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A four- to seven-fold increase in the prevalence of current mood, anxiety, substance use and any mental disorders in Indigenous adults compared with non-Indigenous Australians has been reported. A lifetime prevalence of major depressive disorder was 23.9%. High rates of comorbid mental disorders indicated a transdiagnostic approach to treatment might be most appropriate. The effectiveness of psychological treatment for Indigenous Australians and adjunct Indigenous spiritual and cultural healing has not previously been evaluated in controlled clinical trials.
This project aims to develop, deliver and evaluate the effectiveness of an Indigenous model of mental healthcare (IMMHC). Trial registration: ANZCTR Registration Number: ACTRN12618001746224 and World Health Organization Universal Trial Number: U1111-1222-5849.
The IMMHC will be based on transdiagnostic cognitive–behaviour therapy co-designed with the Indigenous community to ensure it is socially and culturally appropriate for Indigenous Australians. The IMMHC will be evaluated in a randomised controlled trial with 110 Indigenous adults diagnosed with a current diagnosis of depression. The primary outcome will be the severity of depression symptoms as determined by changes in Beck Depression Inventory-II score at 6 months post-intervention. Secondary outcomes include anxiety, substance use disorder and quality of life. Outcomes will be assessed at baseline, 6 months post-intervention and 12 months post-intervention.
The study design adheres to the Consolidated Standards of Reporting Trials (CONSORT) statement recommendations and CONSORT extensions for pilot trials. We followed the Standard Protocol Items for Randomised Trials statement recommendations in writing the trial protocol.
This study will likely benefit participants, as well as collaborating Aboriginal Medical Services and health organisations. The transdiagnostic IMMHC has the potential to have a substantial impact on health services delivery in the Indigenous health sector.
G. A. Cohen famously argued that fundamental normative principles (for example,
concerning justice) are “fact-free” in such a way that
their truth is independent of non-normative facts. For our purposes here, we
take Cohen’s claim as given. Our focus is on what might be thought of
as the “other side” of this issue — on whether
the non-normative facts that determine what might be feasible for us to
accomplish are value-independent. We argue that they are not, that people have
reason to think that the normative properties of different possible options can
and sometimes do have a crucial impact on their feasibility. In other words:
facts about feasibility are partially dependent on Cohen’s
“fact-free moral principles.”
It was a special feature of Musgrave's, Olson's and … Buchanan's work that they stressed the theoretical importance of group size.
(Tuck 2008: 3–4)
Although the Prisoner's Dilemma was originally developed and analyzed as a two-person interaction, many of the most important applications of what we might loosely call “Prisoner's Dilemma thinking” involve issues in the social sciences that are concerned with much larger numbers. This fact immediately poses a question: How does the two-person version differ from the large number Prisoner's Dilemma? Do the lessons of (and intuitions arising from) the two-person case carry over to larger scale social applications?
The general consensus in the economics literature is that the differences are very considerable – amounting to something like a qualitative difference between small-number and large-number situations. Consider, for example, the case of market provision of so-called “public goods.” As Richard Tuck observes in the epigraph, virtually all the classic writers on public goods provision make two points: first, that the public goods problem is very like the Prisoner's Dilemma problem in certain critical respects; and second, that small-number cases are unlike large-number cases in that voluntary action is much more likely to secure satisfactory levels of public goods provision in the small-number setting. Buchanan, for example, observes:
the numerous corroborations of the hypothesis in everyday experience are familiar. Volunteer fire departments arise in villages, not in metropolitan centers. Crime rates increase consistently with city size. Africans behave differently in tribal culture than in urban-industrialized settings. There is honor among thieves. The Mafia has its own standards… Litter is more likely to be found on main-traveled routes than on residential streets.
(Buchanan 1965/1999: 322)
There is in short consensus that numbers make a difference; but much less consensus concerning exactly how and why they do.
Doing the best we can in the world as it is requires that appropriate account be taken of “feasibility considerations.” The object of this essay is to examine what “appropriate account” amounts to — and specifically how “feasibility” should be conceptualized so as to operate most congenially with “desirability considerations.” One element in this exercise is to recognize “feasibility” not so much as a category as “coming in degrees” (just as desirability must be recognized). A second element is to specify evaluands as actions — objects that the advisee controls — rather than as objects that lie somewhere intermediate along the path from actions to final desirability principles. This move serves to collapse all feasibility issues to ones relating to the consequences of genuine actions rather than “feasibility of” other kinds of objects of evaluation. A particular problem in the proper treatment of feasibility considerations is the tendency to begin from the “ought-implies-can” principle, a point of departure that frames feasibility considerations in a dismissive or otherwise inadequate way.
