The reality of phantom limbs

This paper evaluates the joint influence of peripheral neurophysiological factors and higher-order cognitive and affective processes in triggering or modulating a variety of phantom limb experiences, including pain. Part 1 outlines one way in which the sympathetic nervous system may influence phantom limb pain. A model involving a sympathetic-efferent somatic-afferent cycle is presented to explain fluctuations in the intensity of sensations referred to the phantom limb. In part 2, the model is extended to explain the puzzling finding that onlyafter amputation are thoughts and feelings capable of evoking referred sensations to the (phantom) limb. While phantom pains and other sensations frequently are triggered by thoughts and feelings, there is no evidence that the painful or painless phantom limb is a symptom of a psychological disorder. In part 3, the concept of a pain “memory” is introduced and described with examples. The data show that pain experienced prior to amputation may persist in the form of a memory referred to the phantom limb causing continued suffering and distress. It is argued that two independent and potentially dissociable memory components underlie the unified experience of a pain memory. This conceptualization is evaluated in the context of the surgical arena, raising the possibility that under certain conditions postoperative pain may, in part, reflect the persistent central neural memory trace left by the surgical procedure. It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, cognitive, and affective processes.     

Shame and fragmentation in the marital dyad

The paper outlines an expansion of object relations theory to account for fragmentation and shame. This expansion promotes a better psychodynamic perspective on the type of marital conflict escalation that occurs when each spouse turns to the other for empathic receptiveness while that other is also in a disorganized and vulnerable state of mind. Escalation occurs when spouses have different needs for safety and optimum distance and when the shame generated by continued exposure of these needs is not acknowledged. Clinical precepts promoting a focus on fragmentation and acknowledgement of shame are elaborated.     

The unforgivable humiliation: A Dilemma in couples' treatment

Therapists sometimes encounter cases of intense marital discord in which the disaffected spouse seems unable to specify the reason for his or her discontent except in the vaguest, most general terms. Such cases may be extraordinarily difficult to treat, as the disaffected partner may seem impervious to any attempt at negotiation, to the point of dissolution of the marriage. The reason for the disaffected spouse's intransigence may seem unclear to the other spouse, to the therapist, and even to herself/himself. We hypothesize an explanation for this phenomenon in terms of the disaffected partner's experience of having suffered humiliation at the hands of the other spouse and offer a plan for treatment, citing case materials.     

Illegality 1988

The author presents how the Holocaust appears symbolically in an obsessive-compulsive neurosis in 1988 in Budapest, through the therapy of a 16-year-old boy and his family. The behavior therapy that was first applied made the symptoms even more serious, supposedly because the index patient interpreted it as pursuit. The hypothesis supposed the appearance of the Holocaust in the third generation—as a family myth—and intervention based on this hypothesis brought an end to the neurotic symptoms. The knowledge of historical processes is very important in psychotherapeutic treatment.I would like to acknowledge my debt and my appreciation to Valeria Kiss, occupational therapist, Central National Institute, Budapest, who has had a major role in creating therapy, as co-therapist. I would like to thank Beata Susansky and Gareth Dewar for helping in translation and Andras Posman for helping with the figures of the genogram.     

The case of Peter and Susan: The psychotherapeutic treatment of an acute psychotic episode at the Arbours Crisis Centre

The case of Peter and Susan is an example of multiple crisis intervention at the Arbours Crisis Centre in London. Both were treated by psychoanalytic psychotherapy together with intensive interpersonal support in a live-in therapeutic milieu, with successful results.An extended discussion about the work of the Arbours Association in London will be published by Human Sciences Press as a chapter entitled, An Alternative Sanctuary: The Arbours Crisis Centre, in the forthcoming book,Healing Human Systems, edited by U. Reuveni and R. & J. Speck. For further information about the Centre write to: The Arbours Association, 41a Western Park, London N.8.     

The redundancy of work alienation and job satisfaction: Some evidence of convergent and discriminant validity

The multitrait-multimethod matrix (MTMM) technique was used in an attempt to help clarify the ambiguities regarding concepts of work alienation, job satisfaction, and the relationships between them. Within each attitude domain considered separately, generally acceptable evidence of convergent and (to a lesser degree) discriminant validity was found for the trait measures (four dimensions of alienation and five of satisfaction). However, the discrimination between alienation and satisfaction measures was no greater than that among satisfaction and among alienation, casting doubt on the demarcation of these as two distinct domains. The measures of satisfaction and alienation also were not correlated differentially with demographic and self-esteem measures. Note was taken of the limitations in our knowledge and operationalization of these areas, as these relate to the assumptions of MTMM technique regarding independence of both underlying trait constructs and measurement methods.     

Prerequisite vs. in vivo acquisition of self-feeding skill

Separating the acquisition of prerequisite skills from the learning of skills in vivo may be a more efficacious procedure for self-help training of low functioning developmentally delayed children. Two procedures for training independent use of a fork at meals were compared using two equivalent groups of three subjects each, in multiple baseline design. Using previously accepted procedures, one group was trained during meals while the experimental group received prerequisite training making use of simulated food (styrofoam pieces). Data during training, generalization-to-meal, and follow-up were collected. For 6 months following training, the efficacy of prerequisite training was upheld. The complexity of individual responses to the singular or conjunctive use of social and edible reinforcement for the purpose of self-feeding skill generalization and maintenance, is discussed.     

Opportunity for thought as a mediator of attraction to a dissimilar stranger: A further test of an information seeking interpretation

It has previously been shown that confusion, produced by an ambiguous film, leads to increased attraction to attitudinally dissimilar others. It was posited that confusion leads to a search for information that will help to structure the confusing situation, and that dissimilar others have perspectives that are of value in this regard. In the present study, subjects were exposed to either a confusing film, a nonconfusing film preceded by an explanation designed to produce confusion, or the nonconfusing film with no preceding explanation. They then were either given an opportunity to think about the film's meaning or were deprived of this opportunity through a filler task. It was argued that the opportunity to think about the film would allow subjects to gain structure, and that this would reduce their confusion, decrease their need for more information, and thereby decrease their attraction to a dissimilar other. The results supported this contention. That is, subjects exposed to either the confusing film or the nonconfusing film with an explanation and then given an opportunity for thought showed significantly less attraction to a dissimilar stranger than their counterparts who were deprived of this opportunity.     

A test of the generality of the word-context effect

Three experiments tested the generality of the finding of Reicher (1969) and Wheeler (1970) that a word context facilitated the accuracy of recognition of an embedded target letter. In the present experiments, the context was a letter and the target was a letter fragment. The letter context greatly facilitated the recognition of the letter fragment. In Experiment I, this improvement was in many cases from chance level to perfect performance. An interpretation of this effect in terms of greater familiarity of the fragment and its context was disconfirmed in Experiment II. A procedure of preexposure cueing in Experiment III eliminated the superior recognizability of fragments having a letter context.