Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.     

Management strategies in response to an institutional crisis: The case of earthquakes in the Netherlands

When a policy sector is confronted with a relatively strong and steep decline in legitimacy, we speak of an institutional crisis. We know little about the causes or consequences of these crises. This article explores how institutional crises are managed. It focuses on the effects of management strategies observed in a case study of an institutional crisis in the Netherlands. While we found that policy elites displayed a tendency to maintain the status quo of a policy sector, we also found that the effectiveness of their response strategies was negated by the counter‐response it evoked among freshly energized interest, advocacy and citizen groups. We conclude that the resolution of an institutional crisis is inherently contested. Based on our case study, we develop a theoretical model and formulate propositions that may help to improve our understanding of institutional crisis management.     

Teaching Students about the Vietnam War: The Case for Balance

This work examines how the American role in the Vietnam War has been portrayed in standard college- and university-level textbooks dealing with American foreign policy. It argues that this topic has been presented in a manner that leaves an incomplete understanding. This conclusion is based on scholarship that has been available for decades as well as much Cold War historiography that has appeared since 1975. I conclude that the distortions need to be addressed for several reasons. Their propagation produces bad scholarship, gratuitously alienates Americans from their institutions of government, and justifies anti-Americanism and authoritarianism elsewhere.     

Political economy,poverty, and polycentrism in the Global Environment Facility’s Least Developed Countries Fund (LDCF) for Climate Change Adaptation

Climate change adaptation refers to altering infrastructure, institutions or ecosystems to respond to the impacts of climate change. Least developed countries often lack the requisite capacity to implement adaptation projects. The Global Environment Facility’s Least Developed Countries Fund (LDCF) is a scheme where industrialised countries have disbursed $934.5 million in voluntary contributions to support 213 adaptation projects across 51 least developed countries. But how effective are its efforts—and what sort of challenges have arisen as it implements projects? To provide some answers, this article documents the presence of four “political economy” attributes of adaptation projects—processes we have termed enclosure, exclusion, encroachment and entrenchment—cutting across economic, political, ecological and social dimensions. Based on extensive field research, we find the four processes at work simultaneously in our case studies of five LDCF projects being implemented in Bangladesh, Bhutan, Cambodia, the Maldives and Vanuatu. The article concludes with a discussion of the broader implications of the political economy of adaptation for analysts, program managers and climate researchers at large. In sum, the politics of adaptation must be taken into account so that projects can maximise their efficacy and avoid marginalising those most vulnerable to the impacts of climate change.     

Global poverty and inequality: are the revised estimates open to an alternative interpretation?

The level of, and trends in, global inequality and global poverty are indicative assessments of who has benefited from economic growth. The revision of price data has led to a reassessment of those estimates. Through an extensive overview of the implications, we argue that the data can be read in different ways. Official estimates show global extreme poverty and global inequality are considerably lower than previously thought. We argue that these changes are much less significant than they at first appear, and we present a more nuanced alternative interpretation by exploring changes across the entire global distribution.     

Northern Ireland: 20 Years After the Cease-Fires

In the closing months of 1994, the principal paramilitary organizations in Northern Ireland declared that their campaigns of violence were at an end. The cease-fires called by republican and loyalist groupings represented the most significant heralds of a complex process of conflict transformation that continues to unfold even twenty years on. In this introduction, we set out to map the key developments that have shaped the tortuous narrative of the Northern Irish ‘peace process’, thereby providing the historical backdrop for the articles that follow. While remarkable progress has been made over the two decades since the paramilitary cease-fires, the political context and future of the region remain rather more fraught than is often assumed abroad. It is perhaps best, then, to speak of the six counties in terms not of resolution but rather of ambiguity. Twenty years on from the optimism that greeted the paramilitary cease-fires, Northern Ireland retains the essential ‘inbetweenness’ of a political space that has moved from a ‘long war’ through a ‘long peace’ and into a profoundly undecided future.     

