(The) neural mechanisms of biased attitudes towards patients with mental and physical illness : Neural evidence during mentalizing task involving prosocial behavior

신원교 서울대학교 대학원 2018 국내석사

Patients with mental illness are largely stigmatized even though they suffer from illness and experience pain like those with physical illness. At present, little is known about the neural mechanisms underlying the stigma of mental illness and how it biases valuing the welfare of patients with mental- and physical illness. Here, we show the neural evidence of such biased attitude using mentalizing task involving prosocial behavior. During fMRI scanning, 40 participants were asked to make mental state inferences about patients labeled with mental illnesses or physical illnesses regarding prosocial behavior. Participants predicted more unfavorable responses of the mentally-ill to the prosocial behavior, which was related to higher prejudice level. However, they expected more positive responses when inferring the minds of the physically-ill, which was linked to higher empathic concern. Neural data revealed greater activities in the anterior insula and dorsal MPFC when predicting the internal states of the mentally-ill compared to the physically-ill. Activities in these regions were related to increased motivation to behave without prejudice, indicating more externally-oriented processing. In contrast, empathically-driven amygdala and value-based ventral MPFC activations were linked to prediction of more favorable responses of the physically-ill. The present study shows that the a patient’s type (i.e., physical or mental) biases people to treat those two kinds of patients as separate entities and this affects neural computations that reflect psychological processes involved in empathy and prosocial behavior. Such findings suggest that people might not consider the mentally-ill as patients who suffer pain, but rather experience the world in an inappropriate or abnormal way.

Sojourning Mentality, Acculturative Stress, and Mental Health Among Chinese International Students and Visiting Scholars in the United States

Zeng, Liwen ProQuest Dissertations & Theses The University of 2022 해외박사(DDOD)

This dissertation bridges the literatures on race, migration, and health to highlight the acculturation experiences and related health implications among Chinese immigrants, particularly sojourning Chinese international students in the US. Due to their temporary stay in the recipient society, Chinese students usually demonstrate a sojourning mentality that is characterized by a strong attachment to their home country and a keen desire to return home after fulfilling their migration goals. This mentality appeared more intense during the COVID-19 pandemic when the migration environment (particularly the anti-Chinese racism) featured a heightened level of hostility to sojourning Chinese immigrants in the US. Therefore, this dissertation utilizes data from multiple sources to investigate how sojourning mentality (and possible changes during the pandemic) interplayed with Chinese students’ experiences of acculturation and acculturative stress, and their mental health status. For the first study that comprises my dissertation, I have utilized the nationally representative survey data from the 2002-2003 National Latino and Asian American Study (NLAAS) to investigate the link between acculturation and mental health among Chinese immigrants in the US. Specifically, I have employed weighted OLS regression and binary logistic regression analyses to examine the relationship between acculturative stress and psychological distress among foreign-born Chinese immigrants, and whether such an association persists and varies on the basis of respondents’ levels of ethnic identification (the best proxy measure available for sojourning mentality in the NLAAS). My findings indicate that higher levels of ethnic identification are associated with respondents’ lower levels of psychological distress. However, for respondents who have stayed in the US for over 20 years, higher levels of ethnic identification are associated with greater vulnerability to psychological distress when they encounter acculturative stress simultaneously. For the second study of my dissertation, I designed and conducted a cross-sectional online survey among Chinese international students and visiting scholars currently studying in the US. The goal was to establish and validate a psychometric scale of sojourning mentality. Using convenience and network sampling, I managed to recruit 698 participants, with 643 qualified responses and a completion rate of 80.7%. Using multiple rounds of exploratory factor analyses (EFA) on a convenience sample of 545 adult Chinese international students and visiting scholars studying in the US, I constructed a 24-item measurement scale of sojourning mentality that is composed of 4 factors, including Attachment to Chinese Identity, Motivations to Stay in the Host Society, Preparedness to Return to China, and Motivations to Leave the Host Society. I further assessed the construct validity of this measurement scale by examining its association with three theoretically related concepts, including acculturative strategy, acculturative stress, and depression. This 4-factor solution accounts for over 60% of the total variance and exhibits satisfactory internal reliability and construct validity. This study is original and unprecedented, as it has established and validated the very first psychometric scale of sojourning mentality. Future research is strongly encouraged to apply this scale to other sojourning population(s), using probabilistic sampling.For the concluding study of my dissertation, I employed qualitative data from 59 in-depth interviews with Chinese international students recruited from my online survey in stage 2, in order to investigate their decision about whether to return to China, and to examine how such a decision (and resultant sojourning mentality) can influence and interact with their acculturation in the US during the COVID pandemic. Overall, I find that this population of foreign students demonstrates diverse levels of orientation toward returning to China, including immediate return (“yes, immediately.”), postponed return (“yes, in a few years.”), undecided return (“It depends.”), and refusal to return (“No, I will stay here.”). Except for Chinese visiting scholars who were determined sojourners, a majority of the students constantly develop, negotiate, and readjust their decisions about whether to return, and they do so throughout their entire stay in the US. By further exploring the post-migration experiences of the 55 interviewees who expressed at least some degree of intention to sojourn, I identify consistently and persistently four types or levels of sojourning mentality, including exploratory, pragmatic, disillusioned, and detached sojourning. I find that each mode of sojourning mentality can lead to distinctive acculturation attitudes and acculturative stressors that these students mostly embrace and encounter. These findings, therefore, provide supportive evidence for the call for a measurement scale of sojourning mentality.

