Bipolarity, monopolarity and "dichotomous functional decay" as principles of differential diagnosis and "functional pathology" of endogenous psychoses

On the basis of Leonhard's Classification of the endogenous psychoses an attempt is made to trace the phenomenology of the monopolar and bipolar affective psychoses as well as Leonhard's "unsystematic schizophrenias" to three different functional anomalies. The differential diagnosis between the "cycloid psychoses" and the "unsystematic schizophrenias" as well as the problem of the so-called schizoaffective psychoses connected with them, is of particular interest. The arrangement to "functional areas" seems to be suitable.     

The revival of "Dora": advances in psychoanalytic theory and technique

For nearly six decades after its publication in 1905, Freud's remarkable case of Dora remained untouched by critical comment. However, beginning in the early 1970's, an abundance of articles began to appear, which focused exclusively on the Dora case. The present paper reviews the literature of this so-called "Dora revival" in order to explain the historical and theoretical reasons leading to this extraordinary burst of research. Above all, two vital developments in the psychoanalytic discipline created the climate that fostered the Dora revival. First, there was a revolutionary change in attitude toward the phenomenon of countertransference: in contrast to the classical view of countertransference as a disruptive interference in treatment, analysts increasingly regarded countertransference as a pervasive and natural process, which could be potentially utilized to enhance understanding of the patient's unconscious conflicts and defenses. Second, there was enormous and rapid growth of a comprehensive psychoanalytic theory of adolescence and its treatment. Thus, based on a more favorable attitude toward countertransference, and a much improved understanding of the unique problems of adolescence, psychoanalysts could reexamine and better understand the decisive events that contributed to Freud's abortive analytic treatment of Dora.     

"Enmeshment" and "Fusion"

The paper examines two related concepts utilized by two different schools of family therapy. Any family seen to be "enmeshed" is also seen as "fused," and vice versa. The difference in the level of focus, on the "system containing the individuals" (structural) or the "individual in the system" (fusion), determines the difference in therapeutic approach of these two schools.     

Detrimental therapist-client relationships--beyond thinking of "dual" or "multiple" roles: reflections on the 2001 AAMFT Code of Ethics

This article presents reflections on and a critique of the recent revision of the AAMFT Code of Ethics on the multiple relationship ethical standard. A brief historical overview of terminology and the debate surrounding "dual" and "multiple" relationship ethical rules in marriage and family therapy is provided. The term "exploitation" is also delimited. Ethical principles and a set of standards addressing "detrimental" versus "potentially beneficial" interactions are introduced, deriving from works in other mental health professions. The article recommends: (a) the terms "dual" and "multiple" relationships should be abandoned; (b) the ethical principles underlying the AAMFT Code of Ethics need to be examined; and (c) the debate on the topic of detrimental therapist-client interactions in marriage and family therapy needs to be revisited, especially in light of a "positive ethics."     

Spousal perpetuation of chronic pain behavior

The literature reviewed here demonstrates that spousal response to pain display can reinforce and thereby perpetuate the patient's pain behavior. Relationships characterized as sick-role homeostatis reflect a nexus of behavioral contingencies which are highly resistant to treatment. Though such relationships could developde novo subsequent to accident or injury, modeling and familial effects in chronic pain suggest a rich personal and family history of chronic pain learning experiences. Spousal reinforcement of pain behavior is greater in satisfied relationships and tends to involve contingent attention and caring rather than assistance or taking over tasks and chores. As the vast majority of pain patients and spouses report being satisfied with their marriages, spousal involvement in chronic pain treatment is critical.     

What catatonia can tell us about "top-down modulation": a neuropsychiatric hypothesis

Differential diagnosis of motor symptoms, for example, akinesia, may be difficult in clinical neuropsychiatry. Symptoms may be either of neurologic origin, for example, Parkinson's disease, or of psychiatric origin, for example, catatonia, leading to a so-called "conflict of paradigms." Despite their different origins, symptoms may appear more or less clinically similar. Possibility of dissociation between origin and clinical appearance may reflect functional brain organisation in general, and cortical-cortical/subcortical relations in particular. It is therefore hypothesized that similarities and differences between Parkinson's disease and catatonia may be accounted for by distinct kinds of modulation between cortico-cortical and cortico-subcortical relations. Catatonia can be characterized by concurrent motor, emotional, and behavioural symptoms. The different symptoms may be accounted for by dysfunction in orbitofrontal-prefrontal/parietal cortical connectivity reflecting "horizontal modulation" of cortico-cortical relation. Furthermore, alteration in "top-down modulation" reflecting "vertical modulation" of caudate and other basal ganglia by GABA-ergic mediated orbitofrontal cortical deficits may account for motor symptoms in catatonia. Parkinson's disease, in contrast, can be characterized by predominant motor symptoms. Motor symptoms may be accounted for by altered "bottom-up modulation" between dopaminergic mediated deficits in striatum and premotor/motor cortex. Clinical similarities between Parkinson's disease and catatonia with respect to akinesia may be related with involvement of the basal ganglia in both disorders. Clinical differences with respect to emotional and behavioural symptoms may be related with involvement of different cortical areas, that is, orbitofrontal/parietal and premotor/motor cortex implying distinct kinds of modulation--"vertical" and "horizontal" modulation, respectively.     

