Master of Arts, The Ohio State University, 2022, Medical Humanities and Social Sciences

In this thesis, I use a close reading of two memoirs by existential psychiatrist Irvin Yalom to develop a narrative approach to psychiatry. This approach treats each patient's story as a unique work of literature. It involves the psychiatrist's listening for literary elements such as tone, incongruity, and figurative speech in patient stories. It also requires the psychiatrist's engagement in cooperative acts of storytelling and interpretation, which, I suggest, provide insight into the patient's inner and outer life. This insight helps the psychiatrist to understand the patient's needs, whether these needs are psychosocial, neurobiological, medical, or otherwise. Ultimately, I argue that this approach prepares psychiatrists to respond creatively to the complex challenges of mental illness.

Committee: Aaron Friedberg (Committee Co-Chair); James Phelan (Committee Chair) Subjects: Literature; Medicine; Mental Health; Psychotherapy

Master of Science, The Ohio State University, 1968, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1970, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1971, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Arts, The Ohio State University, 1963, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1922, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1971, Graduate School

Committee: Not Provided (Other) Subjects:

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2024, Nursing

Objective: Acts of aggression and violent behaviors are common in acute health care settings. Violence risk assessment tools are used in healthcare settings to screen patients for the risk of violent behaviors. This project focuses on the use of the V-RISK-10 violence screening assessment tool in an inpatient mental health care facility in the United States. The purpose of this project was to improve consistent use of the V-RISK-10 tool and improve communication of the V-RISK-10 results to the staff providing direct care. Methods: A literature review of violence screening tools was completed. The specific aims of the project were to monitor the V-RISK-10 completion rate in the electronic health record (EHR), provide education on the V-RISK-10 tool, evaluate effectiveness of staff education on the tool, improve communication of the tool by adding a column to the whiteboard in the report room which identifies the violence risk level, monitor completion rates of documentation of the violence risk level on the whiteboard, and monitor rate of code violets occurring over time. Results: Ninety-six of ninety-eight staff completed the e-Learning module and scored the minimum of 80% to pass the test. Total compliance of writing the V-RISK-10 result on the whiteboard was 85% or higher. Thirteen patients had a code violet called during the project period. Six patients had more than one code violet. Five of the six patients (83%) were assigned a V-RISK-10 assessment of moderate or high risk for violence. Conclusions: The V-RISK-10 assessment did correlate for the most part for the patients with one or more code violet incidents. The V-RISK-10 screening tool is helpful in identifying patients at risk for violence while in the inpatient mental health setting.

Committee: Miranda Knapp PhD, DNP, APRN, AGCNS-BC, CNE, EBP-C (Other); Diane M. Stauffer DNP, RN, CNE (Other); Chelsea Horn MSN, RN (Other) Subjects: Mental Health; Nursing; Psychology

Psy. D., Antioch University, 2024, Antioch Seattle: Clinical Psychology

This mixed-methods study explored the quality of life and lived experiences of adult individuals with diagnoses of schizophrenia spectrum disorders residing and receiving treatment on the Social Learning Program (SLP) at Fulton State Hospital, a high-security state forensic facility. Eleven participants completed the WHOQOL-BREF quantitative quality-of-life measure. Ten participants completed in-depth, semi-structured, qualitative interviews. Interviews were transcribed then analysed using Interpretive Phenomenological Analysis. The major themes that emerged included “Working the Program,” “Relationship Dynamics with Self and Others,” “Meaning,” “I've Been Having Breakthroughs,” and “Areas for Improvement in the Program.” Combined, the findings of the present investigation demonstrate the utility of the SLP and highlight the importance of studying the lived experience and quality of life of individuals with diagnoses of schizophrenia spectrum disorders residing in forensic facilities.

