Between memory and destiny: Repetition1

This essay focuses mainly on the topic of repetition (agieren)—on its metapsychological, clinical, and technical conceptions. It contains a core problem, that is, the question of the represented, the nonrepresented, and the unrepresentable in the psyche. This problem, in turn, brings to light the dialectical relation between drive and object and its specific articulation with the traumatic. The author attributes special significance to its clinical expression as ‘destiny’. He points out a shift in the theory of the cure from recollection and the unveiling of unconscious desire, to the possibility of understanding ‘pure’ repetition, which would constitute the very essence of the drive. The author highlights three types of repetition, namely, ‘representative’ (oedipal) repetition, the repetition of the ‘nonrepresented’ (narcissistic), which may gain representation, and that of the ‘unrepresentable’ (sensory impressions, ‘lived experiences from primal times,’‘prelinguistic signifiers,’‘ungovernable mnemic traces’). The concept‐the metaphor‐drive embryo brings the author close to the question of the archaic in psychoanalysis, where the repetition in the act would express itself. ‘Another unconscious’ would zealously conceal the entombed (verschüttet) that we are not yet able to describe‐the ‘innermost’ rather than the ‘buried’ (untergegangen) or the ‘annihilated’ (zugrunde gegangen)‐through a mechanism whose way of expression is repetition in the act. With ‘Constructions in analysis’ as its starting point, this paper suggests a different technical implementation from that of the Freudian construction; its main material is what emerges in the present of the transference as the repetition of ‘something’ lacking as history. The memory of the analytic process offers a historical diachrony whereby a temporality freed from repetition and utterly unique might unfold in the analysis. This diachrony would no longer be the historical reconstruction of material truth, but the construction of something new. The author briefly introduces some aspects of his conception of the psyche and of therapeutic work in terms of what he has designated as psychic zones. These zones are associated with various modes of becoming unconscious, and they coexist with different degrees of prevalence according to the psychopathology. Yet each of them will emerge with unique features in different moments of every analysis, determining both the analyst's positions and the very conditions of the analytic field. The zone of the death drive and of repetition is at the center of this essay. ‘Pure’ repetition expresses a time halted by the constant reiteration of an atemporal present. In this case, the ‘royal road’ for the expression of ‘that’ unconscious will be the act. The analyst's presence and his own drive wager will be pivotal to provide a last attempt at binding that will allow the creation of the lost ‘psychic fabric’ and the construction, in a conjectural way, of some sort of ‘history’ that may unravel the entombed (verschüttet) elements that, in these patients' case, come to the surface in the act. The analysand's ‘pure’ repetition touches, resonates with something of the new unconscious of the analyst. All of this leads the author to underline once again the value of the analyst's self‐analysis and reanalysis in searching for connections and especially in differentiating between what belongs to the analyst and what belongs to the analysand. A certain degree of unbinding ensures the preservation of something ungraspable that protects one from the other's appropriation.     

Imbalanced word-reading profiles in eighth-graders

This current study introduced a new method to investigate the prevalence and correlates of significant imbalances in the relative accuracy with which eighth-graders read nonwords (e.g., prauma) and exception words (e.g., vaccine). Substantial proportions of students showed imbalanced word-reading profiles, but these were not strongly tied to differences in reading and spelling achievement. Of the students without reading difficulties, 19% had imbalanced word-reading profiles favoring exception words and 17% had imbalanced word-reading profiles favoring nonwords. Of the poor readers, 39% met the criterion for phonological dyslexia (with imbalanced word-reading profiles favoring exception words) and 14% met the criterion for surface dyslexia (with imbalanced word-reading profiles favoring nonwords) in relation to the eighth-grade benchmark readers, but the incidence of these types of dyslexia varied with verbal ability. Of the poor readers with normal verbal ability, 60% were classified as phonological dyslexics and none was classified as surface dyslexic. In students low in verbal ability, surface dyslexia was more common. However, when imbalanced word-reading profiles were defined in relation to fourth-grade reading-level controls, only 12 phonological dyslexics and 1 surface dyslexic were identified. Relatively few cases of either type of developmental dyslexia appeared to be "pure."     

