妊娠期糖尿病管理策略

妊娠期糖尿病(gestational diabetes mellitus,GDM)是指妊娠期发生或首次发现的不同程度的糖代谢异常。未加控制的妊娠期高血糖可对母子产生极大的围产期和远期危害。妊娠后糖代谢发生明显变化妊娠期血糖的管理和控制与非孕期不同。GDM一经确诊,应及时干预,加强母儿监测,控制妊娠期血糖,以降低母儿并发症,改善围生儿结局;产后对母儿严密随访,异常者给予相应处理,以减少或延缓产妇在产后发展为成为2型糖尿病的可能及预防子代发生肥胖、高血压、糖尿病等代谢综合征的发生。     

Token transfer between mother and offspring chimpanzees (Pan troglodytes): mother–offspring interaction in a competitive situation

Chimpanzees can flexibly use tokens in cognitive tasks, but it is still unknown if they can share and/or compete over tokens as they do for food. This study aimed to evaluate the interactions spontaneously occurring between mother and offspring chimpanzees when tokens exchangeable for food were provided. Forty tokens were scattered on the floor in an experimental playroom. Three mother and offspring chimpanzee pairs were tested. Each token was exchangeable for a piece of food in a vending machine installed on the wall of the playroom. In the beginning of the study, both mother and offspring took tokens and exchanged them for pieces of food independently. Later, two offspring started to take more tokens than their mothers. At that time, the offspring whimpered or cried more often than during earlier sessions. This behavior compelled the mothers to abstain from taking tokens. The mothers sometimes shared their tokens with their offspring, or were tolerant of their offspring taking their tokens from their hand. For one pair, the offspring sometimes shared tokens with her mother when her mother begged for the tokens. These results suggest that chimpanzees’ cognitive abilities enable them not only to use tokens, but also to compete for tokens, as they do for food. The results also suggest that token sharing between mother and offspring may be bidirectional and that transfer of tokens mainly occurs as a result of begging, although on some occasion offspring were able to obtain a token directly from his/her mother through tolerated scrounging.     

The mother within the mother

This paper describes the subjective experience of internalization, focusing on the daughter's inner world as the encounters becoming and being a mother. Three case vignettes at three phases of a woman's mothering cycle are used to demonstrate modes of registration and expression of her own internalized mother as these in turn involve her offspring. Some issues in analyzing the new mother are raised by the material, as well as implied questions about how "mothering" behaviors emerge at later junctures.     

On the Differences Between Rush Rhees and Simone Weil

Rhees seems unaware that Simone Weil differed from him both in her conception of philosophy and of its relation to religion. She differed also in her view of the relation between religion and science. On her view, the aim of science is to find the laws which will allow us to apply deductive reasoning to nature. The necessities revealed had for her a religious significance. But this can be understood only given her view of the relation between God and the world. On her view, the creation of the world did not involve an extension of God's power. It involved a withdrawal of his power, so that there could be an existence independent of himself. God does not interfere in the details of the world but sustains it through a network of necessities. For this reason, these necessities can serve as a sign of God.     

FROM PRIMARY MATERNAL PREOCCUPATION TO DEAD MOTHER*

Ferenczi (1929) writes about the unwelcome child who is not ushered into this world with care and grows up in the grip of the death instinct, with a depressive streak and a weakness in the capacity for life. Andre Green’s (1986) concept of the dead mother describes a similar phenomenon, by which the image of a loving mother is transformed into an inanimate, dead parent. The absent mother becomes the negative, which will then take up a central position in the child’s psyche. Winnicott (1956) describes a different maternal participation, and proposes that towards the end of her pregnancy the ordinary devoted mother develops a psychological condition which he calls primary maternal preoccupation, the main feature of which is the mother’s heightened attunement to her baby at the expense of all else. I suggest that there is a potent and clinically relevant connection among these concepts: a depressed or damaged mother can still provide temporary devotion before reverting back to a state of depressive absence and that, conversely, even the devoted mother will eventually recover from the state of primary maternal preoccupation and begin to tend to other matters, and the mother’s reclaiming herself can be traumatic for the child even under the best of circumstances. The connection among these concepts is illustrated with clinical material, including transference and countertransference implications, from the treatment of a young woman who grew up as an unwelcome child.     

THE ROLE OF AN IMMIGRANT MOTHER IN HER ADOLESCENT’S IDENTITY FORMATION: “WHO AM I?”