Committee: Michael J. Toohey PhD, ABPP (Committee Chair); Alicia Pardee PhD (Committee Member); Melissa Kennedy PhD (Committee Member) Subjects: Clinical Psychology; Mental Health; Psychology; Rehabilitation; Social Research

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2022, Philosophy, Applied

This dissertation asserts we have prima facie reason to believe that at least sometimes, two or more moral persons can share a single brain and body. Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a disintegration of memory, consciousness, and experience. This gives the impression of multiple personalities who alternate control of the body, only to eventually change to another personality who often has no memory of the events that transpired, or even any other personalities supposedly sharing the body. While many philosophers agree that a body can house only one person with moral rights and duties, DID cases challenge this assumption. Derek Parfit believes that to be a person is to be a continuity of causally connected mental states, including memories, intentions, experiences, and personality traits. If an alternate personality qualifies as a person, then, there exist cases in which two or more persons can share a single brain and body. Some real-life cases, then, should also be considered as examples of multiple personhood. Given that we have prima facie reason to believe some alternate personalities (“alters”) are persons, some alters may then have a right to life. Treating DID with reintegration therapy involves something like killing an alter. As such, reintegration therapy is only sometimes morally permissible, due to the asymmetric claims to the body between the original personality and an alter.

Committee: Sara Worley Ph.D. (Committee Chair); Lisa Handyside Ph.D. (Other); Christian Coons Ph.D. (Committee Member); Michael Weber Ph.D. (Committee Member) Subjects: Ethics; Metaphysics; Philosophy; Psychology

PhD, University of Cincinnati, 2022, Medicine: Epidemiology (Environmental Health)

Objective: Data from electronic health records (EHRs) was used to determine individual characteristic association with aggressive incidents in children and adolescents during psychiatric hospitalization. Predictive probability of risk factors for aggression was examined to provide an evidence-based methodology for early detection of unsafe behavior among adolescent psychiatric inpatients and reducing harmful incidents. Methods: This retrospective study involved 10,054 unique patient admissions to inpatient psychiatry at Cincinnati Children's Hospital Medical Center (CCHMC) from April 1, 2010 until June 30, 2021. Children and adolescents aged 4-18 years old were admitted through the emergency department (ED). All admissions were unique and no patient had more than one inpatient admission at CCHMC during the study period. Factors obtained in the ED assessment prior to admission were analyzed. Aggressive incidents were documented by the psychiatric nursing staff using the Overt Aggression Scale (OAS). Pearson's chi-squared tests were conducted to determine associations between aggressive incidents and categorical variables. Wilcoxon's rank sum exact tests were used to compare the continuous characteristics in aggressive and nonaggressive groups. The Brief Rating of Aggression by Children and Adolescents (BRACHA) alone was compared to an expanded model for risk prediction. For the expanded model, the optimal predictors were identified using random forest. The expanded model cut point was chosen based on similar sensitivity to the BRACHA score cut point. Predictive power of the expanded model was compared to that of the BRACHA alone using the Delong's test. The expanded model was evaluated comparing logistic regression and recursive partitioning. The optimal model was chosen based on improvements to sensitivity, specificity and the area under the curve (AUC) of the receiver operating characteristics (ROC). Results: Age, sex, health insurance, living arr (open full item for complete abstract)

Committee: Scott Langevin Ph.D. (Committee Member); Richard Brokamp Ph.D. (Committee Member); Marepalli Rao Ph.D. (Committee Member); Lisa Martin Ph.D. (Committee Member); Ranjan Deka Ph.D. (Committee Member) Subjects: Epidemiology

Doctor of Philosophy, The Ohio State University, 2022, Psychology

The diagnosis of attention-deficit hyperactivity disorder (ADHD) in younger adults is rising. Laboratory tests (also known as neurocognitive testing) have been used to understand ADHD-specific characteristics in cognition, complementing clinical questionnaires and interviews. It is important to better characterize ADHD because affected people have diverse symptoms, and they often require different treatments. However, current research using neurocognitive testing has limitations: 1) it focuses on ADHD subgroups such as boys; 2) the sensitivity of existing tests to detect clinical characteristics is in question; 3) results are analyzed with summary statistics unsuitable for the study of individual differences and the entire ADHD spectrum; 4) current reviews suggest that conflict processing is a promising but understudied domain for understanding ADHD-specific characteristics. Computational psychiatry is a growing field of research offering new tools to link physiological data with behavioral data derived from neurocognitive testing. The objectives of this dissertation are to explore an improved test environment for ADHD. Specifically, developing and implementing cognitive and social-cognitive tests which tap into the domain of conflict processing; which integrate research in cognitive psychology; and which are suitable for the application of computational modeling. The aims are to: 1) characterize decision-making processes of younger adults with ADHD; 2) study how individual differences relate to symptom severity; and 3) link test performance to physiological measures collected with eye-tracking. The developed test environment, as part of this dissertation, consisted of a cognitive and social-cognitive computerized test that tapped into the processing of perceptual and motivational conflict, respectively. Sixty-eight adults (aged 18-35, gender balanced, nADHD=34, ncontrols=34) completed these tests, while I collected eye-tracking measures. I used computational mod (open full item for complete abstract)

