Hamlet: plea for a measure of normality

The author first considers issues in psychoanalytic interpretations of literary characters, especially the question of treating the character as fiction (the aesthetic illusion) or as a real person. The position he adopts is to interpret Hamlet as a potential person, created by Shakespeare and an expression of Shakespeare’s actual – and intuitive – view of man.

With a synopsis of the tragedy and the context of its creation as background, the author then reflects on questions concerning the play. How does Shakespeare present the characters? Is Hamlet’s madness pretended or real? Which conflicts does he handle in the course of the play? Has Oedipal dynamics a role as motivational factor in his mind?

Hamlet is irrational, impulsive, emotional, inhibited, brooding, suspicious, revengeful, condemning and much more. But, in the view of the author, he is all this in a human, ‘normal’ way. There is nothing convincingly pathological or constricted in his character. ‘Un-normal’ is his intelligence and his wit. Hamlet – an intelligent, reflected, resourceful prince in late Renaissance – who has wrestle with a madhouse of political intrigues, family murders and deceitful friends.

Hamlet in Shakespeare’s text – a fairly normal person in quite a mad world.     

Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing

An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain (LBP) during prolonged standing. We examined asymmetry of lumbopelvic movement timing during a clinical test of active hip abduction in back-healthy people who developed LBP symptoms during standing (Pain Developers; PDs) compared to back-healthy people who did not develop LBP symptoms during standing (Non Pain Developers, NPDs). Participants completed the hip abduction test while movement was recorded with a motion capture system. Difference in time between start of hip and lumbopelvic movement was calculated (startdiff). PDs moved the lumbopelvic region earlier during left hip abduction than right hip abduction. There was no difference between sides in NPDs. In PDs, the amount of asymmetry was related to average symptom intensity during standing. Asymmetric lumbopelvic movement patterns may be a risk factor for LBP development during prolonged standing.     

High- compared to low-arched athletes exhibit smaller knee abduction moments in walking and running

High- (HA) and low-arched athletes (LA) experience distinct injury patterns. These injuries are the result of the interaction of structure and biomechanics. A suggested mechanism of patellofemoral pain pertains to frontal plane knee moments which may be exaggerated in LA athletes. We hypothesize that LA athletes will exhibit greater peak knee abduction moments than high-arched athletes.MethodsTwenty healthy female recreational athletes (10 HA and 10 LA) performed five over-ground barefoot walking and five barefoot running trials at a self-selected velocity while three-dimensional kinematics and ground reaction forces were recorded. Peak knee abduction moments and time-to-peak knee abduction moments were calculated using Visual 3D.ResultsHigh-arched athletes had smaller peak knee abduction moments compared to low-arched athletes during walking (KAM1: p = 0.019; KAM2: p = 0.015) and running (p = 0.010). No differences were observed in time-to-peak knee abduction moment during walking (KAM1: p = 0.360; KAM2: p = 0.085) or running (p = 0.359).ConclusionsThese findings demonstrate that foot type is associated with altered frontal plane knee kinetics which may contribute to patellofemoral pain. Future research should address the efficacy of clinical interventions including orthotics and rehabilitation programs in these athletes.     

Counseling Chemically Dependent Chronic Pain Patients in an Integrated Care Setting

This article identifies the chronic pain population and explores a holistic integrated approach to treatment and its appropriateness for counseling the chronic pain patient with substance use disorders.     

Excluded by Laughter: Laughing Until it Hurts Someone Else

Can laughter cause social pain? Given the host of ways exclusion is communicated, we examined if exclusive laughter could produce the aversive consequences accordant with social exclusion. Using a validated recall paradigm, participants recounted a time of exclusive or inclusive laughter or a typical Wednesday (control condition). Participants recalling exclusive laughter felt more ostracized, increased social pain, thwarted basic needs, worsened mood, reduced relational evaluation, and increased temptations to aggress compared to inclusive laughter or a typical Wednesday; there were generally no significant differences between the inclusive laughter and a typical Wednesday. Participants recalling exclusive laughter also felt more verbally and emotionally bullied, demonstrating empirically, for one of the first times, a link between social exclusion and bullying.     

THE INTERPLAY OF DEDUCTIVE AND INDUCTIVE REASONING IN PSYCHOANALYTIC THEORIZING

Deductive and inductive reasoning both played an essential part in Freud's construction of psychoanalysis. In this paper, the author explores the happy marriage of empiricism and rationalism in Freud's use of deductive reasoning in the construction of psychoanalytic theory. To do this, the author considers three major amendments Freud made to his theory: (i) infant and childhood sexuality, (ii) the structural theory, and (iii) the theory of signal anxiety. Ultimately, the author argues for, and presents Freud as a proponent of, the epistemological position that he calls critical realism.     

Effects of experimentally increased trunk stiffness on thorax and pelvis rotations during walking

Patients with non-specific low back pain, or a similar disorder, may stiffen their trunk, which probably alters their walking coordination. To study the direct effects of increasing trunk stiffness, we experimentally increased trunk stiffness during walking, and compared the results with what is known from the literature about gait coordination with, e.g., low back pain. Healthy subjects walked on a treadmill at 3 speeds (0.5, 1.0 and 1.5 m/s), in three conditions (normal, while contracting their abdominal muscles, or wearing an orthopedic brace that limits trunk motions). Kinematics of the legs, thorax and pelvis were recorded, and relative Fourier phases and amplitudes of segment motions were calculated. Increasing trunk stiffness led to a lower thorax–pelvis relative phase, with both a decrease in thorax–leg relative phase, and an increase in pelvis–leg relative phase, as well as reduced rotational amplitude of thorax relative to pelvis. While lower thorax–pelvis relative phase was also found in patients with low back pain, higher pelvis–leg relative phase has never been reported in patients with low back pain or related disorders. These results suggest that increasing trunk stiffness in healthy subjects causes short-term gait coordination changes which are different from those seen in patients with back pain.     

Stiffness properties of the trunk in people with low back pain

The purpose of this study was to examine the dynamic properties of the trunk during unstable sitting and to determine differences between healthy and low back pain (LBP) participants.Participants sat on a custom-made chair that was able to swing freely in the sagittal plane. The chair was mounted on a force platform to measure loads acting at the trunk. Each participant was asked to find a balanced position after the chair was tilted backward and released. Movements of the trunk and chair were recorded. Effective moment of inertia, stiffness and damping coefficients were derived using a second order linear model. 10 participants were re-tested to assess reliability.Trunk stiffness was found increased for LBP subjects (p < .05) while no difference was found for damping coefficient. Gender and initial tilt angle did not affect viscoelastic properties of the spine.A second order linear model adequately described the biomechanical response of the trunk. It was shown that the trunk response was mainly elastic for all participants. The increase in trunk stiffness in LBP subjects could be a compensatory strategy to decrease pain and the risk of further injuries, but further investigations are needed to understand the nature of the viscoelastic alterations.     

红斑性肢痛症合并周围神经损害1例诊治分析

红斑性肢痛症是一种罕见的临床综合征,以肢端皮肤间歇性皮温升高、发红、肿胀及烧灼样痛为特点,病变主要累及四肢末端,尤以下肢多见,多呈对称分布,较少见于面部和耳部.其症状常因运动和遇热而加重,休息和遇冷而减轻.临床上常分为原发性和继发性两大类,其中原发性红斑性肢痛症,多认为与编码Nav1.7亚单位的SCN9A基因突变有关.目前该病发病机制尚不明确,治疗上缺乏确切有效的治疗方案,临床易误诊误治.本文报道了红斑性肢痛症合并周围神经损害1例,以期提高对该病的认识.