Immigration is a complex bio-psycho-social process and the immigrant mother has a truly complex task in lending her ego strength to her adolescent offspring. The normal adolescence’s decathexis of the love object and the consequent search for a new object may not happen smoothly for those adolescents whose mothers are immigrants. The immigration experience may cause the immigrant mother, who lost her motherland, deeper disturbance in self-identity as well as disequilibrium in her psychic structure, which in turn impacts adversely her adolescent’s development. The adolescent’s inadequate early experience with an immigrant mother may result in a deeper disturbance in his separation-individuation process as well as his identification process. An immigrant mother who has not mourned adequately, with a different sociocultural background has to go through a far more complex development of motherhood. The case of an adolescent boy, Jason, demonstrates the impact of immigrant motherhood on his ego development.     

Fear of a black (and working-class) planet: young women and the racialization of reproductive politics

Racialized and class specific as well as gendered heterosexuality is compulsory for young women. Substantial academic literature addressed the incidence of premarital adolescent heterosexual intercourse paying particular attention to young working-class women and (especially in the US) to young women of color. During the 1980s, journals and academic texts in the US debated the so-called black underclass disregarding the effects of Reaganomics: increasing poverty, homelessness, ill health, and unemployment, which affected young African-American women. From a traditional (hetero)patriarchal standpoint, any teenage pregnancy is a problem. Hence pregnancy avoidance and planned parenthood focus on young working-class women and young women of color presumed to constitute the problem of the (hetero)sexually active teenager. The ideology of fetal rights as used in anti-abortion and pro-life arguments represents the life of a pregnant woman as in direct opposition to that of her fetus. The ideology of adolescence constructs all young people as inherently prone to irresponsibility, especially if they are female, working-class, and black. In the Third World, young women considered as irresponsible mothers more likely face enforced sterilization than access to abortion in the guise of genetic counseling for disabilities or without explicit consent during other gynecological operations. Feminists point out that under current legislation in England and Wales, fetuses defined as seriously handicapped can be aborted up to the moment of birth. The legacy of eugenicist ideas lives on in assumptions about the inherent deficiencies of young working-class women, young women of color, and young women with disabilities as potential mothers. Yet despite the institutional, cultural, and ideological force of appropriate heterosexual and reproductive activity, young women continue to challenge common sense definitions of normality and deviance.     

The mother’s mental representation of her infant

Abstract

The mother’s intrapsychic mental representation of her infant begins before pregnancy and is modified during pregnancy and thereafter. Parents have conscious expectations and unconscious fantasies about their infant, which are all too often not consistent with reality. Early intervention in infant–parent disturbances is important for repair of the relationship and prevention of later pathogenic development. A clinical example of a mother’s unconscious ambivalent mental representations of her infant is presented.     

Nussbaum,Kant, and the Capabilities Approach to Dignity

The concept of dignity plays a foundational role in the more recent versions of Martha Nussbaum’s capabilities theory. However, despite its centrality to her theory, Nussbaum’s conception of dignity remains under-theorised. In this paper we critically examine the role that dignity plays in Nussbaum’s theory by, first, developing an account of the concept of dignity and introducing a distinction between two types of dignity, status dignity and achievement dignity. Next, drawing on this account, we analyse Nussbaum’s conception of dignity and contrast it with Kant’s conception of dignity. On the basis of this comparison between Nussbaum and Kant, we highlight tensions between Nussbaum’s Aristotelianism, which is central to her conception of dignity, and her commitment to political liberalism. This leads us to conclude that Nussbaum’s claim that her conception of dignity is only a partial political conception is implausible and that her conception of dignity seems to commit her to a satisficing form of perfectionist liberalism.     

Unplanned pregnancies and abortion counselling. Some thoughts on unconscious motivations

In a climate where the numbers of abortions and repeat abortions are increasing, it is necessary to improve our understanding of the dynamics that motivate the behavior of abortion seekers. While genuine contraceptive failures do exist, many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. The management of any pregnancy is often accompanied by feelings of ambivalence, and abortion itself is an expression of ambivalence reflecting a previously unconscious wish for a baby and a conscious wish to end the pregnancy. How these issues are handled also reflects the position the woman occupies in her life cycle. Examination of the early mother-child relationship may shed light on what unconscious needs are being expressed through the "acting out" mechanism of repeat abortion. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism of self harm. Until such conflicts are resolved, abortions may be repeated. The abortion experience may also reflect a desire for a woman to individuate from her mother. Abortion counseling offers women an opportunity to understand and work through the damage resulting from their relationship with their own mothers. One case study, of a 25-year-old undergoing her fifth abortion, provides an example of acting out psychic pain resulting from a damaging maternal relationship. This woman lacked the capacity for self-care and could only tolerate counseling sessions until she overcame the acute vulnerability imposed by her most recent abortion. Another case study, of a 27-year-old seeking counseling after experiencing overwhelming feelings of guilt, shame, and inadequacy, provides an example of a woman seeking individuation and unconditional love. This woman used counseling successfully to develop a better understanding of herself and a certainty that she could be loved despite her flaws. Such dynamics do not always inform the abortion experience, but abortion is always a distressing experience, and counseling should always be available. Abortion counselors must come to terms with their own ambivalent feelings and unconscious conflicts in order to serve their clients.     

