Puerperal psychosis: Vulnerability and aftermath

The puerperium is a particularly vulnerable time for a depressive psychotic breakdown, with important consequences for both mother and child. While general psychiatric experience helps in the overall management, psychoanalytic insights help towards understanding the central psychopathology. Illustrative case-studies are presented.

Based on hospital admission rates, puerperal psychosis is regarded as a rare condition (one in 500 deliveries). In this paper, evidence is given to suggest that puerperal psychosis is a far commoner condition (three in 100 deliveries), and that many less-severe cases remain undetected and untreated in the community. It is argued that understanding interventions in these cases can be therapeutic for the mother, as well as having major implications for the baby's development.     

Community,subjectivity, and intersubjectivity

This paper deals with the notions of subjectivity, intersubjectivity, and community from several different points of view that include subjective and intersubjective agency, a sense of community, the community as a social institution, and the idea of social justice. The context of these considerations can be found in the Community–Social–Psychological approach to social action as it is often practiced in Latin America. A review of these themes is considered important because different models of community intervention and practice may lead to different expressions of community interaction.     

Representation, interaction, and intersubjectivity

What the participants share, their common "sense" of the world, creates a foundation, a framing, an orientation that enables human actors to see and act in coordination with one another. For recurrent activities, the methods the participants use to understand each other as they act change, making the intersubjective space in which actors operate richer and easier to produce. This article works through some of the issues that emerge from a close examination of intersubjectivity as it is managed through representation and interaction. The data that are presented document, in detail, a sequence of related interactions, within and across episodes of cooperation, where continuity and change can be observed. The emergence of conversational structure and coordinating representations are significant milestones in the long-term development of a representational practice that support the runtime co-construction of intersubjective space. Conversational structures emerge interactively to mediate recurrent points of coordination in the domain activity, and only secondarily the conversation itself. Coordinating representations change the representational practice of the participants by making it easier to manage their "shared view" of the collective work, enabling the participants to make progress, expand the field of the common activity, while exhibiting more control of if and when explicit grounding occurs.     

Subjectivity and intersubjectivity,subject and person

Continental Philosophy Review -     

Self psychology,intersubjectivity, and group psychotherapy

The basic concepts of self psychology are presented. The three self-object transferences of mirroring, idealizing, and twinship are described and applied to group therapy. The therapist's role is: 1) to accept the patient's need to idealize the leader, the group, or the specific members; 2) to receive recognition and admiration; and 3) to understand the patients search for twinship. The group therapist also has the responsibility of teaching group members to have empathy for one another.     

Microphenomena research,intersubjectivity and client as self-healer

This article describes an approach to counselling and psychotherapy which complements dominant discourse approaches to clinical evaluation based on New Public Management systems which underpin the Improved Access to Psychological Therapies scheme within the field of therapy. It is based on an approach to research and practice development which I will call practitioner microphenomena research. In order to demonstrate the method, I will examine an extract from a single case study of a client with major depressive disorder from the point of view of intersubjective theory and a little-known approach to therapy called anthroposophic psychotherapy based on the work of Rudolf Steiner. I will show how the two clinical methods are well suited to examining the microphenomena of practice and can be integrated into a coherent whole. A central feature of the account will be the anthroposophical view about the central importance of our individuality or ‘I’ which has similarities with the Jungian self but is still distinct from it.     

Impaired embodiment and intersubjectivity

This paper considers the importance of the body for self-esteem, communication, and emotional expression and experience, through the reflections of those who live with various neurological impairments of movement and sensation; sensory deafferentation, spinal cord injury and Möbius Syndrome (the congenital absence of facial expression). People with severe sensory loss, who require conscious attention and visual feedback for movement, describe the imperative to use the same strategies to reacquire gesture, to appear normal and have embodied expression. Those paralysed after spinal cord injury struggle to have others see them as people rather than as people in wheelchairs and have been active in the disability movement, distinguishing between their medical impairment and the social induced disability others project onto them. Lastly those with Möbius reveal the importance of the face for emotional expression and communication and indeed for emotional experience itself. All these examples explore the crucial role of the body as agent for social and personal expression and self-esteem.     

Mirror neurons and the phenomenology of intersubjectivity

The neurological discovery of mirror neurons is of eminent importance for the phenomenological theory of intersubjectivity. G. Rizzolatti and V. Gallese found in experiments with primates that a set of neurons in the premotor cortex represents the visually registered movements of another animal. The activity of these mirror neurons presents exactly the same pattern of activity as appears in the movement of one's own body. These findings may be extended to other cognitive and emotive functions in humans. I show how these neurological findings might be “translated” phenomenologically into our own experienced sensations, feelings and volitions.     

