Reality as Trauma

Trauma is usually understood as reaction to an exceptional disorganizing event. Instead, it can be recognized as the underlying fabric of everyday experience, entailing reality’s fundamental unpredictability, constant change, and the inevitable erosions wrought by sickness, aging, and death. This paper draws on Ferenczi’s psychoanalytic thinking to develop this view of reality as trauma, and to suggest a shift in interpersonal self-regard as central to psychoanalytic change.     

Virtual Reality as a Selfobject Function: Towards Reclaiming Unlived Potentialities

ABSTRACT

In this article, I illustrate how virtual reality may promote reclaiming unlived potentialities, unconscious or disavowed. Using Kohut’s concept of the Virtual Self, I suggest that virtual aspects of the self, its potential capability, are unconscious (or unknown) until met by someone or something that promotes their transformation into a conscious state of mind and supports their realization. In this sense, the virtual experiences of the self are drawn from the preconscious. Three vignettes demonstrate the transformative potential of virtual experiences when they are perceived as recognizing, and responsive to, the Self’s needs. Two vignettes are drawn from ancient myths and illuminate how the virtual zone has inspired transformation and expansion of self awareness already in ancient times. A third vignette is presented to illustrate how, at the advent of social media, disavowed and dissociated needs are channeled into cyberspace as communications that are unconsciously geared to reclaim unlived potentialities. Cyber reality converses with conventional reality and, thus, is appreciated as a mode of psychic advance toward a new kind of self consciousness.     

Sham surgery: an ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Sham surgery: An ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Reality Testing and Testing Reality in Group TreatmentPart I: Reality and Reality Testing

This two-part contribution addresses reality, reality testing, and testing reality—how we think about and may technically approach these concepts. Part I provides a topic overview and focuses on reality testing. Part II (in an upcoming issue) focuses on testing reality and how it promotes emergence of new or previously inhibited forms of engagement.

Reality testing and testing reality represent two fundamental, reciprocal manifestations of the drive to know and of tasks of learning: approaching problems and solving them. While testing reality involves approaching reality without necessarily looking for or coming to definition or clarity, reality testing centers on a particular theme or object. It evolves towards organization and rationality, with a goal to define and solve problems—or to avoid them.

Engaging the group and supporting individuals in these two types of approaches to learning requires a well-defined therapeutic focus on process and purpose; at times, different tactics and techniques are appropriate.     

When Possibility Informs Reality: Counterfactual Thinking as a Cue to Causality

People often engage in counterfactual thinking, that is, imagining alternatives to the real world and mentally playing out the consequences. Yet the counterfactuals people tend to imagine are a small subset of those that could possibly be imagined. There is some debate as to the relation between counterfactual thinking and causal beliefs. Some researchers argue that counterfactual thinking is the key to causal judgments; current research suggests, however, that the relation is rather complex. When people think about counterfactuals, they focus on ways to prevent bad or uncommon outcomes; when people think about causes, they focus on things that covary with outcomes. Counterfactual thinking may affect causality judgments by changing beliefs about the probabilities of possible alternatives to what actually happened, thereby changing beliefs as to whether a cause and effect actually covary. The way in which counterfactual thinking affects causal attributions may have practical consequences for mental health and the legal system.     

Psychiatric Diagnosis as a Function of Assessor Profession and Sex

Diagnostic impressions formed by 26 clinicians after intake interviews with 200 randomly assigned outpatients at a community mental health center were analyzed by assessor discipline and sex and by patient sex and age level. Professional status was positively related to diagnostic severity among male assessors—nurses, social workers, psychologists, and psychiatrists made increasingly higher proportions of psychotic diagnoses. Female therapists were less likely than their male counterparts to render psychotic diagnoses. This finding was most robust for doctoral interviewers, especially psychologists, and for patients who were female or under 30. Results are discussed in relation to the need for a model of the diagnostic process that allows for the role of practitioner attributes. Previous largely negative findings may have had their source in the failure of contrived analogue procedures to evoke emotions in the rater comparable in intensity to those aroused in the real-life encounter.     

虚拟与"虚拟实在"

"虚拟"是这个时代的热门词,也是当下文化的关键词.在三亿多的网民中,很多人见面时的问候语从"吃过没有"变为"魔兽了吗"抑或"摘菜了没有",网络虚拟生活已经成为国人乃至世人一种必不可少的生活方式.二十年前美国学者迈克海姆写过一本关于虚拟实在的书,大约十年前引入国内,引发了国内学者关于"虚拟实在"的研究和讨论.但由于当时国内的信息技术尚未普及,网民数量稀少,所以他的书和这场讨论未能引起社会轰动并深入持久下去.如今恰逢读网时代,我们重拾"虚拟实在",重新探讨它的形而上以及与"虚拟"的区别与联系,因为它是我们在谈及当下文化时绝不能回避和忽略的问题.     

Making the Parents as Partners Principle a Reality: The Role of the Alliance

We explore the dimensions of the Parents as Partners principle, the widely touted, but somewhat elusive construct in the literature on treating children with serious mental illness, whose poorly defined boundaries, lack of empirical grounding, and overemphasis on instrumental dimensions attenuates its usefulness as a guide for practice and research. Four major barriers to the realization of this principle are outlined, all of which may impede actualizing partnership in practice and may also inhibit the early formation of a positive clinician/parent alliance, a neglected, though key dimension of true partnership practice. The alliance, which has a long clinical and research history in psychotherapy and behavioral research, and more recently, in a variety of community-based interventions, is a precursor to active client partnership with helpers and to treatment participation, as well as therapeutic in its own right. After reviewing relevant alliance research, we close with a beginning research agenda to incorporate the alliance as an integral component of future conceptualization and research about the Parents as Partners principle.     

Diagnosis as Part of a Large Social Emotional System

This article examines the diagnosis of mental illness as part of a process that can be more clearly understood if envisioned as part of a larger system that goes on in most social encounters. These encounters can go in three directions: Labeling, Enabling, and Normalization. Labeling is equivalent to stigmatization, the awarding of a shameful status. Enabling awards a prideful status: “There is nothing wrong with you.” Normalization takes a middle ground: you have a problem, but it's not shameful. These ideas are discussed as depicted in the film Lars and the Real Girl (2007). The film teaches a powerful lesson: how a community might manage mental illness without the social side-effects.     

Reality Testing and Testing Reality in Group Treatment

This two-part contribution addresses concepts of “reality,” “reality testing,” and “testing reality,” as they apply to group treatment. Part I provided topic overview and focused on reality testing. Part II focuses on testing reality and how it promotes emergence of new or previously inhibited forms of engagement.

Whereas reality testing centers on a particular theme or object, with a goal to define and solve problems, testing reality involves approaching targets of interest without necessarily looking for or coming to definition or clarity. It is wide open, spontaneous, and unbounded, and may take the individual and group into realms that are uncomfortable and even unwanted. Engaging the group and supporting individuals in these two approaches to learning requires a well-defined therapeutic focus on process and purpose; at times, different tactics and techniques are called for.