The seventh penis: towards effective psychoanalytic work with pre‐surgical transsexuals

The author reflects on his contrasting analytic work with two transsexual patients. He uses three previous psychoanalytic studies (Stoller, Morel and Lemma) to explore whether effective analytic work with the issues driving a person's determined wish for sex reassignment surgery (SRS) is possible. Particular consideration is given to how such work might navigate a path between traumatizing and pathologizing the patient on the one hand and avoiding important analytic material out of fear of so doing on the other. The author proceeds to ask whether it is possible to tell in advance, with any degree of reliability, who is and who is not likely to benefit from surgery. He considers certain diagnostic issues in relation to these questions. Illustrations are given of how, in practice, countertransference anxieties about psychopathologizing transsexual patients can contribute to significant difficulties in working clinically with them. It is argued that the understanding and containment of such anxieties could eventually lead to more effective analytic work, and that such work might be further facilitated by considering the contribution of mind‐body dissociation to transsexualism.     

Self-blame attributions,control appraisals and distress among cardiac rehabilitation patients

This study examined associations between self-blame attributions, control appraisals and distress among cardiovascular disease patients participating in a cardiac rehabilitation (CR) programme. Questionnaire data were collected from 129 patients at the beginning and end of CR. We found little evidence that characterological self-blame (CSB) affects distress symptoms, but behavioural self-blame at the beginning of CR was positively associated with distress symptoms concurrently, and 12 weeks later. Furthermore, diet- and exercise-focused self-blame was only modestly, positively related to control appraisals concurrently, while CSB was negatively associated with control. Prospectively, we found few significant associations between self-blame and control. Results imply that making any type of self-blame attribution during CR does not aid in adjustment or enhanced control appraisals. Our findings suggest that CR staff should encourage patients to recognise their control over reducing risk for recurrence, but should discourage patients from looking backward and ruminating about factors that may have contributed to disease onset.     

Editorial

Abstract

Intersex in Church documents has, thus far, been given very little coverage in its own right. However, it is sometimes presented as a foil to transgender; a "natural" if unfortunate state in contrast to the resolutely "non-biological" state of transgender. This serves to stigmatize transgender, and fails to understand the extent to which intersex disrupts binary, dualistic notions of sex and gender in their entirety. Utilizing opposites such as biological/non-biological is not, in fact, the most useful way to represent the relationship between intersex and transgender. Rather, it must be acknowledged that both conditions profoundly undermine the givenness of certainty and either/or tropes as "goods" when it comes to sex identity at all. This article gives a brief summary of some occurrences of the unproblematized contrasting of intersex and transgender in some Church documents, and suggests that they are being contrasted in the wrong ways.     

Distinguishing youths at risk for anxiety disorders from self‐reported BIS sensitivity and its psychophysiological concomitants

The aim of the study was to explore the psychophysiological concomitants of self‐reported behavioral inhibition system (BIS) sensitivity in adolescents (12 to 17 years old) supposed to be at risk for anxiety disorders. Twenty participants with high scores in self‐reported BIS sensitivity (at‐risk group) were matched in age and sex to 20 participants scoring in the normal range in BIS sensitivity (control group). Negative affect, negative emotion regulation style, and anxiety symptomatology were assessed by means of self‐reported measures. Cardiac and electrodermal response signals were recorded during baseline, paced breathing, exposure to an attentional task with response cost and fear‐relevant slides conditions. The at‐risk group exhibited higher scores on measures of negative affect, negative emotion regulation style, and anxiety symptomatology than their control counterparts. After controlling for negative styles of emotion regulation, groups did not differ in skin conductance reactivity during the attentional task with response cost, but participants at risk exhibited more nonspecific skin conductance responses than the control group during baseline recording. Regarding the cardiac concomitants, participants at risk presented lower vagal tone at resting conditions as compared to participants in the control group. Additionally, at‐risk participants exhibited lower flexibility across experimental conditions in heart rate and cardiac sample entropy measures than participants in the control group. These findings add knowledge on psychophysiological concomitants of BIS sensitivity and are discussed in light of associations between temperament and development of anxiety disorders in youth. They show how psychophysiological patterns observed in resting conditions could be useful endophenotypes to reliably detect individuals at risk before the disorder onset.     

