Anxiety in adolescence and its significance for psychoanalysis

The theme of this paper is the well-known resistance of adolescents to participate in analytic treatment and analysts' reservations about treating adolescents, which is perhaps less well known. Several reasons are discussed: For adolescents, the revival of separational and fusional anxieties during the process of individuation as well as resistance to the analytic setting are held responsible; analysts may lack sufficient awareness of their own adolescence and its resulting anxieties to be able to confront this developmental period. In addition, there are countertransference anxieties that are triggered and kept alive by the behavior of the juvenile patient. The different types of analyst anxieties as well as those of the adolescent under analysis are explained and their significance in the process of individuation and the course of therapy is noted.     

Intolerance of responsibility for internal conflict

A type of patient is described, who has marked intolerance of taking responsibility for his internal conflicts so as to confront them, analyze them, and change. Defensive repetition in pathological object relations aims to avoid what is wrong within and to engage another so as to protect oneself. Genetic, dynamic, and technical aspects of such defensive, dependent relating are considered. Responsibility for oneself and for what is within oneself is held to be terrifying--more than anyone can bear on his own. How destructiveness has become, and remains, so terrifying is discussed.     

Spelunking as a manifestation of a counterclaustrophobia

Material is presented from the case history of a patient whose interest in spelunking (cave exploration) was found to be an unconscious expression of a type of counterclaustrophobia. Both oedipal and preoedipal determinants of the claustrophobic anxieties are delineated. Of particular note in this instance is the testicular element in the genesis of the patient's claustrophobia. His confusion of the movements of his testicles into his inguinal canals during childhood defecation with the movements of the feces themselves lent an special intensity to his fear of being flushed away from the mother by an expulsive anal birth from the claustrum. Childhood anxiety aroused when his testicles would become trapped in the inguinal canals was an important forerunner of the adult fear of being trapped in confined spaces. A counterphobic element of the spelunking per se was his enjoyment in hanging suspended by a rope in caves. In this manner, he was able to act out (by virtue of his body-testicle equation) his identification with, and control over, the disappearing testicles in the setting of a claustrophilic union with the mother.     

Psychoanalytic enlightenment and the greening of diplomacy

The author reviews aspects of psychoanalytic theory which have helped him in his career as an American diplomat and political analyst. He cites the works of Erikson (1950, 1968, 1969), Volkan (1979, 1987), and Mack (1979, 1983) as especially helpful, and praises the late Jeanne Knutson, founder of the International Society of Political Psychology, for her work on the psychology of victimhood. The role and function of completed and incomplete mourning are discussed as fundamental aspects of unresolved ethnic and sectarian conflict, and the importance of asking and granting forgiveness in the resolution of violent political conflict is explored. The paper ends with a specific application of the meaning of forgiveness in the relationship between Christians and Jews.     

Recency effect in recall of a word list when an immediate memory task is performed after each word presentation

Subjects studied 12-word lists for free recall. During presentation of the lists, each word was followed by a supraspan sequence of digits, which the subjects tried to reproduce. This task, unlike those used in previous research with this continual distractor procedure, presumably taxed immediate memory capacity to the full. Nevertheless, the word recall data showed a pronounced recency effect. Moreover, the magnitude of the recency effect was found to be just as great with this task as with a more typical task in which the demands on immediate memory are likely to be fewer. These findings reinforce the emerging view that the recency effect need not be the product of immediate memory.     

Risk behaviors and health. Contrasting individual and population perspectives

This article discusses risk behaviors, seemingly voluntary actions of individuals that have adverse health consequences. The central theme is to examine these behaviors from two contrasting perspectives, that of the individual and that of the population as a whole. It is argued that distinguishing between individual and population views is important for understanding and interpreting health risk data, for developing conceptual and theoretical models for explaining these behaviors, and for devising intervention strategies to modify them. It is argued that an appreciation of both the individual and the population perspectives is important to developing effective action strategies for reducing these behaviors as public health problems.     

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.     

Reducing smoking among pregnant adolescents

Pregnant adolescents who smoke present a double obstetrical risk. Not only is the adolescent mother at risk from the biological, social, educational, and economic factors associated with childbearing at a young age, she and her developing infant also risk the complications associated with maternal smoking. This paper describes a psychosocial intervention designed to reduce smoking in a group of pregnant adolescents. Five modules are presented. Each is designed to: (1) heighten awareness of the issue, (2) provide motivational messages, (3) enhance the adolescent's social skills, and (4) teach specific smoking-cessation skills.