Adolescent suicide attempters presenting to a pediatric facility

This study profiles the characteristics of adolescent suicide attempters and the treatment they received in a pediatric emergency room (ER). A retrospective chart review of 4,072 adolescents seen in the ER at a children's hospital (CH) from July 1984 to June 1985 was undertaken. Twenty-seven adolescents who had deliberately injured themselves were identified. The average age was 14 years 7 months (range 11-19 years). Fifty-two percent of the patients were white and 78% were female. Ingestion was the most common method (78%), followed by attempted hanging (11%), and wrist laceration (7%). After evaluation by a pediatrician in the ER, 30% of the patients were treated and released, 11% were transferred directly to a psychiatric hospital, and 59% were admitted to the CH, with an average hospital stay of 1.88 days. Once hospitalized, consultations from psychiatry (81%), social service (50%), psychology (19%), and neurology (6%) were obtained. At the time of discharge from either the ER or CH, the patients had a variety of plans for ongoing care, with 52% being referred to outpatient counseling, 37% being transferred to a psychiatric hospital, and 11% having no documented plan for ongoing care. These results demonstrate that the evaluation of suicidal adolescents cared for in a pediatric facility may be episodic and suggest the need for a comprehensive program to approach the problem.     

Anxiety in adolescence and its significance for psychoanalysis

The theme of this paper is the well-known resistance of adolescents to participate in analytic treatment and analysts' reservations about treating adolescents, which is perhaps less well known. Several reasons are discussed: For adolescents, the revival of separational and fusional anxieties during the process of individuation as well as resistance to the analytic setting are held responsible; analysts may lack sufficient awareness of their own adolescence and its resulting anxieties to be able to confront this developmental period. In addition, there are countertransference anxieties that are triggered and kept alive by the behavior of the juvenile patient. The different types of analyst anxieties as well as those of the adolescent under analysis are explained and their significance in the process of individuation and the course of therapy is noted.     

Intolerance of responsibility for internal conflict

A type of patient is described, who has marked intolerance of taking responsibility for his internal conflicts so as to confront them, analyze them, and change. Defensive repetition in pathological object relations aims to avoid what is wrong within and to engage another so as to protect oneself. Genetic, dynamic, and technical aspects of such defensive, dependent relating are considered. Responsibility for oneself and for what is within oneself is held to be terrifying--more than anyone can bear on his own. How destructiveness has become, and remains, so terrifying is discussed.     

Psychoanalytic enlightenment and the greening of diplomacy

The author reviews aspects of psychoanalytic theory which have helped him in his career as an American diplomat and political analyst. He cites the works of Erikson (1950, 1968, 1969), Volkan (1979, 1987), and Mack (1979, 1983) as especially helpful, and praises the late Jeanne Knutson, founder of the International Society of Political Psychology, for her work on the psychology of victimhood. The role and function of completed and incomplete mourning are discussed as fundamental aspects of unresolved ethnic and sectarian conflict, and the importance of asking and granting forgiveness in the resolution of violent political conflict is explored. The paper ends with a specific application of the meaning of forgiveness in the relationship between Christians and Jews.     

How dreams are told: secondary revision--the critic, the editor, and the plagiarist

Secondary revision is a highly provocative concept arising out of Freud's attempts to explain the construction of dreams, but it remains relatively ill-defined. It includes three related, yet by no means identical aspects of the process by which the dream acquires its more or less final form during the experiencing, the remembering, and the telling. It represents one of the most interesting hypotheses dealing with the fluid world between sleeping and waking, a field which still presents us with a host of unanswered questions. Secondary revision not only reflects the higher levels of the dreamer's mental functioning superimposed on his biological substructure, but it also operates as a sensitive indicator of the cultural factors which have helped mold his personality. These factors include both the subculture of the analytic situation and the impact of society in the larger sense. I make reference to individual dreamers in analysis and to the world of dreams recorded in the past from our own and other cultures.     

The changing face of visual persistence

In three experiments, the effect of target luminance on estimates of visual persistence was determined on a popular successive-field task. Even though the experiments differed from each other only in terms of minor changes in stimulus conditions, very different effects were obtained across the three experiments. The different findings were attributed to the often overlooked roles of masking and target degradation on tasks of persistence. Implications for the numerous contradictory findings in the persistence literature are discussed, and the current popularity of the successive-field task is questioned.     

The "second skin": perceptions of disturbed and nondisturbed early adolescents on clothing, self-concept, and body image

The purpose of this investigation was to determine if there were differences between regular education and emotionally disturbed early adolescents with respect to self-concept, body image, and selected uses of clothing. A questionnaire was administered to 74 regular education students from three middle schools. An additional 27 students labeled emotionally disturbed were surveyed from one of the schools. The questionnaire contained existing measures of self-concept and body cathexis and a revised clothing scale developed by the authors. Analysis of the data using t tests revealed significant differences between the groups with regard to self-concept and body image. In both cases, regular education students perceived themselves more positively than did those labeled emotionally disturbed. Factor analysis of the clothing-use measure gave rise to five distinct factors, one of which revealed a significant difference between the groups when analyzed by t tests. This factor, "dependence," examined the emotional effects of the use of clothing on individuals, such as the ability to influence mood. The emotionally disturbed students were less likely to use clothing to influence mood than were the regular education students. The results of this investigation lend further credence to the importance of self-concept in the education curriculum, and imply that the usual aspects of the curriculum that deal with self-concept may be served better by helping the individual become more realistic and self-accepting. The use of clothing as a tool to enhance self-concept merits further investigation.