Parenting a damaged child: mourning, regression, and disappointment

This paper is an examination of the long-term parenting experiences of parents who have given birth to CNS damaged infants. In particular, the focus is on the mourning, regression, rage, and depression that frequently attend these parents throughout their lives and can become pathological and pathogenic interferences with the provision of good-enough parenting. Several clinical vignettes were presented, each of which illustrated the usefulness of different psychoanalytic clinical theories about normality and pathology of parenting and parent-child interaction. The now-classical contribution of Solnit and Stark (Mourning and the Birth of a Defective Child, 1962) is reviewed along with Benedek's and others' psychoanalytic theories about normal parenting. The thinking of these writers is within the framework of structural/libidinal theory and seems to be useful in describing certain parenting problems that concern the mourning and regressive aspects of parenting. However, it was proposed that some of the adaptive coping and pathology encompassed by Solnit and Stark's explanations is not comfortably illuminated by the structural clinical theory of conflict and drives. Freud's discussion (1917) compares mourning and melancholia, which he differentiated as related but dynamically distinct clinical phenomena. This work is briefly recalled as an earlier point in theory building where structural theory was not sufficient to explain clinical depression and rage that exceeds normal mourning (as in Freud's melancholia). It is felt that an additional theoretical perspective on parenting provided by self psychology can fill in some of the gaps left by structural theory explanations. The self psychology perspective is particularly helpful with understanding the rage, ambivalence, and chronic depression often experienced by parents of damaged children. According to this perspective, the damaged child is a disappointing selfobject for the parent, and the parent's self organization will give him the resources to cope adaptively or to develop narcissistic pathology. Three types of intrapsychic problems for a parent are described: mourning the lost object, the fantasied perfect child; experiencing and recovering from regression to early identifications with his own parents; withstanding tension and regulating one's self (experiencing chronic depression and rage) when confronted with a great disappointment in a selfobject (represented by the damaged child). It is important when designing intervention strategies in a hospital or pediatric clinic setting to clarify which type of problem is the major focus of the parent's struggle.(ABSTRACT TRUNCATED AT 400 WORDS)     

Structural differentiation of psychological performances in epilepsy patients

Investigating the specific of psychic performance disorders in epileptics structural aspects in addition to quantitative performance differences are considerable. We compared psychometrically obtained performance structures of epileptic children and adults and of parallelised healthy control persons. It became evident, that the performance differentiation hypothesis is to corroborate also in epileptic patients. The psychic performance structure of epileptics is characterized by a lower differentiation level of the basis functions underlining the performances. Our factor analytic investigations emphasize the importance of deceleration of psychic/psychomotoric speed in epileptics as primary basic disorder.     

Psychometric detection of depressive mood conditions

An investigation into the diagnostic value of psychometric methods for the diagnosis of depressive states involved five psychometric questionnaires, one concentration test procedure, and one problem-solving approach to register cognitive processes. The data obtained for 80 depressive patients of varied aetiology were compared with those of sample of 80 neurotics without depressive aberration. Even univariate comparisons revealed statistically significant differences between the two samples. Multivariate methods (factor analysis, discriminative analysis) yielded more differentiated information. The "Scale for depression depth measurements" was found to be of particular diagnostic relevance; it was standardized for the time being.     

Personality and social resources in immediate and continued stress resistance among women

In this study we investigated the immediate and continued impact on women of a major stressful event, the outcome of pregnancy, and the mitigating effect of self-esteem and intimacy with their spouse on their reactions. Few other studies have investigated initial reactions to crisis events. Ninety-nine Israeli women who experienced either normal delivery or pregnancy complications were interviewed at the time of the event and 3 months later. High self-esteem was found to limit feelings of depression at both times. Intimacy with spouse limited depression at the event, but not at follow-up. High self-esteem was seen as always being exploitable by women who possessed it, whereas the benefit of intimacy with spouse was seen as being dependent on situational demands and environmental constraints. Cross-cultural implications were presented.     

Recipient's mood, relationship type, and helping

We conducted two studies to examine how a potential helper is affected by having a communal orientation toward a relationship with a potential recipient and by the potential recipient's sadness. We hypothesized that (a) having a communal orientation would increase helping and that (b) people high in communal orientation, but not others, would respond to a potential recipient's sadness by increasing helping. These hypotheses were tested in two studies. In Study 1, individual differences in communal orientation toward relationships were measured by using a new communal orientation scale reported for the first time in this article. In Study 2, manipulations were used to lead subjects to desire either a communal or an exchange relationship with another person. In both studies, subjects were exposed to a sad person or to a person in a neutral mood whom they were given a chance to help. As hypothesized, in both studies communally oriented subjects helped the other significantly more than did others. Also as hypothesized, in both studies communally oriented subjects but not others, increased helping in response to the other person's sadness although this effect reached statistical significance only in the second study.     

A short-form measure of loneliness

The revised UCLA Loneliness Scale (ULS-20) and a four-item short form (ULS-4) are widely used in personality research (Russell, Peplau, & Cutrona, 1980). In an exploratory factor analysis of the ULS-20, we identified eight items that loaded substantially on the first factor. These items were combined to form an alternative short-form measure, the ULS-8. The results of this study indicate that the ULS-8 is reliable, valid, and a better substitute for the ULS-20 than is the ULS-4. Consistent with the previous research, the loneliness measures (ULS-20, ULS-8, ULS-4) were strongly related to socially undesirable personality characteristics, but loneliness was uncorrelated with the six different health-related behaviors (exercise, meal regularity, alcohol use, hard drug use, smoking, and hours of sleep) assessed in this study.     

Discovering what it all means

This article deals with appropriate communication and interpersonal skills that nurses may use in order to support patients who are experiencing self-concept changes related to their health problems. Three areas of patient need related to self-concept are explored. The stages of adaptation to loss and the crucial task of grief work are reviewed, and nursing interventions designed to strengthen the self-concept and support patients as they adapt to loss are suggested. Sensitive communication, although a low-visibility nursing skill, is cited as critical in assisting the patient to achieve an optimum level of wellness.     

Choice between reliable and unreliable outcomes: mixed percentage-reinforcement in concurrent chains.

Pigeons' choices between alternatives that provided different percentages of reinforcement in mixed schedules were studied using the concurrent-chains procedure. In Experiment 1, the alternatives were terminal-link schedules that were equal in delay and magnitude of reinforcement, but that provided different percentages of reinforcement, with one schedule providing, reinforcement twice as reliably as the other. All pigeons preferred the more reliable schedule, and their level of preference was not systematically affected by variation in the absolute percentage values, or in the magnitude of reinforcement. In Experiment 2, preference for a schedule providing 100% reinforcement over one providing 33% reinforcement increased systematically with increases in the duration of the terminal links. In contrast, preference decreased systematically with increases in the duration of the initial links. Experiment 3 examined choice with equal percentages of reinforcement but unequal delays to reinforcement. Preference for the shorter delay to reinforcement was not systematically affected by variation in the absolute percentage of reinforcement. The overall pattern of results supported predictions based on an extension of the delay-reduction hypothesis to choice procedures involving mixed schedules of percentage reinforcement.