정신보건법 제정과정 연구

김주현 연세대학교 보건대학원 2003 국내석사

정신건강과 이에 대한 정책적 노력과 관심의 세계적인 경향은 정신분열병 등 만성정신질환에 대한 치료나 재활뿐만 아니라 초기단계의 가벼운 정신질환에 대한 조기 발견 및 치료, 예방측면이 강조되고 있다. 1960년대 이후 근대화에 따른 사회 환경의 급격한 변화로 정신 건강을 위협하는 요인이 급증함에 따라 선진국에서는 이미 10-20년 전에 정신보건법을 제정하였고, 그 후 개정을 거듭하여 국민이 급속히 변화되어 가는 경제적, 사회적, 문화적인 여러 여건 아래서 잘 적응하여 정신건강을 유지할 수 있도록 꾸준히 노력하여 왔다. 정신보건법에는 건강회복이라는 환자 자신의 이익을 위하여 환자의 자유를 제한한다는 이율배반적인 속성이 있다. 따라서 정신보건법의 법 정신을 정신질환자를 효과적으로 치료하여 사회에 복귀시키는 일차적인 목표를 설정하면서도 그것을 위하여 강제로 화자를 치료에 투입하는 과정에서 일어날 수 있는 인권의 침해를 최소화할 수 있는 방법을 강구하는데 있다. 우리나라의 정신보건법은 1968년 대한신경정신의학회가 정신위생법 제정 촉구를 시작으로 오랜 논의와 진통 끝에 보건복지부의 정신보건법안과 민주당의 정신보건법안의 절충 과정를 거친 법안이 1995년도 정기국회의 마지막 날인 12월 9일 정신보건법으로 본 회의를 통과하였다. 우리나라의 정신보건정책은 1995년 정신보건법 통과를 계기로 정신질환자에 대한 입원치료 및 격리. 수용을 탈피하고 정신질환의 예방, 치료, 재활 및 사회복귀 중심으로 변화하는 회기적인 전환을 맞이하였다. 정신보건법이 제정되기까지 많은 시간이 소요되었음은 물론이고 무수히 많은 논의가 있어왔다. 정신보건법 관련 연구에서도 이러한 논점들을 중심으로 연구가 이루어져왔으나 정신보건법의 제정과정에 대한 연구는 없었다. 정신보건법의 제정과정을 되짚어봄으로서 제정과정의 문제와 특징을 살펴보는 것은 의미 있는 일이라고 생각된다. 따라서 본 연구는 우리나라의 정신보건 현황을 전반적으로 파악하고 정신보건법의 의제화 및 입법과정을 구체적으로 고찰하고자 한다. 정신보건법의 제정과정을 고찰함에 있어서는 우선, 입법에 즈음하여 어떠한 면에 중점을 두었고 이를 법률내용에 포함시켰는가를 살펴보고, 입법과정을 민주성과 전문성에 입각하여 분석하였다. 그 내용을 요약하면 다음과 같다. 1. 입법과정 중점내용 정신보건법의 제정논의는1968년 대한신경정신의학회의 입법건의가 있은 후 1985년 첫 입법논의가 이루어 졌고, 1990년대에 들어서면서 본격적인 제정시도가 이루어졌다. 정신보건법 제정의 구체적인 논의는 사회적으로 크게 논란이 되었던 정신질환 연관 사건들이 있을 때, 주로 집중적이고 공개적으로 이루어지는 특징을 보여주고 있다. 따라서 정신보건법의 주요골자나 취지가 입.퇴원 절차나 입원종류에만 집중되어지고 있는 문제점을 안게 되었으며, 정신보건법은 기존 정신의료시설의 전반적인 재검토, 환자의 재활을 위한 사회복귀정책을 포함한 정신보건정책, 이에 대한 재원조달을 휘한 재정방안 등은 제대로 포함되지 못한 채 제정되었다. 그러므로 정신보건법은 현실적인 문제해결을 위한 입법토의가 중심이 되어 법 제정과정이 진행된 특징을 가지고 있다. 2. 민주성 정신보건법의 입법과정은 법과 관련된 모든 사람들의 의견을 가능한 한 포용해야 한다는 민주성의 원칙에서 살펴보면, 우선 의견수렴을 위한 다양한 노력이 진행되었던 것으로 생각된다. 비록 정신보건법 제정이 장기적인 입법계획에 근거하여 이루어 것은 아니지만, 정신보건법과 연관되어 있는 다양한 집단들의 갈등관계들을 조성하고 상충되는 가치들과 협상하여 만족할만한 입법의 타당성을 확보한 것으로 생각된다. 과거 국내의 다른 법안들이 민주적인 입법토의과정을 생략한 채, 행정부의 주도하에 일방적으로 진행된 예가 상당수 있었다. 이러한 입법 풍토에서 정신보건법의 민주적 입법과정은 좋은 선례가 될 것으로 생각된다. 그러나 정신보건법의 입법과정에서 나타난 국회 및 정부의 적절한 조정기능의 미흡과 갈등관계 집단들의 과다한 이익추구는 필요이상의 논쟁과 법 제정기간의 장기화를 초래한 중요한 원인으로 생각된다. 3. 전문성 입법과정에 있어서 전문성은 법의 현실적 실천 가능성에 대한 전문적인 검토와 타법과의 상충 및 위헌여부 등의 법률적 전문성을 동시에 만족시킬 수 있어야 한다. 정신보건법은 정신질환자에 대한 치료와 인권을 동시에 다루는 자신들의 입장을 주장하고 관철시키려고 노력하였다. 이 과정에서 법안의 내용은 상당부분 수정되고 보완될 수 있었고, 법안의 현실의 틀 안에 자리매김 하는데 중요한 역할을 하였다. 그러나 국회내의 입법과정에서 나타난 법안에 대한 구체적인 심의 및 검토과정은 상당부분 생략되어져 국회 내 입법과정을 전문성에 입각하여 판단하기에는 어려움이 따른다. Political efforts and international interest in metal health and its promotion show a tendency to lay emphasis on not only treatment of mental disease like schizophrenia but also early detection in light case of schizophrenia, it's treatment and prevention. As factors that threaten mental disease have increased with sudden change in social environment since 1060, the Mental Health Act was established in the development countries 10-20 years ago and amended for several times to help people maintain their mental health under sudden economic, social, and cultural change. The Mental Health Act has an antinomic attribute in the respect that it benefits a patient for health recovery whereas it limits his or her freedom in return for treatment. The first principle of The Mental Health Act is set to cure mentally-ill patients effectively and return him or her to a society, but it also takes steps to minimize an infringement upon personal right during the treatment. Starting with suggestion of Korean neuropsychiatric Association in 1968, The Mental Health Act in Korea was under discussions and debate for a long time. The bill was finally passed in October 19, 1995 on the last day od a regular session of the National Assembly. With passage of the bill as a momentum, there was a drastic switch in the Korean policy for the mental health from isolation and admitting mentally-ill patients to a hospital to preventing schizophrenia, and curing and returning mentally-ill patients to a society. Until legislation of The Mental Health Act, much time was spent for arguments and debates. Studies on Mental Health Act focused on the argument issues but there was no study on legislating process and its features. While looking over the process of legislation process and features would be worthy of study. This thesis aims to grasp the general situation of the preservation of mental health and to investigate the process that The Mental Health Act came up for discussion and legislated. Before legislation process examined, what was mainly considered and what was included in the bill were studied, and legislation process was invested in the point of democratism and professionality. A summary is as following. 1. What was mainly considered on legislation process The issue on legislation of The Mental Health Act was discussed in 1985 at first after Korean neuropsychiatric Associations proposal, and in 1990s, the trial for legislation began in earnest. Heated discussions on legislation The Mental Health Act rose temporarily and publicly when the criminal accidents occurred. Therefore, main issues on The Mental Health Act were limited to focus on the arrangements for mentally-ill patients entering and leaving a hospital or types of hospital treatment: The Mental Health Act was legislated without considering the medical facilities on the whole, the policy for the preservation of mental health, and financial resources. the arguments and legislation for The Mental Health Act tended to be based on solving the contemporary and practical problems. 2. Democratic features When The Mental Health Act considered in the point of democratism which means as many opinions should be considered as possible, there was an effort to collect opinions on the preservation of mental health. Even though legislation of The Mental Health Act was not under the long-range plan, it obtained appropriateness with trials to disentangle conflicts among several groups. In the past, some bills were passed without sufficient discussions and debates as the administration took the lead in legislation with a one-sided view. With democratic process that it underwent, The Mental Health Act set a good example of legislation process. government and the National Assembly, however, showed inefficiency in settling conflicts by arbitration and some groups looked after their own interests too much, making debated exceed more than needed and consuming unnecessary time for legislation. 3. Professional features professionality on the legislation should include professional examination on both the possibility of realization and legal study on contradiction with other laws and violation of the constitution. Since The Mental Health Act deals with treatment of mentally-ill patients as well as human rights, several groups wanted to carry their professional opinions through in the point of preservation of health and legislation. In the meantime, while amended and made up for the weak points, the bill took sufficient time for the application. Since quite a many procedures of deliberation and consideration during legislation process were omitted, it is still hard to consider the legislation process in the point of professionality.

