Erna and Melanie Klein

Erna was one of the child patients treated by Melanie Klein in Berlin, employing her recently discovered play technique. Since Erna died in Chile, the authors considered the IPA Congress in Santiago an opportunity to present a paper as a homage both to Erna and, especially, to Klein. She learned much from that very disturbed child, which she later used to sustain the ongoing development of her theories. The paper explores biographic data relevant to understanding both the case and the theories. It analyses the case material to follow Klein in the discovery and the handling of the child's transference and the harsh expressions of hate, jealousy and envy, which are brought in, with sad consequences, by strong persecutory feelings. Klein's comparison of this case with that of Freud's Wolf-man is also considered, mostly to show that the similarities were less than originally claimed, and that Klein, perhaps, was introducing a theoretic shift which led her technique to gradually change from ' Nachträglichkeit ' to the 'signification-resignification' pair, akin to Strachey's concept of the mutative interpretation. Lastly, the comprehension of Erna's strong psychotic traits and the links with later developments of the theory on psychosis are studied.     

BIOMEDICAL ETHICS: MUSLIM PERSPECTIVES ON GENETIC MODIFICATION

Technology pertaining to genetically modified foods has created an abundance of food and various methods to protect new products and enhance productivity. However, many scientists, economists, and humanitarians have been critical of the application of these discoveries. They are apprehensive about a profit‐driven mentality that, to them, seems to propel the innovators rather than a poverty‐elimination mentality that should be behind such innovations. The objectives should be to afford the most benefit to those in need and to prevent hunger around the world. Another major concern is the safety of genetically modified food. Muslims, as well as those in other religious communities, have been reactive rather than proactive. Muslims must connect scientific knowledge and ethical behavior based on faith. In Islam, there is no divide between the two. God has commanded us to seek knowledge and make discoveries to better our lives and our environment. We are trustees of this world and everything in it. The poor, the sick, and the wayfarers have a right to be fed and cared for. God reminds Muslims continuously that the earth and all the heavens belong to God; therefore, no one should feel hunger, no one should suffer or be prevented from sharing this bounty.     

Sociobiology and Moral Discourse

In the intellectual lineage of sociobiology (understood as evolutionary social science), this article considers the place of moral discourse in the evolution of emergent systems for mediating behavior. Given that humans share molecular systems, reflex systems, drive systems, emotional systems, and cognitive systems with chimpanzees, why is it that human behavior is so radically different from chimpanzee behavior? The answer is that, unlike chimps, humans possess symbolic systems, empowering them to override chimplike default morality in favor of symbolically mediated moral codes. The article concludes with a brief discussion of the power of religious symbols to influence moral behavior by reprogramming emotional systems.     

An Assessment of Ethnocultural Beliefs Regarding the Causes of Birth Defects and Genetic Disorders

With the expansion of genetic services to various cultural groups, genetic counselors encounter clients who hold diverse beliefs inscribed by their culture about health conditions. Thus, clients may attribute the cause of a birth defect or genetic condition to a culturally-based health belief. This present study was conducted as a pilot study in order to assess the beliefs about the causes of birth defects and genetic disorders held by women of different ethnocultural backgrounds. This study proposed that women who do not have a family history of a disorder will differ in their knowledge about the cause of a birth defect or genetic disorder compared to women who have an affected child. In addition, this study determined to what extent culturally-based health beliefs are attributed to being the cause of a birth defect or genetic disorder in the 1990s.     

Genetic Counselors' Judgments of Patient Concerns: Concordance and Consequences

The aims of this prospective study were to determine (a) the concordance between patient concerns and genetic counselors' judgments of these concerns, (b) the predictors of patient and counselor judgments, and (c) the relationship between concordance and patient outcomes. Patients' and counselors' views were sought before and after 131 routine genetic consultations. Before consultations, there was concordance about level of patient concern to within one point in 63% (82/131) of consultations and about type of patient concern in 60–84% of consultations. Lack of concordance in judging level and type of concern was associated with lower satisfaction with information and higher anxiety after the consultation. The biggest predictor of counselor judgment of concern was professional background: doctors judged patients to be more concerned than did nurses. Concordance of concern was predicted by counselors' experience in genetics: less experienced counselors overestimated patient concern. Future research needs to determine whether improving judgment of concern improves patient outcome.     

