Civil commitment of the mentally ill: an overview

This article discusses historical themes that led to the civil commitment reforms of the sixties and seventies. The changes in the substantive criteria for commitment are analyzed and critiqued. The author believes that the present criteria tend to focus so specifically on various external indicia of mental illness that they render commitment difficult for many seriously ill patients. An alternative commitment scheme is discussed.     

System of cities dynamics in newly industrializing nations

Rapid industrialization in such countries as Korea, Malaysia, and Taiwan suggests that the complex functional structures of cities in the periphery may appear early in development. This paper proposes a 4-stage framework for the dynamics of a system of cities in a developing country undergoing industrialization and encompassing both nonindustrial and industrial development. The synthesis is assessed with evidence from the newly industrializing Asian nations of Korea, Malaysia, and Taiwan. The 4 stages of cities' industrial change include 1) increasing primacy with industrial satellites, 2) increasing primacy with industrial satellites and nodal towns on a transport network, 3) rapidly increasing primacy with rapidly growing industrial satellites and nodal towns on the transport network, and 4) decreasing primacy with slowly growing industrial satellites and rapidly growing peripheral industrial towns. The 4-stage synthesis suggests that economic development in the periphery may occur even while the primate city maintains its hegemony over control and coordination functions. Peripheral industrial growth does not challenge this hegemony. The growth of industrial cities is, instead, part of a process of regional specialization in which the low cost labor in the periphery becomes an attraction for industry. These stages are not inevitable. Government efforts are necessary to develop rural areas in terms of social improvements (education and health), capital infrastructure (transportation and utilities), and fair payments to farmers for their outputs. These seem to be the lessons learned from the industrialization process in Korea, Malaysia, and Taiwan.     

Unusual hanging deaths

Four unrelated hanging deaths involving young white males, all in enlisted status in the United States military, are presented. Taken in a military context, one scene served as a suicide note equivalent with the unmistakable message of extreme defiance toward military regulations. In two cases, the elaborate attire of the decedents could have lead to the misclassification of the manner of death if investigative information had not been considered. Extensive background investigation and review of medical records in the fourth case disclosed that the victim had an eight- to ten-year history of compressing his neck to cause unconsciousness. He left an extensive suicide note in which he concluded that "hanging would be good." Each case has certain unique features, as a group, the cases all demonstrate a continuum from obvious suicide to cases where the manner of death is, at first, equivocal.     

The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul

The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates.     

Introduction to the Baby Jane Doe papers

A conference was held at the State University of New York at Stony Brook in October 1984 to discuss the controversy concerning treatment of a newborn with severe congenital defects that became known as the Baby Jane Doe case. Fox provides some background information on the case to introduce a set of of six articles consisting of papers delivered at the conference. These articles deal with historical aspects of the treatment debate (Stanley J. Reiser), problems of clinical decision making (John M. Freeman), the legal issues involved (John A. Robertson), coverage of the case by the media (Stephen Klaidman and Tom L. Beauchamp), federal efforts to regulate the treatment of handicapped newborns (Lawrence D. Brown), and the alliance that arose between opponents of abortion and advocates of the rights of the handicapped (Constance Paige and Elisa B. Karnofsky).     

Sudden infant death syndrome. Morphology update for forensic pathologists--1985

Herein presented are current concepts regarding the sudden infant death syndrome (SIDS) including a definition of the phenomenon and a discussion of its present role in post-neonatal mortality in this country, a few of the recently published results (both clinical and morphological) of the NICHD Cooperative Epidemiologic Study, a report on the status of the so-called "Tissue-Markers for Hypoxia" and a summary of other recent morphologic observations.     

Legislative and educational alternatives to a judicial remedy for the transfer trauma dilemma

Transfer trauma is alleged to be an increase in morbidity and mortality in institutionally relocated chronically ill elderly. Efforts by the legal profession to persuade courts that transfer trauma should be a legally recognized phenomenon invoking judicial protections against transfer (the "transfer trauma argument") have been unproductive. In O'Bannon v. Town Court Nursing Center, Inc., the United States Supreme Court denied standing to elderly persons claiming a property interest in remaining in alleged substandard facilities. The Court rejected the argument that the possibility of transfer trauma constituted a deprivation of life or liberty that would have required due process protections of notice and hearing. Despite the Court's preclusion of transfer trauma litigation in a constitutional context and the general unwillingness of lower courts to recognize the phenomenon, attorneys continue to burden the judicial system with frivolous transfer trauma arguments. The unfruitful pursuit of a judicial remedy for the ethical and social problems that arise with relocation of the elderly continues, in part, because of a misguided belief that this distressing social phenomenon is best remedied by the courts. Judicial unwillingness to recognize the transfer trauma argument, however, does not preclude legislative consideration of the humanitarian issues concerning the institutional relocation of elderly persons. This Article examines gerontological research in order to understand the judicial rejection of the transfer trauma argument and argues in support of legislative and educational solutions for the ethical and social problems attending transfer.     

Characteristics of adolescent incest sexual perpetrators: Preliminary findings

Adolescent incest sexual perpetrators seen at an out-patient clinic were interviewed regarding demographic characteristics and occurrence of deviant and nondeviant sexual behaviors. Results indicate that subjects (1) committed more sexual crimes than they had been arrested for, (2) reported a very early onset of sexual behavior, (3) had additional DSM-III psychiatric disorders, and (4) reported previous sexual victimization. Recommendations for future research are made.