Undergraduate Nursing Students' Attitudes Toward Mental Illness and Mental Health Nursing

Konzelman, Lois ProQuest Dissertations & Theses The University of 2017 해외박사(DDOD)

Historically, nurses have lacked recognition for the work they do, especially in the area of mental health. There is a shortage of qualified mental health nurses to meet the demand for services. Many rural areas in the United States have few or no mental health services to offer communities. Encouraging positive attitudes toward mental health nursing is an important step in the recruitment of new nurses into the specialty. This study used Colaizzi's method of phenomenology to explore the beliefs held by undergraduate BSN students towards mental health nursing and how undergraduate nursing education affected those attitudes. The purpose of the research was to understand undergraduate nursing students' attitudes toward mental health, to understand the impact that content and clinical experiences and experiences with non-mental health faculty have on attitudes toward mental health nursing, and to understand how undergraduate nursing education can contribute to the de-stigmatization of mental health nursing. Guided by Goffman's (1963) stigma theory, 20 participants were interviewed. Data analysis revealed three major themes: a) student nurses had varied attitudes toward mental health nursing, b) students had varied understanding of mental illness and mental health nursing at the end of the course rotation and c) clinical experiences and teaching strategies produced attitudinal changes in undergraduate nursing students. The two subthemes extracted from the first theme were students attitudes ranged from favorable to unfavorable and attitudes were based on experience and exposure to mental illness and mental health nursing. Subthemes from the second theme included students did not comprehend content as presented and they compartmentalized illnesses as medical or mental. Subthemes from the third theme included students had concerns over loss of technical skills and they did not comprehend the role of the mental health nurse even after clinical experiences.

