Pentheus rather than Oedipus: On perversion,survival and analytic ‘presencing’1

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term ‘autotomy’ (borrowed from the fi eld of biology) to describe perversion formation as an ‘autotomous’ defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted ‘desire for ritualised trauma’ ensues. The specifi c nature of the perverse scenario embodies the specifi c experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre‐arranged and stage‐managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero‐a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (diffi cult) psychoanalytic treatment of perversion focuses on patient‐analyst interconnectedness‐brought about by the analyst's ‘givenness to being present’ or ‘presencing’‐at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential‐emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.     

Grey Matter: Ambiguities and Complexities of Ethics in Research

Ethical dilemmas are often not discussed in the dissemination of educational research. While the ethical guidelines for research seem clear at first glance, a closer look at the intimate nature of qualitative research reveals that there are many ambiguities or ‘grey’ areas where researchers must rely on their personal value systems. This article discusses the challenges faced by an experienced educator, although novice researcher, in considering the ethical parameters of her own research with adolescents with hearing loss. In particular, the grey ethical areas identified by the researcher include: (a) vulnerable population; (b) researcher role confusion; (c) consent; (d) privacy, confidentiality, and anonymity; as well as (e) the nature of risk. Based on the author’s own reflections on beginning the research process, the article presents possible pitfalls and ways of overcoming the possibility of becoming immobilized by the ethical enigmas of research.     

The interaction of state and trait aspects of self-focused attention affects genital, but not subjective, sexual arousal in sexually functional women

In this study we investigated the effects of state and trait aspects of self-focused attention on genital and subjective sexual arousal of sexually functional, healthy women during presentation of audiovisual erotic stimuli. Psychophysiological sexual response was measured as vaginal pulse amplitude using a vaginal photoplethysmograph. Experiential aspects of sexual arousal were measured both during stimulus presentation and retrospectively after stimulus offset. Trait level of sexual self-focus was measured with the Sexual Self-Consciousness Scale. State self-focus was induced by switching on a TV camera that pointed at the participant's face and upper torso. A manipulation check revealed that both groups experienced equally elevated levels of self-focused attention of their physical appearance. Induction of state self-focus per se did not affect genital responses, but an interaction effect of self-focus and participants' level of trait sexual self-focus was revealed. Compared with women with low scores on this trait, women with high scores exhibited smaller genital responses when state self-focus was induced. Both groups did not differ when no self-focus was induced. Increase of state self-focus did not affect subjective sexual arousal, but participants with a high level of trait sexual self-focus reported stronger subjective arousal, compared with those with low trait level. The results were discussed with reference to previous work in this field. Some implications for treatment of sexual arousal disorder were discussed.     

Predicting Early Sexual Activity with Behavior Problems Exhibited at School Entry and in Early Adolescence

Youth who initiate sexual intercourse in early adolescence (age 11–14) experience multiple risks, including concurrent adjustment problems and unsafe sexual practices. The current study tested two models describing the links between childhood precursors, early adolescent risk factors, and adolescent sexual activity: a cumulative model and a meditational model. A longitudinal sample of 694 boys and girls from four geographical locations was utilized, with data collected from kindergarten through high school. Structural equation models revealed that, irrespective of gender or race, high rates of aggressive disruptive behaviors and attention problems at school entry increased risk for a constellation of problem behaviors in middle school (school maladjustment, antisocial activity, and substance use) which, in turn, promoted the early initiation of sexual activity. Implications are discussed for developmental models of early sexual activity and for prevention programming.

麻醉告知与手术告知纠纷案问题探讨

麻醉告知和手术告知是两项独立的医疗活动,术后不良后果既可由手术引起,亦可由麻醉引起。术后不良后果发生原因的确定应作为医疗纠纷中责任划分的重要依据。案例表明,麻醉告知和手术告知在法律上没有单独存在的必要,依法完善手术风险的告知义务已成为医务工作者面临的新问题。     

知情同意在中医药临床诊疗中的应用思考

知情同意在中医药临床诊疗中的应用,医生要掌握知情同意的要素和方法,将中医药的不良反应及中医药特殊性告知病人,让病人的充分知情、自愿选择、实施同意。医疗机构也要承担推进知情同意应用的责任,开展不良反应监测、建立实施规范,教育和评估知情同意落实情况。     

签字与知情同意

从“丈夫不签字妻子难产死亡”案例入手,对我国临床医疗中普遍存在的签字等同于知情同意现象进行剖析,从知情同意的伦理视角对我国现行术前签字制度、代理行使签字权等现实问题进行思考。提出应正确理解知情同意,健全法律见证程序,完善医疗法规,大力开展医疗风险教育,营造医患诚信文化氛围。     

植入前遗传学诊断中性别选择的伦理辩护

植入前遗传学诊断（PGD）是在胚胎植入子宫前进行遗传学检查的新技术。它可对植入胚胎进行性别选择,从而引发了会增加我国出生人口性别比的担忧。通过对PGD性别选择伦理风险的分析,指出其用于医学需要时不会对性别比造成危害。但在实施过程中需要医生、患者及社会全体人员共同参与,避免该技术用于非医学目的的需要。     

患者拒绝签署紧急手术知情同意书的处理对策

签署手术知情同意书是医方履行告知义务,保障医患双方合法权益的一种重要手段。当患者病情需要紧急手术但患者或其家属拒绝签署手术知情同意书时,医院面临错失抢救时机和巨大的医疗风险,甚至可能因此成为被告。结合我院临床工作中的成功经验,探讨医院如何在尽可能抢救患者生命的情况下,规避相关法律风险。