Can this be evil? Evilness seen as intention or drive

This article was originally read as an introductory plenary paper at the German-Nordic Clinical Conference, September 2015 in Berlin. The heading of the conference was ‘On Cruelty and Destructiveness’. The paper takes as its starting point the composite figure of Dr Jekyll and Mr Hyde. It discusses the meaning of intentionality, or the lack of a conscious intention of being evil, in comparison to evil deeds caused by uninhibited drive satisfaction. Evilness is put into a social and a psycho-developmental context. Examples of contemporary atrocities are discussed, leading up to a formulation of a multi-factorial explanatory model of evil, taken from Michael Stones book ‘The Anatomy of Evil’.     

The Confluence of Adverse Early Experience and Puberty on the Cortisol Awakening Response

Associations between early deprivation/neglect in the form of institutional care with the cortisol awakening response (CAR) were examined as a function of pubertal status among 12- and 13-year-old post-institutionalized youth. CARs indexed hypothalamic-pituitary-adrenocortical reactivity. Post-institutionalized youth were compared to youth adopted internationally from foster care (adoption control) and to nonadopted youth reared in families comparable in parental education and income to the adoptive families. Post-institutionalized youth exhibited a blunted CAR if they were at earlier but not if they were at later stages of puberty. Similarly, for both groups of internationally adopted youth combined, earlier but not later stages of puberty were associated with more blunted CARs at higher but not lower levels of parent-reported pre-adoption physical and social neglect.     

Validation of a motivation-based typology of angry aggression among antisocial youths in Norway

This article describes the validation of the Angry Aggression Scales (AAS), the Behavior Inhibition System and the Behavior Activation System (BIS/BAS) scales, the reactive aggression and proactive power scales in relation to a Norwegian sample of 101 antisocial youths with conduct problems (64 boys, 37 girls, mean age 15 ± 1.3 years) and 101 prosocial controls matched on age, gender, education, ethnicity, and school district. Maximum likelihood exploratory factor analyses with oblique rotation were performed on AAS, BIS/BAS, reactive aggression and proactive power scales as well as computation of Cronbach's alpha and McDonald's omega. Tests for normality and homogeneity of variance were acceptable. Factor analyses of AAS and the proactive/reactive aggression scales suggested a hierarchical structure comprising a single higher-order angry aggression (AA) factor and four and two lower-order factors, respectively. Moreover, results suggested one BIS factor and a single higher-order BAS factor with three lower-order factors related to drive, fun-seeking and reward responsiveness. To compare scores of antisocial youths with controls, t-tests on the mean scale scores were computed. Results confirmed that antisocial youths were different from controls on the above-mentioned scales. Consistent with the idea that anger is associated with approach motivation, AAS scores correlated with behavioral activation, but only explosive/reactive and vengeful/ruminative AA correlated with behavioral inhibition. Results generally validated the quadruple typology of aggression and violence proposed by Howard (2009).     

Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy

In order to explore goals of parents and psychotherapists prior to child psychotherapy, the following questions were asked: (1) How are goals for psychotherapy formulated? (2) How can similarities and differences between parents’ and psychotherapists’ goals be understood? Questionnaires regarding psychodynamic child psychotherapies (n = 33) with parallel parental work were analysed using qualitative methodology. The child psychotherapists’ goals were often connected to the intrapsychic and relational development of the child. The parental therapists formulated goals focused on providing support to parents. The parents’ goals, on the other hand, concerned to a great extent giving the child help and to a lesser degree receiving help for themselves. They expressed their expectations concerning the child’s psychological development with a more everyday use of language, often with an emphasis on general psychological wellbeing. The study also indicated that parents had limited knowledge about the therapy’s implementation and framework. Some clinical conclusions could be made. Negotiating goals prior to parental and child psychotherapy can help create realistic expectations and promote a beneficial therapy situation.     

Children in psychodynamic psychotherapy: changes in global functioning

This study was part of the Erica Process and Outcome Study. The aim was to investigate if children's global functioning improves after psychodynamic psychotherapy. Variables that may predict changes in global functioning were examined both statistically and qualitatively, for example, the child's age and gender; diagnosis and comorbidity; treatment variables. The sample consisted of 33 children (five to 10 years of age) who participated in psychodynamic psychotherapy with parallel work with parents. Twenty-nine children had at least one DSM-IV diagnosis, and 15 children had comorbid conditions. At the start of psychotherapy, the most frequent diagnoses were attention disorder and disruptive behaviour. Child psychotherapists rated the children's global functioning using CGAS and HCAM. Large effect sizes were obtained (d = 1.80 and d = 1.98). However, no statistical correlations were found between global functioning and the selected variables. In order to illuminate the complex connection between process and outcome the study was complemented with in-depth case studies where data were taken from questionnaires, completed by the child therapists every third month. Two child therapies were selected: one in which the therapist rated a large change and one in which a small change was rated (CGAS). The analysis showed that important individual change, for example, attainment of formulated goals, was not always reflected in the change rated using the CGAS. Findings suggest that psychodynamic child psychotherapy can be beneficial. However, further research is needed to identify factors that contribute to change in children's global functioning.     