(The) Japanese penal system : focusing on mentally-ill prisoners

Yasumasa, Nakamura Sungkyunkwan University 2015 국내석사

The basic Japanese penal system is ruled by the Criminal Code and Code of Criminal Procedure. The way to treat mentally disordered offenders in criminal court is ruled by Article 39 of the Criminal Code. According to those articles, insanities will not be punished and the quasi-insanities have their punishments reduced. Japanese penal facilities are divided into several different kinds, such as normal prisons, medical prisons/medical juvenile houses, traffic prisons and so on. The author of the thesis would focus on medical prisons and their treatment for mentally disordered inmates. There are 4 medical prisons in Japan, at Hachioji (Tokyo), Okazaki (Aichi), Osaka and Kitakyushu (Fukuoka), where the author focused on, especially. The speciality of Kitakyushu Medical Prison is specialised in treating mentally disordered inmates. The author visited Kitakyushu Medical Prison in July, 2014 and could get some information on that facility. Around 100 mental illness prisoners are housed and under control by prison guards and medical staff. According to the prison guards, some inmates who have serious mental illness cannot do work as their punishments. For those inmates, what they have to give is medical treatment. As a result of their medical treatment and therapeutic treatment, some disordered inmates could recover from their diseases. However, some inmates who have been staying there more than five decades because of the seriousness of their disease and the length of their imprisonment. For those old inmates, this facility have day-care rooms to nurse them. Their basic medical and therapeutic treatment for mental illness inmates is based on Cognitive Behavioural Therapy (CBT). They have pottery classes for their therapy. In addition to medical and therapeutic treatment, they have a function as a prison. As a result of their treatment, some inmates recover and can be under condition of doing “work.” Nowadays, as the prison guard explained, eating disorders is becoming a big problem in this facility. Even though several different kinds of eating disorder is diagnosed in the world, and there are quite small number of criminal cases in law reports, but the number of inmates with eating disorders have been increasing. One reason why the number is increasing is that there are still a lack of understanding among prosecutors and judges, compared with police. A new law was enacted for mentally disordered offenders that made them have medical treatment in 2005. In order to be targeted for this Act, offenders need to commit one of 5 specific crimes: murder; arson; rape; robbery; forcible indecency and bodily injury including attempted offence except bodily injury. Even though the government enforced the law to make a good system, scholars thought governmental appraisal for carrying out this act was not effective enough and the government just pretended to have done their duty. This Act ruled that the subjects of this Act have to be hospitalised 18 months, but government wants hospitals to release their patients as early as they could. In England (the word England means England and Wales in this article), they have long history of criminal insane treatment. England had several amendment of their Acts on treatment of mentally disordered offenders and inmates in their history. They have several Special Hospitals (high security hospitals) Broadmoor special hospital. Their patients have committed crimes and been sent to that hospital. Thus, those patients are criminally insane. However, the patients have their own cell key by themselves. This is much different from the Japanese case. Moreover those high security hospitals, they have Regional secure units in across the country. They are not like high security hospitals but they have mid-level security as a hospital. Those things are hospital-related. England also had therapeutic prisons, and it is called Grendon Therapeutic Prison. Those who work in penal facilities in England are GP (General Practitioner), who are members of the NHS (National Health Service). Therefore, their salary will be paid by the NHS. All medical treatment is controlled by NHS in England. As scholars said that there were less claims on salary issues in England. The Korean penal system is bit similar to the Japanese one. For example, the kinds of penalties are quite similar. Both have life-time/term-limited imprisonment with/without work, fines, minor fines and penal detention. There are several differences among those two countries’ system, and the biggest difference is death penalty. Both Japan and Korea have the death penalty, but Korea has stopped execution from late-90s. On the other hand, Japan is one of the countries which keeps capital punishment as the heaviest punishment. Then, Korean penal facilities seem slightly different from Japanese ones. The author is going to introduce about several Korean penal facilities, although one of them is juvenile school, and those are related to mental disordered offenders and inmates. Those facilities have prisons as penal facilities, also they have special treatment centres on some prisons’ property. In Korea, there are relatively much more sex crimes than Japan in each year, thus they have special centre for those sex offenders at special treatment centres. The correctional facilities in Korea are divided into several districts across the country. And each district has some core treatment centre for mental illness offenders and inmates. Finally, the author is going to show the difference between those two countries in his conclusion. In the author’s conclusion, he is going to discuss the difference between Japan, Korea and England. Those three countries may have both good points and bad points in their correctional policies, Acts and facilities. First, the author considers the good points in the Japanese and Korean penal correctional systems. As a result of thinking about, good points of those countries, he reaches the conclusion that Korean ones look slightly better partly than the Japanese one. Then, he thinks about the bad points in the Japanese and Korean correctional systems due to their chemical treatment. Then, he thinks that he cannot agree with Korean preventive detention and medical treatment in order to reduce sex impulse for some part. He is going to mention about the reason why he thought so. In the final part of the article, the author proposes the way to improve the Japanese and Korean penal and correctional policies, Acts and facilities. These countries may have some room to improve their correctional policies. Moreover, the author considers that the Japanese one should be improved more than Korean one. As he mentions where he was talking about medical doctors in penal facilities in Japan, there were a risky situation among Japanese correctional medication. In order to improve this, the Japanese government is seriously required to think about this problem as soon as they could.

