Week 10 Flashcards
Aggression
Behaviour that is intended to injure a person or to destroy property
Can be physical or verbal
Different types of aggression
Psychoanalytic theory Freud 1920
Many of actions determined by instincts particularly sexual instinct
When expression of these instincts is frustrated an aggressive drive is induced
Aggression is a basic drive like hunger
Catharsis
Frustration- aggression hypothesis Dollard et al 1939
Aggression is always a consequence of frustration
The existence of frustration always leads to some form of aggression
Revised frustration- aggression hypothesis Berkowitz 1989
Inability to attain a goal- frustration- negative affect- aggressive drive- overt aggressive behaviour
Aggressive cues. ^
Aggressive cue theory Berkowitz 1966
Frustration produces anger rather than aggression
Frustration is psychologically painful and anything that is psychologically or physically painful can lead to aggression
For anger/psychological pain to be converted into aggression cues are needed: environmental stimuli associated with either with aggressive behaviour or with the frustrating object or person
Ethological perspective Lorenz 1963
Aggression is fighting instinct in beast and man which is directed against members of the same species
Important in the evolutionary development of species as it allows individuals to adapt to their environments survive in them and successfully reproduce
Social learning theory Bandura 1963
Past learning
Current punishments and rewards
Social and environmental factors
Aggressive behaviours are learned through reinforcement and the limitation of aggressive models
Observational learning
Deindividuation
Certain groups situations can minimise the salience of peoples personal identities reduce their sense of public accountability and in doing so produce aggressive or unusual behaviour
-group size
-anonymity
Stanford prison experiment Zimbardo et al 1971
Prisoners and guards stepped far beyond boundaries
Dangerous and psychologically damaging situations arose
One third guards judged to have exhibited “genuine” sadistic tendencies
Obedience- milgram 1963
Many people indicated their desire to stop the experiment and check on the learner
Some test subjects paused at 135 volts and began to question the purpose of the experiment
Most continued after being assured that they wouldn’t be held responsible
Up to 3x 450 volt shocks
Neurobiological factors
Neuroanatomical differences: prefrontal areas, amygdala, hippocampus, hypothalamus
Lower levels of serotonin
Higher levels of testosterone before birth and in early childhood
Lower levels cortisol
Ways in which brain functioning can lead to aggression:
-increased arousal interfering with the ability to think
-decreased ability to inhibit impulses
-impairment of attention, concentration, memory, and higher mental processes
-misinterpretation of external stimuli and events
Phineas gage 1848
Most front part of left side of brain destroyed
Became impatient, irritable, erratic and uncaring
Warning signs of aggressive behaviour
Irritability: rising tension
Fast speech
Restless pacing
Loud voice
Glaring eyes
Verbal threats
Intrusion into others personal space
Gut instinct
Dealing with angry patients
Avoid being defensive
Calm, speak firmly
Body language
Demonstrate you’re taking concerns seriously
Nature or nurture aggression
Nature: believe aggression is an innate drive- psychoanalytic theory, ethology, neurobiology
Nurture: believe aggression is a learned response- social learning theory, neurobiology
Psychoanalytic theory personality composed three elements
Id: impulsive and unconscious, responds immediately to basic desires, aggression is part of Id
Ego: our rational self, represses aggressive impulse
Superego: ideal image of ourselves, repress aggressive impulse
Catharsis
Process of providing release from strong or repressed emotions. Acting aggressive is an effective way to reduce aggressive impulse
General aggression model GAM
Suggests aggression is a result of both the personality and interaction of the person in the situation
GAM can be broken down into : proximal processes and distal processes
Proximal processes: immediately related to aggressive behaviours begins with 2 inputs- situational input and personal input these influence the internal state which then influences appraisal and decision process which then determines whether a thoughtful or impulsive action takes place. The social encounter then influences situational and personal input for next cycle
Distal process: influence short term processes through long term aggressive behavioural tendencies show how continued exposure to aggression develops long term aggressive personalities
2 factors that influence development of aggressive personality: biological modifiers, environmental modifiers
Personality developed effect personal and situational inputs
Confidentiality
‘Patients have a right to expect that their personal information will be held in confidence by their doctors’ GMC 2017
‘Patients entrust us with or allow us to gather, sensitive information relating to their health and other matters as part of their seeking treatment. They do so in confidence and they have the legitimate expectation that staff will respect their privacy and act appropriately’ NHS code of Practice 2003
Principlism
Arguments for confidentiality if we look at 4 principles model
Non-maleficence: disclosure- potential harm
Autonomy: requires security, self determination
Beneficence: it’s rare that breaching a patient’s confidentiality would be in their interests
Justice: fairness
Deontological
A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence
- a legal obligation that is derived from case law
- is a requirement established within professional codes of conduct
-must be included within NHS employment contracts as a specific requirement linked to disciplinary procedures
Utilitarian
There would be multiple and potentially severe ramifications for individual patients and for society as a whole if doctors breached confidentiality
Therefore rule utilitarians would support maintaining confidentiality generally act utilitarians would assess on a case by case basis
Virtue ethicists
Would a good doctor breach confidentiality
What constitutes a legal breach
An individual can sue in the civil courts for breach of confidentiality
It’s also possible to pursue a criminal case
To establish a legal branch:
- the information disclosed must have the quality of confidentiality
-the information must have been gained in confidential circumstances
-the plaintiff must show that there was unauthorised use of the information
Successful suits also show that harm resulted from the breach
The breach does not have to be deliberate
What constitutes a professional breach
Information that can identify individual patients must not be used or disclosed for purposes other than healthcare without the individuals explicit consent, some other legal bases or where there is a robust pubic interest or legal justification to do so. In contrast, anonymised information is not confidential and may be used with relatively few constraints
NHS code of practice of confidentiality 2003
-where and when you saw the patient
-patients with rare diseases
Assume confidentiality
GMC guidance:
In general you can only share personal information about a patient within the healthcare team or for the purposes of audit
Even then you should make every effort to ensure patients are aware that their information might be shared in this way
And patients can refuse to let you do so
If this will affect their care (not being able to refer to another team) you must make sure your patient is aware of that