The contribution of Hartmann's adaptational theory to psychoanalysis, with special reference to regression and symptom formation

My experience of clinical work is consistent with the conclusion that both practice and theory are improved by applying the contributions of Heinz Hartmann. His work provides an important conceptual bridge to understanding the adaptive and pathologic changes that appear in the course of human development. The specific details of those changes are just as much an issue demanding the analyst's attention as is the tracing of patterns of childhood instinctual life. In this paper, I will point to some areas of controversy where renewed attention to Hartmann's ideas might be useful, and I will attempt to illustrate the clinical utility of his theoretical contributions.     

The estimation of the parameters of a negative binomial distribution with special reference to psychological data

As an analytical tool the negative binomial distribution may have wide applications in the psychological field. The estimation of its parameters is demonstrated to be often inefficient when fitting by the method of moments. This causes possibly true hypotheses to be rejected. Formulas for the efficiency of the moment method and solution of the likelihood equations are derived. Efficiency graphs and detailed tables for the function reduce the maximum-likelihood method to a minimum of computational labour. Practical applications of the ease and power of the M.L. procedure are given.The author wishes to express his gratitude to the South African Council for Scientific and Industrial Research for permission to publish this paper; to Mr. A. G. Arbous for supplying the data on absenteeism; to Mr. R. V. Sutton for the data on Two-hand Co-ordination errors; and last, but not least, to the staff of the Statistical Section who computed various tables under the expert guidance of Mr. J. S. Maritz.     

The premodern and the postmodern: Some parallels,with special reference to Hinduism

Insofar as the postmodern exists, it is held to represent a break with the modern, a break no less radical than that of the modern with the premodern. In this paper I point to certain similarities between on the one hand what are said to be key aspects of the postmodern and on the other hand the premodern. It may well be fruitful to look for further parallels on either side of modernity.     

The role of audition in early psychic development, with special reference to the use of the pull-toy in the separation-individuation phase

The role of audition as an important perceptual modality in early psychic development has been neglected. Some reasons for this neglect are suggested. In the development of psychoanalytic technique, the analyst has changed from a "tactile presence" to a "visual presence," then finally, with the analyst positioning himself behind the couch, to an "auditory presence." Several clinical examples from analytic patients as well as child development in normal and deaf children provide instances of each type of perceptual "presence." It is suggested that, in evaluating analyzability, analysis requires a specific ego ability, namely, tolerance for the analyst as an "auditory presence." It is emphasized that some patients, for reasons of development, constitution, and/or significant stress (separation), cannot work with the analyst as an "auditory presence," but regress to the analyst as a "visual" or "tactile" presence. The importance of audition in early mother/stranger differentiations, and in the peek-a-boo game, is a developmental precursor to the use of audition as a contact modality in the separation and individuation phase. Audition permits active locomotion and separation from tactile and visual contact modalities between toddler and mother, while at the same time maintaining contact via their respective "auditory presence" for each other. The utilization of the pull-toy in mastering the conflicts of the separation-individuation phase is demonstrated. The pull-toy is heir to the teddy bear and ancestor to the tricycle. Greater attentiveness to the auditory perceptual modality may help us understand developmental phenomenon, better evaluate the potential analysand, and clarify clinical problems of audition occurring in dreams and those areas of psychopathology having to do with auditory phenomena. The more refined tripartite conept of "presence" as it relates to the predominant perceptual modality--tactile, visual, auditory--is felt to be a useful conceptualization for both developmental and clinical understanding.     

EEG findings in 130 enuretics with special reference to spike potentials

As a result of an one time electroencephalographic transversal examination of 130 patients with enuresis aged from 3 to 18 years a back ground activity that was too slow for their age was found as the most frequent abnormal finding (31,5%). Focal sharp waves and spikes were observed in 20 per cent; they seem to be more frequent in enuretics than in other children and adolescents with disorders of behaviour. Their frequency is dependent on age. They are of small use for proving an epilepsy as possible cause of enuresis.     

Current trends in neuropathic pain treatments with special reference to fibromyalgia

Neuropathic pain and fibromyalgia are prevalent diseases which have major consequences on healthcare resources and the individual. From the clinical point of view neuropathic pains represent a heterogeneous group of aetiologically different diseases ranging from cancer to diabetes. Patients with fibromyalgia also display clinical features common in neuropathic pain suggesting that there might be some overlap. The mechanisms responsible for symptoms and signs in both diseases are still unknown. Recently, there have been numerous reports of various pharmacological treatments of neuropathic pain and fibromyalgia with often disappointing results. Most of the studies were of short duration, had high attrition rates, and displayed other methodological problems. Some compounds had high rates of adverse effects which makes it often difficult for the patients to tolerate the treatment, especially in the long-term. At present, the best options for medication treatment are tricyclic antidepressants in lower dosage than usual in psychiatric disorders and a wide range of anticonvulsants. Opioids are sometimes recommended but have been found to have minor efficacy. Recently, there have been more controlled trials, which are reported here if they had been published between 2002 and 2004. Various compounds have been tested in different studies. Treatment of fibromyalgia, which has many features in common with depressive symptoms, became the focus of interest. New promising studies with dual serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipram) and a newer antiepileptic drug (pregabalin) are in progress. Future research will have to apply new approaches (e.g., using a mechanism-based classification of neuropathic pain and carrying out studies in populations with the same symptom but not necessarily the same disease) in order to find effective treatments for these common and often debilitating diseases.