대학생의 애착외상이 정서조절곤란에 미치는 영향:정신화의 매개효과

문일수 제주대학교 교육대학원 2022 국내석사

본 연구에서는 대학생의 애착외상이 정서조절곤란에 미치는 영향에서 정신화 의 매개효과를 검증하고자 하였다. 연구의 목적을 달성하기 위하여 설정한 연구 문제는 다음과 같다. 연구문제 1. 애착외상, 정서조절곤란, 정신화 간에 유의미한 관계가 있는가? 연구문제 2. 애착외상과 정서조절곤란과의 관계에서 정신화가 매개효과가 있는가? 본 연구는 전국 만 18세 이상 30세 미만의 4년제 대학생으로 온라인 설문을 조사하여 자료를 수집하였다. 측정도구는 애착외상 척도, 정서조절곤란 척도, 정신화 척도 및 인구통계학적 특성 조사문항으로 구성된 설문지를 사용하였다. 본 연구에서 수집한 자료는 통계분석 프로그램인 SPSS 26.0을 사용하여 분석하였다. 대학생의 애착외상, 정서조절곤란, 정신화 척도의 신뢰도 검증을 위하여 신뢰도 분석을 실시하였다. 그리고 대학생들의 인구통계학적 특성을 파악하기 위 하여 빈도와 백분율을 산출하고, 각 변인 간의 관련성을 확인하기 위해 각 변수 간 상관분석을 실시하였다. 또한 애착외상이 정신화와 정서조절곤란에 미치는 영 향과 정신화가 정서조절곤란에 미치는 영향을 분석하기 위하여 단순회귀분석을 실시하였다. 이를 바탕으로 애착외상이 정서조절곤란에 미치는 영향에서 정신화 가 매개효과를 하는지 검증하기 위해 Baron & Kenny(1986)가 제안한 매개효과 검증절차를 실시하였고, 마지막으로 매개효과의 통계적 유의한지를 검증을 위해 Sobel test를 실시하였다. 첫째, 대학생의 애착외상, 정서조절곤란, 정신화의 상관분석을 실시한 결과, 애 착외상과 정서조절곤란 간에는 유의미한 정적상관, 애착외상과 정신화 간에는 유 의미한 부적상관, 정신화와 정서조절곤란간의 유의미한 부적상관이 나타났다. 둘째, 대학생의 애착외상이 정서조절곤란과의 관계에서 정신화의 매개효과를 검증하기 위해 Baron & Kenny(1986)가 제안한 매개효과 검증절차를 실시한 결 과, 부분매개효과가 나타났다. 연구 결과를 종합해보면 애착외상과 정서조절곤란과의 관계에서 정신화의 매 개효과를 확인하였다. 이러한 결과는 정신화 수준을 높이는 것이 정서조절곤란에 문제를 감소시킬 수 있는 개입이 될 수 있음을 보여준다. 따라서 애착외상을 경 험한 대학생의 정서조절곤란과 이를 매개하는 정신화라는 심리적 기제를 밝힘으 로써 효과적인 상담개입 방안에 대한 이론적 근거를 제공한 데 있다. The purpose of this study was to examine the mediating effect of mentalization on the effects of attachment trauma on emotional regulation difficulties in college students. The research questions set to achieve the purpose of the study are as follows. Research Questions 1. Is there a significant relationship between attachment trauma, emotional dysregulation, and mentalization? Research Question 2. Does mentalization have a mediating effect on the relationship between attachment trauma and emotional regulation difficulties? In this study, data were collected by conducting an online survey of four-year college students aged between 18 and 30 across the country. As a measurement tool, a questionnaire consisting of attachment trauma scale, emotional regulation difficulty scale, mentalization scale, and demographic characteristics survey questions was used. The data collected in this study were analyzed using SPSS 26.0, a statistical analysis program. Reliability analysis was conducted to verify the reliability of college students' attachment trauma, emotional regulation difficulties, and mentalization scales. Then, frequency and percentage were calculated in order to understand the demographic characteristics of college students, and correlation analysis was performed between each variable to confirm the relationship between each variable. In addition, simple regression analysis was performed to analyze the effects of attachment trauma on mentalization and emotional regulation difficulties and the effects of mentalization on emotional regulation difficulties. In addition, in order to verify whether mentalization has a mediating effect in the effect of attachment trauma on emotional regulation difficulty, the mediating effect verification procedure proposed by Baron & Kenny (1986) was carried out, and the Sobel test was conducted to verify the statistical significance of the mediating effect. did First, as a result of correlation analysis of attachment trauma, emotional regulation difficulty, and mentalization of college students, there was a significant positive correlation between attachment trauma and emotional regulation difficulty, a significant negative correlation between attachment trauma and mentalization, and a significant negative relationship between mentalization and emotional regulation difficulty. correlation appeared. Second, in order to verify the mediating effect of mentalization in the relationship between attachment trauma and emotional regulation difficulties in college students, the mediating effect verification procedure proposed by Baron & Kenny (1986) was conducted, and as a result, a partial mediating effect was found. Combining the results of the study, the mediating effect of mentalization was confirmed in the relationship between attachment trauma and emotional regulation difficulties. These results show that increasing the mentalization level can be an intervention that can reduce the problem of emotional dysregulation. Therefore, the purpose of this study is to provide a theoretical basis for effective counseling intervention by illuminating the psychological mechanism of difficulties in emotional regulation of college students who have experienced attachment trauma and mentalization that mediates them.

