The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.     

Knowing and not knowing: the analyst's pregnancy

The author examines some of the dynamics associated with the shifting experience of knowing and not knowing as it arises in response to the pregnancy of the analyst. This experience, as well as the thinking process behind it, is ubiquitous in psychoanalytic work, but is particularly apparent in the work demanded by the analyst's pregnancy. An indepth case history is presented to illustrate the ways in which pregnancy in the analyst may powerfully revive important dimensions of the patient's past.     

The list strength effect: A contextual competition account

Research on the list strength effect (LSE) has shown that learning some words on a list more strongly than others impairs memory for the weakly learned words when tested with a recall task. Norman (2002) demonstrated that the LSE also occurs within the recollection process of a recognition test. In this study, a mechanistic dual-process account of the LSE was tested that simultaneously makes predictions concerning additional sources of context in interference effects. In two experiments, we attempted to replicate Norman's (2002) findings and provide the basis for our modeling efforts. We found evidence for a recollection LSE in raw measures of responding, with memory performance also benefiting from reinstatement of perceptual characteristics at test. However, large differences in the hits between the lists were accompanied by small differences in false alarms, such that when d' is calculated, differences between the lists are not significant. We propose an account of the LSE whereby the actual effect of competition between items on the list is small, although present, and difficult to distinguish from large effects of bias due to the strength manipulations. We argue that our findings provide support for a mechanistic explanation of LSE that is based on competition of source activation and changes in the thresholds for responses.     

Kidney Transplants From Young Children and the Mentally Retarded

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other.     

Less guilty by reason of adolescence: developmental immaturity, diminished responsibility, and the juvenile death penalty

The authors use a developmental perspective to examine questions about the criminal culpability of juveniles and the juvenile death penalty. Under principles of criminal law, culpability is mitigated when the actor's decision-making capacity is diminished, when the criminal act was coerced, or when the act was out of character. The authors argue that juveniles should not be held to the same standards of criminal responsibility as adults, because adolescents' decision-making capacity is diminished, they are less able to resist coercive influence, and their character is still undergoing change. The uniqueness of immaturity as a mitigating condition argues for a commitment to a legal environment under which most youths are dealt with in a separate justice system and none are eligible for capital punishment.     

What do children do in the rime-analogy task? An examination of the skills and strategies used by early readers

Despite the intense debate surrounding the use of orthographic analogy in the clue word paradigm, little is known about the skills and strategies children actually use and how these compare with their everyday reading of single words. This study, with 4- and 5-year-olds (N=125), supports previous work which suggests children rely on phonological, rather than orthographic, priming in the clue word task since children most frequently produced rhyming words in response to the clue word. The extent to which phoneme and rhyme-based skills, along with letter-sound knowledge, predicted children's performance in the analogy task and in a test of single word reading was contrasted and compared. Our findings suggested that the balance of skills which children drew upon was determined by the demands of the task. The implications of these findings for the validity of the 'orthographic'-analogy task and for teaching beginning readers is discussed.     

Deaf murderers: clinical and forensic issues

Data are reported on 28 deaf individuals who were convicted, pled guilty, or have been charged and awaiting trial for murder. The unique forensic issues raised by these cases are discussed, and their clinical picture presented. A significant percentage of these deaf murderers and defendants had such severely limited communication skills in both English and American Sign Language that they lacked the linguistic ability to understand the charges against them and/or to participate in their own defense. As such, they were incompetent to stand trial, due not to mental illness or mental retardation, but to linguistic deficits. This form of incompetence poses a dilemma to the courts that remains unresolved. This same linguistic disability makes it impossible for some deaf suspects to be administered Miranda Warnings in a way comprehensible to them. This paper identifies the reasons for the communication problems many deaf persons face in court and offers remedial steps to help assure fair trials and police interrogations for deaf defendants. The roles and responsibilities of psychiatric and psychological experts in these cases are discussed. Data are provided on the etiology of the 28 individuals' hearing losses, psychiatric/psychological histories, IQs, communication characteristics, educational levels, and victim characteristics.