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  #11  
Old September 22nd, 2004, 10:12 PM
George Neeson George Neeson is offline
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Default Re: Discussions of Adler's Journal Articles, Volume 2, Chapters II-III

I shall limit myself to just one comment in this present discussion. Adler in chapter 2, on page 17 para 2 foresees the real danger of the state's involvement in health care. That risk arises in the physician when he abrogates his responsibility to the community and allows the government to take everything over. Yes, provision for the poor is necessary albeit there is no valid reason why medicine can not be provided without charge by doctors, nurses and hospitals as has been the case historically. Adler notes "medicine today plays a role in every government activity ... the physicians willingness to allow themselves to be taken in tow by the government instead of taking the lead in these developments." This is what has occurred in Canada. Canadian physicians have allowed the federal and provincial governments to high jack health care with no private sector to keep the government honest. There is no balance because physicians have not taken firm leadership in the delivery of an equitable health care system. We are one of three countries with socialized medicine with no private sector ... it is outlawed! We are in the company of China, Cuba and then Canada in the absence of a private sector. It is outlawed in all three countries!. This is a shameful situation that falls out of the lack of physician committment to the citizens and allows bureauocrates to run the system unchallenged producing a failed health care system that is very, very expensive and very very ineffective. Physicians have a social and moral responsibility to direct health care for the good of the community and not to enhance their own monitary interests. I do hope that the USA does not go down this damaging pathway.
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Last edited by Henry Stein; September 24th, 2004 at 04:37 PM..
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  #12  
Old September 24th, 2004, 04:25 PM
Henry Stein Henry Stein is offline
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Default Re: Discussions of Adler's Journal Articles, Volume 2, Chapters II-III

George, your comments about Canadian health care have prompted me to start following news feeds and running searches on the topic. It appears that you are on the verge of a physician's strike; nurses and hospital workers have resorted to this strategy in the past to improve their economic situation. One interesting perspective on several values embedded in the crisis can be found at http://www.cwhn.ca/resources/kickers/crisis.html.

Many years ago, I had an office in a medical building adjacent to a church-supported community hospital in San Francisco. The physicians were struggling with a tough-minded, cost-cutting adminstration at the hospital, as well as HMO's that severely limited their services to patients. One doctor, an inspiring fireball of independent thinking and action, propsed the formulation of an "Integrated Medical Group" of doctors who would manage their own insurance contracts. The primary thrust of his plan was to put patient care decision-making back in the hands of the doctors. He claimed that his plan could reduce administative overhead from nearly 30% at the HMO's to under 10% by establishing a lean, local office team. The organization formed, enlisted most of the doctors connected with the hospital, and is still operating successfully.

It may be that a strong group of well-organized, socially responsible physicians could propose better solutions to the health care problems in the U.S. I am inclined to trust physicians more than many of our governmental officials and legislators. Unfortunatley, some of the strongest influences in Washington seem to be from sources that have little interest in the common good. Adler had great hopes for doctors to become active agents for many aspects of community improvement.
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  #13  
Old September 24th, 2004, 04:34 PM
Henry Stein Henry Stein is offline
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Default Re: Discussions of Adler's Journal Articles, Volume 2, Chapters IV & V

Our next discussion of Chapters IV & V, starts September 27th. To prepare, order your copy of Volume 2 of "The Collected Clinical Works of Alfred Adler" at http://go.ourworld.nu/hstein/cw-v2.htm. The following chapter abstracts were created by James Wolf.

Chapter IV, Town and Country (3 parts), written in 1903, challenges the common notion that country living is (currently) healthier than city living, due to the improvement of health conditions in the city, resulting from public health measures, social progress and the growing political power of greater population centers. In Part II, he offers a description of village conditions: the positive consequences of sun and cleaner air; as well as a description of the negative health influences of dirt and uncleanliness. Adler comments on the issue of poverty and the social conditions of villagers and country people. He concludes that villages and cities are interconnected - the health and sanitation conditions of one affect the other. Part III focuses on the interdependence of the country and the city, sanitation, the quality of food, water and the spread of disease. Adler emphasizes the role of physicians and social medicine, and the need to expand an adequate health care system to those living in the country.

Chapter V: State Aid or Self Help (2 parts), was written in 1903. Part I of this article addresses the relationship between the medical profession, the state, the ruling elite and the political forces that negatively affect the equitable distribution of healthcare in Austria. In Part II, Adler discusses the decline of medicine and medical training in Austria as due to the political forces, the system, that holds the medical profession in low regard and which only begrudgingly addresses social issues while attending more to the needs of the ruling elites. He calls on the medical profession to shape it's own future.