정신감정 사례분석을 통한 주취 범법자의 형사책임 고찰

오채근 연세대학교 법학전문대학원 2019 국내박사

본 논문은 정신감정 사례분석을 통해 주취 범법자의 형사책임 판단의 문제점과 개선방안을 고찰하기 위한 것이다. 이를 위해 형사책임, 책임능력, 형법 제10조 제3항, 알콜 관련 정신질환 및 보안처분 등에 대해 문헌 검토 및 실증적 자료를 통해 법이론적 쟁점을 고찰하였다. 이를 바탕으로 국립법무병원에 형사감정이 의뢰된 309명의 주취 범법자에 대한 감정사례를 분석하여 그 문제점을 살펴보고 주취 범법자의 형사책임에 대한 개선방안을 제시하고자 하였다. 범죄성립요건이자 형사처벌의 근거가 되는 형사책임은 그 개념, 근거 및 판단기준 등과 관련하여 도의적 책임론, 사회적 책임론, 성격 책임론, 예방적 책임론 등 다양한 이론이 제시되고 있지만, 정작 범죄성립요건으로서의 행위책임원칙이 구체적으로 무엇을 의미하는지 조차 명확하지 않을 정도로 법이론적 논란이 지속되며 입법적 정립은 요원한 상태이다. 이러한 책임 개념은 비난 가능성이 본질이지만 모든 인간의 행동은 정신적, 생물학적, 사회적 요인이 복합적으로 작용한 결과라는 점, 이러한 구체적 인간에 대한 사회적 인식의 변화, 형사정책적 필요, 형사처벌의 목적 등을 포괄하여 그 내용이 정해져야 한다. 따라서, 비난 가능성에 대한 규범적 평가에는 인간의 정신적 능력을 근거로 한 타행위 가능성뿐만 아니라 사회적 위험성이 있는 성격적 하자, 예방적 필요성 등을 모두 포함하여 형사책임의 내용을 정립하는 것이 바람직하다. 사물변별능력과 의사조절능력으로 정의되는 책임능력은 형사책임 판단의 핵심요소인 동시에 형사처벌의 내용을 결정하는 요소로 보아야 하지만 그 자체를 형사책임과 동일시해서는 안된다. 심신상실 사유로서 사물변별능력은 범죄행위의 옳고 그름에 대한 인지적 판단으로 사실판단의 대상이 될 수 있지만, 의사조절능력은 양적 개념으로 평가적 개념이라고 보아야 한다는 점에서 책임의 정도를 나타내는 심신미약사유로 한정하는 것이 타당하다. 형법 제10조 제3항은 명정 범죄를 예방하고자 하는 형사정책적 필요와 보편적 정의감에 근거한 것으로 명정 범법자의 형사책임을 판단함에 있어서 반드시 고려해야 하는 규정이다. 동 조항의 위험 발생의 예견은 일반적인 법익침해의 위험성을 의미한다고 보는 것이 타당하지만 이를 예견했다고 보기 위해서는 원인행위의 성질뿐만 아니라 행위자의 습성, 과거력, 범행동기, 피해자와 관계, 범행전후 정황 등을 종합적으로 고려하여 구체적인 위험 및 이에 대한 인식이 상당한 정도로 확인되어야만 한다. 그래야만 형사정책적 필요와 책임원칙을 조화시킬수 있는 방법이 될 것이다. 또한 동조항의 자의로의 의미는 명정 유발물질임을 인지하고 스스로 물질을 섭취하였다면, 과실로 심신장애가 초래되었다고 하더라도 자의성이 인정된다고 보는 것이 타당하지만, 알콜 의존 등 알콜 관련 질병이 영향을 준 경우는 자의성을 배제하는 것이 바람직하다고 판단된다. 정신감정 사례분석 결과, 알콜에 의한 주취상태에서의 범죄로 정신감정이 의뢰된 범법자중 심신상실로 감정된 경우는 13명(4.2%), 심신미약으로 감정된 경우는 191명(61.8%), 정상으로 판정한 경우는 104명(33.7%), 판단을 내리지 못한 경우가 1명(0.3%)이었다. 주취 범법자의 경우 일반 정신질환 범법자에 비해 심신상실 판단 비율은 낮았고, 심신미약이나 정상 판정비율은 높았다. 주취 범법자의 범행시 정신상태는 정신병적 상태에 있었던 경우가 79명(25.6%), 단순주취상태가 154명(49.8%), 주취에 의한 기억상실상태가 67명(21.7%), 금단상태가 7명(2.3%), 판단불가인 경우가 2명(0.6%) 이었다. 주취 범죄로 감정의뢰된 309명중 157명(50.8%)에 대해서 치료감호의 필요성을 인정하였고, 24명(7.8%)에 대해서는 그 필요성을 인정하지 않았다. 치료감호 필요성에 대해 판단을 보류한 경우는 128(41.4%)명이었다. 책임능력 판단과 관련된 변수를 분석해보면, 진단명, 범행시 정신상태, 나이는 책임능력 판단에 영향을 미치는 것으로 나타났지만, 학력, 성별, 죄명은 영향이 없는 것으로 나타났다. 또한 감정사례 분석을 통해 심신미약과 심신상실을 구분하는 근거가 되는 기준은 발견하기 어려웠다. 다만, 정상과 심신미약 판단을 구분해줄 변수에 대한 회귀분석결과 죄명, 진단명 및 범행시 정신상태가 영향을 주는 것으로 나타났다. 범행 시 정신상태가 기억상실상태 그리고 진단명이 알콜의존증인 경우 심신미약 판정 확률이 높은 것으로 나타났으며, 범행시 금단상태, 죄명은 재산범, 진단명은 없는 경우 심신미약 판정을 받을 확률이 낮은 것으로 나타났다. 치료감호 필요성 판단과 관련된 변수를 분석해 보면, 단변량 분석에서 진단명, 범행시 정신상태, 책임능력 판단이 치료감호 필요성 판단에 영향을 주는 것으로 나타났으나 회귀분석결과에서는 죄명, 진단명 및 책임능력 판단이 치료감호 필요성 판단에 영향을 주는 것으로 나타났다. 죄명이 폭력범인 경우 치료감호의 필요성을 낮게 보았으며 진단명중에서 알콜의존증 진단을 받은 경우 치료감호 필요성이 높은 것으로 나타났고 책임능력 판단에서 정상을 받은 경우 치료감호 필요성이 낮은 것으로 나타났다. 현행 정신감정은 범행시 정신상태에 대한 평가가 부족하고 판단의 구체적 근거제시가 미흡하다는 점 등이 정신감정의 신뢰도나 타당도를 떨어뜨리는 요인이 되고 있다. 이러한 문제점은 비난가능성 판단의 합리성 제고를 통해 해결해야 하는 것으로 감정주문사항에 행위뿐만 아니라 행위자적 요소를 포함하여 책임의 근거가 될 수 있는 구체적 사실관계를 명시하여 판단을 요구할 필요가 있다. 책임능력 판단은 범죄의 성립요건에 대한 판단이라기보다는 범죄자의 적절한 처우를 결정하기 위한 과정이 주가 되도록 입법적 개선을 하는 것이 형사책임제도의 바람직한 개선책이 될 수 있을 것이다. 주취 범법자에 대한 현행 형사책임제도는 응보위주의 형벌에 초점을 두고 운영되어온 측면이 있고 보안처분은 그 필요성에도 불구하고 형벌과 보안처분을 구분하는 이원주의 형사법체계하에서 다양한 원인에 의해 등한시 되어온 것이 현실이다. 그렇지만, 형벌과 보안처분의 인위적 구분은 다양한 범죄원인에 대한 실효성 있는 대책에 장애를 초래하는 것으로 책임 개념의 확대와 함께 형사제재도 응보와 예방을 모두 고려하는 방향으로 개선할 필요가 있다. 이러한 측면에서 사회적으로 문제가 되고 있는 주취 범법자나 정신질환 범법자에 대한 대책은 응보적 성격의 형벌만으로는 한계가 있는 것으로 치료적 접근이 가능한 부정기의 치료감호나 치료명령제도가 그 대안이 되어야 할 것이다. The purpose of this study is to investigate the problem of criminal responsibility judgment and the improvement plan of intoxicated status criminals through case analysis of mental evaluation. To this end, I examined legal theoretical issues through review of literature and empirical data on criminal responsibility, competence of criminal responsibility, Article 10 (3) of the Criminal Law, alcohol related mental diseases and security-measure. Based on this analysis, I analyzed the cases of 309 alcohol - related criminals who were sentenced to criminal evaluation at the National Justice Hospitals, analyzed the problems, and suggested ways to improve the criminal responsibility of intoxicated criminals. Criminal responsibility, which is the basis of criminal punishment and element for the formation of a crime, has various theories such as moral responsibility theory, social responsibility theory, personality responsibility theory and preventive responsibility theory in relation to its concept, basis and judgment criteria. However, It is not even clear what it means, the legal theoretical controversy continues, and the legislative establishment is a long way off. This concept of responsibility is the essence of the possibility of blame, but considering the fact that all human behavior is a result of a combination of mental, biological, and social factors, including changes in social perceptions of these specific human beings, criminal policy needs, the contents of criminal responsibility should be determined. Therefore, it is desirable to establish the contents of criminal responsibility including the personality defects which are social risks and the preventive necessities in addition to the possibility of other actions based on human mental capacity. The competence of criminal responsibility, which is defined as the mental capacity to distinguish between right and wrong, and the mental capacity to control behavior, should be regarded as a key factor in judging criminal responsibility and determining the contents of criminal punishment, but it should not be identified with criminal responsibility. Although the mental capacity to distinguish between right and wrong as a cause of incompetence can be factual judgment because of cognitive judgment about the right and wrong of criminal act, the mental capacity to control behavior is a quantitative concept and it should be regarded as an normative evaluation concept. therefore, It is reasonable to