Long-term associations of stress and chronic diseases in ageing and retired employees

Long-term associations of prolonged stress symptoms and work-related stressors with chronic diseases were assessed in a sample of ageing and retired food industry workers (N = 100, mean age 62 years) using independent samples t-test, chi-squared test and binary logistic regression analyses. Data was gathered at health checkups and using self-report questionnaires in 1989 and 2000. Prolonged stress symptoms were associated with overall morbidity. Higher scores of stress symptoms predicted musculoskeletal disorders, diseases of the nervous system, eye and ear, endocrine and metabolic diseases, and mental disorders. Of work-related stressors, only job dissatisfaction had a long-term association with endocrine and metabolic diseases. Importantly, prolonged stress symptoms could not be explained by job strain and demands. Identification of prolonged stress symptoms along with traditional and potential risk factors, and combining this knowledge with stress reduction and management is essential for disease prevention and in postponing subsequent onset of disease.     

On the metapsychology of schizophrenia.

The author's point of departure is schizophrenic fragmentation, which has been considered here from a drive-economic and structural point of view, starting from Freud's prestructural conceptions and Jacobson's metapsychological formulations. The view is arrived at in the essay that the central psychological mechanism in the schizophrenic disorder is a drive-energetic decathexis of the basic psychic tissue, or the primal representative matrix, which has far-reaching consequences within the entire psychic organization. The basic psychic tissue corresponds to that area of inner reality which, according to Freud, remains beyond the primal repression and is made up of the first representations of the instinctual drive. The entire psychic organization has then been woven out of this representational tissue, binding drive energies in a preliminary way. According to the view put forward here, schizophrenic fragmentation does not primarily represent a disintegration of the psychic macrostructures or a consequence of the ego's resorting to primitive defences but is a consequence of a drive-energetic crisis at the level of the basic psychic tissue. The disorder manifests itself as the disappearance of inner liveliness and as a diffuse dissociation of the entire representional world, which I have characterized as the disappearance of psychic transparence. Its influences naturally also extend to the realm of the more advanced psychic functions and macrostructures and will invalidate in a radical way the person's drive economy. Reference is made in the article to the possibility that the central task of the primal representative matrix may be the creation of lively connexions and a striving for synthesis throughout the entire psychic organization and that the schizophrenic disorder may be intimately related to the decathexis of this function.     

Method Effects: The Problem With Negatively Versus Positively Keyed Items

Using confirmatory factor analyses, we examined method effects on Rosenberg's Self-Esteem Scale (RSES; Rosenberg, 1965) in a sample of older European adults. Nine hundred forty nine community-dwelling adults 60 years of age or older from 5 European countries completed the RSES as well as measures of depression and life satisfaction. The 2 models that had an acceptable fit with the data included method effects. The method effects were associated with both positively and negatively worded items. Method effects models were invariant across gender and age, but not across countries. Both depression and life satisfaction predicted method effects. Individuals with higher depression scores and lower life satisfaction scores were more likely to endorse negatively phrased items.     

The Reconstruction of Psychic Trauma

The author discusses the difficulties that arose in the analysis of a female patient suffering from a delusional disorder, where traditional criteria of suitability for psychoanalytic treatment were initially lacking and had to be established as part of the process. The transference-countertransference interaction came to a deadlock, understood by the analyst as due to the patient’s pathological dyadic relating. She was lacking in her capacity of reflective functioning, and there was no potential space to foster a fruitful therapeutic dialogue between analyst and patient. The analyst adopted a bystander perspective as a vantage point from which to comment on the patient’s narrative, whereby she succeeded in gradually altering the dysfunctional dyadic exchange into an interaction where a triadic perspective was introduced as a means to making possible meaningful communication between patient and analyst. Substantial changes were achieved with this procedure as a point of departure. The case study highlights aspects of dyadic versus triadic functioning of the analytic pair, and serves to illustrate theoretical points pertaining to the ongoing debate between professionals on how the basic structural elements of the analytic relationship should be conceptualised.     

Method effects: the problem with negatively versus positively keyed items

Using confirmatory factor analyses, we examined method effects on Rosenberg's Self-Esteem Scale (RSES; Rosenberg, 1965) in a sample of older European adults. Nine hundred forty nine community-dwelling adults 60 years of age or older from 5 European countries completed the RSES as well as measures of depression and life satisfaction. The 2 models that had an acceptable fit with the data included method effects. The method effects were associated with both positively and negatively worded items. Method effects models were invariant across gender and age, but not across countries. Both depression and life satisfaction predicted method effects. Individuals with higher depression scores and lower life satisfaction scores were more likely to endorse negatively phrased items.     

The Restitution of Primary Identification Psychoanalysis

The paper discusses different well-known imagined monsters. Starting with the fairy tale and the films on The Beauty and the Beast (La Belle et la Bête), hidden meanings from several psychodynamically valid perspectives are proposed with the aim of finding out what makes this story so popular and everlasting. Projected demons or impulses in Maurice Sendak's Where the Wild Things Are are discussed as well as Mary Shelley’s Frankenstein and his monster who are presented and connected to facts in this author’s life. In the summary links to psychoanalytic thinking are proposed.     

The Role of Psychological Characteristics in the Relation Between Socioeconomic Status and Perceived Health1

Separate analyses of United States and Finnish samples demonstrate a graded (almost linear) relation between socioeconomic status (SES) and risk of poor perceived health. In both studies, positive psychological factors (greater social support; less anger, depression, and perceived stress) and beneficial health practices (nonsmoking; drinking and exercising moderately) were associated with both higher levels of SES and better self-reported health. Psychological and health practice variables were both able to account for some of the SES and poor health gradient. However, contrary to expectations, these factors did not play a more important role in explaining decreased risk at the middle and highest levels of SES, and instead may be most important at lowest levels.     

The effect of severe carotid occlusive disease and its surgical treatment on cognitive functions of the brain

Surgery of a high-grade carotid stenosis is evidence-based stroke prevention. Also cognitive effects are reported after carotid endarterectomy (CEA): both deterioration and improvement, the former attributed to perioperative complications and the latter often to learning effect. By imaging, brain perfusion and diffusion changes were shown in subjects with a high-grade stenosis undergoing CEA. We wanted to find out if the cognition of patients undergoing CEA display postoperative worsening or true improvement in association with findings in serial MR imaging. The patients had a poorer overall cognition than healthy matched controls. The cerebral hemisphere ipsilateral to the stenosis had higher diffusion and more sluggish perfusion leading to perfusion deficits. These asymmetries were abolished by CEA. Postoperatively, the patients showed a trend for cognitive worsening, most often attentional, but over months, the group performance improved similarly to the controls. Still, lower baseline perfusion was associated with a greater cognitive improvement, most clearly in executive functions. Consequently, despite the risk for transient decline, true cognitive benefit by CEA seems possible.