When posting your comments or questions, please identify the chapter number and/or title at the beginning of your message.
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  #14  
Old September 28th, 2004, 11:18 AM
James Wolf James Wolf is offline
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Default Re: Discussions of Adler's Journal Articles, Volume 2, Chapters I-V

RE: Chapters 3 &4. It occurs to me Adler is about 33 years old when he's written these articles and influenced by the radical/progressive thinking of his day. He recognizes here (chapter 4) that the system is self-perpetuating and doesn't see much hope for change. What he says about insurance companies anticipates the situation with managed care in the present day. In the last paragraph of Chapter 4 he states that "The medical profession can shape it's future only by it's own powers." I've always wondered if Adler ever supported the idea violent revolution in his more youthful days (considering his wife's politics) and what point he gave that up. here he seems to think the system will die out in the long run, and that physicians must take the lead themselves in working for change.
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  #15  
Old September 28th, 2004, 03:50 PM
Manu Jaaskelainen Manu Jaaskelainen is offline
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Default Re: Discussions of Adler's Journal Articles, Volume 2, Chapters I-V

Yes, James, I also have also wondered how radical Adler really was in his younger days. However, my conclusion is that Adler never really supported any violent means. He took part in the discussions of the socialist student organizations (where he met his future wife) simply because social issues were not discussed in conservative-nationalistic organizations. These organizations have been described by Stefan Zweig in his memoirs, and commented by Freud who saw in them only "a compact majority". There was lots of drinking, flag-waving, fighting and brawling, and nationalistic heat. The various nationalities were fighting each other - Germans against Czechs, Czechs against Italians, and so on. Later on, Adler spoke sometimes about "misunderstood nationalism". Possibly he meant these organizations, and what emerged from them. The real social issues were debated in those organizations where Adler participated. - In his paper "Town and Country" Adler develops the thesis of a contrast between town and country in health-matters. His answer is that town and country are really interdependent of each other, and this creates a need to develop a better social medicine in the countryside. More doctors, nurses, and hygienists are needed in the country in order to have a better coverage of social-medical services. Adler had spent his childhood in a suburb that lay between Vienna and the countryside. His parents came from a country-area on the Hungarian side. His father was involved in the grain-business, so the family preserved deep ties with the country in spite of the fact that they were living in Vienna. All this creates a need for more government funds for health-care, although Adler himself does not explicitly make this conclusion - it is left for the readers to make it. - In his paper on "State Aid or Self Help" Adler develops the thesis that the existing political structures in the Habsburg-empire are not able to respond to the real health-needs of the population. Adler thinks that the insurance-plans have not produced what should be expected of them, that the insurance companies are only interested in profits and that the medical profession has not the freedom it deserves. Even medical research and teaching are subdued under governmental authorities. Adler's conclusion is more gloomy than in the previous paper: that medical profession can only help itself, "its future only by its own powers". I feel that this paper is even more political than the previous one. I think that the idea of this paper was to wake up the medical profession, to make alarm: see how badly we are! We must take the challenge, we must respect our own ethics and professional obligations! We must make things better! So don't sleep, act! Adler was thinking very much about the living-conditions of the ordinary people, and he felt that by making a professional effort, things could be changed. There is a better health-care somewhere to be found, if a real professional effort is made.

Last edited by Manu Jaaskelainen; September 29th, 2004 at 03:31 PM.. Reason: Minor linguistic corrections
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  #16  
Old September 28th, 2004, 06:12 PM
Henry Stein Henry Stein is offline
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Default Re: Discussions of Adler's Journal Articles, Volume 2, Chapters IV

A news item in the Seattle Times on 9/28/04, adds an interesting contemporary wrinkle to Adler's comments in Chapter IV ("Town and Country") about the relative health conditions in city and country living. In an article titled "Living in suburban sprawl may hurt health, study says," Rob Stein of the Washington Post reports that life in the sprawling suburbs leads to a greater risk for arthritis, asthma, headaches, stomach problems, urinary-tract infections, heart disease, and high blood pressure. It is hypothesized that urban sprawl discourages physical activity, increasing the chances of being overweight or obese. Also, sprawling communities promote a car-dependent lifestyle, experience more air pollution, and have an abundance of fast food chains. According to the study, those people living in spread-out places have more health problems and shorter lives than people living in more compact communities. No conclusions about mental health were reached.
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  #17  
Old September 30th, 2004, 09:37 AM
Henry Stein Henry Stein is offline
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Default Re: Discussions of Adler's Journal Articles, Volume 2, Chapter VI

Our next discussion of Chapters VI, starts October 4th. To prepare, order your copy of Volume 2 of "The Collected Clinical Works of Alfred Adler" at http://go.ourworld.nu/hstein/cw-v2.htm. The following chapter abstract was created by James Wolf.

In Chapter VI, "The Physician as Educator," written in 1904, Adler identifies the problem inherent in educating the child. He identifies the goals and traits of an educator and also the traits and educational power of a good physician. He makes reference to Freud's emphasis on children and the importance of and knowledge of the child's psyche. Aspects of the child's education are mentioned as well as the importance of love and affection, the role of the parents and others in the child's life. He comments on punishment, spanking, and other forms of discipline, positive and negative, related to specific problem areas. He identifies typical issues with children and important points the physician-educator should be aware of. This article reveals Adler's early interest in child guidance and education.

