professional practice–was collected and will be collected also in the future, the analysis of which data set is specially suitable for revaluing construction and the practical application of the experiences later during the building maintenance and reconstruction work. For using the system a so-called “morphological box” has been created, that contains the hierarchic system of constructions, which is connected with the construction components’ thesaurus appointed by the correct structure codes of these constructions’ place in the hierarchy. The thesaurus was not only necessary because of the easy surveillance of the system, but to exclude the usage of structure-name synonyms in the interest of unified handling. The analysis of which data set is specially suitable for revaluing earlier built constructions and can help to create knowledge based new constructions for the future.

“QWERTY-effects”, “Path Dependence” and the Law of Hierarchic Compensations

The concepts of the "QWERTY-effects" and "path dependence" are close to the cybernetic law of hierarchic compensations which refines the law of requisite variety. The law states that in a complex hierarchic system the variety of forms at higher levels of a structure is in inverse proportion to that at its lower levels. On the basis of closeness of these concepts conditions of unification and disintegration of standards and institutions are considered. These are illustrated by the analysis of several particular cases.