A perinatal ethics committee on abortion: process and outcome in thirty-one cases.

The US Supreme Court's June 1992 decision to uphold most of Pennsylvania's law restricting access to abortion confirms that while abortion is still permitted in the US, it is being increasingly regulated. Individual institutions may, however, find ways to permit access to abortion. One hospital formed a mandatory, prospective perinatal ethics committee (PEC) in May 1987 to develop clinical guidelines with which to consider and decide requests by physicians for their patients seeking abortions. The authors obtained the consent of this PEC to study its membership, processes, case outcomes, and clinical decision making. Understanding PEC processes and outcomes may help other institutions to decide whether to institute similar mechanisms. Specifically, the investigators determined the backgrounds and abortion-related beliefs of PEC members and obstetric and gynecology department members, whether the PEC affects the number of abortions performed, how PEC members decide in individual cases, and whether requesting physicians find the PEC helpful. All eleven PEC members and 58 of the 65 medical staff ob/gyn physicians returned background surveys. Study results are presented. Overall, the PEC appeared to function as an affirming regulatory body for second-trimester, medically-indicated terminations and for certain personal choice terminations. Institutional interests were well-served by the PEC and with the assurance of informed consent, the interests of some patients were also well served.     

Public Bodies, Private Selves

ABSTRACT A patient whose case notes had been used, without her permission, during a disciplinary inquiry on the conduct of Wendy Savage (her obstetrician) complained that this was a breach of confidentiality. Her complaint cannot be understood as based on a concern about the possible adverse consequences of this use of the notes: rather, her concern was just with the fact that medical information about her had been made known to others.
My concern is with the meaning and status of the right to privacy, to which the Savage patient appealed. Such a right cannot be reduced to a property right, since this cannot capture what concerned the Savage patient. A proper understanding of what lies behind her complaint requires us to recognise the way in which facts about oneself—in this case facts about one's body—are intimately bound up with one's self, with one's identity, and thus with one's autonomy. What kinds of fact, and thus what conception of the self, are involved in such a conception of privacy need not everywhere be the same; the crucial point is that privacy and the self are concepts which, whatever their particular content, are internally related [1].     

Cognitive-behavioural treatment for tinnitus: A difficult case

Abstract

Tinnitus is a commonly seen and difficult to cure symptom of ear disease. This case study describes an example of cognitive-behavioural treatment for tinnitus. The patient was a 66-year-old woman with prior medical and psychiatric history. Cognitive-behavioural assessment revealed that her thoughts about the cause of her tinnitus made her focus on it and experience annoyance. The aim of treatment was to decrease the annoyance associated with the tinnitus and consisted of applied relaxation and cognitive distraction techniques. Daily registrations of tinnitus distress and annoyance, and general well-being were collected at pretreatment, mid-treatment and post-treatment on visual analogue scales. No clear effects were found on these measures, although loudness showed a slight tendency to decrease. The patient also completed a questionnaire at pretreatment and post-treatment on which no benefits were found. Verbal report and an in-session behavioural test showed positive effects of treatment, but were not mirrored in the self-reported results. The importance of reporting treatment failures is emphasized.     

我究竟该听谁的?——一例恋爱冲突的案例报告

本例是由父母与男友就恋爱问题的不一致意见导致来访者不知道如何选择而引发的一般心理问题。咨询师通过倾听、理解、共情等技术与求助者建立了良好的咨询关系,在此基础上进一步了解来访者的基本情况和相关资料,共同找出问题关键点在于各种交往关系中习惯于迎合别人,而忽视了自己内心感受。通过运用认知疗法进行咨询,引导来访者认识到在恋爱问题上,自己心里的想法和决定最重要,同时也让其认识到自己有这个能力对恋爱问题作出合适的选择。     

Supportive psychotherapy of a psychodynamic orientation as an adjunctive treatment for drug-induced depression: A case study

Abstract

Treatment for drug-induced depression usually consists of cessation or reduction of the causative agent and psychopharmacologic management. In addition, psychotherapy can be useful as an adjunctive treatment. The author presents case material related to a young woman with an inborn physical illness, who became depressed during the course of interferon treatment for a medical complication, hepatitis virus infection. In addition to the cessation of interferon and pharmacologic management, supportive psychotherapy of a psychodynamic orientation was started in order to address the patient’s low self-esteem and anxiety about her future. During the course of psychotherapy, it was understood that the premature cessation of interferon was, to her, a narcissistic injury. It was also important to explore the meanings of her inborn illness and her guilty feelings. After reviewing various formulations of depression, the author discusses the case material from an integrative perspective, which describes vicious cycles of depression.     