limit it to the cause of diminished responsibility indicating the degree of responsibility. Article 10 (3) of the Criminal Code is based on the criminal policy needs and universal justice to prevent crime, and it is a rule that must be considered in judging criminal responsibility of intoxicated criminals. It is reasonable to assume that the anticipation of the risk occurrence in this clause means the risk of infringement of the general interest. However, The specific risks and perceptions must be confirmed to a considerable extent by taking into consideration not only the nature of the causal act but also the behavior of the actor, the history of the act, the motive of the crime, the relationship with the victim, and the circumstances before and after the crime. It would be a way to reconcile criminal policy needs and principles of criminal responsibility. In addition, with regard to the meaning of voluntariness in this clause, it is reasonable to acknowledge the voluntariness if the criminal is aware of it as a causative agent and ingested the substance for himself, though mental disability is caused by negligence. However, When alcohol-related diseases such as alcohol dependence affect, it is considered desirable to exclude voluntariness. As a result of analysis of mental examination cases, Among the criminals requested for appraisal due to crime committed in alcohol intoxication state, 13 (4.2%) were judged as incompetence, 191 (61.8%) were judged as diminished responsibility, 104 (33.7%) were judged to be normal, and 1 (0.3%) was not judged. In the case of the intoxicated criminal offenders, the rate of judgment of incompetence was lower than that of general mentally disordered offenders, but the rate of judgment of diminished responsibility or normal were high. During the crime, the mental status of criminal offenders were 79(25.6%) cases in the psychotic state, 154(49.8%) cases in the simple intoxication state, 67(21.7%) cases in the amnesia state, 7(2.3%) cases in the withdrawal state, and 2(0.6%) cases in the unknown state. Of the 309 intoxicated criminals who were referred for a mental appraisal, 157 (50.8%) were acknowledged the need for medical treatment and custody, and 24 (7.8%) were not. And 128 cases (41.4%) were not judged about the necessity of medical treatment and custody. Analysis of the variables related to the judgment of competence of criminal responsibility revealed that the diagnosis, the mental status at the time of the crime, and the age influenced judgment of criminal competence, but academic background, sex, and crime did not affect. In addition, it was difficult to find a basis for distinguishing between incompetence and diminished responsibility through mental appraisal case analysis. However, regression analysis of variables that can distinguish normal and diminished responsibility judgments showed that crime, diagnosis, and mental status during the crime affected. In the case of amnesia during the crime and the diagnosis of alcohol dependence, the probability of diminished responsibility was high, and the probability of diminished responsibility was low in the case of property crime, alcohol withdrawal state during the crime, and when there was no diagnosis. In the analysis of the variables related to the necessity of medical treatment and custody, it was found that diagnosis, mental status during the crime, and criminal responsibility competence judgment in the univariate analysis had an influence on the necessity of medical treatment and custody, but Regression analysis showed that crime, diagnosis, and criminal responsibility competence judgment affected. When the crime was a violent crime, or when the criminal was judged to be normal in the judgment of criminal responsibility competence, the necessity of medical treatment and custody was low, and was high in the case of diagnosis of alcohol dependence. The current mental appraisal are not enough to assess the mental status during the crime and the Facts on which judgment is based is insufficient. These lowers the reliability and validity of mental appraisal. This problem needs to be solved by raising the rationality of judgment of the possibility of blame, and it is necessary to specify the specific facts that can be the basis of the criminal responsibility including the actor elements as well as the act in the commission by a court to give an expert opinion. It may be desirable to improve the criminal responsibility system by making legislative improvements so that the process of deciding the appropriate punishment of the offenders becomes more important than judging the requirements for the establishment of the crime in the criminal responsibility competence judgment. The current criminal responsibility system for intoxicated criminal offenders has been operated with a focus on punishment centered on retribution. Despite the necessity of security measure, it has been neglected by various causes under the criminal justice system separating security measure from punishment. However, the artificial distinction between punishment and security disposition is an obstacle to effective measures against various causes of crime, and In addition to expanding the concept of criminal responsibility, criminal sanctions need to be improved in the direction of both retribution and prevention. In this respect, the punishment of merely retributive nature has many limitations in the countermeasures against intoxicated offenders and mentally disordered offenders, which are socially problematic. Therefore, for these offenders, indeterminate medical treatment and custody to take a therapeutic approach or treatment order system should be an alternative.

