Correspondence: Mental health care in South Africa

Shame has been an insufficiently studied emotion in psycho-analytic literature until recently, mainly because it tended to be ‘absorbed’ under the concept of guilt. Now it is recognized as a powerful affect of pregenital origin, linked with narcissism and the ego ideal. Shame can be a motivation for achievements and social adaptation, it can protect an individual's integrity and can be a modulator of interpersonal relatedness; it can also function as a defence or initiate psychopathological states, such as depression, self-alienation, identity confusion or acting out. In adolescence shame is a ubiquitous phenomenon, as this developmental stage consists of all the parameters that can trigger feelings of shame. The emotional regression connected with the emergence of primitive impulses, conflicts and defences; the grandiose phantasies and the increased narcissism; the preoccupation with bodily functions and body image; the tendency to idealization and the need for social acceptance constitute the matrix within which shame and shame-derived feelings can develop. Shame is discussed as it is experienced by young patients and often by the therapist. Shame in the countertransference and during supervision is also considered. Stress is put on the importance of taking shame into account as a fundamental factor in psychotherapy with adolescents, particularly in relation to the establishment of the therapeutic relationship, understanding and interpretations. The thesis is illustrated with clinical vignettes.     

Theory in practice

We are privileged to publish the last talk Fordham prepared before he died, which Fordham himself observed was ‘rather discursive’. As he comments, ‘theories are so ingrained in my work that I do not need to remember them’. ‘Theory in practice’ was part of a series of talks on theory by different speakers, given to the Society of Analytical Psychology monthly scientific meeting. It is not a polished nor a comprehensive essay, rather it is the musings of an 89-year-old analyst intended for a group who knew his work and achievements. He was too ill to deliver it himself.

In this informal communication the part theory plays in analytic practice is examined and examples of the different uses to which theory is put within analytic sessions are considered. The usefulness and value of theories are discussed with reference to Jung's theories and attitudes to them and to the theory of the primary self.     

Cooperation in Ethnically Diverse Neighborhoods: A Lost‐Letter Experiment

Several studies suggest a negative impact of ethnic diversity on cooperation, but most of them rely on attitudinal and other indirect measurements of cooperation or are derived from the artificial laboratory setting. We conducted a field experiment based on the lost‐letter technique across 52 neighborhoods in Berlin, Germany. The study has two aims. First, we investigate whether the negative effect of ethnic heterogeneity on cooperation holds for concrete cooperative behavior in a real‐world setting. Second, we test the most prominent psychological mechanism that has been proposed to explain the negative effects of heterogeneity on cooperation, namely in‐group favoritism. We do so by experimentally varying the ethnicity and religion of the senders of letters. We find strong support for the negative effect of ethnic diversity on cooperation. We find no evidence, however, of in‐group favoritism. Letters from Turkish or Muslim organizations were as often returned as those from German and Christian organizations, and the ethnic diversity effect was the same for all types of letters.     

Structural brain abnormalities in patients with Parkinson’s disease with visual hallucinations: A comparative voxel-based analysis

The objective is to evaluate clinical characteristics and cerebral alterations in Parkinson’s disease (PD) patients with diurnal visual hallucinations (VHs). Assessment was performed using magnetic resonance image (MRI) and voxel-based morphometry (VBM). Thirty-nine patients with PD (53.8%) and ten controls were studied. Voxel based morphology analysis was performed. Eleven patients presented diurnal VHs and among these, six had cognitive dysfunction. Patients with VHs performed worse in the mentation-related UPDRS I (p = 0.005) and motor-related UPDRS III (p = 0.02). Patients with VHs showed significant clusters of reduced grey matter volume compared to controls in the left opercula frontal gyrus and left superior frontal gyrus. PD without hallucinations demonstrated reduced grey matter volume in the left superior frontal gyrus compared to controls. Comparisons between patients with VHs regarding the presence of cognitive dysfunction showed that cases with cognitive dysfunction as compared to those without cognitive dysfunction showed significant clusters of reduced grey matter volume in the left opercular frontal gyrus. Cases without cognitive dysfunction had reduced grey matter substance in the left insula and left trigonal frontal gyrus. Judging from our findings, an abnormal frontal cortex, particularly left sided insula, frontal opercular, trigonal frontal gyrus and orbital frontal would make PD patients vulnerable to hallucinations. Compromise of the left operculum distinguished cases with VHs and cognitive dysfunction. Our findings reinforce the theoretical concept of a top-down visual processing in the genesis of VHs in PD.     

议程与习惯性反应对学习时间分配的影响：来自眼动的证据

采用眼动记录技术,操作三种词对位置,探讨议程与习惯性反应对学习时间分配的影响。实验一设置无时间限制条件,结果发现,20名大学生被试均优先选择左边的项目,项目的自定步调学习时间不存在词对位置效应。结果表明,被试的习惯性反应影响项目选择,不影响自定步调学习时间。实验二设置有时间限制条件,结果发现,20名大学生被试均优先选择容易项目并分配更多的时间学习容易项目,且容易项目的选择存在词对位置效应。结果表明,议程驱动主导被试的项目选择和自定步调学习时间,但不能完全消除习惯性反应对项目选择的影响。     

缓慢的力量——Ilizarov技术在中国微言

1950年前苏联骨科医师Ilizarov发现了牵张成骨技术,应用模仿自然的缓慢牵伸力能治愈复杂创伤骨折、骨与软组织的缺损、感染和肢体的严重畸形.这种治疗模式既不同于传统骨科手术技术,也不同于现代的创伤骨科的骨折内固定接骨(AO)技术或截骨矫形技术,这些技术的特征之一就是迅速进行骨的固定和矫正畸形.以每天1mm为特征的Ilizarov技术,不仅解决了缺损和畸形中的骨的问题,而且解决了包括血管、神经、肌肉和皮肤在内的其他软组织的生长问题,对骨科一些创伤和畸形的效果无以伦比.由于诸多原因,在我国的传播不够广泛,还需要各方努力,来一起推动该技术的发展和应用.     

导言：外固定与肢体重建——符合生态医学的新学科

29岁的内蒙古青年,15年前车祸伤致小腿肌肉广泛坏死,遗留整个小腿皮包骨头,重度马蹄内翻足,用足背负重行走,去过多个大医院检查都建议膝关节下截肢,在秦泗河的矫形骨科用细钢针穿骨安装骨外固定器（Ilizarov环式外固定器）,术后通过缓慢牵伸,足内翻畸形完全矫正,可以用足底全负重弃拐行走,避免了截肢。在秦泗河矫形外科用这项技术治疗的5000多例患者中,已经挽救了30多例濒临截肢的下肢残缺畸形,使许多无望、悲观的患者重新迈上了新生活。     

缓慢的力量——Ilizarov技术在中国微言

1950年前苏联骨科医师Ilizarov发现了牵张成骨技术,应用模仿自然的缓慢牵伸力能治愈复杂创伤骨折、骨与软组织的缺损、感染和肢体的严重畸形。这种治疗模式既不同于传统骨科手术技术,也不同于现代的创伤骨科的骨折内固定接骨（AO）技术或截骨矫形技术,这些技术的特征之一就是迅速进行骨的固定和矫正畸形。以每天1mm为特征的Ilizarov技术,不仅解决了缺损和畸形中的骨的问题,而且解决了包括血管、神经、肌肉和皮肤在内的其他软组织的生长问题,对骨科一些创伤和畸形的效果无以伦比。由于诸多原因,在我国的传播不够广泛,还需要各方努力,来一起推动该技术的发展和应用。