Committee: Trish Van Zandt (Advisor); Brandon Turner (Committee Member); Jay Myung (Committee Member); L. Eugene Arnold (Committee Member) Subjects: Neurobiology; Psychobiology; Psychological Tests; Psychology; Quantitative Psychology

Doctor of Philosophy, The Ohio State University, 2021, Psychology

Populations and individuals diverge from each other in their cognitive abilities, and re- searchers have a great interest in characterizing and explaining these group and individual differences. Among research tools, behavioral tasks are widely adopted to assess cognitive abilities due to their simplicity and applicability. In behavioral tasks, descriptive statistics are commonly used as measurement indices for the cognitive abilities of interest. However, because these statistics have a limited ability to characterize the mechanisms underlying each task based on cognitive theories, they cannot fully explain the reasons that may cause group and individual differences. In this dissertation, I adopt hierarchical Bayesian approaches to model several behav- ioral tasks for cognition, with the aim to explore the mechanisms underlying the group and individual differences in populations tested by these tasks. I incorporate existing cognitive theories into the hierarchical Bayesian models, and use estimated parameters to characterize the cognitive abilities of interest. At the group difference level, I show that the hierarchi- cal Bayesian models can be used to identify the potential deficits in populations that have poorer task performance. At the individual level, I show that these models can reveal the behavioral patterns of each individual, and identify potential causes of individual differences. I built theory-based hierarchical Bayesian models to three behavioral tasks respectively: the progressive ratio task that measures motivation; the continuous performance task that measures sustained attention; and the memory updating task that measures working memory abilities. I show that these models have reasonable parameter recovery abilities and good fits to data. I apply these models to several empirical data sets. The progressive ratio task model is applied to a data set measuring motivation of people with and without schizophrenia (Wolf et al., 2014) and first-degree (open full item for complete abstract)

Committee: Trisha Van Zandt (Advisor); Jolynn Pek (Committee Member); Paul De Boeck (Committee Member); Mario Peruggia (Committee Member) Subjects: Psychology; Quantitative Psychology

Master of Fine Arts, The Ohio State University, 2021, English

The Kirkbride plan for American mental hospitals first took hold in the late 1840s and remained the most popular floor plan for insane asylums for the next forty years. Kirkbride asylums were considered vital, scientifically advanced centers of mental health treatment throughout the nineteenth century, but quickly became outdated, overcrowded, understaffed, and dilapidated. Today only about one-third of the original Kirkbride buildings constructed from the 1840s to the 1890s remain standing, but their impact on the national imagination is both enormous and permanent. This thesis for the Master of Fine Arts in Creative Writing at The Ohio State University is a combination of memoir and literary journalism documenting the origins, lifespan, decline, and historic preservation of Kirkbride asylums around the continental United States, as well as the author's own experiences with bipolar disorder and psychiatric care.

Committee: Lee Martin (Advisor); Michelle Herman (Committee Member) Subjects: American History; American Studies; Architecture; Fine Arts; History; Journalism; Landscape Architecture; Mental Health; Psychology; Public Health

Master of Fine Arts in Creative Writing, Cleveland State University, 2020, College of Liberal Arts and Social Sciences

