MAKING ROOM FOR MADNESS IN MENTAL HEALTH: THE IMPORTANCE OF ANALYTICALLY‐INFORMED SUPERVISION OF NURSES AND OTHER MENTAL HEALTH PROFESSIONALS

In this paper, I discuss the importance of psychoanalytically informed supervision and training of nurses and other professionals in mental health settings. Using examples from supervision groups I will illustrate how a psychoanalytic approach to mental health can complement other ways of thinking about practice and management. Psychoanalysis provides a framework for understanding the relationship between the internal world of the patients, the therapeutic relationship and the social system. I will also argue that this understanding helps to develop and maintain therapeutic factors while reducing the risk of damaging behaviour and beliefs.     

Catch 22: the inflammatory nature of insight

I will describe a man I saw in psychoanalytic psychotherapy with a history of serious drug abuse and violent psychotic episodes. At the start of therapy my patient had little capacity to tolerate the anxiety, depression or the inevitable frustrations involved in facing reality. Over time and with the support of the therapy he was able to increase his capacity for self observation noticing the way he withdrew from the world of shared reality into psychotic states of mind in order to avoid painful feelings of rage, humiliation and shame. In the book ‘Catch 22?, Joseph Heller described the paradox of pilots who wish to claim insanity in order to avoid fatal flying missions, while the authorities maintain that in claiming insanity to avoid suicidal missions the individual demonstrates a sane awareness of the insanity of the missions! This insight is deemed to be evidence of the individual’s sanity and consequently their plea of insanity is denied. In this paper, I will show how Mr. A’s developing capacity for reflective functioning lead to a ‘Catch 22’ as the insight he needed as part of the process of recovery threatened to overwhelm him with depressing realities about the extent of his illness.     

Personality and Cognitive Ability as Predictors of Typical and Maximum Managerial Performance

Despite long-established distinctions between typical and maximum performance variables on both the predictor and criterion side, little previous research has directly addressed the extent to which these distinctions translate into differential predictor-criterion relationships. Using a sample of candidates for managerial positions, we examined relations of predictors conceptually linked to typical (i.e., broad, narrow, and compound personality traits) and maximum (i.e., broad and narrow cognitive abilities) performance with corresponding criterion measures (N = 84–873). Supervisory ratings of managerial performance served as the typical performance criterion, whereas maximum performance was assessed via an assessment center. Confirmatory factor analyses supported the distinction between typical and maximum performance. Results also confirmed our hypothesis that cognitive abilities are more strongly correlated with maximum performance than with typical performance and largely supported the expectation of the opposite pattern with personality traits as predictors.     

The Perceptions of Terminated Ministers Scale—Revised

The Perceptions of Terminated Ministers Scale—Revised (PTM-R), a 15-item measure of perceptions of termination appropriate to members of clergy, was developed for use among researchers studying how clergypersons perceive the effects of forced termination events. To examine the reliability and validity of the measure, three samples of clergy were assessed using the PTM and PTM-R. The three samples used Barfoot et al.’s (2005) working definition of forced pastoral exits. Their definition does not distinguish between being fired or forced to resign. Each participant was asked to specify whether they were fired or forced to resign. Recently, Tanner et al. (2012) offered a new definition of forced termination: “Forced termination is the result of a process of involuntary removal of paid and non-paid clergy-persons that results from a period of traumatic and demeaning psychological and emotional abuse” (p. 14). Data analysis among all three samples supports the reliability and validity of the scale and commends it for further use among clergy who have experienced forced termination.     

Two sides of the same coin? On the history and phenomenology of chronic fatigue and burnout

Background: Burnout and chronic fatigue syndrome (CFS) are two fatigue syndromes which have developed largely independently from each other, yet whose similarities in symptoms can be a source of confusion. We aim to explore the phenomenology of burnout and CFS in a historical context as this may provide some insight into the links and relationship between these conditions. Method: A narrative review based on literature in the fields of history, social science and medicine. Results: The origins of CFS lie within medicine, whereas burnout developed in a psychological setting. As well as symptoms, burnout and CFS also share similar themes such as an overload process triggering illness onset, the need for restoration of depleted energy, external causal attributions and the characteristics of people suffering from these illnesses. However, these themes are expressed in either psychological or medical terms according to the historical background. Conclusion: Despite their similarities, there have been few direct comparisons of the two concepts. Culture, illness perceptions and accountability are important issues in both conditions and could contribute to their differences. Comparing burnout and CFS within one sample frame, thus looking beyond the psychology/medicine divide, could be a useful first step towards understanding their relationship.     