Associations Between Suicidal High School Students’ Help-Seeking and Their Attitudes and Perceptions of Social Environment

Suicide is a leading cause of death among adolescents, many of whom fail to disclose suicide concerns to adults who might help. This study examined patterns and predictors of help-seeking behavior among adolescents who seriously considered suicide in the past year. 2,737 students (50.9?% female, 46.9?% male; racial distribution 79.5?% Caucasian, 11.9?% Hispanic/Latino, and 3.6?% Black/African-American) from 12 high schools in rural/underserviced communities were surveyed to assess serious suicide ideation (SI) in the past year, disclosure of SI to adults and peers, attempts to get help, attitudes about help-seeking, perceptions of school engagement, and coping support. Help-seeking was defined as both disclosing SI to an adult and perceiving oneself as seeking help. The relationship between adolescents' help-seeking disclosure and (1) help-seeking attitudes and (2) perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Of the 381 (14?%) students reporting SI, only 23?% told an adult, 29?% sought adult help, and 15?% did both. Suicidal help-seekers were similar to non-suicidal peers on all measures of help-seeking attitudes and social environment perceptions. Positive attitudes about help-seeking from adults at school, perceptions that adults would respond to suicide concerns, willingness to overcome peer secrecy requests, and greater coping support and engagement with the school were associated with students' increased disclosure of SI and help-seeking. This study supports prevention strategies that change student norms, attitudes and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students' perceptions of the availability and capability of adults to help them, and strengthening students' understanding of how existing resources can help them cope.     

Access and control of agro-biotechnology: Bt cotton,ecological change and risk in China

This article argues that if the introduction of genetically modified crops (GM crops) in developing countries is to be successful, we can and should not evade questions of access and control of technology. It implies probing into the experiences, perceptions and understanding of GM crops by the prime user: the farmer. Exactly in these respects the scholarly literature is remarkably silent. We know little about farmers' experiences and perceptions of GM crops' potential risks and benefits. This is evident when concentrating on a major GM crop – Bt cotton – and studying this in the context of China, its second largest producer in the world. Based on the results of a large survey, we demonstrate that Chinese farmers' awareness (‘having heard of’) and their understanding (‘being able to explain’) of Bt cotton is low. This may lead to ill-informed, distorted risk perceptions and a general inability to relate agricultural production problems to the specific nature of transgenic cotton cultivation. A great majority of the farmers find that the Chinese seed market was liberalised too early, in turn leading to a high incidence of ‘stealth transgenics’ or illegal seeds, the undermining of farmers' trust in private institutions, and a weakened biosafety regime. This finding points to the need for continued state intervention in the seed market, particularly in a developing context. Finally, we have discovered that farmers report a significantly lower reduction in pesticide use by Bt cotton than found in other studies. As suggested by recent research, we suspect that the higher pesticide use is necessary to control secondary pests – i.e. pests other than the cotton bollworm. We present empirical evidence that Chinese farmers perceive a substantive increase in secondary pests after Bt cotton was introduced.     

The Campesino-to-Campesino agroecology movement of ANAP in Cuba: social process methodology in the construction of sustainable peasant agriculture and food sovereignty

Agroecology has played a key role in helping Cuba survive the crisis caused by the collapse of the socialist bloc in Europe and the tightening of the US trade embargo. Cuban peasants have been able to boost food production without scarce and expensive imported agricultural chemicals by first substituting more ecological inputs for the no longer available imports, and then by making a transition to more agroecologically integrated and diverse farming systems. This was possible not so much because appropriate alternatives were made available, but rather because of the Campesino-a-Campesino (CAC) social process methodology that the National Association of Small Farmers (ANAP) used to build a grassroots agroecology movement. This paper was produced in a ‘self-study’ process spearheaded by ANAP and La Via Campesina, the international agrarian movement of which ANAP is a member. In it we document and analyze the history of the Campesino-to-Campesino Agroecology Movement (MACAC), and the significantly increased contribution of peasants to national food production in Cuba that was brought about, at least in part, due to this movement. Our key findings are (i) the spread of agroecology was rapid and successful largely due to the social process methodology and social movement dynamics, (ii) farming practices evolved over time and contributed to significantly increased relative and absolute production by the peasant sector, and (iii) those practices resulted in additional benefits including resilience to climate change.