Family Therapy in Trouble: Psychoeducation as Solution and as Problem

The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a “medical model” or “biogenic” view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psycho-therapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.     

The capacity to forgive: An object relations perspective

Forgiveness is commended by Christianity, as well as other religious traditions, as one of the most central of virtues, so central that the New Testament links man's very salvation to his ability to forgive. However, mental health professionals have correctly pointed out that the mandate to forgive is often used by religious patients in the service of defenses such as reaction formation, undoing, and denial. The forgiveness ideal is often misunderstood as a command not to experience aggressive feelings.It is the thesis of this paper that the capacity for genuine forgiveness is central not only to spiritual development but to psychological development as well. It is suggested that Kernberg's object relations theory provides the best model for understanding the nature and importance of forgiveness. Mature forgiveness does not involve the elimination of negative feelings toward others (or oneself) but the integration of negative and positive self-object representations and their connected affect. Anger at the offending persons must then be tempered by appreciation for their concomitant good qualities and motivations or, at the very least, empathy for the flaws which prompted them to behave destructively. The result is a more realistic and balanced view of others (and oneself), a more genuine relationship to the full range of one's own inner experience, and a greater ability to respond constructively to frustrating persons and situations.This paper was presented at the Annual Meeting of the American Psychological Association in New York in August 1987. The author wishes to thank Mark Finn, Ph.D., and David Hamblin, Ph.D., for their valuable discussions in the development of the ideas in the paper. Address requests for reprints to Dr. Gartner, Dept. of Pastoral Counseling, Loyola College, 7135 Mistrel Way, Columbia, MD 21045.     

Frontal amnesia and the dysexecutive syndrome

This study analyzes the memory deficits shown by an amnesic patient with bilateral frontal damage and a dysexecutive syndrome. He resembles a classic amnesic patient in showing grossly impaired episodic memory for both verbal and nonverbal material, together with normal digit span, and on occasion normal recency in free recall. He differs from the classic amnesic pattern however in showing an impairment in both the speed and accuracy of performance on tests of semantic memory, and in clear evidence for impaired performance on some though not all procedural learning tasks. Finally, his autobiographical memory was poor and subject to substantial confabulation. It is suggested that the pattern of deficits is consistent with a combination of a classic amnesic syndrome with the additional problems associated with the frontal dysexecutive syndrome, rather than exhibiting a qualitatively different form of amnesia.     

The perception of an optical flow projected on the ground surface

In most experiments in which the importance of visual control on postural stability is studied, optical stimuli attached to vertical surfaces are used. Analyses of long-term standing readjustments generally involve back-and-forth movements of a visual scene or its projection on vertical circular screens. In a natural environment, however, visual information is largely available from the ground. The aim of the experiment reported was to assess the effect of a flow pattern simulating an open outdoor setting on motion perception and postural control. Subjects were presented with an optical texture projected onto the ground. Periods of motionless texture alternated with equivalent durations of unidirectional flows. The change of position of the subject's centre of gravity over time was recorded on a force platform. Results show that the direction of body sway corresponded with that of texture motion. Important aftereffects, as shown in linear vection experiments, were also observed. However, the latency of postural responses was much shorter than with prolonged unidirectional flows produced in other locations of the visual environment. The hypothesis of an ecological specificity of the flows perceived on the ground during terrestrial displacements is discussed.     

Frontal cortex grafts have opposite effects at different postoperative recovery times

We studied the effect of different postoperative times on the behavioral recovery following brain implants. Adult male rats received cortical tissue grafts 2 weeks after aspiration of the medial frontal cortex. Either 2 (Immediate Group) or 28 (Delay Group) days after grafting, the performance of these rats on a behavioral battery, comprising the Morris water maze task, forepaw use, and grooming, was compared to that of rats with similar lesions and postoperative recovery times but no grafts. Rats tested immediately after receiving implants performed better on the spatial navigation task than rats with similar lesions but no grafts. This improvement, however, was less than that shown by rats with lesions but no grafts permitted to recover for 28 days before testing. In contrast, in the Delay Group, rats with grafts were more greatly impaired than were their operated controls. Neither lesions nor grafts affected grooming although the Immediate Group with grafts were significantly more impaired in using their forepaws during feeding than were any of the other groups. These results lead us to conclude that differing postoperative recovery times and task requirements may account for some of the inconsistent results of the influence of brain grafts on behavioral recovery reported in the literature. We also conclude that cortical tissue implants can have two effects with different time courses and opposite net behavioral effects.