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Proponents of nonviolent tactics often highlight the extent to which they rival arms as effective means of resistance. Erica Chenoweth and Maria Stephan, for instance, compare civil resistance favorably to armed insurrection as means of bringing about progressive political change. In Ethics, Security, and the War-Machine, Ned Dobos cites their work in support of the claim that similar methods—organized according to Gene Sharp's idea of “civilian-based defense”—may be substituted for regular armed forces in the face of international aggression. I deconstruct this line of pacifist thought by arguing that it builds on the wrong binary. Turning away from a violence-nonviolence dichotomy structured around harmfulness, I look to Richard B. Gregg and Hannah Arendt for an account of nonviolent power defined by non-coercion. Whereas nonviolent coercion in the wrong hands still has the potential to subvert democratic institutions—just as armed methods can—Gregg's and Arendt's conceptions of nonviolent power identify a necessary bulwark against both forms of subversion. The dangers of nonviolent coercion can be seen in the largely nonviolent attempts at civil subversion by supporters of Donald Trump during Trump's attempts to overturn the results of the U.S. presidential election in 2020, while the effectiveness of noncoercive, nonviolent power is illustrated by the resistance of U.S. democratic institutions to resist them.
Psychiatrists have an essential role to play in promoting human rights in mental healthcare. The World Health Organization's QualityRights initiative, in partnership with different stakeholders, is improving the quality of psychiatric care in different countries.
A subgroup of patients with anorexia nervosa (AN) undergoing involuntary treatment (IT) seems to account for most of the IT events. Little is known about these patients and their treatment including the temporal distribution of IT events and factors associated with subsequent utilization of IT. Hence, this study explores (1) utilization patterns of IT events, and (2) factors associated with subsequent utilization of IT in patients with AN.
In this nationwide Danish register-based retrospective exploratory cohort study patients were identified from their first (index) hospital admission with an AN diagnosis and followed up for 5 years. We explored data on IT events including estimated yearly and total 5-year rates, and factors associated with subsequent increased IT rates and restraint, using regression analyses and descriptive statistics.
IT utilization peaked in the initial few years starting at or following the index admission. A small percentage (1.0%) of patients accounted for 67% of all IT events. The most frequent measures reported were mechanical and physical restraint. Factors associated with subsequent increased IT utilization were female sex, lower age, previous admissions with psychiatric disorders before index admission, and IT related to those admissions. Factors associated with subsequent restraint were lower age, previous admissions with psychiatric disorders, and IT related to these.
High IT utilization in a small percentage of individuals with AN is concerning and can lead to adverse treatment experiences. Exploring alternative approaches to treatment that reduce the need for IT is an important focus for future research.
States accused of perpetrating cyber operations typically do not confirm or deny responsibility. They issue ‘non-denial denials’ or refuse to comment on the accusations. These ambiguous signals are prevalent, but they are largely ignored in the existing cyber literature, which tends to treat credit claiming as a binary choice. The ambiguity of non-denial denials and ‘non-comments’ allows states to accomplish two seemingly opposed goals: maintaining crisis stability and leaving open the possibility of their involvement in the attack. By deliberately remaining a suspect, a state can manipulate rivals’ perceptions of its cyber capability and resolve. Refusing to deny responsibility can also shape rivals’ perceptions of allies’ capabilities, enhancing the credibility of deterrence. All of this can be accomplished without the escalatory risks that would come with an explicit admission of responsibility. Where previous research has focused on the dangers of escalation and the limitations of costly signalling with cyber, we show that non-denial denials and non-comments make cyber operations considerably more useful than the literature appreciates.
In the continuous work to reduce the use of coercion in the psychiatric care, attention in Denmark has especially been directed towards mechanical restraint, i.e. the use of belts to fixate patients to a bed. While the use of mechanical restraint is currently decreasing, increases in other types of coercive acts are observed (e.g., forced medication and hourly episodes of manual restraint). The use of manual restraint refers to mental health workers immobilizing a patient to avoid harm to self or others. Manual restraint is generally considered less intrusive to a patient’s autonomy than the use of mechanical restraint. However, no study has yet explored if it is actually experienced as such by the patients.