The early appearance and intergenerational transmission of maternal traumatic experiences in the context of mother-infant interaction

The paper describes the case of a girl of 8 weeks, referred by her mother because of 'intolerable hysterical attacks' triggering maternal impulses of abuse. Maternal perception of her infant was distorted to the extent that the mother was re-experiencing encounters with her own intrusive and traumatizing mother in the face of her screaming child. She also perceived the infant's motor impulses as physical attacks on herself and expressed intense anxieties about her daughter's future aggressive potential. The infant was viewed by her mother as extraordinarily and dangerously greedy. Even neutral infantile vocalizations were perceived as manipulating and sadistic. She tried to ward off these anxieties by employing a rigid scheme of rules and obsessively controlling the father's and grandmother's interaction with the child. The mother feared being overwhelmed by the infant's needs if she were to yield to them in a flexible way. The mother's background of early neglect and trauma is described, in the light of recent literature about the early intergenerational transmission of traumatic experiences, in order to demonstrate possible treatment modalities and the need to consider both protective and risk factors.     

Experiencing double-bind conflict: A semantic differential assessment of interaction perceptions

Four interaction-perception perspectives of the fictitious target of a double-bind conflict were provided by four groups of subjects. The perspectives included perceptions of a daughter about herself and her father (the double-bind source), and her estimates of his perceptions of both himself and her. As predicted, the target saw herself as weak but “good”, and as cooperative and highly frustrated, while attributing all the opposite characteristics to the source, who was seen as strong but “bad”, and uncooperative and not frustrated. Further, it was found that she believed he saw himself as strong and very good, but frustrated and moderately cooperative. These observations are consistent with a hypothesis that double-bind experiences result in frustration and mixed feelings toward one's self and the source of the dilemma. It was also concluded that the target's belief that her father would not recognize her weakness, nor her cooperativeness, nor her frustration, and would disinterestedly evaluate her as neither good nor bad resulted from the inconsistent and contradictory communications which had contributed to the double bind.     

Response to “Poison Cookies” Discussions

This is a response to the discussions of the case presented by this author. Responding to the discussions has allowed the author to pull together her own ideas about the case as well as about the work we do. The author sees Sheldon (Shelly) Bach's view of sadomasochism as a particular type of object relationship as informing her own point of view. Next comes a discussion centering on Steven (Steve) H. Knoblauch's emphasizing the importance of the internal symbolic world of the patient. The author makes the point that understanding the level of differentiation of the internal objects in the patient's representational world is important in thinking about the types and timing of interventions the analyst makes; for example, those which Mary-Joan Gerson describes in her comments. Finally, the author addresses Sue Grand's response, especially her emphasis on the importance of siblings in our patients’ histories and the resulting sibling transferences to the analyst.     

一例中学生转学适应问题咨询案例报告

本文对一中学生由于转学导致的心理问题的案例进行了详细报告,来访者的主要问题为生活事件引起的心理压力导致焦虑等情绪产生。在该案例的咨询过程中,主要通过排解负性情绪、纠正认知偏差等过程让来访者的心理问题得到解决,同时,通过咨询使来访者的个性得到完善和发展。     

Child abuse and neglect by parents with disabilities: A tale of two families

Two families, in which the children had been placed in foster care due to abuse and neglect by parents who had disabilities, were studied. In the first case, the mother was instructed in skills that our assessment suggested were important for her child's survival. The mother readily acquired and applied these skills, a fact reflected both in changes in her behavior and in changes in the child's well-being. In the second case, the parent's incremental resumption of child custody was made contingent upon completion of relevant parenting tasks. Initially, improvements in the completion of such tasks were evident, but over time and with the onset of militating factors, no further progress was made and all parental rights were terminated. The implications of these cases for behavior analysis and the effort to reunite and preserve families are discussed.     

A further footnote to Freud's "fragment of an analysis of a case of hysteria".

While ther is no evidence that Freud ever had in analysis a leading political figure, he did analyze the sister of one, and made her the basis of an important case study. Dora's brother, Otto Bauer, was an influential Marxist theoretician and leader of the Austrian Socialist Party from 1918 to 1934. Freud's Dora case illuminates the psychodynamics of Otto Bauer's life and career, and a re-examination of the case together with recent research also provides us with new information about Freud's analysis of Dora and the milieu in which they both lived.     

