Reply to Commentaries by Dodi Goldman and Avgi Saketopoulou

In this newly fashioned dialogue that allows us three respondents to continue our first-round discussions, I treasure the opportunity of learning more about Farhi's and Milner's works through the lenses of Dodi Goldman and Avgi Saketopoulou. Both respondents bring additional important historical information to this virtual roundtable, giving me another chance of re-reading Farhi's text through these new perspectives. I think that Goldman's information about Milner's interest in the natural science contributes a great deal to my understanding of her amazing capacity to tolerate her patient's changing psychotic states. I also learn a lot from Saketopoulou's sensitive discussion of the patient's last phone call to Milner shortly before her death in which the patient informs Milner that she had failed her in similar ways as Winnicott had failed Milner. I suggest a slightly different reading of the word failure and propose that the patient's utterance was a sign of a renewed strength rather than a statement of utter disappointment. A discussion of the place of phantasy in the intra-uterine life of a baby is also included in my response.     

Making a Memorial Place: The Photography of Shimon Attie

Assisting the analysand in making the past a living present held within a bearable yet unpredictable future is what psychoanalysis is so much about. Events of the past can never be redone, or fully repossessed, but they must be reconstructed in the context of the transference–countertransference experience of the analytic relationship. In order to make the past a useful present and presence, we need metaphors to give it shape—metaphors that capture the memorial activity linking the past with the present and future in a meaningful manner. In this paper, I explore the ways in which the work of the American photographer Shimon Attie creates a memorial place in which the past is not simply remembered but instead is actively mourned. In The Writing on the Wall, Attie collects broken fragments from prewar German-Jewish life in Berlin, and, by projecting these found shards of former lives onto the buildings in the Berlin Scheunenviertel, which once housed these people, he creates a potential space in which a present can suddenly come alive by the superimposition of a past that was supposed to have been obliterated. In this transitional realm, the spectator is given a wide realm of to-and-fro movements between past and present that permits the creation of an object world that did not exist before. I suggest that Attie's intricate weavings of past, present, and future serve as instructive models for the psychoanalytic process in which the analyst can find himself in a similar position of opening up a playground where the past can be brought into the present and where the presentness of the past can come alive. The ability to move back and forth between the present and the past suggests a link to the Freudian concept of deferred action, later taken up by Lacan under the notion of après-coup, where the impression (Prägung) of an earlier event, having lain dormant for a long time, breaks through into the present through a retroactive action that then completely reshapes the present impression. I draw comparisons to psychoanalytic practice, in which the superimposition (the stacking on top of one another) of recollections, dreams, and associations pries open in the analysand's mind a psychic space in which memories of a seemingly insignificant past absorb a sudden sense of urgency when revisited through this retroactive process.     

Science and its applications: INSERM reflections

The history of science must be introduced onto the curriculum, scientific culture must be developed if the young are to receive a global, healthy understanding of science and technology.

The experiment pioneered by INSERM clubs is, from this point of view, exemplary.     

Drawing as a means of communication at the initial interview with children with cancer

Cancer is always associated with distress and fear. In working with children who have cancer, a trusting relationship and meaningful dialogue often cannot be established by talking on its own. Drawings may offer an opportunity for children to express their feelings without giving up resistance completely. This paper summarizes the aims of the first interview with an ill child, one of its main purposes being the evaluation of the children's and their family's resources to cope with the strains of the illness. The meaning of drawings in this process is discussed in two case reports.     

Risk perceptions,worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Pilot Evaluation of the ACT Raising Safe Kids Program on Children’s Bullying Behavior

Research documents that parents play a critical role in the development and maintenance of behavior problems in children. Few bullying prevention programs, however, target children in early childhood or include a parenting component in spite of experts recommending that parent training in behavior management be addressed. Based upon these recommendations, the present study examines the relationship among parent characteristics (hostility, depression, and overall parenting skills) and child bullying and the effects of the American Psychological Association’s ACT Raising Safe Kids program on reducing early childhood bullying. The ACT-RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Fifty-two parents/caregivers, representing children ages 4–10, completed the Brief Symptom Inventory, the ACT Parents Raising Safe Kids Scale, and Early Childhood Bullying Questionnaire (derived from the Child Behavior Checklist and Strengths and Difficulties Questionnaire). Twenty-five of these parents/caregivers were trained in effective parenting including nonviolent discipline, child development, anger management, social problem-solving skills, effects of violent media on children, and methods to protect children from exposure to violence through the ACT-RSK program. The remaining 27 parents/caregivers received treatment as usual. Results indicate decreased bullying in children whose parents completed the ACT-RSK program. Furthermore, of the parent characteristics assessed, parental hostility is the only significant parent predictor for child bullying. These findings suggest the efficacy of this brief intervention for preventing bullying.     

Prolonged Exposure Therapy for a Vietnam Veteran With PTSD and Early-Stage Dementia

Although prolonged exposure therapy (PE) is considered an evidence-based treatment for PTSD, there has been little published about the use of this treatment for older adults with comorbid early-stage dementia. As the number of older adults in the United States continues to grow, so will their unique mental health needs. The present article describes the successful coordination of care and application of PE in the assessment and treatment of a Vietnam veteran with comorbid PTSD and early-stage dementia. Measures related to the patient's cognitive and psychological functioning were obtained before, during, and after treatment. PE was associated with significant declines in PTSD and depression symptoms. Moreover, the patient's cognitive functioning was made clearer in the absence of severe psychiatric symptoms. Factors contributing to the patient's positive response are discussed.     

When Are Thought Experiments Poor Ones?

A characteristic of contemporary analytic philosophy is its ample use of thought experiments. We formulate two features that can lead one to suspect that a given thought experiment is a poor one. Although these features are especially in evidence within the philosophy of mind, they can, surprisingly enough, also be discerned in some celebrated scientific thought experiments. Yet in the latter case the consequences appear to be less disastrous. We conclude that the use of thought experiments is more successful in science than in philosophy. This revised version was published online in August 2006 with corrections to the Cover Date.