„Neglekt“ bei der Aufmerksamkeitsdefizit-und-Hyperaktivitäts-Störung

They say he is an attention-deficit hyperactivity disorder (ADHD) child. He cannot engage in anything and cannot even play as normal. At home fierce and very loud power struggles are frequent. He has no friends, mostly he is sitting alone before his computer and he has no other interests. He suffers from sleep disturbances, he sleeps only with the light on, he comes often into the bed of the parents, where he makes a fuss. What does this child have? Is he only ill-bred? Is he anxious – at school or at home? Does he suffer from separation? Or is it a matter of a genetic development problem? The strange phenomenon of “neglect” is traced here in connection with the diagnosis of an ADHD. Lopsided considerations are implicitly connected with this disorder and entice to neglect the developmental disorder in its real cognitive and somatic complexity. In a critical review of biomedical and psychodynamical models, it becomes apparent that newer concepts and results in research are, beside further illuminating this disorder, also helpful for the therapy of these children. Finally, a detailed discussion of the specificities of a psychodynamic developmental therapy follows.     

Der Begriff der „Bekundung“ bei Husserl und Heidegger

The article intends to explore the extension of several Husserlian concepts and issues in Heidegger’s first lectures of the 1920s. To this extent it focuses especially on the concept of Bekundung (intimation), exposed by Husserl in the second book of his Ideas, and also discussed by Heidegger in his Freiburg lecture Grundprobleme der Phänomenologie (WS 1919/20). By following this concept both in Husserl’s theory of the constitution of materiality and causal reality, as well as in his discussion of the personal self, and by pointing out the tensions between the two perspectives, we will try to show that Heidegger’s use of the term can in several aspects be seen as an attempt to solve certain difficulties of the Husserlian perspective. Thus, we wish to sketch out a part of that complex network of continuities and differences that constitute the “common ground” of the two thinkers in the early 1920s.     

Medikamentöse Therapieoptionen bei sekundär progredienter Multipler Sklerose

Anders als bei Patienten mit schubf?rmiger Multipler Sklerose, insbesondere jenen, die erst kurze Zeit erkrankt sind, sind unsere therapeutischen M?glichkeiten für Patienten mit sekund?r chronisch progredienter Multipler Sklerose leider noch immer nicht ausreichend. Dies bedeutet erstens, dass wir unsere zur Verfügung stehenden Therapien frühzeitig im Verlauf der Erkrankung einsetzen müssen, um überhaupt erst einen übergang in eine sekund?re Progredienz zu verhindern. Andererseits kann man, wenn ein Patient bereits in der sekund?r progredienten Phase ist, durch sorgf?ltig überlegten Einsatz Krankheitsmodifizierender medikament?ser Therapien, symptomatischer Therapien und Rehabilitation eine lange Stabilisierung der Multiplen Sklerose bei guter Lebensqualit?t erreichen.     

Die Kindstötung „in oder gleich nach der Geburt“

§ 217 of the German penal code, which intended a milder punishment for the homicide of an illegitimate child by the mother right after birth than for manslaughter, was abrogated without substitution in 1998. The reasoning behind this move does not convince. We will give a short summary of the history of this law. The privileged status of this crime was primarily justified in view of the denied pregnancy and the consequent state of the mother at the time of birth. Even after abrogation of §217 StGB there has to be differentiated between former reasons for privileged treatment, which now can justify from a juridicial point of view the use of §213 StGB (minor manslaughter), and those pathological states of mind which allow for the establishment of reduced or nullified legal responsibility.     

Interkulturelle Aspekte bei der Behandlung somatoformer Störungen

Patients from family-oriented societies have a different perception of pain and different conceptions of healing, which up to now have not been sufficiently appreciated in modern multimodal therapeutic approaches. Inadequate knowledge of anatomy and bodily functions and traditional perceptions of pain (e.g. magic, curses, punishment, etc.) have a substantial influence on diagnostics. The pain experience is regarded holistically in relation to the body, rather than being confined to a particular part of the body. Limited access to psychological complaints often leads to physical complaints. The ailing body is an expression of the social, the economic, the psychological and cultural state of the patient and the history of migration and status in the collective. A multimodal interdisciplinary and culture-sensitive approach is required for effective pain treatment of patients with a tradition-bound background.     

„Krise der Medizin“ – Modelle der Reform

In the 1920s and early 1930s there was a heated debate about the importance of the natural sciences for medicine. Prominent physicians, such as Ferdinand Sauerbruch and Wilhelm His in Germany or Richard Cabot and Charles-Edward Amory Winslow in the USA criticized clinical practices, medical education and research for placing too much focus on the natural sciences and the somatic correlates of human disease and for neglecting the psychological and social dimensions. In spite of a similar diagnosis of the problem, the consequences drawn differed considerably between the German and US contexts: in Germany first steps towards the institutionalization of the new field of psychotherapy and psychosomatic medicine and, in parallel, a consolidation of previously existing approaches of complementary medicine were developed, whereas in the USA the discussions led to the introduction and strengthening of social sciences in medicine, particularly in the field of public health. This article reconstructs the historical debate as well as the proposed models of reform and discusses potential implications for present-day medicine.     

