Psychoanalysis meeting the challenges of globalisation: Commentary on Cláudio Laks Eizirik's paper

Abstract

Identity and structure as signifiers of the unconscious are in flux as a result of the evaporation of the relations in the modern world. The author develops some hypotheses on the input of the changing identity in respect to the psychoanalytic encounter in therapy and to processes in institutions. He comes to the conclusion that the orientation to the individual dynamics, the therapy room and the therapeutic relationship, which is at present substantial for most analysts, will no longer be relevant. Whether we will be successful or not as psychoanalysts depends on whether we see the world growing together, share the responsibility for it and take up the burning questions of globalisation.     

Stigma and the delegitimation experience: An interpretative phenomenological analysis of people living with chronic fatigue syndrome

Individual in-depth interviews with 14 people with chronic fatigue syndrome (CFS) were conducted, focusing on the experience of living with CFS. The interviews were transcribed verbatim and were analysed for recurrent themes using interpretative phenomenological analysis (IPA). Here we present two inter-related themes: “Negotiating a diagnosis” and “Negotiating CFS with loved ones”. Participants reported delay, negotiation and debate over diagnosis: further, they perceived their GPs to be sceptical, disrespectful and to be lacking in knowledge and interpersonal skills. However, participants found delegitimising encounters with their partners more difficult to deal with. Participants viewed such delegitimation as a form of personal rejection; they were hurt by their loved ones’ reactions and subsequently pondered the price of love, respect and friendship. The findings are discussed in relation to extant literature, and recommendations for future research are suggested.     

The development of a smoking-specific locus of control scale

Abstract

A 32-item questionnaire was designed to measure multidimensional locus of control beliefs specifically about giving up smoking (SLC Scale), and administered along with the Multidimensional Health Locus of Control Scale (MHLC) and a short smoking information questionnaire to 211 smokers. Psychometric analyses of the SLC scales included a series of repeated factor and reliability analyses which resulted in a final three-factor solution, containing 11 of the original SLC items. The three factors represented the following types of locus of control for smoking: a combined Internal-Chance factor, a Significant Others factor, and a Powerful Others factor with Chronbach's alpha coefficients of internal reliability of 0.63, 0.56 and 0.55 respectively. Analyses relating to the reliability and validity of the SLC scale are presented and discussed. As expected the SLC correlated more sensibly and significantly with subjects' reported behaviour and intentions regarding giving up smoking than did the MHLC scales.     

Coping,psychological adjustment,and complementary and alternative medicine use in persons living with hiv and aids

Abstract

Many HIV-positive individuals dissatisfied with allopathic approaches to disease management have turned to complementary and alternative medicines (CAM). Although people use CAM for a variety of reasons (e.g., symptom management, holistic approach towards healthcare, improved immunity), the psychological benefits that these treatments may have are still not fully understood. The present study was designed to further previous research that demonstrated relationships between CAM use, stress appraisals, and coping behaviors. HIV-positive individuals (N= 127) completed measures assessing stress appraisals, coping, psychological adjustment, satisfaction with life, and immune functioning. After controlling for ethnicity and sexual orientation, stress appraisals and coping behaviors were found to be related to CAM use. Further, curvilinear relationships between CAM use and adjustment emerged, suggesting that some CAM use may be adaptive. Self-reported immune measures were unrelated to CAM use. In all, it appears that CAM use may be a complex form of coping that assists individuals in adjusting to a life-threatening illness. The implications of these findings with respect to adherence to highly active antiretroviral therapies (HAART) are also discussed.     

The psychosocial impact of caregiving in dementia and quality of life: a systematic review and meta-synthesis of qualitative research

ABSTRACT

Objective: A systematic meta-synthesis of qualitative studies was conducted to interpret and synthesise findings from studies investigating the experiences, quality of life, and psychosocial impact of caregiving on adult informal caregivers of people with dementia.

Design: The meta-synthesis was conducted according to the principles of meta-ethnography.

Results: Fourteen studies describing the experiences of 265 informal caregivers were reviewed. The meta-synthesis elicited the following themes: (1) understanding and making sense of the dementia diagnosis, changing symptoms, and the caregiver role; (2) coping strategies, psychological facilitators and rewards of caregiver role; (3) challenges of caring for a person with dementia and their behaviour; (4) caregivers' relationships with care-recipient and other informal caregivers; and (5) caregivers’ experiences of formal support services and material resources.