Background: Regular physical activity is generally associated with psychological well-being, although there are relatively few prospective studies in older adults. We investigated habitual physical activity as a risk factor for de novo depressive and anxiety disorders in older men and women from the general population.
Methods: In this nested case-control study, subjects aged 60 years or more were identified from randomly selected cohorts being followed prospectively in the Geelong Osteoporosis Study. Cases were individuals with incident depressive or anxiety disorders, diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP); controls had no history of these disorders. Habitual physical activity, measured using a validated questionnaire, and other exposures were documented at baseline, approximately four years prior to psychiatric interviews. Those with depressive or anxiety disorders that pre-dated baseline were excluded.
Results: Of 547 eligible subjects, 14 developed de novo depressive or anxiety disorders and were classified as cases; 533 controls remained free of disease. Physical activity was protective against the likelihood of depressive and anxiety disorders; OR = 0.55 (95% CI 0.32–0.94), p = 0.03; each standard deviation increase in the transformed physical activity score was associated with an approximate halving in the likelihood of developing depressive or anxiety disorders. Leisure-time physical activity contributed substantially to the overall physical activity score. Age, gender, smoking, alcohol consumption, weight and socioeconomic status did not substantially confound the association.
Conclusion: This study provides evidence consistent with the notion that higher levels of habitual physical activity are protective against the subsequent risk of development of de novo depressive and anxiety disorders.
When economists pay homage to the wisdom of the distant past (not the most common of professional exercises) it is more likely that a work two decades old is being admired than one two centuries old. Economics is a science, and the sciences are noteworthy for their digestion and assimilation of the work of previous generations. Contributions remain only as accretions to the accepted body of knowledge; the writings and the writers disappear almost without trace. A conspicuous exception to this rule of professional cannibalization is Adam Smith. Since 1776 he has not lacked for honors that have escaped even his most illustrious peers. Who, after all, wears a David Ricardo necktie? So to the author of The Wealth of Nations, all praise!
How may we best understand the motivational structure that stands behind individuals' acts of voting? In “The Impartial Spectator Goes to Washington” we suggested that expressive concerns swamp narrowly consequential motivations, in contradistinction to normal market transactions in which the priority is reversed. A striking consequence of this fact is that individuals will be led to vote for outcomes that they would reject were they in a position to act decisively. In this regard we found the moral psychology Adam Smith develops in The Theory of Moral Sentiments (TMS) (and, to a lesser extent, in The Wealth of Nations) remarkably fecund in suggesting alternatives to what we call the standard theory of electoral behavior.
Geoffrey Brennan, Professor in the Social and Political Theory Group Research School of Social Sciences, the Australian National University, Canberra, Australia,
Philip Pettit, L. S. Rockefeller University Professor of Politics and Human Values Princeton University, New Jersey
Nature, when she formed man for society, endowed him with an original desire to please, and an original aversion to offend his brethren. She taught him to feel pleasure in their favourable, and pain in their unfavourable regard.
(Adam Smith 1759/1982, p. 116)
We assume in this chapter, in line with what we have argued elsewhere (Brennan and Pettit 2004), that people desire the esteem of others and shrink from their disesteem. In making this assumption, we are deliberately associating ourselves with an intellectual tradition that dominated social theorizing until the nineteenth century, and specifically until the emergence of modern economics. That tradition includes Adam Smith, Thomas Hobbes, John Locke, the Baron de Montesquieu, David Hume – indeed, just about everyone who is recognized as a forebear of modern social and political theory, whether specifically in the economistic style or not. There is scarcely a social theorist up to the nineteenth century who does not regard the desire for esteem as among the most ubiquitous and powerful motives of human action (Lovejoy 1961). Smith's elegantly forthright formulation, offered as the epigraph to this section, simply exemplifies the wider tradition.
We can think of a minimalist version of the basic esteem relationship as involving just two individuals – actor A and an observer, B. The actor undertakes some action, or exhibits some disposition, that is observed by B. The observation of this action/disposition induces in B an immediate and spontaneous evaluative attitude.
We propose an analytic account of dispositional conservatism that attempts to uncover a foundation of what is often taken to be an anti-foundationalist position. We identify a bias in favour of the status quo as a key component of the conservative disposition and address the question of the justification of such a conservative disposition, and the circumstances in which the widespread adoption of such a disposition might be normatively desirable. Our analysis builds on a structural link between the economist's traditional emphasis on questions of feasibility and the conservative's attachment to the status quo.