Sally Beauchamp's career: a psychoarchaeological key to Morton Prince's classic case of multiple personality

By the methods of psychoarchaeology, the identity of Sally Beauchamp, Morton Prince's classic case of multiple personality, has been established. The reconstructed life history has for the first time revealed the roots of the dissociative process. This goal was actually obscured by the tangled web of Prince's rambling 1906 book and his other publications on the case. The determinative events included two instances of sudden infant death during the childhood period of the patient, the earlier of which was apparently never even known to Dr. Prince. Though not mentioned in the patient's autobiography, it probably induced the initial dissociation to defend the integration of the personality. The relevance of the new concept of SIDS (since 1969) is considered. Other disturbing influences were the constant rejection of the patient by her mother, who died at an early age, and probable severe abuse by the widowed father which led her to run away from home (permanently) at age 16. Nine years afterward, therapy with Dr. Prince began and lasted seven years. It is suggested that this case and the parallel one of Breuer and Freud (Anna O.) be comparatively reexamined from the standpoint of modern feminism. The role of the conventional 19th-century woman was not acceptable to either of them, and both probably had an unusually large innate, bisexual endowment. Endogenous conflict, intensified by social demands, produced dissociation as a pseudo-solution until, through opportune therapy and other environmental opportunities, each was able to achieve a productive modus vivendi. The relation of bisexuality to the etiology of personality dissociation in general is considered. An incidental but instructive discovery made in the course of the Prince research was an unknown letter from William James to Morton Prince about The Dissociation of a Personality. This find points up the fact that James's final metaphysic was a form of pluralistic panpsychism derived from both psychical research and the contemporary knowledge about dissociated personality. James postulated a cosmic multiple personality.     

Dreaming of freud: Ferenczi,freud, and an analysis without end

The beginning of this paper documents Sigmund Freud's pre-psychoanalytic experience as a ‘first hand’ observer of childhood behavior both professionally and as the patriarch of a large extended family in Vienna. During 1898, Freud was in the midst of an intensive correspondence with Wilhelm Fliess – his most trusted confidant, mentor and colleague – when he wrote, in part, about his sister Marie whose family was relocating in Berlin. She was apparently about to consult Fliess as her prospective physician. During the process, Freud voiced psychological assessments not only about his sister; but, also about her husband and their three daughters. The youngest among them was a 5-year old whom he characterized as “a rather gifted child, severely [hysterical]” (bracketed word in quotation juxtaposed for clarity).

Eleven years later, Freud wrote a case study about a 5-year old boy whose pseudonym, for publication purposes, was Little Hans. The life of Little Hans (as well as the lives of his parents) has been thoroughly examined and we now know something about how he matured as an adult. In a contrasting context, less is known about the ‘psychological trajectory’ of Freud's 5-year old niece who also distinguished herself in certain respects as she matured during her abbreviated later life. She remained the subject of documentable correspondence mailed to him by his youngest daughter Anna as well as foreboding prospects articulated in a letter he subsequently wrote to an English nephew.     

A Quantitative Case Study of Longitudinal Changes in Identity, Intimacy, and Generativity

A quantitative case study of one woman's development was conducted in order to explore psychosocial change in early adulthood. A contentanalytic coding system for identity, intimacy, and generativity themes derived from E. H. Erikson's writing was applied to letters and diaries of the British writer Vera Brittain written when she was 20 to 21 and 30 to 31 years old. Over time, Brittain used more intimacy and generativity themes and fewer identity themes. Even though Brittain used fewer total identity themes in her writing in her early 30s, her use of one identity subcategory—occupational role—increased in frequency, and the way in which she expressed her identity concerns indicated greater certainty about her identity.     

In search of gender bias in evaluations and trait inferences: The role of diagnosticity and gender stereotypicality of behavioral information

Meta-analytic reviews indicate that the gender of a target person has a significant but small impact on evaluators' judgments about this person. The present study examines the extent to which this small effect reflects evaluators' tendencies not to use an evaluatee's gender because they assume that case information about a target is more informative about his or her abilities, knowledge, and traits than is gender. The first study indicates that decreasing the diagnosticity of case information does not increase the tendency for people to be influenced by the target's gender. However, the first and second study illustrate that despite the weak influence of the target's gender, subjects are still using gender stereotypes when making social judgments about the evaluatee. This is evidenced by the impact of the stereotypicality of the case information. This is most clearly seen in Study 2, which illustrates how components of gender stereotypes are influencing judgments.Portions of this research were supported by a University of Minnesota Dissertation Grant. Thanks go to Gail Swenson, Rose Enriques, and Wayne Bylsma for their assistance in the data collection, to my committee members Eugene Borgida (Chairperson), Marti Gonzales, Mark Snyder, Geoffrey Maruyama, Barbara Loken for their suggestions on the first study, and to Cindy Thomsen and Eugene Borgida for their support, encouragement, and consultations.     

