Differentiating Psychotic Patients From Nonpsychotic Patients With the MMPI–2 and Rorschach

Rorschach responses of 36 process and 23 reactive schizophrenics have been evaluated for presence of primary and secondary process thinking, and for oral, anal, sex, aggression, and anxiety content. Responses of the process schizophrenics involved more primary process than secondary process thought, whereas the reactive schizophrenics' responses showed more secondary than primary process thinking. A linear trend, parallel for both groups, was noted with regard to frequency of content responses, such that anxiety was greater than aggression, which was greater than oral, which was greater than sex and in turn was greater than anal. In both groups oral content was least invaded by primary process thinking, the remaining categories tended to cluster.     

Sadomasochism in the perversions: some thoughts on the destruction of reality.

The author summarizes and develops some of her viewpoints on the perversions (outlined in several of the books and articles she has written). For her all the perversions, whatever their content, develop against an anal sadomasochistic backdrop. Their aim is to destroy reality. Reality, from a psychosexual perspective, may be defined as resulting from the existence of the father separating the mother and the child. This may be formulated in another way: reality is recognition of sexual and generational differences. Or, yet again: mother and father have a procreative sexuality, whereas the child does not. This leads to the idea that the destruction of reality is equivalent to destruction of the paternal universe. Clinical case illustrations are provided, one of which centers on the assassination of an old man who, besides representing a paternal oedipal image, also represents reality itself. This case illustrates in concrete form the murder of the father, and hence of reality, accomplished by the pervert when he eradicates the paternal dimension of psychosexuality by regressing to the anal sadomasochistic dimension.     

Social support,self-esteem and depression: Relationship with risk for sexually transmitted infections/HIV transmission

Sexually transmitted infections (STIs) and HIV are important health problems that affect adolescents. The aim of the present study was to analyze the relationship between 1) depression, self-esteem and perceived social support and 2) sexual risk behaviors according to gender. The sample used in this ex post facto study was composed of 1,005 adolescents of both sexes aged between 14 and 18 years. Participants completed several questionnaires in the classrooms of their secondary education schools. The questionnaires assessed depression, self-esteem and perceived social support and recorded information on sexual behavior and socio-demographic issues. Results showed that, among males, self-esteem predicted higher vaginal risk, depression was related to higher vaginal, anal and oral sexual risk, and perceived support from the family predicted lower vaginal and anal sexual risk. Among females, self-esteem was found to be associated with lower anal sexual risk and perceived support from friends predicted lower anal and oral sexual risk. The study highlights the importance of considering family and friends as well as gender differences in the prevention of STIs/HIV.     

Hostility of asocial youth as measured by the TAT and Rorschach.

23 boys and 13 girls, aged 13 to 17 yr., from two homes for delinquents were given the Thematic Apperception Test. Girls were also given the Rorschach. The 1960 Hafner and Kaplan TAT and Rorschach hostility indices were related to the 1977 Luukkonen indices (aggression-inward, aggression-outward, fantasy-aggression, oral, anal and phallic content), to the Pruitt and Spilka empathy index, and to the Neiger reality index. The TAT hostility index for boys was significantly higher than that for girls; boys expressed more physical and girls more verbal hostility in TAT stories. On the Rorschach, aggression outward and inward correlated significantly with Rorschach hostility, phallic and oral themes.     

Pregenital fixation and perceptual distortions to conflict-laden material.

Three standard questionnaire measures of oral and anal fixation were administered to 142 students. On the basis of their scores 26 students were selected and shown tachistoscopic exposures of pictures designed to activate oral or anal conflicts. Five subjects in each group had extremely high scores on the corresponding measure of fixation, five had extremely low scores, and 16 had intermediate scores. It was hypothesised that individuals who were fixated at one or other of the psychosexual stages would show stereotyped perceptual distortions to repeated dim exposures of the corresponding picture. Highly fixated subjects showed significantly more deviant responses than did subjects who showed low levels of fixation at the same stage. A form of Q-factor analysis indicated that subjects who were fixated at the oral sadistic or anal stages showed different patterns of perceptual distortions to the anal picture than those who were not fixated. These results were interpreted as supporting the link between defenses against anal eroticism and the anal character.     

