Suicide and Suicidal Attempts in the United States: Costs and Policy Implications

The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under‐reporting increased the total cost to $93.5 billion or $298 per capita, 2.1–2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit–cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients.     

Toward a psychology of courage: Implications for the change (healing) process

Courage is a virtue which has been held in highest regard by all societies. In an age in which courage and its companions, human dignity and commitment, seem sadly lacking, it is imperative that we reacquaint ourselves with the implications of these attributes. In this paper we demonstrate the integral relationship between courage and intimacy and the importance of the concept of therapeutic caring to their development. We also introduce the theory of the double in which the self, in the act of intimacy, seeks to come together with its contradictory and disavowed attributes. These concepts are related to a psychotherapeutic paradigm in which we examine the requirements courage, intimacy, and caring impose upon practitioner and client.Paper presented at the 25th winter meeting of The American Academy of Psychoanalysis, New York City, December, 1981.     

The case of Peter and Susan: The psychotherapeutic treatment of an acute psychotic episode at the Arbours Crisis Centre

The case of Peter and Susan is an example of multiple crisis intervention at the Arbours Crisis Centre in London. Both were treated by psychoanalytic psychotherapy together with intensive interpersonal support in a live-in therapeutic milieu, with successful results.An extended discussion about the work of the Arbours Association in London will be published by Human Sciences Press as a chapter entitled, An Alternative Sanctuary: The Arbours Crisis Centre, in the forthcoming book,Healing Human Systems, edited by U. Reuveni and R. & J. Speck. For further information about the Centre write to: The Arbours Association, 41a Western Park, London N.8.     

Divorce in the kibbutz: Affective responses to separation

This article is part of a comprehensive research project in which the central characteristics of the process of divorce in the kibbutz were examined. It appears that the framework of the kibbutz, free as it is from socio-economic pressures and boundary factors not directly connected with the marital relationship as such, provides an excellent and perhaps unique opportunity to investigate the pure emotional effects of the marital breakup.     

Shame and fragmentation in the marital dyad

The paper outlines an expansion of object relations theory to account for fragmentation and shame. This expansion promotes a better psychodynamic perspective on the type of marital conflict escalation that occurs when each spouse turns to the other for empathic receptiveness while that other is also in a disorganized and vulnerable state of mind. Escalation occurs when spouses have different needs for safety and optimum distance and when the shame generated by continued exposure of these needs is not acknowledged. Clinical precepts promoting a focus on fragmentation and acknowledgement of shame are elaborated.     

Do women and men receive different care for sore throats?

Several studies have shown differences in the rates at which women and men receive treatment for several common medical problems, especially heart disease. The reason for these differences and the extent to which men and women receive different treatments for other problems is unclear. The purpose of the current study was to determine whether there are differences in the rates men and women receive antibiotic therapy for pharyngitis (sore throat), whether these differences are related to differences in disease severity or comorbidity across the sexes, and whether these differences could be due to prejudice against women by male clinicians. This was a retrospective analysis of data at two university student health services in Pennsylvania and Nebraska. Male clinicians did not prescribe antibiotics at significantly different rates for male and female patients, but female clinicians prescribed antibiotics more frequently for their male patients.The original data collection was supported in part by a grant from the National Library of Medicine, LM-04321.Presented in part at the Annual Meeting of the Society for Medical Decision Making, Portland, Oregon, October, 1992, and at the Third Primary Care Research Conference, Atlanta, Georgia, 1993.We thank Jane Kreisberg and Linda Rizjis for coordination of the collection of the original data, Linda Gray for help with data entry, and Cheryl Kull and Mary Martino for secretarial support. We are grateful to all the physicians who participated in the original study.     

Applying developmental previewing to the principles of family therapy

This paper discusses the application of principles of infant psychiatry to the diagnosis and treatment of multigenerational family conflict. Using a technique referred to as previewing, the therapist can focus on the interpersonal meaning that the infant's development precipitates in the family and determine how the parents' relationships with the infant replicate their relationships with their own families of origin. The therapist may then use these insights for overcoming conflict and for acclimating parents to new developmental skills in an optimal manner. Specific suggestions for how parents may promote more adaptive patterns of interaction with the infant using previewing are offered.     

Beyond family‐level adversities: Exploring the developmental timing of neighborhood disadvantage effects on the brain

A growing literature suggests that adversity is associated with later altered brain function, particularly within the corticolimbic system that supports emotion processing and salience detection (e.g., amygdala, prefrontal cortex [PFC]). Although neighborhood socioeconomic disadvantage has been shown to predict maladaptive behavioral outcomes, particularly for boys, most of the research linking adversity to corticolimbic function has focused on family‐level adversities. Moreover, although animal models and studies of normative brain development suggest that there may be sensitive periods during which adversity exerts stronger effects on corticolimbic development, little prospective evidence exists in humans. Using two low‐income samples of boys (n = 167; n = 77), Census‐derived neighborhood disadvantage during early childhood, but not adolescence, was uniquely associated with greater amygdala, but not PFC, reactivity to ambiguous neutral faces in adolescence and young adulthood. These associations remained after accounting for several family‐level adversities (e.g., low family income, harsh parenting), highlighting the independent and developmentally specific neural effects of the neighborhood context. Furthermore, in both samples, indicators measuring income and poverty status of neighbors were predictive of amygdala function, suggesting that neighborhood economic resources may be critical to brain development.