Paranoia and narcissism in psychoanalytic theory. Contributions of self psychology to the theory and therapy of the paranoid disorders

Many factors go into a choice of a therapeutic focus: the patient's psychopathology; the therapist's training, countertransference reactions, and ideological beliefs; and, importantly, a decision about what seems most amenable to treatment and change. As a theory, self psychology describes one aspect of the paranoid process; as such, it is an incomplete theory that complements rather than invalidates more classical theories. As a technique, however, it suggests a style and focus conducive to working with paranoid patients, one that is markedly supportive, nonconfrontational, yet also interpretive. In this context, it must be remembered how difficult it is to treat paranoid patients psychotherapeutically, much less to keep them in treatment. The strategies discussed above do not wholly replace other dynamic approaches (e.g., counterprojective techniques), nor are they universally applicable. Some patients may be more amenable than others. However, the techniques provide a very supportive framework that may help the therapist to be more available to and in contact with the paranoid patient. More broadly, this paper's application of self psychology to the theory and therapy of the paranoid disorders further illustrates the practical utility of this approach. Attention to the narcissistic developmental line, interpersonal selfobject relationships, intrapsychic conflicts and deficits, and empathic immersion in the patients's world are important adjuncts to the psychotherapy of paranoid patients. Rather than an either/or dichotomy, the principle of overdetermination suggests a both/and relationship between self psychology and traditional theory, such that the self psychological approach complements rather than contradicts the classical psychoanalytic theory. The vicissitudes of the self simply add another perspective or vantage point from which to understand and respond to the patient, one which has perhaps more applicability for preoedipally disordered patients.     

Coping strategies and diastolic blood pressure

An organizational field study involving 95 civil service employees examined the ways these individuals coped with the stressful events of their daily living. Lazarus' cognitive-phenomenological analysis of psychological stress provided the theoretical framework. Subjects indicated on Lazarus' Ways of Coping Checklist those coping thoughts and actions used in the specific encounter described as stressful. As hypothesized, individuals experiencing higher diastolic blood pressure were more likely to cope using strategies characterized by wishful thinking, avoidance, and minimization of threat than were individuals exhibiting lower blood pressure. Implications from both an individual and organizational perspective are discussed.     

Subtypes of limbic system dysfunction evoking homicide in limbic (?) Psychotic trigger reaction and temporal lobe epilepsy--evolutionary constraints

Within an evolutionary context two subtypes of limbic system dysfunctioning are compared: (1) the previously proposed limbic psychotic trigger reaction, in which nondrive motivated homicide is triggered by a specific individualized external stimulus, which evokes a brief-lasting active reliving of past (moderately) stressful, frequently repeated ("kindled"?) situations. The brief-lasting out-of-character homicidal episode with flat affect is typically associated with first-time formed or unformed hallucinations of various modalities and with overactivation of the autonomic nervous system. There is no (noticeable) loss of consciousness, enabling the patient's full recall (at times with suicidal attempts) (Pontius, 1981, 1984, 1987). (2) A rare case of homicide during a fugue state with echopraxia in temporal lobe epilepsy is discussed.     

Deprivation/enhancement fantasy patterns in children

Previous studies have shown that females tell stories that change from negative experiences (deprivation) to positive experiences (enhancement) and males tell stories that change in the opposite direction. The current study examines this phenomenon in children using a different story-telling procedure. Results were not consistent with those of previous studies.     

Happiness among adolescents in The Netherlands: ethnic and sex differences

A nationwide sample of 2710 Dutch adolescents and 518 ethnic minority adolescents living in the Netherlands was used to examine ethnic and sex differences in happiness. Analyses of variance were conducted with ethnic background, sex, and length of residence in the Netherlands, as variables. Socioeconomic status was included in the analyses as a covariate. Adolescents from ethnic minority backgrounds, as compared to the Dutch, had significantly lower scores on a generalized estimates of life satisfaction and on a measure of hedonic effect. Both differences, however, explained only a very small amount of variance. Girls (from all ethnic groups including the Dutch) had lower scores than boys on both measures. There was no significant effect for length of residence on either measure.     

Self-esteem, depression, and alcohol dependency among high school students

123 high school students completed the short form of the Coopersmith Self-esteem Inventory-School Form and its Lie scale, Beck's Depression Inventory, and an Alcohol Dependency Scale. Analyses of variance (2 x 4) showed boys had higher mean Lie scores than girls, and freshmen had lower mean alcohol dependency scores than sophomores, juniors, and seniors. Correlations between self-esteem scores and depression scores were significant and negative, but values were significant and positive between self-esteem and lie scores and between depression and alcohol dependency scores. Much work is required to understand better the relations among depression, self-esteem, and drug and alcohol dependency in high school students if interventions are to focus upon prevention.     

Hair mineral analysis: biochemical imbalances and violent criminal behavior

Trace mineral analysis of human hair was utilized to determine whether violent and nonviolent criminals could be differentiated on the basis of concentrations of levels of major and trace minerals. 40 violent and 40 nonviolent inmates from a prison population were selected for study. 27 mineral levels were analyzed and a discriminant function analysis correctly classified 86% of the violent and 78% of the nonviolent inmates. The results lent support to the hypothesis that significantly different levels of trace minerals could be found between the two groups.     

Hypnotic susceptibility and its relationship to outcome in the behavioral treatment of asthma: some preliminary data

12 subjects from an experiment on relaxation therapy for asthma were given the Harvard Group Scale of Hypnotic Susceptibility, Form A. Full scale hypnotic susceptibility scores were positively correlated, at a borderline significance, with improvement in the methacholine challenge test, a measure of asthma severity. Performance on the amnesia item of the Harvard Group Scale was correlated with improvement in self-reported symptoms of asthma.     

Diabetes and illness image: an analysis of diabetic early-adolescents' self-perception through the Draw-a-person test

To study the self-projective representations expressed by diabetic children, aged between 10 and 15 yr., and to compare these with representations of a control group the Draw-a-person test associated with those for subsequent Draw-a-sick-person were administered to 23 children regularly checked by an Antidiabetic Centre. The diabetic subjects drew an image of "sick person" having projective elements with a regressive value and denoting a refuge in the past, together with depressive signs of retiring into themselves and of less consideration of the self. Also, the diabetic children seemed to be less prone to the cultural stereotype which requires a smiling and happy image of "the healthy person." At the same time there was also a transparent symbolic defense which allowed the diabetics to adapt variously and to move from their anxious state toward psychological recovery.     

Georg Ilberg (1862-1942). His life and medical-humanistic legacy

Georg Ilberg, who is almost forgotten nowadays, was a scholar of Kraepelin and Ganser. From 1910 to 1928 he was director of the Landes-Heil- und Pflegeanstalt (country mental hospital) for mental patients Sonnenstein at Pirna. He was active in the scientific-literary field to a great age and worked as editor of the Allgemeine Zeitschrift für Psychiatrie from 1924 to 1934. Although he principally advocated the exclusion of certain mental patients from reproduction at the beginning of the 1930s, in a review in 1942, his integer humanist basic position and his pronounced social feeling made him to protest in public against the putting to death of mental in-patients.