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Raj Malhotra
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My Research Interest

Master's Research Interests
 
Master's Research @ OISE/ University of Toronto
 
Supervisor: Michel Ferrari
Title: Ethical Expertise: Physician Performance in Ethical Decision Making About Serious Surgery
 
Abstract

Informed Decision Making (Informed Consent) is the autonomous authorization of a medical intervention by the patient. A valid informed consent requires an assessment of patient capacity, disclosure of treatment information, and patient's voluntariness. Disclosure involves effective flow of relevant treatment information from the physician to the patient. The type of information that was to be conveyed during disclosures included: (1) patient's role in decision making process; (2) nature of the proposed treatment; (3) the relevant alternative options to having the proposed treatment; (4) expected benefits and risks of the proposed treatment; (5) uncertainties associated with the decision making process; and (6) preferred treatment options. But how thoroughly and how effectively such flow of information has occurred was the matter of concern. This project explores the communication between physicians and patients during the process of informed decision making. The objective of the research was to characterize the nature and completeness of decision making from a corpus of physician-patient conversation. This study used both qualitative and quantitative measures to address the following questions: What constitutes ethical expertise in the physician-patient conversation? How do physicians enhance patients informed decision making about important clinical problems? Do complexity of problems foster more careful scaffolding decision making in physicians? What practices enhance the possibility that patients in fact meaningfully consent to treatment? Results demonstrated that most discussions about informed decision making were made after the mention of the specific problem. It was also found out that more decisions were made in discussing a more complex medical situation. As patients were asked to consider increasingly complex medical problem, their role in decision making did improve. Results further demonstrated that most of the communication discussed clinical issues. Future studies should investigate further, perhaps by alternative method, to interpret mutual decision making by fostering understanding in both doctors and patients in both medical and personal life challenging decisions.

Continuing Research @ Centre for Addiction & Mental Health

Principal Investigator: Louis Gliksman

Title: Toronto Drug Treatment Court Project

Based on the known association between drug abuse and crime, there is a belief that to successfully reduce recidivism rates of drug and non drug related crime, drug abuse must be addressed and treated.  This is the guiding philosophy of the Toronto Drug Treatment Court, a drug diversion program that was developed as a co-operative venture between the criminal justice system and the Centre of Addiction and Mental Health.  Instead of the traditional punitive approach of conviction and jail terms, offenders have the opportunity to engage in a therapeutic intervention as opposed to potentially prolonged involvement with the criminal justice system.

The Toronto Drug Treatment Court was designed specifically to address the unique needs of non-violent offenders who abuse cocaine or opiates. As the first program of its kind in Canada to address this issue, it was designed to meet the specific situation of the Canadian population and of the court system in Canada.  The evaluation that is conducted for this intervention seeks: to assess the effectiveness of this approach in the Canadian context; to document both the strengths and weaknesses of the approaches taken; to ensure that there is a flow of information to the court, treatment providers and community groups; and finally, to determine the long-term cost-effectiveness of this program.

PhD Research @ OISE/ University of Toronto

Coming Soon with proposal ...

THE THEORY OF SEQUENTIAL AROUSAL OF EMOTION

Manoj Kumar Raut

CAS in Psychology, Utkal University

Patra, &  Ferrari

Ontario Institute for Studies in Education of the University of Toronto

@ 2001 Copyright Reserved


Emotion is a quite colorful event noticed in the life of all normal human beings. An experience occurs (as considered by learned psychologists: add references) as a result of the perception of a situation quite akin to the one resulting in an emotional reaction. I have a serious conviction that an emotional reaction does not occur instantly at the perception of an emotion-provoking situation. An emotion is aroused in a sequence or there is a step-by-step activation appropriating in a full-fledged experience of a particular emotion.As our perception is largely influenced by our past experiences, we tend to perceive as we are programmed by our previous associations. These associations never occur in a discrete, disintegrated, or deranged manner. These associations (due to the operation of the law of closure and pragnanze give references to Gestalt theory) form a well-knit whole. They form an integrated story in its own right. Thus, the perception of an emotion-provoking situation follows the path of the previous experience we have about the environmental situation we perceive at the moment.