Probabilities on Sentences in an Expressive Logic

Automated reasoning about uncertain knowledge has many applications. One difficulty when developing such systems is the lack of a completely satisfactory integration of logic and probability. We address this problem directly. Expressive languages like higher-order logic are ideally suited for representing and reasoning about structured knowledge. Uncertain knowledge can be modeled by using graded probabilities rather than binary truth values. The main technical problem studied in this paper is the following: Given a set of sentences, each having some probability of being true, what probability should be ascribed to other (query) sentences? A natural wish-list, among others, is that the probability distribution (i) is consistent with the knowledge base, (ii) allows for a consistent inference procedure and in particular (iii) reduces to deductive logic in the limit of probabilities being 0 and 1, (iv) allows (Bayesian) inductive reasoning and (v) learning in the limit and in particular (vi) allows confirmation of universally quantified hypotheses/sentences. We translate this wish-list into technical requirements for a prior probability and show that probabilities satisfying all our criteria exist. We also give explicit constructions and several general characterizations of probabilities that satisfy some or all of the criteria and various (counter)examples. We also derive necessary and sufficient conditions for extending beliefs about finitely many sentences to suitable probabilities over all sentences, and in particular least dogmatic or least biased ones. We conclude with a brief outlook on how the developed theory might be used and approximated in autonomous reasoning agents. Our theory is a step towards a globally consistent and empirically satisfactory unification of probability and logic.     

The Treatment of Substance‐Abusing Clients in Multiservice Mental Health Agencies: A Practice Analysis

This article examines the work behaviors related to counseling substance‐abusing clients by mental health service providers in multiservice mental health agencies. The results support the need for specialized knowledge and skills in working with substance‐abusing clients.     

Medical student dreams about medical school: The unconscious developmental process of becoming a physician

This paper is a report on a collection of almost four hundred dreams of medical students and postgraduate trainees with the manifest content about medical training. It is a unique dream collection from a defined population that experiences a developmental sequence of observable, reality events. The reality events appear in the manifest content of the dreams along with their symbolic alterations. The dreams are used as a psychodynamic database. The data may illustrate which reality experiences seem psychologically formative, their emotional developmental sequences and their specific emotional content. This is a pilot project exploring whether dream material collected from a discrete task group might give information about a group's emotional adaptation. The dreams seem to show an unconscious developmental process in response to medical training and becoming a physician that unfolds in overlapping stages as trainees learn to master skills and tolerate care-giving responsibility for human life. A progressive, unconscious hero-healer fantasy seems to form. It becomes elaborated in masochistic and then sadistic fantasies. These fantasies are evoked by, and used as a defense against, inevitable but painful anxieties of emotional adaptation to medical education experiences.     

Asymmetric cost and benefit perceptions in willingness-to-donate decisions

Charitable giving entails the act of foregoing personal resources in order to improve the conditions of other people. In the present paper, we systematically examine two dimensions integral to donation decisions that have thus far received relatively little attention but can explain charitable behavior rather well: the perceptions of cost for the donor and benefit for the recipients. In line with current theories in judgment and decision making, we hypothesize that people weigh these dimensions subjectively and perceive them asymmetrically, consistent with prospect theory. Costs for the donor are typically perceived as losses, whereas benefits for recipients are perceived as gains. In four studies, we presented several scenarios to participants in which both donation amounts (costs) and number of lives helped (benefits) were manipulated while keeping the ratio of costs and benefits constant. Results from Studies 1 and 2 showed that willingness to help decreased as donation amounts and number of lives helped increased. Additionally, Studies 3 and 4 provide evidence for a solution to reduce the asymmetry and increase donation amounts as the number of lives at risk increases.