Psychodynamische Psychotherapie bei antisozialen und psychopathischen Störungen der Persönlichkeit

Important theoretical basic principles of the psychodynamic treatment of patients with antisocial and psychopathic personality disorders are presented. Focusing on delinquency and general orientation to the structural level of the personality organization should be integrated. Indications of treatment difficulties, countertransference problems and technical principles are given. Skepticism of the treatment is poorly evidence-based and forensic psychotherapy of these patient groups should be intensified.     

Einschränkungen der Willensfreiheit bei somatoformen Störungen

Etiopathogenetic models of somatoform disorders and philosophical concepts of free will refer to theories of affect processing: affective dysregulation can promote psychosomatic ailments as well as problems in decision making. This observation brings forth the question if freedom of will is impaired in persons with somatoform disorders. By compiling, analyzing and contextualizing relevant models of current neuroscience, psychosomatic medicine and philosophy the psychodynamic construct of alexithymia as an etiologic factor of somatoform disorders and the conceptual integration of affective factors in a model of free will are developed on the basis of a common concept of affect. The synthesis of the discussed results and considerations, the multidimensional impairment of the ability to decide freely and self-determinedly due to somatoform disorders, is critically reflected; however, a blanket assumption is not admissible.     

„Bei den Seepferdchen bekommen die Väter die Kinder“: Verwirrende Realitäten bei der Aufmerksamkeitsdefizit-und-Hyperaktivitäts-Störung

Considering the in-patient diagnostics and treatment of an 11-year-old child with a complex attention disturbance who was treated before in an out-patient setting for many years with methylphenidat and behavioral therapy, we first point out the great variety of attention, cognitive and sensomotorical disorders. Such a comprehensive disorder should rather be considered as a complex neurotical developmental disorder (MCDD – Multiple Complex Development Disorder) and requires treatments in more than one field (psychotherapy, body therapy, training in learning etc.). The individual therapy presented here in detail is based on a developmentally oriented psychodynamic approach involving the latest results of infant, attachment and biomedical research. It is shown how the boy succeeds to develop mechanisms for self-regulation and to experience the therapist as a person who survives his attacks.     

„Da wirst du ja auch bekloppt bei“

Given a growing demand of psychotherapeutic care the interest of students in a psychotherapeutic occupation is gaining relevance. At the same time psychoanalytic training institutions and societies have been confronted with a continuous decrease of candidates over the last decades. Psychology students, medical students and students of educational sciences (the latter only in the child and adolescent treatment sector) are admitted for a psychotherapeutic training approved by the health care insurances in Germany and have the possibility to choose between a behavioral or a psychodynamic oriented training. In the present multimethodological cross-sectional study those student groups (N?=?679) were questioned about their interest in a psychotherapeutic training in general and, if they proved to be interested, about their specific choice of training. Amongst psychology students the largest group of those interested in a psychotherapeutic training would opt for a behavioral education. Amongst medical students and students of pedagogy and social pedagogy a psychotherapeutic training is less frequently an option for their future career plans. Amongst the students of educational sciences, for those interested in training, psychodynamic methods are more often of interest. Possible reasons for the students' decisions in the context of the specific German legal situation are discussed.     

Die Beurteilung der Steuerungsfähigkeit bei psychischen Störungen

Psychiatric assessment of culpability is conducted in two steps: firstly, the psychiatric diagnosis is to be made and attributed to one of the legal terms that entail the requirements for diminished or lack of legal responsibility. Secondly, one has to assess from a psychiatric perspective whether the mentally disturbed suspect who was aware of the unlawfulness of the actions was also able to act in accordance with awareness and to refrain from unlawful actions. The latter is called the capacity for self-control. The ultimately legal normative term of capacity for self-control corresponds to psychobiological concepts of executive and motivational self-control as well as to the psychological models of intentional control of actions (Goschke) and ”disactualization” (Janzarik). These concepts and models are outlined and discussed, particularly with regards to paraphilia and behavioral disorders. In the context of these conditions we sometimes find free-floating considerations about the capacity for self-control without even addressing the question whether the severity of the disorder has crossed the threshold for diminished legal responsibility. The author argues the case for an overall view of the suspect’s personality and abilities, weaknesses and decisions as displayed in the history of the criminal act.     

„Innerer Richter“ und „Herzenskündiger“ im Wandel der Zeit

The last few years have seen a deepening of the understanding of the role of metaphor and metaphorical processes first in the cognitive sciences, more recently also in psychoanalysis. What had for a long time been viewed as an imprecise way of understanding turned out to be central for a comprehension of how the mind functions. Most important was the step of distinguishing metaphorical processes as a fundamental way how the mind works from the linguistic form of metaphor. The essay deals with a number of core metaphors for superego conflicts and for interpersonal relations; In particular, the differentiation between people who focus more on things versus those who stress inner life and emotions.     

Ein „now moment“ unter der Lupe

This paper is based on the publications of Daniel Stern’s Process of Change Study Group, which contain new hypotheses concerning the analytical process and how it works. The various stages in the system proposed by this group (“moving along”—”now moment”—”moment of meeting”) are illustrated by a case history with regard to relevant aspects of the transference and with special emphasis on the observed countertransference. The hypothesis used to explain the detailed “now moment” and “moment of meeting” is based on psychoanalytical considerations. This process is analyzed with reference to the concepts of “reparative regression” or “regression for the sake of recognition”, progression and regression, fulguration, and creativity, autonomy, and intimacy.