This study explores patients’ perspectives on manual and mechanical restraint, respectively.
We are currently performing a qualitative interview study of 10 patients, who have been exposed to both types of coercion. The interviews will be transcribed verbatim and analysed for thematic content.
We expect to discover more nuanced perspectives of the intrusiveness of the different forms of coercion—perspectives that may challenge the assumption that one type of coercion is by default better than another. The study’s results will be presented.
In this study, we only look at two types of coercion. More investigation into the differentiation of patients and ideal type of coercive measure is paramount to the ambitions of a better and more humanistic psychiatric care.
Prevention and treatment of aggression in psychiatric hospitals is achieved through appropriate medical treatment, professional skills, and optimized physical environment and architecture. Coercive measures are used as a last resort. In 2018 Aarhus University Hospital Psychiatry moved from 19th-century asylum buildings to a newly built modern psychiatric hospital. Advances within psychiatric care have rendered the old psychiatric asylum hospitals inadequate for modern treatment of mental disorders.
To examine if relocating from a psychiatric hospital, dating from 19th century to a new, modern psychiatric hospital decreased the use of coercive measures.
This is a retrospective longitudinal study, with a follow-up from 2017 to 2019. We use two designs; 1) a pre-post analysis of the use of coercive measures at Aarhus University Hospital Psychiatry before and after the relocation and 2) a case-control analysis of Aarhus University Hospital Psychiatry and the other psychiatric hospitals in the Central Region. Data will be analyzed in STATA using an interrupted time-series analysis or similar method. Additionally case-mix and sensitivity analysis will be performed.
Preliminary results show a 45% decrease in the total number of coercive measures and a 52% decrease in the use of mechanical restraint. The reduction that may reasonably be attributed to the relocation is still to be determined and will be presented at the congress.
The study may illuminate how future development and planning of psychiatric facilities might improve psychiatric treatment and increase the understanding of how structural changes might contribute the prevention of the use of coercive measures.
The Christian and Islamic doctrine of the virgin birth claim God asexually impregnated the Virgin Mary with Jesus, Mary's impregnation was fully consensual (virgin consent), and God never acts immorally (divine goodness). First, I show that God's actions and Mary's background beliefs undermine her consent by virtue of coercive incentives, Mary's comparative powerlessness, and the generation of moral conflicts. Second, I show that God's non-disclosure of certain reasonably relevant facts undermines Mary's informed consent. Third, I show that a recent attempt by Jack Mulder to rescue virgin consent fails. As divine goodness and virgin consent are more central to orthodoxy, Christians and Muslims have powerful reason to reject virgin birth.
Multiculturalism gives preference to group rights over individual rights. This may challenge democratic values. This chapter focuses on the Amish denial of education from their adolescents. Criticizing Wisconsin v. Yoder (1972), the analysis focuses on the power of the Amish community over its members. The main questions are: Is it reasonable to deny the Amish adolescents’ standard American education? What are the limits of state interference in norms of illiberal communities who invoke separatism as a mechanism of cultural and religious preservation? It questions the extent that the discussed court ruling has suggested reasonable compromises to accommodate multiculturalism and outline the limits of state interference in practices of illiberal communities that deny basic rights to children.
This book explores the main challenges against multiculturalism. It aims to examine whether liberalism and multiculturalism are reconcilable, and what are the limits of liberal democratic interventions in illiberal affairs of minority cultures within democracy. In the process, this book addresses three questions: whether multiculturalism is bad for democracy, whether multiculturalism is bad for women, and whether multiculturalism contributes to terrorism. Just, Reasonable Multiculturalism argues that liberalism and multiculturalism are reconcilable if a fair balance is struck between individual rights and group rights. Raphael Cohen-Almagor contends that reasonable multiculturalism can be achieved via mechanisms of deliberate democracy, compromise and, when necessary, coercion. Placing necessary checks on groups that discriminate against vulnerable third parties, the approach insists on the protection of basic human rights as well as on exit rights for individuals if and when they wish to leave their cultural groups.