A murder occurs in Bay Village, known as the “Bubble” because of the idyllic, affluent community it presents along the shores of Lake Erie. The victim is MAGGIE MARTIN, wife to assistant DA GIL MARTIN, who has prosecuted many of Cleveland's scumbags. Gil Martin grieves her death, only to be faced with the possibility that Maggie had an affair with a former boyfriend, TOM MITCHELL. Mitchell is a member of MHM (Men Helping Men), a group of sex addicts. Detectives LEWIS FERRELL and DENNIS GRANGER pursue their investigation with the help of Dr. ABBY DUNNE, a respected psychiatrist whose son is a Bay Village police officer. Dr. Dunne is counseling JAYSON PARKER, a homegrown sociopath who hated Maggie. One of Parker's friends is DEREK KUHN, who attempts suicide after clothes drenched in Maggie's blood are discovered under his bed. The detectives believe Derek is the killer and arrest him. When Tom Mitchell is murdered after an MHM session in Cleveland, the police begin to question if Maggie's murder is connected to her former boyfriend's murder? Ferrell and Granger team with Cleveland Detective RICHARD MATHESON to find the truth. The Bubble's annual Bay Days Carnival has arrived. Jayson Parker sadistically taunts LUCY MARGOLIS, a humpbacked carnival ride operator, as he schemes to get even with his parents and community at the July 4th fireworks. The chapters presented seek to develop the trio of main characters who will become the basis for a series of mysteries taking place in and around Cleveland. Bay Village is chosen because it is a suburb I know well, it is along the shores of Lake Erie, and it is a small community fifteen minutes from Cleveland proper.The intent is to showcase Cleveland, its suburbs, and to provide a fun ride for fiction lovers and those who love who-done-its!

Committee: Imad Rahman (Advisor); Michael Geither (Committee Member); Mary Biddinger (Committee Member) Subjects: American Literature

PHD, Kent State University, 2020, College of Arts and Sciences / Department of English

The comic book industry and the United States mental health system met many times during the twentieth and twenty-first century. In 1941, psychologist William Moulton Marston, believing society needed reform, created the character of Wonder Woman to inspire readers to imagine a utopian future and advocated for the form of comics as a way to address social issues. In 1948, Fredric Wertham, psychiatrist and director of the Lafargue Mental Health Clinic in Harlem, also took an interest in comics. Wertham likewise thought society needed reform, but saw the images in comics as a cause rather than a solution for rising juvenile delinquency in the United States. He tried to rally parents and politicians to regulate children's reading practices, taking his cause as far as the Senate Judiciary Committee's Subcommittee to Investigate Juvenile Delinquency in 1954. In the course of a little less than two decades, these mental health specialists would leave an impact on the industry that would shock the form and its status for years. The enmeshment of mental health and comics would extend beyond these controversial figures, a history that is central to this dissertation project. The meetings of comics and mental health often led to new stories and shaped the future of the form in distinct ways. In this dissertation, I explore these critical moments where the history of comics and psychological health overlap, focusing on mainstream comics to understand the way that the comic book industry developed under the influence—and intrusion—of these practitioners of mental health and how their ideas prompted new stories. The many relationships comics has had with the psychological sciences that I consider in this project offer insight into the changing discourse of mental health in the United States, how those fields have redefined how we think about the self, and how comics have both documented and distributed these ideas.

Committee: Vera Camden PhD (Advisor); Tammy Clewell PhD (Committee Member); Jennifer MacLure PhD (Committee Member); Jon Yoder PhD (Committee Member); Susan Roxburgh PhD (Committee Member) Subjects: Art History; Literature; Psychology; Psychotherapy

Master of Arts, The Ohio State University, 2019, Psychology

Attention-deficit and hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders. Nevertheless, phenotypes of ADHD are heterogenous, and remain vaguely defined. For instance, current cognitive test procedures are often inconclusive on the characteristics of ADHD and frequent comorbidities are mostly neglected. This thesis is composed of three parts: The first part describes existing approaches (e.g., theories, ADHD subtypes, comorbidities), as well as empirical findings from current test procedures (e.g., neurocognitive tasks) for ADHD across eight cognitive domains. It will be shown that the findings from these reviews point towards a spectrum of ADHD and comorbidities that often seem beyond the scope of existing studies, because of the nature of the administered test procedure, the type of applied analysis, as well as the pre-categorization of participants. The third part therefore introduces a proposal for measuring a spectrum of not only ADHD, but also comorbidities in a set of test procedures susceptible to identified clinical characteristics. To support these proposals, the second part describes the results from the application of the Ratcliff Diffusion Model to the neurocognitive test performances of an existent clinical dataset (e.g., the MTA study). It will be illustrated that significant differences between controls and ADHD children become apparent, when accounting for gender and medical treatment. Specifically, unmedicated ADHD children seem to take less time for cue retrieval and motor output (smaller Ter), accumulate information at a slower rate (smaller v), and show higher variability in response times. ADHD boys are characterized by a small Ter when interstimulus interval is short, whereas ADHD girls are characterized by an overly conservative decision criterion (large a). Moreover, stimulants not only increase drift rates as suggested by previous studies, but also reduce the gender-specific ADHD characteristics (e.g., small (open full item for complete abstract)