Thinking Childbirth from an Emancipatory Perspective? Phenomenology and Psychoanalysis1

Feminist thought, despite the importance of its work, has not resolved the phenomenon of women's subordination in the care and education of children, and in society as a whole. Meanwhile, we are witnessing a gradual but continuous process of disconnection between women's bodies and subjectivity, and the conception, pregnancy and birth of children, due to developments in reproductive techniques. Considering this paradoxical tension, the author proposes to return to the very place where this subordination and anticipated rupture occur, to consider whether mothers could find there both the means to reclaim their childbirth experiences and potential levers for emancipation and rebirth, on both a personal and societal level. To this end, she describes, from the point of view of a singular woman, and from an emancipatory perspective, the phenomenological and psychoanalytical itinerary of childbirth by which this woman, in becoming a mother, is born to herself by giving birth to her child. By co-constituting the universal meaning of childbirth and becoming a philosophical mother, this singular woman operates a real paradigm shift in our representations of the mother and the metaphysical structure of the sexes.     

Phenylketonuria in Children and Mothers: Genes, Environments, Behavior

ABSTRACT— Phenylketonuria (PKU) is an inborn metabolic error in which metabolism of phenylalanine into tyrosine is disrupted. If the diet of an infant with PKU is not restricted, blood phenylalanine levels are elevated, leading to irremediable brain damage and severe mental retardation. Children with PKU who are placed early and continuously on a low-phenylalanine diet develop normal levels of intelligence, and brain damage is largely prevented. However, if the diet of a mother with PKU is unrestricted during her pregnancy, high phenylalanine levels in her blood can cross the placental barrier and damage the developing fetus in multiple ways. These results demonstrate how genes and environmental factors combine to create prenatal environments that can have profound effects on the growth and development of offspring during infancy and childhood.     

A new vision of a classical question: How to become a mother?

Abstract

This article offers a reflection on conception, pregnancy, and the first mother–infant relationships of mothers with motoric and sensory disabilities. Based on more than 13 years of experience with women with motoric and sensory disabilities who had a desire for a child, the author analyzes this unusual situation from three different points of view: the medical help to procreate, meeting a partner for the mother, and the link with the initial maternal family, i.e. the mother’s mother. The last part concerns the possibility of the development of a mother–infant relationship when bodily function is lacking.     

Adolescent vicissitudes and medical judgement: a case study

Professional concern about the widespread occurrence of adolescent pregnancy is based upon its negative impact on the social, developmental, and economic prospects of the mother and her infant. The usual presumption is that the pregnant adolescent is in good health but suffers from socioeconomic and cultural disadvantages, which the pregnancy will exacerbate. The problems of the pregnant adolescent are more complex when she also has a severe medical handicap. We draw upon such a case to illuminate the issues which arise when medical problems interact with the vicissitudes of adolescence. Although it is clear that the patient's own behavior contributed substantially to the tragic outcome of this case, we believe that greater professional anticipation of the contingencies of adolescent development might have produced a more favorable result.     

THE FEASIBILITY OF BASIC SOCIOECONOMIC HUMAN RIGHTS: A CONCEPTUAL EXPLORATION

To be justifiable, the demands of a conception of human rights and global justice must be such that (a) they focus on the protection of important human interests, and (b) their fulfilment is feasible. I discuss the feasibility condition. I present a general account of the relation between moral desirability, feasibility and obligation within a conception of justice. I analyse feasibility, a complex idea including different types, domains and degrees. It is possible to respond in various ways if the fulfilment of basic socioeconomic human rights against severe poverty seems at first to be infeasible.     