When posting your comments or questions, please identify the chapter number and/or title at the beginning of your message. On October 10th, this thread will be merged with the Volume 2 cumulative thread.
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Last edited by Henry Stein; October 1st, 2004 at 03:55 PM..
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  #18  
Old October 6th, 2004, 02:17 PM
Manu Jaaskelainen Manu Jaaskelainen is offline
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Default Re: Discussion of Adler's Journal Article, Volume 2, Chapter VI: "The Physician as Educator"

"The Physician as Educator" (1904) is an early paper that documents Adler's interest in psychological and educational issues. Adler had joined Freud's "Wednesday Society" in 1902, and his interests now included psychological, educational and social issues. In contrast to Freud, Adler thinks that human beings are malleable, and environmental influences have a definite say in the formation of human personality. He writes that no one who believes in hereditary determinism is not a suitable person as educator. Here one may see that differences start growing between him and Freud who believed in a biological-style determinism. One of the important goals in education is, according to Adler, personal growth. It is the task of the educator to enhance this growth. Adler feels that there is a great potential in physicians as educators: "The human soul must become a familiar instrument and, like the educator, he must avoid wasting his strenght on superficial manifestations." Adler refers to two important works in the history of psychology: Preyer's "The Soul of the Child" and Karl Groos' "On the Inner Life of the Child". Furthermore, Adler refers to Freud. However, Freud was pessimist: he had no great trust in the possibilities of education. Adler emphasizes the importance of physical education for the well-being of the child. This aspect is very important again in our days. Adler devotes a lenghty discussion on the subject of punishment. According to him, punishment cannot be avoided but physical punishment and other aggressive forms of punishment must be avoided by all means. He discusses the problem of lying, and he writes that it is important to discuss calmly the motive for lying. If this can be done reasonably, the lying may possibly stop. Direct confrontation is often harmful. Adler speaks of the importance of the conscience. Adler discusses organ inferiority, a theme that would become a central trait of his psychology. Adler does not deny the importance of sexuality, but thinks that the important goal is to educate the child toward becoming a useful member of the community. - It is very interesting to see how certain things were "in the air" at the turn of the century. Then, about a century ago, the Finnish government, acting under the rule of the Russian Emperor, decided that physical punishment should be forbidden in schools. His Grace, the Emperor of Russia, accepted this proposal, and an act was given by the Czar, even if this rule was restricted to Finland. Adler himself refers to a law given in Habsburg-empire where physical punishment was forbidden. We all know that it took a long time before the prohibition of physical punishment developed from an idea to everyday practice. What I find still more interesting in Adler's paper is his idea that the goal of education is to enhance psychological growth. If one takes into account the time when Adler published his ideas, I take them very advanced.

Last edited by Manu Jaaskelainen; October 7th, 2004 at 02:37 PM..
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  #19  
Old October 6th, 2004, 09:58 PM
James Wolf James Wolf is offline
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Default Re: Discussion of Adler's Journal Article, Volume 2, Chapter VI: "The Physician as Educator"

Manu, your post was very interesting. I had no idea corporal punishment had been forbidden by law that early in Finland or anywhere else. Adler certainly was in the forefront. I also thought it was quite good you picked up on Adler's statement about those who believe in the power of heredity so strongly and this marked, perhaps, an early indication of his disagreement with Freud. Nature vs. Nurture is still very much in discussion with the all the research in genetics. Also there was a recent article (May 20) in Time Magazine about The Teenage Brain and how it develops, not fully maturing until about age 25. Through brain imaging, some researchers are emphasizing that the neuro-physiological development explains much of your typical teenagers behavior - much more than purely psychological influences there. Even so, Adler's ideas and principles seem so important in to influence the building of self esteem and connectedness. This short article lays out an outline of future Adlerian child guidance work - Driekurs and to present day advocates. Also here is the idea that child rearing cannot be separate from community/societal interests.
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  #20  
Old October 7th, 2004, 02:48 PM
Manu Jaaskelainen Manu Jaaskelainen is offline
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Default Re: Discussion of Adler's Journal Article, Volume 2, Chapter VI: "The Physician as Educator"

Yes James, the brain-physiology is important. However, I think there are some studies that demonstrate that the maturing is not totally a biological process. I cannot remember now any exact references, but there is, I believe, some evidence that environmental factors may act as boosters or brakes in the development of individual personality. I think that it was D.O.Hebb who made a number of interesting (albeit ethically questionable) experiments with apes that demonstrated that sensory deprivation may delay the development of brain functions. So if something is correlated with brain processes, it could mean that these brain processes are enhanced or delayed by environmental influences. If small babies grow up in a stimulating and friendly environment, this should have an impact on their brains. All this brings to my mind a slogan that the father of modern Finnish psychology, Eino Kaila, often used: structure determines function, but function determines structure as well. From him stems another slogan: my drives compel my will, but my will compels my drives as well!

Last edited by Manu Jaaskelainen; October 8th, 2004 at 02:36 PM..
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