The internal family and the facts of life

Primitive defensive mechanisms innvolving splitting and projections are an essential process in the development of the infant. However, if these persist into adult life unmitigated by more depressive processes involving introjection and awareness of secure good objects they are shown to be inadequate to the task of coping with life crises, based as they are on the denial and distortion of reality. In this paper, I describe two patients who were seen in very different treatment settings and in whom such mechanisms were predominant. These began to fail when the patients were faced with difficult external events. These caused feelings of panic about impending mental disintegration. I then show how these patients sought to re-establish their primitive defensive structures.     

The uses of humor in life,neurosis and in psychotherapy: Part 1

Abstract

Joy and sadness, the comic and the tragic, making jokes and telling jokes, have been known in life, literature, the theater, and art since the dawn of civilization. Following in the footsteps of classical antiquity, Freud added to the philosophical analysis of humor the insights offered by the psychoanalytic method. The bridge was the cathartic method of treating neuroses, where discharge of affect was one of the foundations of technique, and the cathartic, or discharge, function of humor. Freud's analysis of humor, that “A joke … is the most social of all mental functions that aim at a yield of pleasure” introduces Freud's first explicit formulation of an interpersonal approach to the human situation in health and disorder.     

Suicide Risk Documented During Veterans' Last Veterans Affairs Health Care Contacts Prior to Suicide

A total of 295 veterans who died by suicide in 2009 across 11 states and received Veterans Affairs (VA) health care in the 6 months prior to death were identified. The suicide risk factors documented and the care received at these veterans' last VA contacts are described, and the study explores whether veterans present differently to VA care (i.e., different risk factors documented or different care settings accessed) based on the proximity of their last contact to suicide. Many veterans were seen in primary care (n = 136; 46%) for routine follow‐up (n = 168; 57%). Fifty‐three (18%) were assessed for suicidal thoughts; 20 (38%) of whom endorsed such thoughts. Although higher frequencies of some risk factors at last contacts more proximal to suicide compared to those more distal were observed, findings overall highlight the challenges clinicians face detecting enhanced risk prior to suicide.