靑少年 精神健康을 爲한 環境要因과 福祉支援體系에 關한 硏究

김형택 東國大學校 大學院 1999 국내박사

Based on the recognition of the importance of the mental health of the youth, this study is designed to provide practical and concrete solutions for the improvement of the welfare support system of the adolescent in Korea. Up to recent years, the welfare services for them have focused on the prevention from the juvenile delinquency and the aids for those who do not have familial support. However, as society changes rapidly and demands proper responses to the world diversity, the ranges of the welfare policies for the youth should expand to help our young generation find their own identity and lead them to sound adulthood. This study combines two methodologies- literature research and survey analysis to bring about the most proper solutions for the social situation in Korea. 'Social Systems Theory Model' has been employed to discuss the environmental factors of the youth mental health as a theoretical underpinning, which became the foundation of the analysis of the survey on the adolescent. The survey was administered to the high school students residing in Seoul. The survey consists of five different categories of questions, which are mental-world, home, school, society and religion in order to understand their psychology and their dilemma caused from their social environment. The result of the survey revealed that their familial, academic, and social environments influence the mental health of the youth to a great extent, but the impact of the religion is minimal in comparison with the other social factors even though 74.5% of the students said they have a religion. In addition to the analysis of the survey on the students, the evaluation on the current welfare system and policy in Korea have been discussed in four different categories- organization, budget, human resources, and participation. The analysis on the welfare organizations for the youth has drawn an attention to some problems. The governmental and civil organizations are inorganically and unsystematically related to each other so that the services are not properly distributed to the beneficiaries. The lack of the professionals and that of the budget for the adolescent welfare exist in both sectors. Also, the participation of the youth who are the very beneficiaries is excluded from the policy- making. In order to improve these extant problems this study suggested as follows. Firstly, it is important to turn the current welfare policy focusing on mere materialistic support to the mental health care equipped with trained professionals in policy- making and practices. Furthermore, the familial, academic and social environments should be equally taking responsibilities for raising our children with sound and healthy mind. The educational function of family should not be ignored. The educational setting for school must be designed for the full development of each student. Also, mass media should recognize their influence on give the adolescent and be desirable and beneficial impact on them. As for the welfare system and organizations, government should diversify their policies. And it should find an efficient way to connect its services and resources with those of the civil organizations in order to prevent from wasting resources and missing appropriate beneficiaries. This can be fulfilled by the establishment of service network, the improvement in communication, and the willingness of cooperation between the government and the public. They will bring about more efficient governance to the adolescent welfare system in Korea. In conclusion, this study contributes to recognize the significance of the mental health of the youth and to present practical and concrete ways to approach the current problems and dilemma. By employing 'Social Systems Theory Model' and combining it with the actual social survey on the high school students their study provides the appropriate analysis on the environmental factors and the welfare support system for the mental health of the adolescent. For establishing a solid nation with good citizens, the importance of the mental health of our young generation cannot be more emphasized than any other. Considering the analysis of the environmental factors and the welfare support system as a whole, the government must focus on establishing the policies for the mental health of the adolescent and have the youth welfare department under the direct control of the president. These endeavors will be possible for our society to properly respond to the changing demands of their mental welfare and provide them with adequate services.

Climate Change and Farmer Mental Health: A Participatory and Systems-Based Approach

Weatherly, Christopher P Washington University in St. Louis ProQuest Disser 2023 해외박사(DDOD)

Because of their closeness to and dependence on the land, climate change will disproportionately impact farmer mental health (Berry et al., 2011). Despite local and global reliance on U.S. Midwest farmers' mental health and wellbeing, there are limited studies elucidating the impacts of our changing climate on their mental health (Yazd et al., 2019). The proposed dissertation addresses this gap by leveraging qualitative data from community stakeholders and applying a systems perspective in two phases to address the research question: How does climate change impact farmer mental health? The study takes place in farming communities in rural southeastern Iowa, which have experienced demonstrated increases in daily average temperature, changes in precipitation, and more frequent acute storm, drought, and flooding events linked to climate change (Berendzen et al., 2011; L. Liu & Basso, 2020; NOAA, 2020). For the first phase of the study, semi-structured interviews with farmers and local mental health providers explored varied impacts of recent climate change-related weather events on farmers’ livelihoods. Findings from these interviews informed the second phase of the study, which consisted of group and individual model building sessions conducted with farmers and mental health providers to map pathways and mechanisms between climate change and mental health. Model building sessions also generated action ideas for potential interventions to mitigate impacts and treat adverse mental health outcomes. The final product of this research project is a preliminary formal qualitative scoping model that articulates processes and feedback loops contained within the intersection of climate change-related weather events and farmer mental health. The research project answers calls from prominent researchers for systems-based and participatory approaches to further build relevant and accurate theories that reflect the complicated, nuanced, and changeable nature of mental health contained within the context of an ever-changing climate (Berry et al., 2018; Yazd et al., 2019).

애착 외상 경험 대학생을 위한 정신화 기반 대인관계 증진 집단상담 프로그램 개발 및 효과

전성은 전남대학교 2024 국내박사