Papers by Harold Bursztajn
The lancet. Psychiatry, 2018
Routledge eBooks, 1990
tions of the book. Illustrations are reasonably clear and informative, but the indexing is rather... more tions of the book. Illustrations are reasonably clear and informative, but the indexing is rather confusing: in many instances several pages are cited for a topic that is limited to a single page. This very readable book serves to supplement current textbooks with a rather refreshing approach, empha¬ sizing physician-patient relationships and interpretation of presenting symptoms and signs in gastrointesti¬ nal disease. It cannot be, and does not pretend to be, a substitute for a general text of postgraduate gastro¬ enterology.
Oxford University Press eBooks, Dec 1, 2017
<p>The number of individuals with intellectual disability and/or autism spectrum disorder w... more <p>The number of individuals with intellectual disability and/or autism spectrum disorder who are 65 or older is growing because of increased longevity and a proportionally larger number of individuals being diagnosed across the lifespan. Many of these individuals live with caregivers who are aging and thus eventually need out-of-home placement. Individuals with Down syndrome may also need out-of-home placement as they have an exceedingly high risk of neurocognitive disorder with age. This chapter provides the epidemiology of older adults with intellectual disability and/or autism spectrum disorder and discusses the changes in criteria for these in DSM-5. The chapter also discusses the challenges these individuals and the forensic psychiatrist may face in the judicial system. Individuals may not understand their rights and may be prone to confess or be coerced. They may also lack of full comprehension, making it difficult for them to assist in their defense and describe details of offense. The overlap of geriatric psychiatry and intellectual disability and/or autism spectrum disorder and the law is an area ripe for further research.</p>
Ethics, Medicine and Public Health, Oct 1, 2016
Summary This article explores the place of narrative in the constitution of selfhood, and through... more Summary This article explores the place of narrative in the constitution of selfhood, and through this lens examines its multifaceted role in the clinical encounter. It begins by explaining and critically evaluating the recent view advocated by Schachtman and others that narrative is wholly constitutive of the self. On this view, the role played by narrative is not merely a descriptive one, but serves more fundamentally as the ontological substrate upon which identity is invariably built and sustained. Understood as such, this capacity may distinctively modulate the meanings, motivations, and attitudes individuals adopt in reaction to and in anticipation of happenings in their lives. Acts of self-narrative can serve not only to describe meaningful facts about a person's life, but may also serve to reflexively influence the very states of affairs that they aim to describe. After assessing the theoretical attraction of this view, counter-evidence to this theory is adduced from clinical neuropsychiatric cases wherein lapses of narrative, such as those observed in dementia, dissociative identity disorder, autism and amnestic syndromes, do not entail wholesale losses of selfhood. Analyses of cases such as these reveal that there is more than narrative that is constitutive of selfhood and identity, and further raises the question of whether the absence of conveyed self-narrative ought to be interpreted as evidence of a failure of this capacity versus as evidence that an agent simply is no longer is motivated to express it. Rather than a monotonic construct, it is argued that narrative is one of a cadre of crisscrossing capacities sharing some family resemblance and with characteristically open texture that variably combine to produce selves with no single common denominator, but rather with dynamic clusters of commonalities. Six other symbiotic dimensions are identified that contribute to an intact scaffolding of selfhood, and disturbances within each of which might lead to distinctive pathologies. In particular, the capacities for self-other representation; diachronic unity; synchronic unity; consciousness (in particular, awareness); ecologic embededdness; and cognitive unity are explained and evaluated, along with pathologies that may arise in the setting of disturbances of each. It is contended that avenues of research studying the neural substrates corresponding to these different dimensions of selfhoold, as well as how these varied neuronal systems coalesce to produce a phenomenologically integrated and unified self is much needed. Further clarity with respect to these issues can shed further light on how particular brain lesions may differentially affect elaborations of selfhood. Such research could foreseeably include functional neuroimaging studies, non-invasive brain modulation (e.g., transcranial magnetic stimulation; transcranial direct current stimulation), and targeted neuropsychological testing of individuals with apparent disruptions of self stratified according to the different dimensions elucidated to aid in uncovering the enigmatic neuroanatomy and neurophysiology of selfhood. The cross-disciplinary nature of each of these avenues underscores the profound importance of deep and sustained collaborations among philosophers, ethicists, clinicians and researchers to optimize and advance approaches to the pathologies of the mind and the self. Neuroethical upshots of the account of selfhood developed are discussed, including implications for treatment of individuals with neurodegenerative conditions wherein the self itself is called into question, for the foundation and function living wills, and for approaches to pain management in individuals with disorders of consciousness. While narrative, when elicited, can provide a vital window into patient experience, lapses of narrative may be just as central to the psychoanalysis of the self and to the therapeutic encounter. What is not, and cannot be spoken, is often as vital as the narrative itself.
The American Journal of Medicine, Feb 1, 2022
The cure should not be worse than the disease; so must we be cautious about our response to COVID... more The cure should not be worse than the disease; so must we be cautious about our response to COVID-19. More in this video with Harold J. Bursztajn, MD.
The grief that the Shoah brought to its victims would make its reappearance even at happy times l... more The grief that the Shoah brought to its victims would make its reappearance even at happy times long afterwards.
I was 9 years old in December 1959 when I left and 60 in July 2011 when I returned to Lodz, Polan... more I was 9 years old in December 1959 when I left and 60 in July 2011 when I returned to Lodz, Poland. My return—a journey through time as well as space—was a continuation of a trip from my home in Cambridge, Massachusetts, where I teach and practice clinical and forensic psychiatry, to Berlin, where I gave a number of presentations at a conference of the International Academy of Law and Mental Health (IALMH).
Following trends in medicine, psychiatry is faced with limited resources and third-party administ... more Following trends in medicine, psychiatry is faced with limited resources and third-party administration of resource allocation. This has affected psychiatric practice in many ways and altered the doc-tor-patient relationship. Trends toward resource-sensitive, third-party–related psychiatric practice may be accelerated by the current social concerns regarding the economy. Thus, an awareness of social context and the growing recognition that autonomy-enhancing alternatives to paternalistic care are fundamental to improve both the effectiveness and accessibility of care in limited-resource environments are each becoming vital for an informed clinical and risk-management practice perspective.1
Physicians are often conflicted regarding prescription medications for pain, especially pain comp... more Physicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.
American Journal of Psychiatry, 1999
Journal of Clinical Ethics, Mar 1, 1993
General Hospital Psychiatry, Sep 1, 2002
Psychiatric Clinics of North America, Sep 1, 1994
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Papers by Harold Bursztajn