Factor analytic examination of Kline's scales for psychoanalytic concepts

Seventeen personality scales were administered to 133 subjects to investigate the relation of three new psychoanalytically-derived scales to the personality scales of Howarth and Eysenck, respectively. A previous study (Howarth, 1980a) suggested that Kline's oral optimism scale related to Eysenck's extraversion scale, oral pessimism to neuroticism, and Kline's anal syndrome scale to Eysenck's psychoticism scale. In order to investigate this further Eysenck's scales were included as well as ten scales of Howarth's and Kline's three scales. The factors found among the 17 variables were: I. Anxiety; II. Psychoticism; III. Sociability; IV. Anality; V. Lie scale; VI. Conscience.The present study found that the anal scale was relatively independent of all of Eysenck's ‘superfactor’ scales and did not verify the possibility that this anal scale might relate to psychoticism (as measured by Eysenck). However, the present study verified the previously found relation between oral optimism and extraversion and, of the three Kline scales, oral pessimism related more to psychoticism than the anal syndrome scale.     

Conservatism and defense style

The dynamic theory of conservatism suggests that conservatism can be described as an ego-defensive behavior. Furthermore, the theory of defense style suggests that defensive behaviors are revealed in individuals' attitude structures. The present study was designed to examine the relationship between conservatism and defense style. Measures of conservatism, anal personality traits, and defense style were completed by 238 university students (103 men, 134 women, 1 unidentified). The measure of anal personality traits was included to replicate factors previously discovered with similar conservatism measures. A principal components analysis with oblimin rotation indicated that conservatism and anal personality traits loaded alongside mature defense style. The findings suggest that conservatism can be located within the theoretical model of defense style. However, it is suggested that the match between liberal attitudes and mature defense style be investigated in future research.     

Understanding the unprotected sexual behaviors of gay, lesbian, and bisexual youths: an empirical test of the cognitive-environmental model.

The cognitive-environmental model (CEM; M. Fishbein et al., 1991) was used to understand the unprotected sexual behaviors of 156 gay, lesbian, and bisexual youths. Unprotected anal sex among the males was associated directly with poor protection skills (e.g., incorrect use of barrier methods, such as condoms), poor intentions to use barrier methods, and poor norms by sexual partners concerning barrier methods. Furthermore, the association between low self-efficacy and increasing unprotected anal sex was attributed to poor intentions. Direct associations of unprotected oral sex with poor intentions and poor partner norms also emerged, as did an indirect relation between unprotected oral sex and low self-efficacy via poor intentions. These last 3 findings were replicated when examining unprotected oral or vaginal-digital sex among the females. Relations among the CEM factors supported some CEM-theoretical propositions.     

Stress, coping, and high-risk sexual behavior.

We examined the relation between stress, coping, and a high-risk sexual behavior (unprotected anal intercourse) in 398 nonmonogamous gay and bisexual men from the AIDS Behavioral Research Project in San Francisco. Unprotected anal intercourse during the previous month, the amount of stress experienced during the previous month in each of 10 domains, six types of coping (self-controlling coping, escape-avoidance, distancing, planful problem-solving, seeking social support, and positive reappraisal), and spiritual beliefs and spiritual activities were assessed through self-report. There was no relation between stress and unprotected anal intercourse. However, there was a relation between coping and unprotected anal intercourse. Subjects who reported unprotected anal intercourse used sex more of the time to help cope with stressful situations than did subjects who did not report unprotected anal intercourse. Unprotected anal intercourse was negatively associated with seeking social support and spiritual activities and positively associated with self-controlling coping, which involves keeping one's feelings to oneself, and positive reappraisal. The findings suggest that social aspects of coping may be a key to understanding differences between those who engage in high-risk sexual behavior and those who do not.     

Determinants of Relapse and the Rule Violation Effect in Predicting Safer Sex Goal Violations1

Knowledge of the determinants of lapses into unsafe sex are important parts of HIV prevention interventions. The present study examines the determinants of lapses into unsafe sex, and the role of attribution in predicting lapses into unsafe sex within an HIV prevention treatment program for homosexual men based on the relapse prevention (RP) model (Marlatt & Gordon, 1985). Self-reported negative emotional states and general urges to engage in sex were perceived to precede violations of safer sex goals. Stable and global attributions for a goal violation related to the probability of a second concurrently assessed violation. Prospective analyses indicated that future unprotected oral and anal sex was predicted by current unprotected oral and anal sex. In addition, more stable and external attributions for previous goal violations added to the prediction of future unprotected anal sex. Results are discussed in relation to the RP model, the role of attributions in safer sex goal violations, and treatments to reduce unsafe sexual behavior.     

Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents

The objective of this study is to provide preliminary psychometric properties of the Hopkins Symptom Checklist-37 (HSCL-37A) for refugee adolescents. The HSCL-37A is a modification of the well-known HSCL-25 and assesses symptoms of internalizing and externalizing problems that have been associated with reactions to trauma. Four independent heterogeneous samples (N=3890) of unaccompanied refugee minors, immigrants, and native Dutch and Belgian adolescents were assessed at school. The confirmative factor analyses, per language version, support the two-factor structure of internalizing and externalizing behavior. The total and subscales show good internal consistency and acceptable test-retest reliability in spite of the heterogeneous sample populations. The construct, content, and criterion validity of the HSCL-37A were also examined and found to be good. The findings of this study suggest that the HSCL-37A is a reliable and valid instrument to be used among culturally diverse refugee adolescents to assess emotional distress and maladaptive behaviors.     

The influence of sphincter control and genital sensation on body image and gender identity in women.

The development of one aspect of feeling female is hypothesized to account for certain phenomena in the treatment of young women patients. Fear of loss of genital pleasure experienced as contractions of the anal and genital-urinary sphincters is seen as the central issue in conflicts manifested in genital, oral, and anal modalities. It is suggested that the female's awareness of her genital arises from the generalization of sphincter sensation in the little girl, which is then represented in the body image. The body image is postulated as a link between genital pleasure and the valuing of femininity.     

The hero, the anima and the claustrum: anality and idealization

Joe Redfearn's (1979) classic paper 'The captive, the treasure, the hero and the anal stage of development' is recognized as seminal to the development of Jungian thought about anality, particularly its integration with mainstream (Freudian, Kleinian) psychoanalytic perspectives. This paper develops such an approach through drawing on contributions from Meltzer, Green, Bion, Chasseguet-Smirgel and Kernberg. More specifically, it is argued that over-investment in hero and anima archetypal configurations may represent an attempt to replace the resource of the internal parental couple that, at the level of unconscious phantasy, has been destroyed by the aggrieved child's attack on the primal scene. Unless this usually dissociated sadism can be integrated, the creative epistemophilic instinct may remain blunted, giving rise, through projective identification, to the adoption of a pseudo-adult identity based on appropriation or assertion. This in turn may lead to manic attempts to reach authentic ('animating') experience through the (often erotized) excitement of heroic endeavour. Consideration of both Redfearn's and the author's own clinical material demonstrates how close attention to process as well as content is fundamental to revealing and addressing such likely-to-be dissociated scenarios.     

All holes are the same: Emerging from the confusion

The author describes a type of mental development in which the primitive libidinal value of faeces and urine is kept unaltered all through adulthood. In this instance, individuals harbour fantasies of projective identifi cation with the internal parents, denying their real dependence, which leads to a pseudomaturity. These fantasies are usually accompanied by anal and genital masturbation and have intense aggressive content. Furthermore, there is a signifi cant confusion among all body orifi ces, leading to an inability to distinguish the self from the object, the inner world from outside reality. Individuals with this type of development can only maintain limited object relations and have highly erotized excretory activities. Manipulation of faeces may occur. This structure works as a defence against breakdown, but may also provide pleasure as it gives the illusion of omnipotent control of the object, as typical in pathological organizations. The author presents clinical material and discusses the diffi culties of the analysis, in which the patient tries to seduce the analyst into colluding with his mental functioning, primarily as a means of communication as well as a projection of his despair and his disbelief in the analyst's ability to help him.     

The Course of Representation in Memory During the Comprehension of Paragraphs

The course of the representation built in memory from a text during comprehension of paragraphs was studied by a probe technique (immediate item recognition). Three experiments showed that response times, the main variable, gradually increase as a function of the lag between the probe (a word or an atomic proposition) and its target in the text. In Experiment 3 the same result was also found with a priming technique. The absence of any kick-up over the course of time was confirmed by several additional analyses of individual data. The results were only weakly consistent with models assuming two distinct memory stores, in particular a specific “short-term memory store,” but highly consistent with models involving semantic activation and subsequent gradual deactivation.     