The subjectivity of the mother in the mother–son relationship. Attachment,separation, and autonomy

Abstract

Margaret Mahler and John Bowlby's positions are crucial in understanding the tensions that can arise in mother–son relationships. A more recent development of a systems view illuminates the co-construction of this relationship that occurs mainly out of awareness. A systems model of development that describes the co-construction and bi-directional influence between mothers and sons will be used in this paper. The often-neglected subjectivity of the mother is the focus, and the relationship between the mother and her adult son is viewed as a process whereby all participants strive to achieve a balance among attachment, separation, and autonomy. In addition, the contributions of the mother and the impact on her of the son's difficulties in attachment, separation, and autonomy are highlighted. In a case illustration, the subjectivity of the mother in relation to her son is explicated, showing how the son distances himself from his mother and why themother is at a loss to understand how and why this has occurred. The mother's perspective was dominated by anger and disappointment toward her son as well as by self-blame and self-justification. As a result of psychotherapy, the mother was enabled to come to terms with the estrangement of her son.     

Mothers and Daughters from Today's Psychoanalytic Perspective

In this paper, I review and synthesize findings that may help us remodel the way we think about the vicissitudes of the mother-daughter relationship. Although exciting new ideas are burgeoning in the literature, there seems to be a lag between discoveries and their integration into clinical practice. Older theories emphasizing separation and the girl's “change of libidinal object” from mother to father reflect linear models that do not encompass the development we observe and experience. Newer theories depict development as interactive and relational throughout the life cycle—leading not to separation but to autonomy with connectedness. Applying male models to the female superego or speaking of the “female Oedipus complex” is misleading. New myths are being proposed to describe the conflicts integral to the girl's triangular situation. Applying the myth of Persephone and Demeter has been especially instructive. Many analysts tend to pathologize or infantilize the woman's ongoing tie to her mother and tend to misunderstand the intense ambivalence between daughter and mother. Once we recognize that the course of development is not linear, we should expect to see the woman revisiting, reexamining, and resynthesizing representations of self-versus-mother and self-with-mother over her lifetime.     

从一心一意到三心二意：青少年的媒体多任务行为

计算机时代的到来带来了青少年媒体使用行为的变化,其中媒体多任务现象尤为显著。为全面了解在青少年群体中日渐普及的媒体多任务行为,本文首先介绍该现象的概念界定,其次概括研究中的理论基础和测量方式,并总结了青少年媒体多任务的影响因素和影响后果。未来应加强对智能手机等新兴媒体对媒体多任务行为的影响、媒体多任务行为的性别差异、媒体多任务行为的生态化测量以及媒体多任务行为积极影响的研究。     

The image schema and innate archetypes: theoretical and clinical implications

Based in contemporary neuroscience, Jean Knox's 2004 JAP paper ‘From archetypes to reflective function’ honed her position on image schemas, thereby introducing a model for archetypes which sees them as ‘reliably repeated early developmental achievements’ and not as genetically inherited, innate psychic structures. The image schema model is used to illustrate how the analyst worked with a patient who began life as an unwanted pregnancy, was adopted at birth and as an adult experienced profound synchronicities, paranormal/telepathic phenomena and visions. The classical approach to such phenomena would see the intense affectivity arising out of a ruptured symbiotic mother‐infant relationship constellating certain archetypes which set up the patient's visions. This view is contrasted with Knox's model which sees the archetype an sich as a developmentally produced image schema underpinning the emergence of later imagery. The patient's visions can then be understood to arise from his psychoid body memory related to his traumatic conception and birth. The contemporary neuroscience which supports this view is outlined and a subsequent image schema explanation is presented. Clinically, the case material suggests that a pre‐birth perspective needs to be explored in all analytic work. Other implications of Knox's image schema model are summarized.     

Wendy's Story: analytic perspectives on J. M. Barrie's Peter and Wendy

This essay is a study of Peter and Wendy, J. M. Barrie's 1911 novel based on his 1904 play Peter Pan. Utilizing Jungian and Kleinian theory, the tale is treated as an expression of Wendy's psyche in transformation, tracking her passage into puberty and the transition from omnipotent narcissism towards depressive concern which accompanied her differentiation from idealized identification with her mother. The resultant changes in Wendy's parental imagos are given particular emphasis, especially the moves towards the integration of her split paternal imago, symbolized by Peter Pan and Captain Hook. This enables Wendy's fuller engagement with the Oedipus situation, resulting in her assimilation of unconscious aspects of the instinctual feminine. In turn, she opens to a conception of parental intercourse which is more reality orientated and allows an internal sense of coupledom vital for her own capacity to form adult relationships.