Parental responses to competence and trauma in infants with reproductive casualty

This study of 31 infants in neonatal intensive care and their parents examined the relationship involving infant characteristics (medical and behavioral), parent characteristics (personality and situational variables), and the development of parental attachment. As expected, infants who were more visually competent had mothers who were more attentive. Contrary to expectation, greater prematurity was related to greater parental involvement. There were important differences in maternal and paternal responses, with mothers using more denial to cope with the medical crisis. Parents who relied heavily on denial were found to have impaired attachment.This study is based on a M. A. thesis submitted to Michigan State University by the first author under the direction of the second author. The authors are grateful for the support and assistance of Thomas Helmrath, M. D., Elizabeth Seagull, Ph.D., Dess Johnson, M.S. W., and the staff of the Regional Neonatal Intensive Care Unit at E. W. Sparrow Hospital.     

Luther's Trinitarian Hermeneutic and the Old Testament

In this study, the author shows that Luther's trinitarian understanding is shaped by the royal Psalms' dialogical model as well as informed by a hermeneutics that moors a trinitarian semantics in the Hebrew text of the Old Testament. The analysis concentrates on Luther's translation into German of two Hebrew names for God and of passages classically associated with the trinitarian doctrine (Psalm 110:1; Psalm 2:2.12). The result is a trinitarian structure of transparency. The text's syntax, narrative and direct speech mirror literally the transparency of the divine essence through the distinguishing characteristics of each trinitarian person.     

Luther’s Trinitarian Hermeneutic and the Old Testament

In this study, the author shows that Luther’s trinitarian understanding is shaped by the royal Psalms’ dialogical model as well as informed by a hermeneutics that moors a trinitarian semantics in the Hebrew text of the Old Testament. The analysis concentrates on Luther’s translation into German of two Hebrew names for God and of passages classically associated with the trinitarian doctrine (Psalm 110:1; Psalm 2:2.12). The result is a trinitarian structure of transparency. The text’s syntax, narrative and direct speech mirror literally the transparency of the divine essence through the distinguishing characteristics of each trinitarian person.     

Working with Bangladeshi young women

The author describes once-weekly psychoanalytically informed work in a child mental health setting with young Bangladeshi women making the transition to adulthood. She argues that the prevalent notion of 'culture conflict' used to account for patterns of emotional disturbance and self-harm in these young women is reductionist and represents a denial of severe family dysfunction and individual psychic pain. She shows how, despite cultural differences, psychoanalytically informed thinking can provide a basis for understanding these young women's experience and facilitate their emotional growth. However, faced with complex unconscious processes, the worker has to remain alert to her countertransference in order not to be drawn into an unhelpful collusion or denial of reality. Organizational defences may also operate to protect staff and their institutions from awareness of such high levels of emotional distress, which therefore remain hidden. The author is grateful to the two young women who consented to publication in the hope that it might help others. Details have been changed to protect their anonymity.     

Parallels between depression and lament

This article compares the experiences portrayed by the psalmists in Psalm 31 and Psalm 102, both psalms of lament, with the current concept of major depression. It concludes by exploring how the insights of the psalms may be applied in pastoral care directed toward those who suffer from depression.     

Mental health consultation in infant day care: A new frontier of prevention

This paper deals with the mental health aspects of infant day care emphasizing that mental health input into the design, implementation and ongoing supervision/evaluation of the majority of day care programs is minimal at the present time. The author proposes the following three criteria by which the adequacy of mental health input in a day care program could be judged: 1) ongoing mental health consultation to the caregiver staff on a weekly basis and by the same clinician(s), 2) assignment of primary caregivers to the infants, 3) periodic naturalistic observations of the infants to be recorded and discussed by the caregivers. The author postulates that consultation to the caregiver staff of infant day care programs represents the opportunity to establish a new frontier of prevention. Therefore, the mental health profession should consider it a goal that every infant day care setting would have a mental health clinician as a consultant. The methods, preventive functions and manpower aspects of such consultation work is discussed.     