Coercion in psychiatry is a controversial issue. Identifying its predictors and their interaction using traditional statistical methods is difficult, given the large number of variables involved. The purpose of this study was to use machine-learning (ML) models to identify socio-demographic, clinical and procedural characteristics that predict the use of compulsory admission on a large sample of psychiatric patients.
We retrospectively analyzed the routinely collected data of all psychiatric admissions that occurred between 2013 and 2017 in the canton of Vaud, Switzerland (N = 25,584). The main predictors of involuntary hospitalization were identified using two ML algorithms: Classification and Regression Tree (CART) and Random Forests (RFs). Their predictive power was compared with that obtained through traditional logistic regression. Sensitivity analyses were also performed and missing data were imputed through multiple imputation using chain equations.
The three models achieved similar predictive balanced accuracy, ranging between 68 and 72%. CART showed the lowest predictive power (68%) but the most parsimonious model, allowing to estimate the probability of being involuntarily admitted with only three checks: aggressive behaviors, who referred the patient to hospital and primary diagnosis. The results of CART and RFs on the imputed data were almost identical to those obtained on the original data, confirming the robustness of our models.
Identifying predictors of coercion is essential to efficiently target the development of professional training, preventive strategies and alternative interventions. ML methodologies could offer new effective tools to achieve this goal, providing accurate but simple models that could be used in clinical practice.
With the globalization of Chinese capital, economic statecraft has become an increasingly prominent component of China's foreign policy. In this article, I examine China's use of economic inducements in developed democracies, a topic of growing concern for policymakers, focusing on the case of Australia. I show how Beijing's attempts to coopt public voices and influence Australia's foreign policy using non-transparent political donations and academic funding generated a strong backlash. At the same time, economic interdependence has provided a buffering effect, with key domestic actors in Australia advocating for cooperative relations, although this effect can in turn be limited by Beijing's coercive economic tactics. My findings underline the reputational costs of certain approaches to economic statecraft, the value of building supportive coalitions, and the challenges faced by China's authoritarian state capitalist model. They also highlight the impacts of globalized Chinese capital in developed democracies, including the resilience and vulnerabilities inherent in democratic political processes.
This study explores the relationship between temperature and the number of aggressive incidents and coercive interventions in the years 2007–2019 in six psychiatric hospitals in the south of the Germany with a total of 1007 beds. The number of aggressive incidents among 164 435 admissions was significantly higher on ‘heat days’ (≥30°C). Furthermore, there was a dose–response relationship between the number of aggressive incidents and increasing temperature. In contrast, the number of coercive interventions was not related to temperature. Considering the background of global warming, rising temperature could result in more frequent aggressive behaviour during in-patient treatment of psychiatric patients.
Chapter four looks at the development of the violent struggle and details the options the actors have available to deal with violent challenges. The causal mechanisms leading to escalation here focuses on a different set of shifts in saliency for the belligerents. The chapter shows that important escalatory potential can be found in the response of the state towards the sometimes only peaceful expression of opposition. The cases that are brought forward here are Northern Ireland and the Philippines in the 1970s, where escalation was triggered by the specific responses from the government.
The World Health Organization has developed training material to support its QualityRights Initiative. These documents offer excellent strategies to limit coercion. However, the negative portrayal of psychiatry, the absolute prohibition on involuntary treatment and the apparent acceptance of the criminalisation of individuals with mental illness are causes for concern.
