COCAINE ADDICTS AND THEIR FAMILIES: AN EMPIRICAL STUDY OF THE PROCESSES OF IDENTIFICATION

The processes of identification between adolescent cocaine addicts and their parents were studied in 402 subjects, in total 134 familial triads (father"mother"son), subdivided into two groups of 67 triads, one of these groups having as the child an adolescent of masculine sex dependent on cocaine and the other, equal in number, being a control group, duly matched for age and socio-economic status. The instrument employed was the Rorschach test (1922), limited to the application of the Lerner Defense Scale (LDS; Lerner & Lerner, 1980). The findings in the affected triads showed up as consistent statistically for the presence of intense processes of pathological identification, especially between father and son, a sign of the importance of the presence of disturbances of paternal function in the development of this addiction. The utilisation of very regressive defence mechanisms, above all of projective identification, was the predominant mode of procedure in triads with a dependent child. In comparisons between the fathers the odds ratio (OR) for projective identification was 8.66 to 1, which points to the association between cocaine addiction and the primitive mental functioning of the fathers. With empirical methodology these findings serve to corroborate the psychoanalytical conclusions based on studies of single case studies, testifying that the dysfunctions of identificatory phenomena in familial functioning are predominant in the mental organisation of cocaine addicts.     

A rose by any other name is not the same: the role of orthographic knowledge in homophone confusion errors

Homophone confusion errors were examined in a series of 6 experiments. Across a variety of tasks, readers consistently made more errors on homophone trials than on control trials. These effects were established in Experiment 1 using a semantic-decision task in which participants judged whether pairs of words were related or unrelated. For both related and unrelated trials, error rates were higher for homophones as compared with controls. Results such as these have previously been taken as evidence for the role of phonology in lexical access and reading. However, differences in orthographic knowledge (more specifically, knowledge of spelling-to-meaning correspondences) across participants and homophone items significantly predicted homophone errors across all tasks. In addition, spelling tasks and multiple-choice questionnaires revealed differences in orthographic knowledge across participants and homophone items. Although these results do not rule out a role for phonology in lexical access, they indicate that homophone confusion errors may also be due to factors other than phonology.     

The mental pain of the psychoanalyst: A personal view

Abstract

Mental pain is a common concern of psychoanalysts in their professional life. Combining her clinical experience with previous contributions by others, the author presents a personal overview of the patient-triggered mental pain of the analyst. Countertransference is considered to be the major source of the analyst's work-derived mental pain. This type of mental pain is not to be avoided or discarded by the analyst. Rather, the analyst will benefit from tolerating and even welcoming professional mental pain: in most cases, mental pain will bring with it rich clinical material that, upon interpretation, will help him or her to offer previously intolerable contents back to the patient in a transformed version that now becomes acceptable. The analyst's mental pain may emerge in his dreams; clinical examples of this phenomenon are presented. It is suggested that there is an increased chance of the analyst undergoing mental pain when treating patients suffering from severe psychopathology, and a clinical case is reported to illustrate this assertion. The author proposes that a lifelong effort is to be expected from analysts in terms of enhancing their threshold of tolerance to professional mental pain. In situations of mental pain, analysts must be particularly aware of the need to modulate their interpretations before transmitting them to the patient. The capacity of analysts to transform their mental pain (Ta, according to Bion) will depend on the plasticity of their container functions, the quality of their transformation abilities and, in particular, their threshold of tolerance to mental pain.     

Distinction between mental pain and psychic suffering as separate entities in the patient's experience

Abstract

Mental pain and psychic suffering are herein defined as two separate concepts in psychoanalysis. The concept of mental pain lies at the core of psychoanalysis; it was introduced by Freud and was further elaborated by a number of investigators, mostly by Bion. Mental pain refers to a pain that the patient reports as being impossible to describe in words, and lacking any associations, whereas psychic suffering can be both named and described by the patient. Mental pain is derived from non-tolerance on the part of the psychic apparatus when it is harmed by very painful emotions. In contrast to psychic suffering, mental pain resists elaboration and transformation by dream-work. How to address and transform the patient's mental pain is a major challenge facing the analyst in his clinical work because mental pain may halt or slow the progression of the analytical process. To overcome this hindrance, the work of the analyst is focused on helping patients to modify their mental pain into psychic suffering, that is, to reactivate in the patient the chain of transformations that generates thought. The analyst is also challanged with the mental pain of the patients because he has himself to tolerate the mental patient induced by counter transference. Suggestions for the analyst on how to deal with the mental pain of the patient during psychoanalytic therapy are proposed.     

Improving Fairness in Coverage Decisions: Performance Expectations for Quality Improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.     

Discriminating Personality Disorders Using the WAIS-R: A Comparison of Three Approaches

The purpose of this article is to determine if performance on the Wechsler Adult intelligence Scale-Revised (WAIS-R) can be used to discriminate between the different taxonomies of personality disorder classification specified by three models: the biosocial, the interpersonal, and that described by the Diagnostic and Statistical Manual of Mental Disorder (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). Three discriminant function analyses were performed and the results indicated the usefulness of the WAIS-R in making such differentiations for all the approaches. The WAIS-R proved most effective with the biosocial model, evidencing a robust and clinically meaningful pattern of results. implications for further research are discussed.     

Clinical Utility of the MMPI–2 Restructured Clinical (RC) Scales in Therapeutic Assessment: A Case Study

Summary: In a recent paper, Haan and Livson reported sex differences between male and female psychologists in their evaluations of adult men and adult women. Their conclusions have implication for the validity of clinical, assessments and were interpreted in terms of stereotypic sex rote perceptions. However, their statistical analysis was in fundamental error. When the data they employed were reanalyzed, no reliable sex differences between men and women psychologists were found, a finding in accord with a number of previous investigations of this problem.     

Influence of body dissatisfaction on 1-year change in nutrient intake of overweight and obese inner-city African American children

This analysis aimed to examine the relationship of baseline body dissatisfaction with 1-year change in nutrient intake of inner-city, overweight and obese, African American children. This is a secondary analysis of 1-year pre-post data available for a convenience sample of 88 children. After adjusting for baseline intake of dietary variables and intervention group status, baseline body dissatisfaction was associated with 1-year increases in intake of energy, and all macronutrients in girls, but not in boys. These relationships were not substantially altered after adjusting for baseline BMIz and global self-worth. After including all adjustment factors, increasing baseline body dissatisfaction in girls was associated with 1-year increased intake of total energy, total sugars, total fat, discretionary fat, and total carbohydrates. This analysis suggests that, in girls but not necessarily in boys, body dissatisfaction might need to be targeted during interventions that aim to improve nutrient intake.