Addiction and Self‐Deception: A Method for Self‐Control?

Neil Levy argues that while addicts who believe they are not addicts are self‐deceived, addicts who believe they are addicts are just as self‐deceived. Such persons accept a false belief that their addictive behaviour involves a loss of control. This paper examines two implications of Levy's discussion: that accurate self‐knowledge may be particularly difficult for addicts; and that an addict's self‐deceived belief that they cannot control themselves may aid their attempts at self‐control. I argue that the self‐deceived beliefs of addicts in denial and of self‐described addicts differ in kind. Unlike the self‐deception of an addict in denial, that of the self‐described addict allows them to acknowledge their behaviour. As such, it may aid an addict to develop more self‐control. A paradoxical implication is that this self‐deception may allow an addict more self‐knowledge.     

Indirect majority and minority influence: An exploratory study

In a 2 × 2 design, 85 subjects were asked to estimate the size of angles (direct influence) that were either 90 or 85°, after being confronted with incorrect judgements of a majority (88 per cent) or a minority (12 per cent) of people estimating the angles at 50°. Additionally, pre- and post-test measures were used to establish indirect influence on subjects' judgements pertaining to acute angles (i.e. on the estimation of the length of lines constituting the angles, and on the imaginary weight of figures represented by these angles). Overall, little direct influence is observed. This may partly be due to the introduction of a denial of the credibility of the source in all conditions. In fact, some evidence of direct influence is only found in the majority–85° angles condition. An instance of indirect influence (on the estimation of length of lines) appeared as the result of a majority stance when the angles in the experimental phase were 90°. When these angles were 85°, indirect minority influence (on the estimation of weight of figures) was observed. These effects had been predicted on the basis of the hypothesis stating that indirect majority influence would be possible when subjects expected consensus on the correct response (in the 90° angles condition), without being able to reach consensus at the manifest level (because of the denial and the restriction imposed by the clear shape of 90° angles). Indirect minority influence was hypothesized to be stronger in a situation that allows for diverse responses (i.e. for 85° angles).     

Verführung in der Gegenübertragung

The author presents a counter-transferential dream of the director of a flat sharing community for mentally disabled persons. On the one side she realizes hereby a tension between the performances which have to be presented for external quality assurance and the “work which is not to be seen”, i.e. the coping with emotions and phantasies of the caring staff. On the other side she discovers, motivated by Freud, Morgenthaler and most of all by Elisabeth Lenk, in this dream a mimetic (ecstatic, sexual) dimension which may become a threat for the coherence of the subject. An attempt at interpretation leads to the extremes of exhibitionism and voyeurism as they are activated in the care work. Institutions produce their own counter-transferences steeped in the phantasms prevailing in these institutions (here: mental disability). In the counter-transference dream analyzed here the author discovers elements of the primal scene and examines the relevance of the associated phantasies in the constitution of the subject of the caring staff, of the cared-for persons and of the author herself.     

Sense of reality,reality testing and reality processing in borderline patients1

Although borderline patients are suitable for it, they often undergo repeated testing of phantasies against objective reality without success. A reason for these partial failures is that subjects have not been able to build a solid sense of reality and have found many diffi culties for processing reality demands and possibilities. The author puts forward some thoughts on this question, such as the importance of working through the depressive position and the Oedipus complex in the process of building up a solid sense of reality. A sense of reality also favours continuous reality processing. When reality processing becomes as continuous as life itself, the repetition of individual reality tests becomes less frequent and necessary, and more satisfying. The author also presents some recommendations for the psychoanalytic treatment of such patients, stressing the importance and the diffi culties of the introduction of the borderline patient into the triangular situation because primitive defences‐such as disavowal and denial‐are mobilized.     

The psychologist as admitting clinician. A single case example

An experiential view of significant issues associated with independent hospital practice for psychologists is offered through a case presentation. The example is a model of practice in effect at a 90-bed, free-standing, inpatient facility opened in 1985, that gives psychologists full professional staff privileges.     

