Penetrating Subjectivity: Response to Commentaries

In response to the commentaries by Altman, Straker, and Suchet, the author considers the ways in which thirdness—in various manifestations—has aided in the continuing process of thinking about race. She responds to Straker’s invitation to interrogate further what it means to write from within and without a context, considering some of the defensive strategies that manifest when writing about race from a position of whiteness. Following Suchet’s lead, the paper looks too at the notion of the decolonization of the mind and how this is a project that unfolds in parallel with the decolonial moment being witnessed in broader socioeconomic contexts. In response to Altman’s commentary on the clinical aspects of the paper, the author engages with what it means to enter more fully into a process of mutual recognition when working in cross-racial dyads and considers, finally, the question of far she is able, as a white clinician and writer, to jeopardize the self in the process of unsettling whiteness.     

Kandidaten in psychotherapeutischer Ausbildung

In the context of the discussion about a reform of psychotherapeutic training in Germany the question arises, which factors influence the decision of psychologists and physicians for a particular training. 343 candidates in psychodynamic, behavioural or psychoanalytic training were asked about their motives for the training, their professional objectives in general and their satisfaction with their choice of training. The candidates' decision for a particular training was associated with personal attitudes and professional goals, with the given information about psychotherapeutic treatment within their studies and with their field of study. For the most part, the respondents are not satisfied with the quality and quantity of information on psychotherapeutic treatment within their studies. Candidates in analytic training are altogether more satisfied with their choice of training and do not plan to start an additional psychotherapeutic training as often as candidates in behavioral training. The consequences of these results in particular for the medical and psychological curricula (a more balanced representation of psychotherapeutic methods) are discussed.     

Ausbildungs- und Berufserfahrungen älterer Psychoanalytiker

Based on the discussion about the crisis of psychoanalysis and in particular of psychoanalytic training, 145 (female and male) analysts older than 70 years of age were interviewed about their training and professional experiences as well as about their attitudes towards psychoanalysis. This older generation is of great interest because their training generally took place prior to 1967 and preceded the introduction of guideline therapy (cost coverage by the general health insurance) and under much less formalized conditions, which can be seen almost as a contrast to the current circumstances and conditions. This research has shown that especially personal or content and value-based motivations (personal problems, therapeutic experience, interest in the subject, the desire for depth, self-realization and expansion of the situation perceived as restrictive of their former profession) were the main determining factors for the choice of career. The training analyses were, despite some exceptions, of substantial length even then (an average of 544 h), but often had a lower frequency (30% had less than 3 h per week). Since the age limitation for running a psychoanalytic practice within the general health services (formerly 68 years) is no longer compulsory, the results of this study regarding the professional life of older psychoanalysts are of special interest. Of the respondents 45% are still running their own practice and 22% are working as training analysts.     

The legacy of Hans Selye and the origins of stress research: A retrospective 75 years after his landmark brief "Letter" to the Editor(#) of Nature

Hans Selye's single author short letter to Nature (1936, 138(3479):32) inspired a huge and still growing wave of medical research. His experiments with rats led to recognition of the "general adaptation syndrome", later renamed by Selye "stress response": the triad of enlarged adrenal glands, lymph node and thymic atrophy, and gastric erosions/ulcers. Because of the major role of glucocorticoids (named by Selye), he performed extensive structure-activity studies in the 1930s-1940s, resulting in the first rational classification of steroid hormones, e.g. corticoids, testoids/androgens, and folliculoids/estrogens. During those years, he recognized the respective anti- and pro-inflammatory actions of gluco- and mineralocorticoids in animal models, several years before demonstration of anti-rheumatic actions of cortisone and adrenocorticotrophic hormones in patients. Nevertheless, Selye did not receive a Nobel Prize, which was awarded in 1950 to the clinician Hench and the two chemists who isolated and synthesized some of the glucocorticoids. Nonetheless, Selye was internationally recognized as a world authority in endocrinology, steroid chemistry, experimental surgery, and pathology. He wrote over 1500 original and review articles, singly authored 32 books, and trained 40 PhD students, one of whom (Roger Guillemin) won a Nobel Prize for isolating the hypothalamic releasing factors/hormones. Here, we consider the main implications of his first article launching the biological stress concept and the key ideas and problems that occupied him. Selye considered "Stress in heath and disease is medically, sociologically, and philosophically the most meaningful subject for humanity that I can think of".     

Health Related Quality of Life in Children with Congenital Heart Disease

Health-related quality of life in children with congenital heart disease (CHD) was compared to that of healthy children. Furthermore, agreement between child and parent reports was examined. In addition, differences in quality of life related to the severity of CHD were evaluated. One hundred children with CHD aged between 8-18 years and their parents answered a health-related quality of life-questionnaire during their visit to the paediatric cardiology outpatient department. CHD children reported reduced motor functioning and autonomy compared to healthy children. Parents of children with CHD reported their children to have a reduced quality of life in the domains of: motor functioning, autonomy and cognitive functioning. Agreement between child and parent reports was moderate. Children systematically reported lower health related quality of life on the domain of positive emotions than did parents. Health related quality of life in children with CHD appeared not to be influenced by severity of the disease. In conclusion, regardless of the severity of the disease, children with CHD reported their health related quality of life on several domains to be lower than that of healthy children. This means that on several domains, the emotional impact of problems in health status is greater for children with CHD than for healthy children. When CHD patients visit the clinic, it is important that physicians actively ask patients as well as parents about the child's motor functioning, autonomy and cognitive functioning. Children with problems in these domains can then be identified, and psychological interventions can take place at an early stage.     

The Intervention of Robot Caregivers and the Cultivation of Children’s Capability to Play

In this article, the authors examine whether and how robot caregivers can contribute to the welfare of children with various cognitive and physical impairments by expanding recreational opportunities for these children. The capabilities approach is used as a basis for informing the relevant discussion. Though important in its own right, having the opportunity to play is essential to the development of other capabilities central to human flourishing. Drawing from empirical studies, the authors show that the use of various types of robots has already helped some children with impairments. Recognizing the potential ethical pitfalls of robot caregiver intervention, however, the authors examine these concerns and conclude that an appropriately designed robot caregiver has the potential to contribute positively to the development of the capability to play while also enhancing the ability of human caregivers to understand and interact with care recipients.