"Meaning" connections and causal connections in the human sciences: the poverty of hermeneutic philosophy

In much of psychoanalytic theory and therapy, Freud repeatedly inferred a causal connection between thematically kindred events by relying on the kinship between their thematic contents. This paper strongly endorses his search for causal explanations. But it argues in detail that (1) his causal inferences from thematic connections rest on an important fallacy, which undermines major etiologic conclusions in psychoanalysis; (2) a related, weighty inferential error is damaging to the Freudian theory of transference, when it infers the pathogenic role of an early childhood scenario from the thematic reenactment (recapitulation) of that scenario in the adult patient's interactions with the analyst, and with other people. Both arguments draw on subject matter in psychoanalysis, physics, evolutionary biology, common-sense psychology, history, and medicine to arrive at a fundamental caveat for all of the sciences: Even when the thematic kinship (or so-called "meaning connection") between events is indeed of very high degree, this fact itself does not license the inference of a causal linkage between these events. A corollary of this result is that we must reject the accusation of Karl Jaspers and the hermeneutic philosophers that Freud's own conception of the psychoanalytic enterprise suffered from a "scientistic self-misunderstanding."     

Contemporary Psychotherapy: Moving Beyond a Therapeutic Dialogue

Psychotherapy was developed as a means of using words to heal emotional pain. Although a therapeutic dialogue can be helpful to many clients, some people need a more action-based intervention. Psychotherapy may be enhanced by adapting several therapeutic procedures that have been found effective in physical therapy. Where physical therapy can help clients learn to manage chronic physical pain, psychotherapy can help clients learn to manage chronic emotional pain. Both physical therapy and psychotherapy can help to facilitate awareness, flexibility, strength and endurance in order to maximize the clients functional ability.     

Dialogue in Therapy's "Borderzone"

This article explores some implications of practicing therapy from a discourse perspective. In particular, the dialogues of therapy are portrayed as a context in which client and therapist practice culture. Therapy, from this perspective, can optimally take place in an imaginary dialogic meeting place--a "borderzone"--wherein the discussions of therapy can occur in respectful ways. Discursive therapists are encouraged to see the differends, or potential stuck times of therapy, as times to turn to alternative discourses to keep the dialogue resourceful and collaborative.     

"Dwelling in the Past": The Role of Rumination in the Treatment of Posttraumatic Stress Disorder

Prolonged exposure, a cognitive behavioral therapy including both in vivo and imaginal exposure to the traumatic memory, is one of several empirically supported treatments for chronic posttraumatic stress disorder (PTSD). In this article, we provide a case illustration in which this well-validated treatment did not yield expected clinical gains for a client with PTSD and co-occurring major depression. After providing an overview of the literature, theory, and treatment protocol, we discuss the clinical cascade effect that underlying ruminative processes had on the treatment of this case. Specifically, we highlight how ruminative processes, focusing on trying to understand why the traumatic event happened and why the client was still suffering, resulted in profound emotional distress in session and in a lack of an "optimal dose" of exposure during treatment.     

古代中国人心中的"我"及其启示

本文先对“我”作语义分析．指出“我”的本义足指个体自身,“我”的其它含义皆由此本义引申而来。然后简要指出古代中国人的“我”的观念对当代中国人树立健全的“我”有3点启示：1．先要肯定小我存在的价值,然后再鼓励人们追求大我的价值;2．健全的“我”必足融道德我、理智我和审美我于一体的“我”;3．健全的“我”必是一独立自主的“我”。     

When adolescents "mismanage" their chronic medical conditions: an ethical exploration

Many adolescent patients with chronic medical conditions do not manage their illnesses very closely and often put themselves at risk for serious health complications. Setting aside cases of nonadherence that are due to practical difficulties involving the implementation of a management plan, a deeply problematic question remains. How should health care providers respond to adolescent patients who express a conscious and value-driven decision to pursue other goals and interests that are incompatible with their doctors' recommended directives? Using two guiding ethical principles, the "relevant difference principle" and the "principle of noninterference," as well as available empirical data on adolescent decision making and risk perception, the paper concludes that most adolescents ages 14 and older should be allowed to make self-determining decisions regarding the management of their chronic medical conditions.     

On the "Gray's Elegy" Argument and its Bearing on Frege's Theory of Sense

In his recent book, The Metaphysicians of Meaning (2000), Gideon Makin argues that in the so-called "Gray's Elegy " argument (the GEA) in "On Denoting", Russell provides decisive arguments against not only his own theory of denoting concepts but also Frege's theory of sense. I argue that by failing to recognize fundamental differences between the two theories, Makin fails to recognize that the GEA has less force against Frege's theory than against Russell's own earlier theory. While I agree with many aspects of Makin's interpretation of the GEA, I differ with him regarding some significant details and present an interpretation according to which the GEA emerges as simpler, stronger, and more integrated.     