Escort Advertisements and Male Patronage of Prostitutes

Sociologists have devoted limited attention to investigating reasons for male patronage of female prostitutes. To date this research has largely been comprised of non-representative samples of clients. We expand sociological inquiry of this question through a content analysis of the advertisements of 237 female Internet escorts who advertise on a large, national-in-scope (U.S.A.) website. Our findings largely complement those of previous studies that have examined this topic via interviews with clients or prostitutes as well as those of studies that analyzed johns' postings on Internet websites. Offerings of “Girl Friend Experiences,” unrushed encounters, and escort-type services are more common than offerings of anal sex, S&M, B&D, and fetish services. We also discuss the impact of the Internet on the structure of one of society's oldest institutions.     

Drug use and unprotected anal intercourse among gay men

Conducted a longitudinal study of 604 New York City gay men to examine the link between unprotected insertive and receptive anal intercourse and drug use with sex. Data spanning four 12-month periods from 1980 to 1987 indicated that the link between drug use and high-risk sex diminished as the acquired immunodeficiency syndrome (AIDS) epidemic progressed. Strong and significant cross-sectional associations (average r = .30, p less than .0001) were found between drug use with sex and both types of anal intercourse in the year prior to the onset of AIDS. By 1987 the magnitude of these associations was markedly reduced (average r = .09, p less than .05). Longitudinal results indicate that, although cessation of drug use with sex is associated with subsequent lower rates of unprotected anal intercourse, initiation of drug use with sex is not associated with subsequent increases in this sexual activity. These findings support both causal and noncausal interpretations of the link between substance use and high-risk sex among gay men.     

A Qualitative Assessment of the Sex Education Needs of Married Iranian Women

Despite a comprehensive reproductive health program there is little sex education available in Iran. In this article we present results of a study conducted to identify content area for a proposed sex education program for married Iranian women. Twenty-one married female clients (23–45 years) and 18 reproductive health providers, recruited from urban health clinics in Tehran using non-probability sampling, participated in four focus group discussions. Sexual health information needs related to reproductive tract and sexually transmitted infections, “acceptability” of certain sexual practices such as oral and anal intercourse, and the sexual response cycles and physiology of men and women. Women’s sexual concerns related to communication, incompatibility of sexual interests and desire, and their ability to maintain a strong marriage. Two themes cut across women’s responses to all questions: modesty and maintaining a strong marriage. Results contributed to the design of a sex education program that addressed the specific information needs and concerns of Iranian women.     

Antitheses and the obsessive-compulsive

The characteristic "style" of the obsessive-compulsive is examined and is seen to be marked by an antithetical quality. The major defense mechanisms used--undoing, isolation, and reaction formation--al involve opposites: contradictory acts following each other, the keeping apart of ambivalent feeling states, and the turning of wishes into their opposites. The cognitive modes of the obsessive-compulsive are marked by dichotomies: sharply focused attention which misses essential points and a non-inclusive all-inclusiveness. The obsessive's regression to the anal phase produces ambivalent emotions, contradictory attitudes to feces and defecation and related future sublimations, and doubt over sexual identity. A harsh superego creates an alternation between obedience to it and defiance, and feelings of both perfection and imperfection. The ambivalent and contradictory early family environment is seen as an influencing factor in the creation of the antithetical style of the future obsessive-compulsive: the natural ambivalence of the anal stage is confronted by ambivalent mothering, and antitheses then predominate.     

Diaries of significant events: socio-linguistic correlates of therapeutic outcomes in patients with addiction problems

The principles of narrative therapy imply that autobiographical diaries written by patients in treatment will not only facilitate but also elucidate progress. The relationship between the linguistic content of diaries and progress in treatment was examined in this study. Complete sets of daily diaries of ‘significant events’ written by 16 patients receiving treatment for drug, alcohol and food addictions at a residential centre, using the 12-step approach of the Anonymous fellowships, were typed up for analysis. Three forms of socio-linguistic enquiry were employed: narrative characterization; evaluative statement coding and computer analysis of word strategies. Results indicated that success in treatment as rated by counselling and psychiatric staff was associated with the following characteristics of diary narratives. They are (a) focused on individual progress, whether adopting a ‘positive interpretative’ or ‘negative reactive’ style; (b) less critical of self over time and more positive about others external to the treatment centre; (c) both positive about the treatment programme and critical of self; (d) using words indicative of ‘insight’ and ‘negativity’ as assessed by Pennebaker's LIWC programme. It is concluded that autobiographical material can usefully be employed to assess progress in treatment, and that its intrinsic value in effecting change should be further explored. © 1997 John Wiley & Sons, Ltd.