This response to my critics discusses four claims that are central for A Theory of Global Governance. The first claim is that observing a high level of conflict and contestation in world politics is not proof of the unimportance of global governance, since many of the current conflicts and contestations are about international institutions. The second claim is that the 1990s saw a rise of trans- and international authority beyond the nation-state that is essential for the rise of a global political system. Third, a global system of loosely coupled spheres of authority relies on ‘critical deference’ (reflexive authority) but also contains numerous elements of coercion. And fourth, a technocratic legitimation of intrusive international authorities cannot build on emotions or a sense of belonging. This deficit creates a political opportunity structure that allows for the rise of a myriad of dissenters. The relative importance of them depends on the availability of resources for mobilization and not on the quality of reasons for resistance.
The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown.
To investigate the frequency and risk factors for repeated emergency compulsory psychiatric admission (ECPA); and to identify targets for interventions to reduce repeated ECPA.
Data were collected from a database of electronic patient files (EPFs) held by three psychiatric emergency services (PES) in the Netherlands. Analyses were based on the data for adult patients (aged 18–75 years) with a first PES contact in 2010–2015. Using descriptive statistics and regression analysis, we studied the associations between baseline patient factors and repeated ECPA and time to readmission, within a 2-year follow-up period.
We included 6059 patients: 15.6% had two or more ECPAs. In total, 66% of second ECPAs had occurred within 6 months of the first. About 30% of all ECPAs were repeated ECPAs. Two baseline factors were associated with a higher frequency of a second ECPA: history of receiving any mental healthcare treatment, whether in-patient or out-patient or both, and a lower level of self-care. Three were associated with a lower frequency: ethnicity (other than Dutch), older age and suicidality. Lower Global Assessment of Functioning (GAF) scores and housing problems were associated with a shorter time to compulsory readmission and persistent psychiatric problems with a longer time to compulsory readmission.
We found that 15.6% of patients had two or more ECPAs. Two-thirds of the second ECPAs had occurred within 6 months of the first. Like earlier studies, the risk factors we identified suggest that interventions to reduce the risk of repeated compulsory psychiatric admission should seek to improve self-care, general daily functioning and homelessness.
This chapter does not advocate for one particular brand of realism as the supreme analytical tool. Instead, it presents a synthesis of theories across International Relations to explore the various factors that shape how states and nonstate actors approach peace. No one theory is “the best” at explaining peacekeeping and peacemaking. Rather, each theory provides a piece of the puzzle that explains peace as a dependent variable. This chapter begins by defining realism and integrating the various subtheories of realism to provide a framework to explain when actors choose cooperation over conflict. It frames the discussion in the context of realist strategies for maintaining peace and resolving conflicts. The synergistic cross-paradigmatic approach I propose explains how the various theories shape actor behavior, within the structure provided by realism. The chapter concludes by highlighting the outstanding shortfalls that remain in any peacebuilding approach
Many interventions to reduce the use of seclusion and restraint have been suggested in the last decades. Evidence-based interventions in old age psychiatry are different from those in general psychiatry. A common database for psychiatric hospitals introduced in 2004 allowed to examine the use of seclusion and restraint over 16 years under routine conditions.
A registry for coercive measures in the Federal State of Baden-Wuerttemberg has been available since 2015, and comprises all 32 hospitals licensed to admit involuntary patients. A study group had collected data prospectively since 2004 from a subsample of these hospitals. We analyzed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2004 to 2019 among a total of 1,038,239 admissions.
The proportion of cases affected by coercive measures dropped significantly from 28.4 to 10.5% in patients with ICD-10 F0 disorders, while rates in patients with other diagnoses decreased insignificantly from 7.0 to 5.4%. The cumulated duration of coercive measures per affected case also dropped significantly among patients with F0 disorders, while changes in patients with other diagnoses remained insiginficant.
The use of coercive measures in patients with organic disorders could be reduced by about 50% in a State of 11 million inhabitants within 15 years, while in contrast no substantial reduction occurred among all other diagnostic groups. Specific interventions to reduce coercive interventions seem to be particularly successful for this patient group.