A perpetual state of almost

Mr. B came to analysis describing what he called a perpetual state of almost, a feeling of almost living, both intrapsychically and intersubjectively. The perpetual state of Almost is a state in-between presence with the Other and absence from the Other. It is a state in-between a sense of self, and an absence of self. This paper proposes a deeper understanding of the defensive, insulating structure of this in-between gap, examining what enabled it to change from a static, inert state into a transient, fluid one, oscillating between states of presence and absence as a vehicle for transformation.     

缺位与越位的思考——医疗保健体制改革的定位

政府的缺位和医院的越位是目前医疗体制改革的症结所在。政府将医院推向市场,意味着政府放弃医疗的社会保障职能。医院失去政府的约束和支持,逐利将成为其必然行为。平价医院只是缓和矛盾的一时之计,只要医院不退出市场,看病难、看病贵就难有灵丹妙药,医患关系也将难以和谐。     

Forms of presence and absence in a digital age

The structural importance of absence for human development is considered crucial in psychoanalytic thinking. The necessary conflict between the principles of pleasure and reality is situated in the intersection of presence/absence, gratification/frustration. However, nowadays a physical encounter with an-Other always contains a tangible aspect of partial absence, when the person you are with is in potential simultaneous interaction with someone else, through the portable screen. The author argues that digital technology has a profound impact on our daily existence, where a central aspect is this displacement of the dimension of presence/absence. Certainly, a relationship between two people has always contained a third, but we may now be facing something qualitatively different. In a world of omnipresent connectedness, we are never completely alone and never completely together. This constant connectedness can be seen to cause a transformation of the third position, altering the structure of triangular space. Furthermore, the digital presence of the other has specific imaginary qualities, rather than symbolic, and the full implications of this are yet to be discovered. The author discusses these issues in relation to everyday social settings as well as symptoms presented in the consulting room.     

Winnicott and Derrida: development of logic-of-play

In this essay I develop the logic of play from the writings of the British psychoanalyst Donald W. Winnicott and the French philosopher Jacques Derrida. The logic of play serves as both a conceptual framework for theoretical clinical thinking and a space of experiencing in which the therapeutic situation is located and to which it aspires. I argue that both Winnicott and Derrida proposed a playful turn in Western thinking by their attitude towards oppositions, viewing them not as complementary or contradictory, but as 'peacefully-coexisting'. Derrida criticizes the dichotomous structure of Western thought, proposing playful movement as an alternative that does not constitute itself as a mastering construction. I will show that Winnicott, too, proposes playful logic through which he thinks and acts in the therapeutic situation. The therapeutic encounter is understood as a playful space in which analyst and analysand continuously coexist, instead of facing each other as exclusionary oppositions. I therefore propose the logic of play as the basis for the therapeutic encounter. The playful turn, then, is crucial for the thought and praxis expressed by the concept of two-person psychology. I suggest the term playful psychoanalysis to characterize the present perspective of psychoanalysis in the light of the playful turn. I will first present Derrida's playful thought, go on to Winnicott's playful revolutionism, and conclude with an analysis of Winicott's clinical material in the light of the logic of play.     

24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations

Although theory on team membership is emerging, limited empirical attention has been paid to the effects of different types of team membership on outcomes. We propose that an important but overlooked distinction is that between membership of real teams and membership of co-acting groups, with the former being characterized by members who report that their teams have shared objectives, and structural interdependence and engage in team reflexivity. We hypothesize that real team membership will be associated with more positive individual- and organizational-level outcomes. These predictions were tested in the English National Health Service, using data from 62,733 respondents from 147 acute hospitals. The results revealed that individuals reporting the characteristics of real team membership, in comparison with those reporting the characteristics of co-acting group membership, witnessed fewer errors and incidents, experienced fewer work related injuries and illness, were less likely to be victims of violence and harassment, and were less likely to intend to leave their current employment. At the organizational level, hospitals with higher proportions of staff reporting the characteristics of real team membership had lower levels of patient mortality and sickness absence. The results suggest the need to clearly delineate real team membership in order to advance scientific understanding of the processes and outcomes of organizational teamwork.     

Socioeconomic background,nonverbal IQ and school absence affects the development of vocabulary and reading comprehension in children living in severe poverty

Few studies have examined how socioeconomic status (SES) affects two essential parts of human development, namely vocabulary and reading comprehension, in children facing severe poverty. The Roma population is the largest minority group in Europe, the majority of whom live in severe poverty. This study compared the development of 322 Roma children with the development of 178 non‐Roma children, between the ages of 7 and 10 years, living in Romania. The Roma children had poorer initial vocabulary and reading comprehension skills as well as slower growth rates for both compared to the non‐Roma children. Importantly, SES had a direct influence on growth in both reading comprehension and vocabulary. The effect of SES was partly mediated by school absence and nonverbal IQ. This is a powerful finding since it suggests that poverty may have detrimental effects not only on reading but also on the development of verbal abilities.     

The destruction of time in pathological narcissism

This paper describes the characteristics of subjective time (in contrast to objective time), with particular reference to a specific form of pathological experience and relation to the passage of time in patients with narcissistic personality undergoing psychoanalytic treatment. The clinical manifestations and technical approach to this pathology of time experience are outlined in the context of illustrative clinical vignettes.     

THE EFFECT OF THE ABSENCE OF CLOSE SUPERVISION ON THE USE OF RESPONSE COST IN A PRISON TOKEN ECONOMY1

A naturally occurring experiment, in which direct supervision of a token economy in a penal system was removed and re-instated, is reported. A retrospective analysis revealed that in the absence of close supervision the use of response cost rose dramatically, both in terms of categories of behaviors for which response costs were levied and in the frequency of their use. The return of direct supervision led to a decreased use and an end to the growth of categories of behaviors punished.     

我国医疗卫生改革中的伦理缺席

“中国的医疗卫生体制改革从总体上说是不成功的”结论的发表在社会上引发了对卫生改革的种种议论,从卫生改革的设计、实施和评估三方面论述了由于政府的缺位和伦理学的缺席,将卫生改革引向功利主义的死胡同,使得卫生改革背离了公正的目标而导致失败。但退回计划经济体制下的办医模式同样没有出路,在今后的深化改革中,必须强调医学目的,贯彻以人为本的指导思想,加大政府的投入,围绕公正目标,建立覆盖全民的医疗保障体制。     

父亲缺失对儿童心理发展的影响

父亲对儿童心理发展的影响正日益受到研究者的重视。父亲缺失的研究使得研究者有可能对父亲缺失家庭儿童和完整家庭儿童的人格特点进行对比,进而推理父亲的作用。它已成为当前对父亲作用研究的重要的研究范式。文章阐述了当前对父亲缺失研究的主要观点,包括父亲缺失对儿童性别角色发展的作用,父亲缺失对儿童道德和犯罪行为的影响,父亲缺失对儿童人际交往能力、个体化发展等的影响。在文章最后对未来的研究提出了一些设想。