The use of genetic test information in insurance: The argument from indistinguishability reconsidered

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.     

Ministry to the chronic hemodialysis patient

The beginning point of ministry to those persons suffering from renal failure and turning to hemodialysis in order to sustain life is a sensitive understanding of the total dialysis experience. The minister or chaplain who visits a hemodialysis unit only occasionally will be more effective in bringing his skills to the task by understanding the unique dynamics of the physical, emotional and spiritual adjustment of those who depend on this relatively new therapy. The specific elements of this ministry in terms of those closely involved, professional care givers, families, and patients, are discussed with attention to the factors that tend to make ministry to the hemodialysis patient unique.This article is the result of a one-year chaplain residency at the Veterans Administration Hospital in Nashville, Tennessee, in partial fulfillment of clinical requirements for the D. Min. degree in Pastoral Theology and Counseling at the Divinity School, Vanderbilt University, Nashville, Tennessee.     

Explizite und implizite psychoanalytische Behandlungspraxis

Zusammenfassung  Die Psychoanalyse wurde mit dem Ziel konzipiert, Verdrängungen dem Bewusstsein zugänglich zu machen und dadurch die Kindheitsamnesie aufzuheben (Freud 1937). Mit der Ausweitung des psychoanalytischen Behandlungsspektrums auf präödipale Störungen und Verbreitung der Objektbeziehungstheorie entwickelte sich allerdings eine alternative Behandlungsstrategie, die Therapie der emotionalen Erfahrung. Der damit verknüpfte Dualismus führte lange zu einer Kontroverse über eine einheitliche psychoanalytische Behandlungstechnik. Nur langsam setzte sich die Erkenntnis durch, dass angemessene Deutungen und ein entwicklungsfördernder Umgang mit der Übertragung zwei therapeutische Ansätze darstellen, die nicht voneinander zu trennen sind.Vor dem Hintergrund der neueren Gedächtnisforschung zeigt sich, dass beide Ansätze sich einerseits ergänzen, andererseits aber auch gegensätzliche Pole im Indikationsspektrum der psychoanalytischen Praxis repräsentieren. Die Einsichtstherapie der klassischen Analyse hat das episodische, explizite Gedächtnis als Bezugspunkt und in dieser Weise auch weiterhin Gültigkeit. Demgegenüber bezieht sich die Therapie der emotionalen Erfahrung auf implizites Erfahrungswissen, das den Kern der Patienten mit einer Entwicklungspathologie ausmacht.In dieser Arbeit wird die implizite psychoanalytische Behandlungspraxis im Umgang mit archaischen Ich-Zuständen erläutert. Dabei wird die Bedeutung der bekannten Behandlungskonzepte Objektverwendung, Metabolisierung und containment hervorgehoben.

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Explicit and implicit psychoanalytical practice

Psychoanalysis was conceived with the aim of making suppressed experiences available to the consciousness and by means of this, reversing childhood amnesia. In the course of the extension of the psychoanalytical treatment spectrum to pre-oedipal disturbances and the increasing influence of the object relation theory an alternative therapeutic strategy, the therapy of emotional experience, was developed. The related dualism led to a long-lasting controversy about a uniform psychoanalytical technique. The insight that adequate interpretations and beneficial handling of the relationship are two therapeutical approaches which have not to be separated from each other, has been accepted slowly.Against the background of recent memory research it turns out that on the one hand both approaches supplement each other, but on the other hand they are contrasting poles in the indication spectrum of psychoanalytical practice. The therapy of insight of classical psychoanalysis has the explicit memory as a reference point and is therefore still valid. On the contrary, the therapy of emotional experience refers to implicit experience which is the core of developmental pathology.In this paper the implicit psychoanalytical practice, dealing with archaic ego states, is discussed, referring to such well-known concepts as object use, metabolization and containment.

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Nach einem Vortrag zum 50-jährigen Bestehen des Lou Andreas-Salomé Instituts in Göttingen am 30.10.04.

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Lebensqualität von ärztlichen und psychologischen Psychotherapeuten

In a large empirical cross-sectional study the quality of life of medical and psychological psychotherapists ( n =71, respectively n =103) was examined as well as the influence of the different therapeutic methods used. Instruments used were the Questionnaire on Quality of Life of Physicians (Reimer and Jurkat 2003) respectively the Questionnaire on Quality of Life of Psychologists (Jurkat and Reimer 2003) as well as the SF-36 Health Survey (Bullinger and Kirchberger 1998). The majority of participants in both samples are satisfied with their life. Psychological psychotherapists are comparatively more content with their work situation and judge their own health more positively than their medical colleagues do. Both groups feel their income situation to be a loss in quality of life. A common fear is an even greater bureaucratic burden and financial deterioration. Thus it seems that psychohygienic measures and secure job perspectives may contribute to raising the quality of life of psychotherapists.     

Tinnitus als soziale Infektion?

Background

11 out of 35 male employees of a central alert team with rescue coordination function developed a tinnitus disorder. This clinical case-study highlights the psychodynamic background of this accumulation.

Methods

Employees were investigated by psychometric questionnaires and semistructured psychodynamic biografical interviews. Additionally aspects of group dynamics and organisational structure were assessed.

Results

All staff members reported adverse work conditions. Medical and psychometric examination of the tinnitus patients did not reveal severe pathological findings. The interviews identified psychodynamic conflicts dealing with autonomy and regulation of self-esteem. All tinnitus patients reported a very adverse or punitive father relation and difficulties in performing a stabile male role and self-image. Group dynamics was dominated by paranoid and regressive tendencies complicated by maladaptive coping, crude perception of external facts and a pronounced experience of aggressive impulses.

Conclusion

The remobilisation of infantile powerlessness, ineffectiveness and helplessness triggered by adverse work conditions and the introduction of a new culture of personal responsibility within the work organisation together with an impaired coping of separation conflicts enforced by traumatic aspects of the relation with the father may have promoted the tinnitus symptomatology. Additionally, due to the missing awareness of the importance of such group dynamical processes the employers contributed to an increasing psychosocial distress, which promoted the accumulated manifestation of tinnitus as a conflict expressive symptom.     

Affektive Interaktion zwischen Patienten und Therapeuten

Zusammenfassung Eine positive therapeutische Beziehung wird therapieschulenübergreifend als wichtige Voraussetzung für den Therapieerfolg angesehen. Meist wird jedoch in Studien lediglich die schriftliche Patienteneinschätzung erfasst. Nonverbale Aspekte der Interaktion zwischen Patienten und Therapeuten werden kaum untersucht. Aus einer Studie zur Vorhersage des Erfolgs stationärer Fokaltherapie werden affektive Interaktionsprozesse im Erstinterview exemplarisch zwischen einer erfolgreichen und einer nicht erfolgreichen Behandlung mit mikroanalytischen Verfahren (facial action coding system, FACS) verglichen. In der nicht erfolgreichen Therapie waren die mimischen Affektäußerungen reziprok; Therapeutin und Patientin zeigten ähnliche vorherrschende (sog. Leit-)Affekte. Erfolgreicher waren die Behandlungen, wenn die Therapeuten komplementäre Affektmuster zeigten. Implikationen für Behandlungstechnik, Supervision und Weiterbildung werden diskutiert.