“无为”之为和循证医学

"无为"治疗是为理性所认可的,实为有为的,既有利于患者又有利于医疗资源配置的治疗观念,但在医疗实践中很难推行。循证医学在我国的推广,对推行"无为"治疗有着特殊的意义。它有利于为病人作出最佳医疗决策,有利于人性化的医学实践,还有利于为诊治检验作出规范,这和"无为"治疗观念是合拍的。     

Cognitive Behavior Therapy for Relatively Active and for Passive Chronic Fatigue Syndrome Patients

In chronic fatigue syndrome (CFS), facilitating, initiating, and perpetuating factors are distinguished. Although somatic factors might have initiated symptoms in CFS, they do not explain the persistence of fatigue. Cognitive behavior therapy (CBT) for CFS focuses on factors that perpetuate and prolong symptoms. Recently it has been shown that, based on their level of activity, two groups of patients can be distinguished. For so-called “relatively active” CFS patients, the main perpetuating factors are nonaccepting and demanding cognitions leading to bursts of activity. For so-called “passive” CFS patients, their fear that activity might worsen their symptoms (which results in an avoidance of activity) is the most important perpetuating factor. These differences in perpetuating factors result in separate treatment manuals for relatively active and for passive CFS patients. Before describing the treatment manuals, we outline basic assumptions, considerations before starting CBT for CFS, and ways to determine the activity pattern.     

Pathophysiologic observations of facial neuralgia

The different etiology and pathogenesis of face-neuralgiae requires a spezific therapy of the respective illness. New aspects are formed in the last years in the so-called idiopathic neuralgia. She has good chances with the therapy through the Jannetta-operation. The evident mechanical lesion by compression, the ephaptic genesis and the special pain-characterization with trigger-attacks not support the "idiopathic". This is called "ictal neuralgia". The paper attempts pathophysiological to explain the specific pain. It shows aspects to the trigger mechanism, to the intensity of the pain and to the ictal pain-characterization.     

The Impact of Chronic Health Conditions as an Underlying Challenge on Couple’s Wellbeing

Chronic health conditions affect over 100 million Americans (Cano and Leonard in J Clin Psychol 62(11):1409–1418, 2006). Many clinicians are not integrating chronic physical health symptoms into psychotherapy. There is a complexity of issues that arise within the context of chronic health conditions. Making more need for couple and family therapists, whose primary focus is on a systemic family perspective, to understand how chronic health conditions are impacting family systems when they present for therapy (Canavarro and Dattilio in Contemp Fam Ther 33:87–90, 2011; Poleshuck et al. in Prof Psychol 41(4):312–318, 2010). The correlation of chronic health conditions on marriages and relationships has received limited attention in clinical research. This secondary data analysis examines the differences in overall well-being and psychological distress of individuals and couples seeking therapy who report a presence of chronic health conditions. Original research on the relationship between chronic health conditions and well-being, as measured by comparison of means, will be presented. Few studies investigate how chronic health conditions, when not the primary reason for seeking therapy, influence wellbeing and distress upon entering therapy. This study included 2742 participants from a clinical sample of individuals and couple seeking therapy in a family therapy clinic at a university training clinic. Independent t-tests, as well as ANOVA, were run to compare well-being and psychological distress of individuals and couples in the sample. Results showed significant differences in both overall wellbeing and psychological distress for both individuals who reported chronic illness for themselves, or their partners, than those that reported no chronic illness. There were also significant differences between groups on both well-being and psychological distress [F (2, 2706)?=?47.55, p?=?.00, F (2, 2697)?=?54.59, p?=?.00]. This results showed significant differences in well-being when no member of the couple has chronic health conditions, one member, or both members, with both members decreasing wellbeing significantly. This study demonstrates that chronic health conditions impact both the individual diagnosed, their partners, and is especially impactful if both members of a couple are diagnosed with chronic health conditions. Study limitations and clinical implications are also discussed.     

Medikamentenübergebrauchs­kopf­schmerz

Prospective longitudinal studies clearly demonstrate a causal relationship between the overuse of painkillers and migraine relievers and chronic headache. Overuse of any acute headache medication is the main factor in about 30-50% cases for chronic headache, and thus chronic headaches may be attributed to overuse. The prevalence of medication overuse headache (MÜKS, Eng: medication overuse headache, MOH) is likely to be around 3%.The diagnostic criteria of MOH are: Headache more than 15 days per month, Regular overuse of one or more drugs for acute symptomatic headache treatment of over more than 3 months, Headache has developed or is aggravated during medication overuseHeadache disappears or reverts to its initial level within 2 months after discontinuation of the drug overuse. Clinically, it is usually a “mixed” holocranial headache that is no longer consistent with a migraine or tension headache. The so-called “swing model” has proven itself in the context of psychoeducation. If painkiller withdrawal is not possible, in the outpatient setting, then a stationary multimodal withdrawal therapy should also be considered.