Should a school honor a student's DNR order? A lawyer responds: a student's right to forgo CPR.

...Instead of and certainly before advising the school or S.A. to go into court, I would urge them to try to resolve the question where it arises -- in the classroom, not the courtroom. And I would ask school officials to try to place themselves in S.A.'s shoes, and to imagine how she feels about her situation; and to ask themselves how they will feel if they administer CPR against her and her parents' wishes. Is there no way that they can do more than nothing, but less than CPR? Which image would we prefer to attach to S.A.'s case, that of some lawyers giving a press conference on the courthouse steps or of a story about a school that made it possible for one of its students to spend her precious time with her friends, classmates, and teachers, as they learn together that death does not need to separate the living from the dying?     

Learning from the patient: The East,synchronicity and transference in the history of an unknown case of C.G. Jung

This article presents the history of one until now unknown case of C.G. Jung: Maggy Reichstein. Born in Indonesia in 1894 in a very aristocratic family, she brought her sister to Zurich to be treated by Jung in 1919, and later she herself was in analysis with him. Jung used her case as example in his lecture in 1937 on the realities of practical psychotherapy, relating it to the process of transference and countertransference. Jung deepened his studies in Eastern psychology after a series of dreams she had, which culminated in the Yoga Kundalini Seminars. She was also the case presented in his article of 1951 on the concept of synchronicity. Jung wrote that her case, concerning synchronicity, remained unique in his experience. Jung also published some of her mandalas. He considered her able to understand his ideas in depth. Reichstein was for Jung an important case, which challenged and triggered his interests in different subjects.     

Mad Scientist: The Unique Case of a Published Delusion

In 1951, entomologist Jay Traver published in the Proceedings of the Entomological Society of Washington her personal experiences with a mite infestation of her scalp that resisted all treatment and was undetectable to anyone other than herself. Traver is recognized as having suffered from Delusory Parasitosis: her paper shows her to be a textbook case of the condition. The Traver paper is unique in the scientific literature in that its conclusions may be based on data that was unconsciously fabricated by the author’s mind. The paper may merit retraction on the grounds of error or even scientific misconduct “by reason of insanity,” but such a retraction raises the issue of discrimination against the mentally ill. This article asks what responsibilities journals have when faced with delusions disguised as science, what right editors have to question the sanity of an author, and what should be done about the Traver paper itself. By placing higher emphasis on article content than author identity, scientific integrity is maintained and a balance is struck between avoiding discrimination against the mentally ill and not preventing patients from seeking needed treatment.     

A Witness Breaks His Silence: The Meaning of a Therapist's Response to an Adolescent's Self-Destruction

I describe the case of a self-mutilating adolescent girl and my dilemma, as her therapist, about telling her parents about her self-abuse. I use two complementary, mutually enhancing relational theories of trauma—Ferenczi's (1933) and Davies and Frawley's (1994)—to help understand the minefield I was in. Davies and Frawley describe certain relational configurations that are typical of trauma victims. I believe that it is not only unavoidable but therapeutically vital for therapists to participate in these configurations so they can know the patient's experience in a personal way. It is also crucial that they be witnesses who provide recognition for the patient's pain and, in so doing, relieve the intolerable feeling of isolation that Ferenczi proposed was the most basic trauma. In addition, I discuss the observation that some people who have not been previously traumatized in any gross way manifest characteristics of trauma.     

The influence of ethnicity,social class,and context on judgments about U.S. women

In 2 studies, the authors investigated impression formation as influenced by category-based stereotypes associated with ethnicity and social class. The participants in Study I made judgments about 1 target woman, described as interested in running for office in the Parent Teacher Organization (PTO) of her children's school. The hypothetical woman was presented to the respondents along with her photograph and information about her ethnic background (Anglo-Saxon, Latina, or Jewish) and occupation (middle class or working class). In Study 2, the authors changed the context and presented a younger target woman (also varied by ethnicity and social class) to the respondents as the new girlfriend of their older brother or cousin. In both studies, judgments were assessed by the participants' responses to 45 bipolar adjectives that, in each case, yielded 8 component factors. In both hypothetical contexts, social class was a powerful trigger for a variety of negative expectations: With respect to ethnicity, the Latina women were judged to be more unsuitable for the job of PTO vice president than were the Anglo-Saxon or Jewish women. The authors discussed potential psychological and social consequences of such category-based judgments.