Committee: Roger Ratcliff Prof. Dr. (Advisor); Patricia Van Zandt Prof. Dr. (Committee Member); Eugene Arnold Prof. MD. M.Ed. (Committee Member) Subjects: Clinical Psychology; Cognitive Psychology; Neurobiology; Neurosciences; Psychobiology; Psychological Tests; Psychology; Quantitative Psychology

PhD, University of Cincinnati, 2017, Arts and Sciences: Philosophy

In this project I elaborate and defend a dimensional model of the relationship between mental normality and pathology, which I dub Continuity Thesis (CT). Throughout the dissertation I set out to accomplish two goals. First, I make space for a dimensional approach in philosophy of psychiatry by presenting a model that is compelling and worth taking seriously as a viable alternative to the more popular categorical counterpart. Second, I flesh out a more precise and non-arbitrary notion of what it means to be vulnerable to a mental disorder. This allows me to counter categorical approaches by showing that the cut-off point between normality and pathology is extremely hard to pin down. The project is divided into three large sections. In the first section (“Background”), I lay the groundwork for a dimensional model of mental disorders. I start by exploring an important historical precedent of CT, namely the psychodynamic account developed by Freud. In the second section (“Strong Continuity”), I start building my dimensional model by proposing to see mental disorders as disruptions of four dimensions of functioning (i.e. salience, confidence, familiarity, and agency). Each of these dimensions represents a different way in which the relationship between individual and environment may be modulated. Mental disorders are thus seen as disruptions of these self-world relations, or as ways in which one's experience of the world can be altered. In the third section (“Meaningful Difference”), I turn more explicitly to the notion of vulnerability and I focus on intermediate cases to uncover their crucial role in the transition from normality to pathology. I discuss a number of case studies where people are imbalanced on one of the dimensions but still fail to qualify as disordered, and I explain what distinguishes them from their pathological counterpart. By introducing the notions of risk and protective factors I also outline a model of how the transition between vulnerable (open full item for complete abstract)

Committee: Heidi Maibom Ph.D. (Committee Chair); Johannes Brandl AoS (Committee Member); Peter Langland-Hassan Ph.D. (Committee Member); Thomas Polger Ph.D. (Committee Member) Subjects: Philosophy

PhD, University of Cincinnati, 2017, Arts and Sciences: Philosophy

Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder. I argue that an account of social cognition that combines elements from situated cognition and theory theory can best account for the range and variety of social abilities and disabilities in ASD. Situated cognition places emphasis on the contribution of the perceptions and bodies of individuals to social interactions. Theory theory focuses upon the development of a theory of mind and the mental processes that guide social understanding and interaction. Proponents of situated cognition argue that properly embedding within a social environment is an important element for the development of social rapport. Coordinating social rhythms with others, such as walking rhythms and postural sway rhythms, are important for the development of social rapport. Individuals with ASD, due to movement atypicalities, do not embed fully within social environments. Difficulties with embedding within a social environment may lead to social isolation. Due to attentional, learning, and movement atypicalities and to not fully embedding within social environments, individuals with ASD develop a less robust theory of mind. Theory of mind is a hierarchical model that consists of many integrated models of social situations. Early social development delays will cause a cycle of delays in social development. The development of a theory of mind involves observing and participating within social environments and using these observations and experiences to construct models of social situations. These models are used to guide attention and behavior in new social situations. Individuals on the spectrum observe less social stimuli and participate less within social environments. Furthermore, learning atypicalities likely interfere with the development of social models and with grouping similar social models together in order to develop a more robust understanding of different types of social situations. (open full item for complete abstract)

Committee: Peter Langland-Hassan Ph.D. (Committee Chair); Anthony Chemero Ph.D. (Committee Member); Heidi Kloos Ph.D. (Committee Member); Heidi Maibom Ph.D. (Committee Member) Subjects: Philosophy

Doctor of Philosophy, The Ohio State University, 1984, Graduate School

Committee: Not Provided (Other) Subjects: Psychology