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.     

Methods for second order meta-analysis and illustrative applications

This paper presents methods for second order meta-analysis along with several illustrative applications. A second order meta-analysis is a meta-analysis of a number of statistically independent and methodologically comparable first order meta-analyses examining ostensibly the same relationship in different contexts. First order meta-analysis greatly reduces sampling error variance but does not eliminate it. The residual sampling error is called second order sampling error. The purpose of a second order meta-analysis is to estimate the proportion of the variance in mean meta-analytic effect sizes across multiple first order meta-analyses attributable to second order sampling error and to use this information to improve accuracy of estimation for each first order meta-analytic estimate. We present equations and methods based on the random effects model for second order meta-analysis for three situations and three empirical applications of second order meta-analysis to illustrate the potential value of these methods to the pursuit of cumulative knowledge.     

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.     

Lay concepts of health and illness from a developmental perspective

Abstract

The concepts of children, adolescents and their mothers with regard to different aspects of health and illness in general and five specific diseases were explored in this study. An exploration with fully standardised questions and open answers was subjected to a content analysis. A reliable rating system was developed to score the sophistication of the answers. The study included 99 Ss of the age groups 5, 8, 12 and 16 years, as well as 48 mothers of the children. Many children and adolescents were able to define health positively (well-being) and not merely as the absence of illness. The definition of illness in general was frequently composed of somatic symptoms and disorders, feeling poorly and things one would like to accomplish but can't. The causality explanations of illness in general were dominated by contagion. The concepts of the older children and the mothers were richer, more elaborated, less concrete and less action-oriented than those of the younger children. However, abstract formulations and complex aspects of illness were very rarely expressed. In addition, concepts regarding the characteristics (definition, symptoms, causality, treatment and prevention) of five diseases (cold, measles, heart infarction, cancer and AIDS) were measured. The pattern of results was strongly influenced by age. By and large, the development of most disease concepts was linear with significant differences between age groups. Conversely, within a given age group, significant differences were found in the cognitive level of disease characteristics, either with respect to the same disease or between different diseases (“horizontal shifts”).     

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.     

The Parallel Episodic Processing (PEP) model: Dissociating contingency and conflict adaptation in the item-specific proportion congruent paradigm

The present work introduces a computational model, the Parallel Episodic Processing (PEP) model, which demonstrates that contingency learning achieved via simple storage and retrieval of episodic memories can explain the item-specific proportion congruency effect in the colour-word Stroop paradigm. The current work also presents a new experimental procedure to more directly dissociate contingency biases from conflict adaptation (i.e., proportion congruency). This was done with three different types of incongruent words that allow a comparison of: (a) high versus low contingency while keeping proportion congruency constant, and (b) high versus low proportion congruency while keeping contingency constant. Results demonstrated a significant contingency effect, but no effect of proportion congruence. It was further shown that the proportion congruency associated with the colour does not matter, either. Thus, the results quite directly demonstrate that ISPC effects are not due to conflict adaptation, but instead to contingency learning biases.     

Two-Year-Olds' Object Retrieval Based on Television: Testing a Perceptual Account

Two-year-olds frequently fail to use information provided by video to find objects hidden in an adjacent room. Schmitt and Anderson (2002) hypothesized that they fail to map the 2-dimensional (2D) video image onto the 3D layout of the search space. Two experiments tested whether 2-year-olds can successfully use information from video when the search space is 2D or when the information is provided verbally (by telling the child where the toy is hidden). In both experiments, children performed poorly in the video conditions but performed well in direct live experience comparison conditions, contradicting Schmitt and Anderson's hypothesis. Performance was above chance on the first trial in the video conditions, suggesting that 2-year-olds do have a memory of the hiding location, albeit one that is easily disrupted by perseverative errors on subsequent trials. Overall, the results are most consistent with the hypothesis that very young children give priority to direct experience over mediated information.