Theory and Method of Marriage Therapy in Contemporary Africa

This paper describes the theory and practice of marriage therapy in use by the author in his marital therapy process across two regions of Africa. The approach is grounded on an inclusive theoretical perspective inspired by the notion of the basic virtues of a healthy marriage as understood in Africa, and the place of the role theory approach in intervening between opposing parties. The theme developed is that a viable contemporary African marriage therapy practice is derivable from this indigenous model. The major discussion highlights the key guiding orientations and processes in implementing such a practice. A comparative view of the Euro-American emphasis in couple therapy is presented as a background for identifying the difference between the Western and the African perspectives.An initial version of the paper was presented as a Guest Lecture to the members of Staff and Graduate Students of the School of Psychology of the University of KwaZulu-Natal, in Durban, South Africa. The author is grateful to Prof. Inge Petersen and her team of staff of the school for their invitation and encouragement.     

Medical Disaster: Why Ken Mattingly Can’t Have Measles in <Emphasis Type="Italic">Apollo 13</Emphasis>

The film Apollo 13 depicts denial of illness and refusal of health care as key components of American masculinity. In the film, male astronauts and mission controllers deny vulnerability to measles and to urinary infections, as well as the need to sleep, to prove their manliness. This is symbolized by their ridicule of flight surgeon Dr. Chuck. Conversely, the astronauts’ wives are depicted admitting vulnerability, especially insomnia. Thus, the film exploits and reinforces existing strands of American culture that view admission of illness and help-seeking as appropriate for women but not men, reinforcing denial and noncompliance as desirable male behaviors.     

Integrating the ivory tower and the treatment institution

Although the application of psychoanalysis to the clinical understanding of, and work with, psychotic and personality disordered patients has developed significantly over many years now, the presence of such an approach alongside other treatment modalities in many treatment settings can often be poor and sometimes absent. This in part reflects the complexity of developing both theoretical understanding and clinical technique in relation to these patients and in many settings a combination of interventions might well be the treatment programme of choice. In this paper, the author puts forward a view that in relation to recent developments in contemporary mental health services, specifically in the provision of care and treatment for forensic and anti-social personality disordered patients and offenders, the application of psychoanalysis might have a particularly important role to play. The experiences of staff working with patients and offenders who project their unprocessed internal anxieties and conflicts into the external environment can often be difficult and disturbing. The author argues that this dynamic needs to be understood as a representation of the patient's unmanageable internal world and, as such, careful attention has to be paid to this sometimes toxic impact on staff groups and care institutions. He argues that an application of psychoanalytic principles has a unique role in this reflective task which should be seen as a necessary and crucial part of the treatment process.     

Suicidology: A Look Backward and Ahead

Using the metaphor of “a long run’ to describe our progress in suicidology, the author looks back to discuss important concepts that have become well established, such as clues to suicide, ambivalence, crisis services, suicide consultations, and psychological autopsies. An example is the psychological autopsy of Marilyn Monroe. Follow-up studies of crisis center clients have indicated that chronically suicidal clients are at the greatest risk of suicide. Recommendations for the long-term treatment of such patients are provided. Research on youth suicide is reported. Finally, the author looks ahead toward new developments in training and treatment.     

Dementia and Suffering in Nursing Homes

SUMMARY

This paper uses case studies of challenging behaviour associated with dementia to demonstrate, firstly, that disturbed behaviour is often a manifestation of suffering caused by multiple phenomena such as medical problems or the care environment. Addressing these causes instead of simplistically ‘treating the behaviour’ usually reduces the behaviour. Secondly, staff distress with a particular difficult resident is often caused by more general fundamental problems such as a lack of support or knowledge. Addressing these problems reduces staff distress. Finally, results from a Swedish intervention study are presented. They show that suffering for both staff and residents can be reduced, and quality of life improved, by providing increased autonomy for hands-on staff, systematic emotional support, and collaboratively developing care plans based on each resident's emotional and physical needs, rather than the problems they present.