 Let's consider a fear-provoking situation and the consequent emotion of fear following it. Fear of the unknown is considered one of the primary sources of fear. We have heard many a stories about the so-called ghosts in our early childhood. One day while waking up at night, we are reminded of those stories and the association of darkness with the concept of ghosts. The discrete environmental stimuli at that moment sequentially arouses the emotion of fear in the individual. The indistinct darkness, the creaking sound created by the opening up of the doors, the tapping sound on the stairs, on the attic and the terrace, hissing sound of the piercing wind, swaying lights creating shadows of daily-use objects are certain environmental stimuli which fire our imagination and lead to the gradual enactment or approximation of the emotion of fear. The amounting response of activities is quite strong and suggestive, as well as impressive. If the first scene after waking up is a dark night, we notice a mild feeling of uneasiness. It gradually gets accentuated with the subsequent perception of the hissing sound of gusts of wind sweeping through the dry leaves rustling and bustling, the shadows created by flickering lights creating strange, indistinct images in the subject, creaking sound of rusted doors, the tapping sound on the staircase. At this moment one may faint if one doubts his own strong mental constitution and integrity of behaviour and experience; overt as well as covert. At the peak of this experience, one is always reminded of the subconscious and unconscious fear and apprehension of an unknown entity named as ghost. But at this stage, he may swoon at the perception of any pseudo-familiar object as well. This reflects in clear terms that he the experience of the emotion has reached its maximum intensity.

 In contradistinction to this concept, if we assume that an emotion occurs at an instant, it lacks practical support of a matured person (elaborate). If in place of this above proposition where there is gradual arousal, we think of something like the penultimate stimulus (like the so-called ghost) at instant, there won't be any emotional expression.

What about secondary emotions such as morality, sense of expertise (Eklavya's expertise or Vishnu Sharma's stories on morality that tended to bring in order out of chaos in further promoting knowledge) .. can we adopt our idea to extend this theory for secondary emotions. Think about it. I will send the ongoing article on secondary emotion of Michel Ferrari.

Let's consider another stimulus or so to say an emotion provoking situation like sex. The urge of sex assumes the form of an emotion through gradual process. If a person (male) is shown the picture of a totally nude lady, he is bound by his senses to stare at it with dilated pupils. But this staring at an object does not arouse a full-fledged emotion in him. It is not sufficient enough to incite him culminating in an emotional reaction. But, on the other hand, if he is shown a series of pictures, slides or video clips of a woman in the act of undressing, it will obviously lead to the emotion of sex. The following sequence may be exhibited; first the woman takes off her ornaments followed by taking off her outer garment (top to bottom), then gracefully her undergarment gradually. This sequence of step-by-step getting undressed to the barest details fires the individual's imagination and registers the proper emotion in him. It's like arousing a coiled-snake with few strokes subsequently leading to its total arousal. In this way, the urge assumes (the urge in the dormant state) a vibrant emotional state. There may be sexual advances, overt aggressions, or masturbation. Here the nude figure is the penultimate stimulus. The stimuli sequentially building up the emotion; the discrete acts of undressing can be called the sequential stimulus. Sex as drive or emotion ? this could help u to expand it.

 

These emotions are also accompanied by bodily changes, which are a result of cortical arousal. The emotion of fear is accompanied by the pounding of heart, sinking feeling in the stomach, cold sweat etc. The emotion of sex is accompanied by rapid blood circulation, basically to the genital or erogenous zones leading to the arousal of the clitoris in the female sex, some times accompanied by vaginal lubrication and stiffening of the nipples of the breast and the erection of the penis in the males.

 

The mechanism of emotion can be elaborated as such. With the gradual unfolding of an emotion, there is a corresponding interaction between the past experience of the individual (acting as feedback) and need for body homeostasis during emergency. The interaction results in step-by-step arousal culminating in the interpretation of the emotional experience. This theory does not discount the physiological basis of emotion but nevertheless, it propounds the psychological basis of the concept of emotion. This theory holds true for other emotions such as anger, disgust, jealousy, joy, and grief. It is now left for the rest of the academic fraternity to acknowledge or to discard this theory.

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