John Monahan

Bio: John Monahan is an academic researcher from University of Virginia. The author has contributed to research in topics: Poison control & Risk assessment. The author has an hindex of 72, co-authored 313 publications receiving 21833 citations. Previous affiliations of John Monahan include University of California, San Francisco & City University of New York.

Controlling "Dangerous" People

Abstract: The label "dangerous" often has been applied in America to persons whose major threat lay in the fact that they offended the moral or esthetic sensibilities of those holding power. In the America of the Revolutionary period, there was comparatively little violent crime, but by today's standards, punishments tended to be harsh and/or humil iating. The mentally aberrant were seen as especially dangerous, since their condition was traced to a devilish infestation, and they were handled with great brutality. Blacks, too, often restive under slavery, were regarded as dangerous persons. Today, similar kinds of ascriptions as "dangerous" are applied to criminals, mental patients, and minorities—with similarly unconvincing evidence to justify the treatment such persons often receive. Danger ought to be determined on a social basis, not by theo logical or medical dictation, and the category ought to in clude all (but only) forms of human and group action which represent real threats.

Effect of a Novel Mindfulness Curriculum on Burnout During Pediatric Internship: A Cluster Randomized Clinical Trial.

Abstract: Importance Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges. Objective To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout. Design, Setting, and Participants This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019. Interventions The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches. Main Outcomes and Measures The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15. Results Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15. Conclusions and Relevance A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout. Trial Registration ClinicalTrials.gov Identifier: NCT03148626.

Empirical Analyses of Civil Commitment: Critique and Context

Abstract: the resident population of state mental hospitals has plummeted in the past decade, cries that commitment be abolished altogether are heard with no decrease in fervor. Many others feel that the pendulum has swung too far, that patients' rights and community care have been seized upon by fiscally conservative legislatures to cease providing any care at all to mentally disordered persons. The controversies over commitment have been framed as is-

The community psychologist as social planner. Designing optimal environments.

Abstract: The environmental movement may provide a vehicle by which community psychologists can contribute to large-scale ecological change. This paper uses one outgrowth of the environmental movement--the environmental impact assessment process--to illustrate the procedures for input by community psychologists can participate in the environmental impact assessment process to (1) predict the effects of any new project on the demand for treatment services and (2) suggest ways in which a project may be designed to prevent psychological problems and enhance community well-being.

Heuristics and Biases: The Psychology of Intuitive Judgment

Abstract: A review is presented of the book “Heuristics and Biases: The Psychology of Intuitive Judgment,” edited by Thomas Gilovich, Dale Griffin, and Daniel Kahneman.

Individual differences in reasoning: Implications for the rationality debate?

Abstract: Much research in the last two decades has demon- strated that human responses deviate from the performance deemed normative according to various models of decision mak- ing and rational judgment (e.g., the basic axioms of utility theory). This gap between the normative and the descriptive can be inter- preted as indicating systematic irrationalities in human cognition. However, four alternative interpretations preserve the assumption that human behavior and cognition is largely rational. These posit that the gap is due to (1) performance errors, (2) computational limitations, (3) the wrong norm being applied by the experi- menter, and (4) a different construal of the task by the subject. In the debates about the viability of these alternative explanations, attention has been focused too narrowly on the modal response. In a series of experiments involving most of the classic tasks in the heuristics and biases literature, we have examined the implica- tions of individual differences in performance for each of the four explanations of the normative/descriptive gap. Performance er- rors are a minor factor in the gap; computational limitations un- derlie non-normative responding on several tasks, particularly those that involve some type of cognitive decontextualization. Un- expected patterns of covariance can suggest when the wrong norm is being applied to a task or when an alternative construal of the task should be considered appropriate.

Peer relations and later personal adjustment: Are low-accepted children at risk?

Abstract: In this review, we examine the oft-made claim that peer-relationship difficulties in childhood predict serious adjustment problems in later life. The article begins with a framework for conceptualizing and assessing children's peer difficulties and with a discussion of conceptual and methodological issues in longitudinal risk research. Following this, three indexes of problematic peer relationships (acceptance, aggressiveness, and shyness/withdrawal) are evaluated as predictors of three later outcomes (dropping out of school, criminality, and psychcpathology). The relation between peer difficulties and later maladjustment is examined in terms of both the consistency and strength of prediction. A review and analysis of the literature indicates general support for the hypothesis that children with poor peer adjustment are at risk for later life difficulties. Support is clearest for the outcomes of dropping out and criminality. It is also clearest for low acceptance and aggressiveness as predictors, whereas a link between shyness/withdrawal and later maladjustment has not yet been adequately tested. The article concludes with a critical discussion of the implicit models that have guided past research in this area and a set of recommendations for the next generation of research on the risk

Risk As Analysis and Risk As Feelings: Some Thoughts About Affect, Reason, Risk, and Rationality

Abstract: Modern theories in cognitive psychology and neuroscience indicate that there are two fundamental ways in which human beings comprehend risk. The analytic system uses algorithms and normative rules, such as probability calculus, formal logic, and risk assessment. It is relatively slow, effortful, and requires conscious control. The experiential system is intuitive, fast, mostly automatic, and not very accessible to conscious awareness. The experiential system enabled human beings to survive during their long period of evolution and remains today the most natural and most common way to respond to risk. It relies on images and associations, linked by experience to emotion and affect (a feeling that something is good or bad). This system represents risk as a feeling that tells us whether it's safe to walk down this dark street or drink this strange-smelling water. Proponents of formal risk analysis tend to view affective responses to risk as irrational. Current wisdom disputes this view. The rational and the experiential systems operate in parallel and each seems to depend on the other for guidance. Studies have demonstrated that analytic reasoning cannot be effective unless it is guided by emotion and affect. Rational decision making requires proper integration of both modes of thought. Both systems have their advantages, biases, and limitations. Now that we are beginning to understand the complex interplay between emotion and reason that is essential to rational behavior, the challenge before us is to think creatively about what this means for managing risk. On the one hand, how do we apply reason to temper the strong emotions engendered by some risk events? On the other hand, how do we infuse needed "doses of feeling" into circumstances where lack of experience may otherwise leave us too "coldly rational"? This article addresses these important questions.