Attitudes to cosmetic surgery among ethnic minority groups in Britain: Cultural mistrust,adherence to traditional cultural values,and ethnic identity salience as protective factors

Previous work has suggested that ethnic minority women have more negative attitudes to cosmetic surgery than British Whites, but reasons for this are not fully understood. To overcome this dearth in the literature, the present study asked 250 British Asian and 250 African Caribbean university students to complete measures of attitudes to cosmetic surgery, cultural mistrust, adherence to traditional cultural values, ethnic identity salience, self‐esteem, and demographics. Preliminary analyses showed that there were significant between‐group differences only on cultural mistrust and self‐esteem, although effect sizes were small (d values = .21–.37). Further analyses showed that more negative attitudes to cosmetic surgery were associated with greater cultural mistrust, stronger adherence to traditional values, and stronger ethnic identity salience, although these relationships were weaker for African Caribbean women than for British Asians. These results are discussed in relation to perceptions of cosmetic surgery among ethnic minority women.     

Making the body (w)hole: A semiotic exploration of body modifications

Abstract

Cultural norms of attraction are dynamic and fluid, and are psychologically intertwined with acts of corporeal modification that use the body as signifier. These norms are expressed in various ways by individuals, but can be seen most plainly when they are worn on the body, such as with body piercing and tattooing. An intertextual understanding of how body modifications play a role in the integration of psyche and soma appears to motivate understanding of how individual choices are reflections of cultural mores. Psychodynamic and semiotic processes from case examples are provided to illustrate how individuals may move between affect and expressiveness as well as how reading the body as text can generate new understandings of an individual's decision to modify, thus allowing clinicians to better work with their modified clients.     

Care of the Patient Undergoing Sex Reassignment Surgery

SUMMARY

Sex reassignment surgery (SRS) has proven to be an effective intervention for the patient with gender dysphoria. As with any surgery, the quality of care provided before, during, and after SRS has a significant impact on patient outcomes. This article is intended to help primary care providers who are already familiar with routine transgender care to understand the specialized processes involved in SRS. Topics include guidelines for the recommendation of SRS, feminizing and masculinizing surgical procedures, suggested timelines for various interventions, expected course and recovery, risks and complications, and revisional surgery that may be required.     

Beauty and the burn: tanning and other appearance-altering attitudes and behaviors

Tanning is often prompted by appearance concerns, yet little is known about associations between tanning and other appearance-altering behaviors. In the current study, we examined potential correlates of indoor and outdoor tanning that, like tanning, may enhance appearance but present health risks. College students (N = 284; Mage = 20.14, SD = 3.39) completed a survey. The main outcome measures were indoor tanning and outdoor sunbathing. Participants also answered questions pertaining to piercings and tattoos, healthy and unhealthy dieting behaviors, cigarette smoking, and interest in cosmetic surgery and enhancements. Results indicate that indoor tanners were more likely to have piercings, tattoos, to engage in healthy dieting behaviors, and to express interest in cosmetic enhancements. Outdoor sunbathers were more interested in cosmetic enhancements than non-outdoor sunbathers, and female outdoor sunbathers reported more unhealthy dieting behaviors than male outdoor sunbathers. These findings provide evidence for college students’ engagement in a constellation of appearance-oriented risk behaviors.     

Prospective correlates of early (30 day) readmissions on a Cardiothoracic Surgery Service

Known to vary widely among hospitals for unclear reasons, early readmissions are associated with higher mortality and are suspected to frequently be due to inadequate discharge preparation/planning. It has been previously documented that the strongest and most consistent predictor of early readmissions in CHF patients is chronic cognitive impairment, and compensatory assistance with adherence on discharge improves early readmission rates. Prospective observational study. The present investigation examined multiple putative perioperative predictors of early readmission in a hospitalized Cardiothoracic Surgery Service. A subtest of the Mini-Cog, Short Term Memory, was the strongestunivariate predictor of early readmissions (p < .001), but the overall Mini-Cog (p = .024), Age (p = .045), Number of Admissions over the Preceding Year (p = .036), an Anxiety Scale (p = .035), Years of Education (p = .055) and a Depression Scale (p = .056) also demonstrated covariation. In a Logistic Regression, only Short Term Memory survived as a predictor variable (p = .007), correctly classifying 76% of patients. Chronic cognitive impairment is a predictor of early readmissions in Cardiothoracic patients. A brief bedside exam interpreted in medical context may permit identification of patients requiring familial assistance for adherence on discharge.     

心理辅导室的建立与小儿外科

手术是小儿外科的主要治疗手段,又是一个创伤过程,同时也是一个心理应激过程,对于患儿来说这种应激会使其产生恐惧心理。同时小儿外科工作具有双重性,不仅要为患儿服务同时还需满足家长不同层次的心理需求。所以有必要在小儿外科科室内建立一个系统的心理辅导机构即心理辅导室来做好家长及患儿的心理疏导。