Innate intersubjectivity: newborns' sensitivity to communication disturbance

In most of our social life we communicate and relate to others. Successful interpersonal relating is crucial to physical and mental well-being and growth. This study, using the still-face paradigm, demonstrates that even human neonates (n = 90, 3-96 hr after birth) adjust their behavior according to the social responsiveness of their interaction partner. If the interaction partner becomes unresponsive, newborns will also change their behavior, decrease eye contact, and display signs of distress. Even after the interaction partner resumes responsiveness, the effects of the communication disturbance persist as a spillover. These results indicate that even newborn infants sensitively monitor the behavior of others and react as if they had innate expectations regarding rules of interpersonal interaction.     

The holding environment and intersubjectivity

The holding environment is explored in the context of the analytic dyad, where it is seen as rooted in the patient's need to be experientially known through the intersubjective interaction. In examining previous emphasis on holding as an optimally attuned empathic environment provided by the analyst, a broadened view of what constitutes a holding environment is presented, underscoring its interactional nature. A distinction is made between empathic holding based on the patient's expressed material, and holding that is generated through the analyst's intersubjective knowledge, gained via ongoing intersubjective engagements and enactments. It is argued that the unmediated connection to the patient's internal representations resulting from these intersubjective interactions, and the ensuing verbal exploration of them, can create a profound sense of being understood and thus held. A clinical process depicting the experience of holding in an intersubjective context is presented.     

Affective ontologies: Post-humanist perspectives on the self,feeling and intersubjectivity

At this particular historical juncture of the Anthropocene it is becoming increasingly clear that, as Val Plumwood puts it, the survival of our species depends upon how our relationships with earth others are reconfigured . Yet as the human is once again placed at the centre of our planetary life, this time as a geological agent, a growing body of scholarship has taken up the challenge of rethinking the human and its limits (see for example the special issue of the journal Angelaki 16(4), 2011). This special issue seeks to contribute to this body of work from the perspective of posthumanist explorations of affect, and thereby to open possibilities for articulating non-solipsistic and non-anthropocentric notions of the subject.     

Schizophrenia and the experience of intersubjectivity as threat

Many with schizophrenia find social interactions a profound and terrifying threat to their sense of self. To better understand this we draw upon dialogical models of the self that suggest that those with schizophrenia have difficulty sustaining dialogues among diverse aspects of self. Because interpersonal exchanges solicit and evoke movement among diverse aspects of self, many with schizophrenia may consequently find those exchanges overwhelming, resulting in despair, the sensation of fusion with another, and/or self-dissolution. In short, compromised dialogical capacities may be a contributing factor to social dysfunction in schizophrenia.     

From intersubjectivity to subjectivity: the transformative roles of emotional intimacy and imitation

How is the transition between intersubjectivity and subjectivity accomplished? While many developmental theorists have argued that social interaction gives rise to individualistic capacities (e.g. representation, language, consciousness), relatively few theorists have attempted to identify the precise mechanisms that might be responsible for this transformation. The present paper addresses this gap by drawing attention to the central role played by emotional intimacy. It is argued that subjectivity arises out of intimate engagement with others, and particular attention is given to the role of imitation in fostering such intimacy. While the primary focus is on infant development, links are made to work with atypical populations because they offer valuable insights into the developmental processes under consideration here. The ultimate aim of the paper is to demonstrate that by recognizing the emotional intimacy inherent within adult–infant interactions, new solutions are offered to theoretical problems that developmental psychology continues to face in accounting for the origins of subjectivity. Copyright © 2006 John Wiley & Sons, Ltd.     

Type A Personality,Self-Control,and Vulnerability to Stress

The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was released in 1992 and has rapidly become the most widely used objective personality assessment instrument with adolescents. Although the MMPI-A reduced or eliminated several problems associated with the use of the original MMPI (Hathaway &; McKinley, 1943) with adolescents, the MMPI-A does produce a high frequency of within normal limits basic scale profiles for individuals with substantial psychopathology including adolescents in inpatient psychiatric settings. To better understand the reasons for this phenomenon, we compared the item endorsement frequencies for the MMPI-A normative sample with results from two adolescent clinical samples, and these results were contrasted to the item endorsement frequencies for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, &; Kaemmer, 1989) normative sample and a clinical sample of adult psychiatric inpatients. Results showed that the MMPI-A contains a substantial number of items that do not show a significant difference in item endorsement frequency between normative and clinical samples. Furthermore, MMPI-A basic and content scales generally show a much lower percentage of effective items than do the corresponding scales for the MMPI-2. We discuss the findings in relation to the frequent occurrence of low range MMPI-A profiles in clinical samples and the potential usefulness of these results in future efforts to develop viable short forms for the MMPI-A.