There are at least two possible approaches to the issue of political extremism. One is to study the operation of groups that are considered on some independent grounds to be extremist – perhaps in terms of the methods they use – and that see themselves and/or are seen by others to be broadly political in some meaningful sense. Thus, we might study the behaviour of the Red Guards or various of the nineteenth-century Russian anarchist groups for whom violence was an explicit tool in the pursuit of their political agenda. And we would distinguish such political terrorism from violence used by organized groups for merely criminal purposes. All such groups are extremist in method. Only those who have an explicit political agenda would be classified as relevant to political extremism. The reference in such a classification would be to the methods such groups use. Whether their political ends are extreme, and how indeed we would identify extremism of political ends, are separable questions. It is these latter questions with which I shall be concerned here. And I shall be concerned about them in a narrow, though not unfamiliar, context – the context of equilibrium outcomes in standard rational actor models of democratic political determination. Part of my reason for taking this approach is that this is where my expertise, such as it is, lies. But there is another reason, one perhaps more defensible.
The effect of [representation] is, on the one hand, to refine and enlarge the public views, by passing them through the medium of a chosen body of citizens, whose wisdom may best discern the true interest of their country, and whose patriotism and love of justice will be least likely to sacrifice it to temporary or partial considerations. Under such a regulation, it may well happen that the public voice, pronounced by the representatives of the people, will be more consonant to the public good than if pronounced by the people themselves, convened for the purpose. On the other hand, the effect may be inverted. Men of factious tempers, of local prejudices, or of sinister designs, may, by intrigue, by corruption, or by other means, first obtain the suffrages, and then betray the interests, of the people.
(Federalist papers, 10, James Madison)
Representation and political agency
Ideas of representation in political theory are notoriously diffuse and recalcitrant. We shall not here be concerned with the full array of these ideas. Our attention in this chapter will be focused on the issue of political agency – on the simple fact of representation, rather than its detailed form. The essential feature of representation, as we shall understand it, is that a mediating assembly of some kind is set between the citizenry and political decision making.
Ambition, avarice, personal animosity, party opposition, and many other motives not more laudable than these, are apt to operate as well upon those who support as those who oppose the right side of a question.
(Federalist papers, 1, Alexander Hamilton)
A simple model
In this chapter we take up the question – first broached in chapter 4 – of the relationship between the operation of institutions that seek to economise on virtue in use or in allocation, and the dispositional choices of individuals. The basic question is whether – or in what circumstances – institutions that economise on virtue in either of these senses may undermine or erode the virtue that they economise on. We will begin by sketching what we consider to be the simplest possible version of a model that is capable of capturing the feedback effect from institutions to dispositions; that is, a model that incorporates both dispositional choice and a structure of political institutions that operate as both sanctioning and screening mechanisms. In this context we will investigate the question of the conditions under which such an institutional structure has virtue producing properties, and the conditions under which the institutional structure may act to destroy virtue. Some of the limitations of this simple model will be addressed in the following section, where we will also outline some generalisations.
The basic model is organised around the choice between dispositions in the face of an imperfect screening device and an imperfect sanctioning device.
This book offers an account of key features of modern representative democracy. Working from the rational actor tradition, it builds a middle ground between orthodox political theory and the economic analysis of politics. Standard economic models of politics emphasise the design of the institutional devices of democracy as operated by essentially self-interested individuals. This book departs from that model by focusing on democratic desires alongside democratic devices, stressing that important aspects of democracy depend on the motivation of democrats and the interplay between devices and desires. Individuals are taken to be not only rational, but also somewhat moral. The authors argue that this approach provides access to aspects of the debate on democratic institutions that are beyond the narrowly economic model. They apply their analysis to voting, elections, representation, political departments and the separation and division of powers, providing a wide-ranging discussion of the design of democratic institutions.
The supposition of universal venality in human nature is little less an error in political reasoning than the supposition of universal rectitude. The institution of delegated power implies that there is a portion of virtue and honor among mankind, which may be a reasonable foundation of confidence. And experience justifies the theory. It has been found to exist in the most corrupt periods of the most corrupt governments.
(Federalist papers, 76, Alexander Hamilton)
Motivation in politics
It seems self-evident that any account of the operation of democratic political institutions must depend on assumptions made about human nature – and specifically about human motivation. After all, within the analytic tradition that we will be working in – the rational actor tradition – human behaviour is understood as the outcome of rational choices, and rational choice is understood in terms of agents' beliefs and desires. The rational option, in the standard Humean/Davidsonian account, is just that option that maximises the agent's desire satisfaction, given the agent's beliefs (beliefs, say, about the consequences of alternative actions). Economists may, in most settings, talk about preferences rather than desires, but the Humean story – or something very like it – underlies virtually all modern economics and correspondingly all rational actor political theory.
Not all scholars admire the rational actor approach to politics. Their criticisms are varied and we will not try to address them all in this book.