肝豆状核变性（Wilson病）治疗策略的变革及思考

评析肝豆状核变性(WD)当前的治疗方法,主要有低铜饮食,铜的螯合剂青霉胺及曲恩汀,锌制剂和四硫钼酸胺,肝移植。介绍WD治疗策略的变革:不再提倡驱铜疗法以去除堆积的铜,而是使血液中的游离铜离子浓度常态化以逆转铜中毒,并结合2007年《柳叶刀》WD治疗专家共识进行思考。最后,展望未来对WD可能的根治疗法,即基因治疗、肝细胞移植及现在可施行的肝移植。     

巴西医疗保障体系

从巴西医疗保障体系的建立、资金筹集和使用等方面介绍巴西医疗保障体系,重点关注巴西全民统一医疗制度。鉴于巴西与我国在卫生系统绩效和医疗保障制度改革中所面临的相似挑战,试图通过对巴西医疗保障体系比较详细地介绍及与我国进行简单的对比,总结成功经验、吸取教训为我国建立全民覆盖的医疗保障体系提供借鉴和参考。     

ART伦理督导的实践与评价

在生殖中心(医院)中,将伦理原则的学习与技术规范的掌握相结合,将伦理学评价与员工的奖惩机制相结合,将伦理学研究与管理骨干的培养相结合,将伦理原则的贯彻与工作总结相结合;发挥医学伦理委员会监督的权威作用,重视群众监督手段的督促作用,借助国家行政督导机构和行业法规的震慑作用,是ART增强道德约束能力的有效机制。     

IAT范式下自尊内隐性的再证明

该研究用IAT测量了被试的内隐自尊,并通过操纵被试在不同的认知负荷条件下进行外显自我评价来考察外显自我评价和内隐自尊之间的关系。得到的结论是,在低认知负荷条件下进行外显自我评价时,外显自我评价和内隐自尊没有表现出一致性;在高认知负荷条件下进行外显自我评价时,外显自我评价和内隐自尊表现出一致性。该研究在IAT范式下表明了内隐自尊和外显自尊的分离,内隐自尊具有无意识性和自动化的特点。     

The effects of music exposure and own genre preference on conscious and unconscious cognitive processes: a pilot ERP study

Did Beethoven and Mozart have more in common with each other than Clapton and Hendrix? The current research demonstrated the widely reported Mozart Effect as only partly significant. Event-related brain potentials (ERPs) were recorded from 16 professional classical and rock musicians during a standard 2 stimulus visual oddball task, while listening to classical and rock music. During the oddball task participants were required to discriminate between an infrequent target stimulus randomly embedded in a train of repetitive background or standard stimuli. Consistent with previous research, the P3 and N2 ERPs were elicited in response to the infrequent target stimuli. Own genre preference resulted in a reduction in amplitude of the P3 for classical musicians exposed to classical music and rock musicians exposed to rock music. Notably, at the pre-attentive stage of processing (N2) beneficial effects of exposure to classical music were observed for both groups of musicians. These data are discussed in terms of short and long-term music benefits on both conscious and unconscious cognitive processes.     

Breast Cancer as Trauma: Posttraumatic Stress and Posttraumatic Growth

Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.     

Biphasic ERK1/2 activation in both the hippocampus and amygdala may reveal a system consolidation of contextual fear memory

There is accumulating evidences to suggest that memory consolidation in some conditions involves two waves of neuronal plastic change. Using two fear conditioning procedures in male C57BL/6J mice, we have recently shown that consolidation of the foreground contextual fear memory required two waves of ERK1/2 activation in hippocampal CA1, while consolidation of cue conditioning was only associated with the early phase of activation. The present experiment further showed that this bi-phasic pattern of ERK1/2 activation was not restricted to hippocampal CA1, but could also be observed in other fear memory-related brain areas. The unpaired conditioning procedure (context in foreground) induced two waves of ERK1/2 activation in hippocampal CA1 and CA3, as well as in the LA and BLA nuclei of the amygdala. In contrast, the paired conditioning procedure (context in background) led to a transient early phase only in hippocampal CA1 and LA. In addition, ERK1/2 phosphorylation in the hippocampus was found to correlate with that in the amygdala nuclei specifically after the unpaired procedure. Taken together, our data suggest that the observed biphasic pattern of neuronal plastic events may reflect the interplay between hippocampal and amygdala activity-dependent plasticity critical for the system consolidation of contextual fear memory.     

Early identification of mental health problems in schools: The status of instrumentation

When embedded within a continuum of mental health services including both prevention and treatment, school-based mental health identification programs can promote improved academic and mental health functioning among students. This article describes the scientific status of assessment instrumentation that may be used for early mental health identification in schools. Currently available instruments are described in terms of their ability to accurately detect youth with mental health problems. Implications for selecting mental health screening and assessment instruments and integrating them into schools are discussed. Finally, a range of approaches to early identification in schools as well as some of the broader ethical and practical issues related to the integration of these strategies into a school-wide continuum of services are presented.