Psychotic functioning in adolescence: The perverse solution to survive

A psychotic breakdown in adolescence marks the emergence of a manifest aspect of a more complex process that has its origins in the patient's family pre‐history and in the patient's childhood story. This period of life is characterized by a sensorial explosion and adolescents will react differently according to the different resources they have at their disposal. Adolescents will attempt to create defensive solutions in order to face this decompensation on their own. In particular, polymorphously perverse behaviours can be utilized because of their specific characteristics in order to create a potent defence used to arrest a still more severe regression and at the same time providing the time necessary to safely navigate through a difficult and dangerous developmental phase. These solutions can be transitory or transform themselves into lasting defensive adaptations. These defensive modalities are very complex and articulated and can become fossilized in time, as, for example, in the case of a use of perverse defences against a breakdown. An analyst finding him/herself in these situations will find it difficult to differentiate in the diagnosis between a condition that is due to a perverse functioning used as a defence against decompensation, and a truly perverse structure that is beginning to emerge after puberty.     

Attenuated Access to Emotions in Obsessive-Compulsive Disorder

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that OCD is associated with attenuated access to internal states. Here we explored the implications of this model in the realm of emotions. Participants with OCD, anxiety disorders, and nonclinical control participants completed the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), assessing two domains of emotional intelligence: Experiential emotional intelligence (EI), reflecting the ability to perceive and feel emotions accurately, and Strategic EI, reflecting the ability to understand and manage emotions correctly. As only Experiential EI requires accurate perception of one’s emotions for adequate performance, we predicted an interaction between group and EI area. Specifically, we predicted that compared to both anxiety disorders and healthy control participants, OCD participants would show a larger deficit in Experiential area of the MSCEIT relative to the Strategic area. Results were fully in line with this prediction. Moreover, supporting the specificity of the hypothesized deficit to OCD, participants with anxiety disorders did not differ from nonclinical control participants in their performance, and findings were not attributable to anxiety or depression levels. These results replicate and extend previous findings obtained with analogue samples and suggest that OCD is associated with attenuated access to emotional states, which may be partially compensated for by reliance on semantic knowledge of emotion.     

Minding the Dreamer Within: An Experimental Study on the Effects of Enhanced Dream Recall on Creative Thinking

Several studies have found an association between frequency of dream recall and creativity. We tested the hypothesis that training individuals to increase dream recall by means of a daily dream log would increase scores on the Torrance Test of Creative Thinking (TTCT). One hundred twenty‐five participants completed a baseline measure of creativity (TTCT, figural version) as well as of dream recall, dissociation, thinness of psychological boundaries, mindful‐attention awareness, and well‐being. Participants were randomly allocated to two groups: the experimental group (n = 55) received a daily dream log; while the control group (n = 32) received a similarly phrased log registering memories of a vivid episode from the previous day. After 27 days, all participants completed follow‐up measurements identical to those at baseline. A non‐randomized non‐intervention group (n = 35) was used to test for practice effects on the TTCT. There was significant selective increase for the “creative strengths” component, which was only observed in the experimental group. There were significant correlations between creativity and dissociation as well as between creativity and thinness of psychological boundaries. Enhanced dream recall through daily dream logging fosters aspects of creativity. Associations between creativity, dissociation, and thinness of boundaries, suggest that increased awareness to dreams increases creativity through a “loosening” of stereotyped thinking pattern.     

Angels and devils: sadism and violence in children

This paper looks at violence and sadism in child and adolescent patients. Psychoanalytic and developmental ideas are brought together to make sense of these children’s presentations and the clinical challenges of therapeutic work with them. Differences are outlined between cold and hotter forms of aggression. The contribution of Glasser and his concept of the core complex is central to the paper, as is an understanding of addictive processes often seen in aggression, including sexual aggression.     

Accidentally True Beliefs and the Williamsonian Mental State of Knowing

In this paper, I will explore some philosophical implications of Williamson’s thesis that knowing is a state of mind (KSM). Using the fake barn case, I will introduce a way to evaluate Williamson’s KSM thesis and determine whether the Williamsonian mental state of knowing can be plausibly distinguished from certain other similar but epistemologically distinctive states of mind (i.e., accidentally true beliefs). Then, some tentative externalist accounts of the supposed differences between the Williamsonian mental state of knowing and accidentally true beliefs will be critically assessed, implying that the evaluated traditional versions of externalism in semantics and epistemology do not fit well with Williamson’s KSM thesis. Ultimately, I suggest that the extended-mind or extended-knower approach may be more promising, which indicates that active externalism would be called for by Williamson’s KSM thesis.     

An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF IPQ-R): Unpacking beliefs about treatment control,personal control and symptom triggers

Objective: This study modified the Revised Illness Perception Questionnaire (IPQ-R) in patients with persistent atrial fibrillation (AF).

Design: Qualitative interviews and think-aloud techniques informed modification of the IPQ-R to be specific to AF patients. Confirmatory Factor Analysis (CFA) (n = 198) examined the validity of the modified IPQ-R (AF-IPQ-R). Exploratory factor analysis (EFA) examined the new AF-triggers scale. Construct validity examined associations between the AF-IPQ-R, quality of life (QoL) and beliefs about medicines. Test–retest and internal reliability were examined.

Results: Interviews indicated that patients viewed triggers of AF rather than initial causes of illness as more applicable. Patients believed specific behaviours such as rest could control AF. Treatment control beliefs related to pharmacological and procedural treatments. These data were used to modify the IPQ-R subscales and to develop a triggers of AF scale. CFA indicated good model fit. EFA of the triggers scale indicated three factors: emotional; health behaviours; and over-exertion triggers. Expected correlations were found between the AF-IPQ-R, QoL and treatment beliefs, evidencing good construct validity.

Conclusion: The AF-IPQ-R showed sound psychometric properties. It provides more detailed specification than the IPQ-R of beliefs that may help to understand poor QoL in AF patients, and guidance for future interventions in this area.     

An Actor's Knowledge and Intent Are More Important in Evaluating Moral Transgressions Than Conventional Transgressions

An actor's mental states—whether she acted knowingly and with bad intentions—typically play an important role in evaluating the extent to which an action is wrong and in determining appropriate levels of punishment. In four experiments, we find that this role for knowledge and intent is significantly weaker when evaluating transgressions of conventional rules as opposed to moral rules. We also find that this attenuated role for knowledge and intent is partly due to the fact that conventional rules are judged to be more arbitrary than moral rules; whereas moral transgressions are associated with actions that are intrinsically wrong (e.g., hitting another person), conventional transgressions are associated with actions that are only contingently wrong (e.g., wearing pajamas to school, which is only wrong if it violates a dress code that could have been otherwise). Finally, we find that it is the perpetrator's belief about the arbitrary or non‐arbitrary basis of the rule—not the reality—that drives this differential effect of knowledge and intent across types of transgressions.     

The analysand and analyst team practicing reciprocal free association: Defenders and deniers

Abstract

By 1900, Freud had formulated an original and operational method of psychoanalytic treatment and research: the technique of free association. In 1912–1915 and later writings, he recommended it as a fundamental procedure and process, called the fundamental rule, in psychoanalytic therapy. In recent years, free association as a method has been variously misrepresented, misunderstood, and denied by some schools of psychoanalysis. This paper reviews the history of free associations and argues for upholding the continuity and relevance of Freud's fundamental methodology and for a renewal of interest in reciprocal, i.e., interactive and interpersonal, free association.