Chronic fatigue syndrome/myalgicencephalomyelitis as a twentieth-century disease: analytic challenges

The challenges of chronic fatigue syndrome (often called myalgic encephalomyelitis, especially in the UK) (CFS/ME) to analytical and medical approaches are connected with our inability to understand its distressing somatic symptoms in terms of a single identifiable and understandable disease entity. The evidence for the roles of viral aetiologies remains inconclusive, as does our understanding of the involvement of the immune system. The history and social context of CFS/ME, and its relation to neurasthenia and psychasthenia are sketched. A symbolic attitude to the condition may need to be rooted in an awareness of psychoid levels of operation, and the expression and spread of CFS/ME may sometimes be aided by the ravages of projective identification. Psychic denial, sometimes violent, in sufferers (especially children and adolescents) and their families may be important in the aetiology of CFS/ME. We draw out common threads from psychodynamic work with five cases, four showing some symptomatic improvement, analytic discussions of three cases being presented elsewhere in this issue of JAP.     

Altered patterns of word associations in dementia and aphasia

The word associations of 38 demented, 17 aphasic, and 22 normal subjects were studied. Both normal and brain-injured subjects appear to make judgments about the grammatical class of the word stimulus. Certain stimulus words (especially nouns and adjectives) elicit paradigmatic responses whereas other words (especially verbs and adverbs) elicit syntagmatic responses. The mechanism producing syntagmatic responses seems relatively resistant to deterioration in dementia or aphasia. However, in dementia the mechanism that generates paradigmatic responses becomes progressively less efficient (possibly due to a loss of semantic markers) and consequently more random (idiosyncratic) responses emerge. Perseverative responses, inhibited in normal subjects, are more prevalent in dementia. Anomic aphasics show a pattern of word associations similar to that of subjects with mild dementia. Broca's aphasics, while making fewer paradigmatic associations than normals, retain enough self-monitoring mechanisms so that few idiosyncratic and perseverative responses are made while more null responses occur. Wernicke's aphasics show a marked shift away from a paradigmatic word association strategy, possibly due to an inability to access semantic markers or a true loss of these markers. Metalinguistic deficits (i.e., a failure to adopt an appropriate strategy) may also contribute to this shift away from paradigmatic associations. Furthermore, a disruption of self-monitoring mechanisms in Wernicke's aphasia leads to an increase in perseverative and idiosyncratic responses.     

Non-accidental injury to children--III. Methodological problems of evaluative treatment research

The practical difficulties of traditional evaluative treatment research with child-abusing families are discussed in the light of a controlled treatment trial conducted with an unselected sample of families in a service setting. Problems encountered included the heterogeneity of the sample, the high rate of non-cooperation, and the consequent sample attrition. Methodological issues of experimental design, data collection, sample attrition and outcome measures at follow-up are discussed, and guidelines suggested for more innovative research.     

Social interactional processes within the family: The study of the moment-by-moment family transactions in which human social development is imbedded

A strategy for the study of social interaction in the family is reviewed that places particular emphasis on those variables that have proven useful or hold promise for the identification and understanding of factors that affect human social development. First, the heavy reliance on observational data and other main features of the approach are described. Second, an attempt is made to summarize some of the more significant findings from this type of research that have added significantly to our understanding of social development within the family. Third, the major research methods used in this approach are described, as well as the research that needs to be done in order to improve the methodology. Finally, a number of major gaps in our substantive knowledge about social interaction within the family are indicated.     

Gerstmann syndrome without aphasia: a longitudinal study

A case of "pure" and complete Gerstmann syndrome resulting from a focal vascular lesion in the posterior parietal area of the left hemisphere and not associated with aphasic disorder or general mental impairment is described. The initial symptom presentation of this patient supported the concept of the autonomous nature of the Gerstmann aggregate but longitudinal findings suggested that these symptoms did not in fact represent a coherent syndrome.     

The effect of reinforcement for global or analytic strategies on the performance of reflective and impulsive children

Second and sixth grade impulsive and reflective children were administered a conceptual style task with a modification that children were reinforced specifically for either global or analytic processing. Results indicated that both reflectives and impulsives were capable of offering either a global or analytic hypothesis under appropriate reinforcement. Results were interpreted as indicating the relevance of motivational factors to reflection/impulsivity and cognitive style.     

Perceptions of labor market variables by college students in business,education, and psychology

The perceptions of psychic and economic rewards available in different occupations, the perceptions of psychic and economic costs of preparing for these occupations, and the perceived availability of jobs for college majors in business, education, and psychology is examined. The findings indicate that these different majors have quite similar perceptions of these variables despite major differences in occupational choices. Further analysis examines the relationships of these variables to occupational choice for these three groups of college majors. Although the perceptions of rewards and costs have limited independent relations to measures of occupational choice, benefits-to-costs comparisons are highly related to occupational choice for all three groups of college majors.     

Conflict and integration in career decision schemes

This study investigates three aspects of the way high school seniors (166 males, 187 females) construe occupational alternatives: intensity (how strongly are career considerations related), conflict (how much conflict is involved in these relations), and evaluative accord (to what extent are one's stated preferences in agreement with the positivity with which occupations are rated on considerations). Using a variant of G. Kelly's (New York: Norton, 1955) grid methodology, students rated 10 career alternatives on 10 career considerations. The results indicate that the three variables are significantly interrelated.     

Surprise but not coherence: Sensitivity to verbal humor in right-hemisphere patients

Verbal humor deficits were investigated in right-hemisphere-damaged patients. It was hypothesized that the appreciation of jokes presupposes two elements: sensitivity to the surprise element entailed in the punch line of a joke and apprehension of the coherence which results when the punch line has been integrated with the body of the joke. The possible dissociation between these elements was tested by asking subjects to select from four alternatives the appropriate ending to a joke. Right-hemisphere patients exhibited a selective attraction to endings which contained an element of surprise but which were not otherwise coherent with the body of the joke. This finding suggests that right-hemisphere patients have difficulty in integrating content across parts of a narrative and confirms the psychological reality of the proposed distinction between the surprise and coherence elements of humor processing.