Psychological Interventions and Genetic Testing: Facilitating Informed Decisions About BRCA1/2 Cancer Susceptibility

Genetic testing for inherited cancer susceptibility, based on the recently identified. BRCA1 and BRCA2 genes, will soon be available on a large scale. However, at present, genetic test results do not lead to clearly indicated diagnostic or preventive measures, and the nature of the psychological impact of BRCA1/2 testing is still largely unknown. This uncertainty, combined with preliminary evidence suggesting significant individual differences in reactions to genetic susceptibility feedback, constitutes a unique challenge for any individual contemplating such testing. We outline the nature of this challenge and then propose an intervention strategy designed to help individuals make deeply processed and psychologically well-informed decisions with regard to their genetic susceptibility. The intervention is guided by recent research findings and theory on the cognitive–emotional processing of cancer-risk information. Specifically, the goal is to prepare the individual for genetic testing by (1) cognitively and emotionally activating, or preliving, the individual's potential reactions to testing feedback; (2) facilitating accurate appraisal of the individual's cognitive–emotional reactions; and (3) enabling the individual to process these reactions through the use of well-established clinical techniques.     

Exceptionalism or Chinamerica: Measuring Religious Change in the Globalizing World Today

Religion is changing fast in this era of globalization. Major global trends include the growth of Muslims, the shrinking percentage of unaffiliated, and the rapid rise of Christianity in global China. By 2030, China is likely to become the largest Christian country in the world while retaining large numbers of Buddhists, Muslims, and folk religious believers. To capture religious changes more accurately, social scientists of religion must sharpen their measurement tools regarding religiosity; pay more attention to the reality of nonalignment among religious identity, belief, and practice; and acknowledge the reality of nonexclusive/multiple religious beliefs, practices, and identities. Scholars must also take responsibility for developing a clear and nuanced definition of religion, abandon exceptionalist thinking, and seek to discover common patterns of religious change across societies. Conceptual and measurement tools at the disposal of social scientists of religion should enable us to perceive and understand the converging changes of religion in China, the United States, and other societies, without ignoring their historical differences and contemporary particularities.     

Genetic Counseling for Fragile X Syndrome: Recommendations of the National Society of Genetic Counselors

The National Society of Genetic Counselors' (NSGC) recommendations for fragile X syndrome (FXS) genetic counseling are intended to assist health care professionals who provide genetic counseling for individuals and families in whom the diagnosis of FXS is strongly suspected or has been made. The recommendations are the opinions of genetic counselors with expertise in FXS counseling and are based on clinical experience, a review of pertinent English language medical articles, and reports of expert committees. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a particular client.     

A Leader-Led Supervision Group as a Model for Practicing Genetic Counselors

With the stage set by the overview of supervision models in the previous paper, thispaper now presents the development and evolution of a currently ongoing leader-ledsupervision group for experienced genetic counselors. I discuss the procedures forgetting started; the creation and maintenance of the contract; typical issues and themesconsidered; the format for case presentation; and the overall growth of the group and itsmembers.     

Who Is at Risk for Psychological Distress in Genetic Testing Programs for Hereditary Cancer Disorders?

Presymptomatic identification of disease gene carriers is becoming an increasingly common part of the clinical management of hereditary cancer disorders. With an expected increase in the number of requests for DNA testing and the limited resources for counseling, the amount of time genetic counselors are able to spend with test candidates will decrease. It is therefore important for counselors to identify persons at risk for psychological distress. Based on a review of experiences with Huntington disease and cancer patients, we describe factors likely to evoke distress in genetic cancer candidates. We also discuss the sometimes widely different ways that test candidates and their partners respond to genetic testing. By exploring risk factors for distress in relevant domains of the research, we can offer counselors guidelines for determining who may need extra counseling.