Conclusion: Our findings highlight the need for a person-centred approach to care planning that also accounts for the needs of the informal caregiver to promote better caregiver well-being and quality of life. Caregivers’ emotional support, coping, resilience, need for information and respite care and adjustment to caregiver identity should be reviewed as part of the care package for the person with dementia.     

Illness representations and distress in women undergoing screening for familial ovarian cancer

Women with a familial or genetic predisposition to ovarian cancer are at significantly increased risk of developing the disease, and this warrants effective risk management strategies. A clinical trial of ovarian cancer screening (OCS) is being conducted to establish the effectiveness of this risk management strategy. This article reports data from its psychological partner study which aims to evaluate the psychological effects of OCS. Leventhal's Self-Regulatory Model provided the theoretical framework for understanding emotional responses to OCS. The revised Illness Perceptions Questionnaire (IPQ-R) is based on this model and the IPQ-R, adapted to the risk of ovarian cancer, was completed by women (N?=?1999) prior to screening. The original IPQ-R factor structure was not replicated but IPQ-R variables explained 14.70% of the variance in women's ovarian cancer-specific distress after controlling for age, general anxiety and depression. Negative emotional representations of ovarian cancer risk and general anxiety were moderately associated with greater ovarian cancer-specific distress whereas cognitive illness representations were weakly related to ovarian cancer-specific distress. Further analyses of data from the ongoing psychological evaluation are needed to determine the predictive utility of IPQ-R variables in explaining distress during OCS.     

Book Review

Performance-based measures and ratings of executive functions were examined in a sample of adolescents with attention deficit/hyperactivity disorder (ADHD) and comparison controls. Performance-based measures of executive function included inhibition, working memory, set shifting, and planning, and ratings of these same executive functions were completed by parents and teachers. Adolescents with ADHD demonstrated lower executive function performance than controls and displayed elevated ratings on the executive function ratings by parents and teachers. Significant associations were obtained between the performance-based measures and the parent and teacher ratings, but each measure was not uniquely associated with its respective scale on the rating scales. When performance-based measures and ratings were examined as predictors of ADHD status, the parent and teacher ratings entered as significant predictors of ADHD status. Further commonality analyses indicated that performance-based measures accounted for little unique variance in predicting ADHD status and also displayed little overlap with the behavioral ratings. These findings highlight the diagnostic utility of behavioral ratings of executive function in predicting ADHD status; however, behavioral ratings should not be assumed to be a proxy for performance on measures of executive function in clinical practice.     

Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders

Executive function (EF) deficit is a hallmark of Fetal Alcohol Spectrum Disorders (FASD), but the vast majority of available evidence comes from school-age children and adolescents. Very little is known about EF during the critical developmental period prior to 6 years of age in FASD. We evaluated EF in 39 children with FASD (3.0–5.5 years) and a comparison group of 50 age-matched, nonexposed controls. Measures included the EF Scale for Early Childhood and a Delay of Gratification task. Compared to age-matched controls, preschool children with FASD had impairments on the EF Scale and showed more impulsivity on the Delay of Gratification task. To confirm the EF Scale finding, FASD group performance was compared to a separate normative dataset (N = 1,400). Those with FASD performed below normal (M = –0.57, SD = 0.92). Within the FASD group, IQ was correlated with the EF Scale (partial r = .60, p = .001) and Delay of Gratification (partial r = .58, p = .005). EF Scale performance did not differ significantly across levels of FASD severity (fetal alcohol syndrome [FAS], partial FAS, or alcohol-related neurobehavioral disorder [ARND]). However, compared to normative data, those with FAS had the largest deficits (M = –0.91 SD from the mean, SE = 0.23), followed by partial FAS (M = –0.66 SD from the mean, SE = 0.26), then ARND (M = –0.36 SD from the mean, SE = 0.20). These novel data show that EF deficits manifest well before the age of 6 years in children with FASD, that they occur across the spectrum, and that EF may be most impaired in children with more severe forms of FASD and/or lower IQs.