What could have been done (but wasn’t). On the counterfactual status of action in Alva Noë’s theory of perception

Alva Noë’s strategy to solve the puzzle of perceptual presence entirely relies on the principle of presence as access. Unaccessed or unattended parts or details of objects are perceptually present insofar as they are accessible, and they are accessible insofar as one possesses sensorimotor skills that can secure their access. In this paper, I consider several arguments that can be opposed to this claim and that are chiefly related to the modal status of action, i.e. the fact that the action that would secure access to the absent aspects is a possibility, something that can (or maybe could) be done. The main difficulty Noë’s account must face is –as several situations demonstrate– that the action that should be performed for the absent aspects to be actually accessed does not have to be itself available for these aspects to be perceptually present. What matters for the absent aspects to be present is not their de facto (i.e. effective) accessibility, but their de jure accessibility. To overcome those difficulties, I propose to rely on a ternary model of the role of action possibilities in perceptual awareness. This model builds on Husserl’s analysis of the role of perceptual circumstances in perception and connection between sense (Sinn) registering and horizontal intentionality.     

Atypical EEG power correlates with indiscriminately friendly behavior in internationally adopted children

While effects of institutional care on behavioral development have been studied extensively, effects on neural systems underlying these socioemotional and attention deficits are only beginning to be examined. The current study assessed electroencephalogram (EEG) power in 18-month-old internationally adopted, postinstitutionalized children (n = 37) and comparison groups of nonadopted children (n = 47) and children internationally adopted from foster care (n = 39). For their age, postinstitutionalized children had an atypical EEG power distribution, with relative power concentrated in lower frequency bands compared with nonadopted children. Both internationally adopted groups had lower absolute alpha power than nonadopted children. EEG power was not related to growth at adoption or to global cognitive ability. Atypical EEG power distribution at 18 months predicted indiscriminate friendliness and poorer inhibitory control at 36 months. Both postinstitutionalized and foster care children were more likely than nonadopted children to exhibit indiscriminate friendliness. Results are consistent with a cortical hypoactivation model of the effects of early deprivation on neural development and provide initial evidence associating this atypical EEG pattern with indiscriminate friendliness. Outcomes observed in the foster care children raise questions about the specificity of institutional rearing as a risk factor and emphasize the need for broader consideration of the effects of early deprivation and disruptions in care.     

Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation

Early adversity, for example poor caregiving, can have profound effects on emotional development. Orphanage rearing, even in the best circumstances, lies outside of the bounds of a species-typical caregiving environment. The long-term effects of this early adversity on the neurobiological development associated with socio-emotional behaviors are not well understood. Seventy-eight children, who include those who have experienced orphanage care and a comparison group, were assessed. Magnetic resonance imaging (MRI) was used to measure volumes of whole brain and limbic structures (e.g. amygdala, hippocampus). Emotion regulation was assessed with an emotional go-nogo paradigm, and anxiety and internalizing behaviors were assessed using the Screen for Child Anxiety Related Emotional Disorders, the Child Behavior Checklist, and a structured clinical interview. Late adoption was associated with larger corrected amygdala volumes, poorer emotion regulation, and increased anxiety. Although more than 50% of the children who experienced orphanage rearing met criteria for a psychiatric disorder, with a third having an anxiety disorder, the group differences observed in amygdala volume were not driven by the presence of an anxiety disorder. The findings are consistent with previous reports describing negative effects of prolonged orphanage care on emotional behavior and with animal models that show long-term changes in the amygdala and emotional behavior following early postnatal stress. These changes in limbic circuitry may underlie residual emotional and social problems experienced by children who have been internationally adopted.     

Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

The conceptualisation of the psychical in psychoanalysis

This article aims to clarify the psychoanalytic conceptualisation of the psychical, which includes a discussion of the relationship between consciousness and the unconscious. The unconscious is conceived of as being on the border between the so-called 'ego's conscious intending' and a rudimentary body-ego experiencing. Phenomenological ideas on the essence of consciousness are used in order to help delineate the crucial differences between consciousness and the unconscious. Only consciousness is characterised by an awareness of itself, that is; self-consciousness. Furthermore, consciousness is characterised by an intentional, synthesising capacity, whereas the functioning of the unconscious, in its most radical form, is the opposite ofthe intentionality of consciousness. It is argued that the unconscious pre-supposes certain pre-sexual processes, in the form of a body-ego's formation of continuity, coherence and wholeness. The body-ego belongs to the sphere of consciousness/self-consciousness, even if self-consciousness is only given implicitly in the body-ego and not as a fully fledged ego cogito . Attention is drawn to neglected issues in psychoanalytic theorising, namely self-consciousness and the constitution of existence. The importance of this neglected area for the psychoanalytic process is illustrated with clinical examples.