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.     

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.     

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.     

Blocking Effects in Two-Choice Discrimination Tasks in Rhesus Monkeys Macaca Mulatta

The Psychological Record - The present experiments investigated blocking effects in rhesus monkeys (Macaca mulatta) in a discrimination learning paradigm using a single stimulus modality. Two...     

Changes in the incidence of nocturnal bruxism in college students: 1966-1989

The frequency of self-reported nocturnal bruxism in three large samples of college undergraduates was compared as a means of assessing change in the incidence of this disorder since 1966. We found the incidence of nocturnal bruxism had increased from 5.1% to 20.5% in college students over the period covered by these studies.     

H-reflexes during a motor skill acquisition task

H-reflex amplitudes were studied during the acquisition of a motor skill involving coordinated isometric plantarflexion at the ankle joints as subjects learned to trace a triangular pattern on an oscilloscope screen by controlling plantarflexion torque applied against load cells. Torque feedback was presented on a subject oscilloscope with the right foot controlling a vertical cursor and the left foot a horizontal cursor. Eleven subjects reached criterion performance. H-reflexes were recorded from the right soleus and timed to the initiation of soleus muscle activity to plantarflex the foot. Average time to complete one trial decreased from 9 sec. in the prelearning block to 4 sec. postlearning. No single learning strategy was evident as subjects varied widely in their levels of H-reflex amplitude, but during postlearning, H-reflex amplitude became consistent within subjects as tracing performance became faster and accurate.     

Magnitude estimates for electrical pulses: evidence for two neural mechanisms

The hypothesis that there are two neural mechanisms for electrocutaneous stimulation--one that is sensitive to low current and is adaptive to repeated stimulation and another that is responsive to high current and is less adaptive--was tested in a control and four main experiments. In the main experiments, magnitude estimates obtained for single electrical pulses (of 2-msec duration) were described by a simple power function for each combination of high- and low-current levels and 10 trial blocks. The results were: (1) The slope of the power function for low current was steeper than was that for high current; (2) for low current, the intercept of the power function decreased with increasing block, whereas for high current, it remained constant over blocks; (3) this decrease of the intercept for low current disappeared when judgmental blocks were separated by a rest period of 8 min; (4) the modulus did not affect the slope; (5) for a large modulus combined with low current, the intercept decreased rapidly over trial blocks, whereas for a small modulus combined with high current, the intercept increased over trial blocks. The first four findings support the two-mechanism hypothesis, but the last one may also be interpretable in terms of the regression to absolute scale values.     

Human optokinetic nystagmus: competition between stationary and moving displays

We reported earlier that occlusion of the central retina and stationary edges have highly interactive effects on the gain of optokinetic nystagmus (OKN; Murasugi, Howard, & Ohmi, 1986). In this study, we explored this effect in more detail. A central occluding band of variable height, flanked by vertical bars, was superimposed onto an array of dots moving at 30 degrees per second. The height of the occluding band required to abolish OKN increased with the separation of the vertical bars. For bars 3.5 degrees apart, OKN was abolished in most subjects when a band only 6' high ran between them. For bars 75 degrees apart, a band at least 20 degrees in height was required to abolish the response. The effects of the stationary figure depended to some extent on the subject's attention, but only at intermediate values of bar separation. Both low- and high-level mechanisms are proposed to account for the results.     

Texture perception in sighted and blind observers

The purpose of the present study was to evaluate the utility of visual imagery for texture perception. In Experiment 1, sighted, early-blind, and late-blind observers made relative smoothness judgments of abrasive surfaces using active or passive tough. In Experiment 2, subjects compared vision and touch in the accuracy of smoothness detection, using a broad range of textures, including very fine surfaces. No differences appeared between the sighted and the blind, and it did not matter if touch were active or passive. Vision and touch showed similar performance with relatively coarse textures, but touch was superior to vision for much finer surface textures. The results were consistent with the notion that visual coding of tactual stimuli is not advantageous (or necessary) for texture perception, since touch may hold advantages for the detection of the smoothness of surfaces.     

Apparent motion: evidence of the influence of shape, slant, and size on the correspondence process

Four stimulus elements configured as a notional diamond were flashed in pairs to elicit apparent motion. When the elements were identical (4 Zs), the direction of apparent motion was ambiguous. When the elements were pairs of different letters (Cs and Os, Es and Zs), letters of different sizes (Zs and zs), or oppositely oblique lines, the direction of apparent motion tended to be between identical elements. This was true, however, only for an initial, brief observation period. Subsequently, the direction of apparent motion tended to be determined by the direction of motion perceived at first, regardless of the character of the elements. This quickly established directional set (within 10 sec) largely swamped any tendency to resolve correspondence in terms of a feature of the stimulus. It appears to be based on spatial rather than retinal or egocentric coordinates.