Substantive unconscious and adjective unconscious: the contribution of Wilfred Bion

The author first provides her readers with a brief summary of some of Freud's ideas, as found throughout his work, on the notion of 'unconscious'. The notion of unconscious as noun is contrasted to the idea of unconscious as adjective, this latter being proposed as a quality, or a state, ever temporary, dynamic, and subject to the constant changes going on in the individual's internal psychic world, as well as to external conditions. After presenting some considerations, the author then contrasts the Kleinian model of the mind to the Freudian, and Wilfred Bion's contribution is discussed at some length. Within Bion's conception of psychic functioning, the model of 'dream' is highlighted and, in this regard, clarifications are sought regarding Bion's view of the unconscious. To conclude, a brief and superficial approximation to the work of Carl Jung is touched upon, although the author admits to knowing little of Jung's positions.     

When religion may be an ethical issue

Though Americans are a religious people, there are times when religion or religious views may confound the ethical process. This article claims that religious values may be expressed as either principles or narratives, then seeks to establish a case for dealing with religious claims as principled narratives. Methods of evaluation are explored and then seven guidelines are offered for dealing with religion in ethics consultations.     

The Client Is the Most Important Common Factor: Clients' Self-Healing Capacities and Psychotherapy

I first briefly review the dodo bird verdict and suggest that we should be responding to it by looking for a new way to conceptualize how therapy works. Then I describe the dominant medical or treatment model of psychotherapy and how it puts the client in the position of a dependent variable who is operated on by supposedly potent therapeutic techniques. Next I argue that the data do not fit with this model. An alternative model is that the client is the most important common factor and that it is clients' self-healing capacities which make therapy work. I then argue that therapy has two phases—the involvement phase and the learning phase—and that the involvement phase is the most important. I next review the five learning opportunities provided by therapy. Finally, I argue that a relational model of therapy focused on consultation, collaboration, and dialogue is better than a treatment model.     

Managing one's body using self-management techniques: practicing autonomy

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy.     

Auguste Comte on Positivism and Happiness

Auguste Comte (1798–1857) is the founder of a French school of thought that became famous for its encyclopaedic account of the sciences as well as for its exposition of what was designed as a way out of a state of intellectual and moral crisis. This essay demonstrates that there is a linkage between the diagnosis of crisis and the pursuit of happiness in Comte's foundation of positivism. It begins by distinguishing Comte's notion of positivism from that of a value-free science. In analysing Comte's peculiar usage of the term happiness, the essay shows that happiness is understood as the result of the convergence (consensus) of three components: a scientific conception of the world, the feelings of love and veneration, and a wisely ordered activity. The essay then demonstrates that the first of these components is of primary importance inasmuch as it is to frame a new horizon within which man is expected to return to a healthy state of mind, to reshape both his hopes and activities, and to discover his own participation in a supreme order acting through the laws of nature as well as through those of the civilization in which he lives. Conveying this new horizon to citizens of a lasting Republic is the sacred mission of sociology. The essay concludes by pointing out that Comte's conception of happiness can be assessed as unifying some main qualities of life as they are classified in Ruut Veenhoven's fourfold matrix.     

What Diagnostic Devices Do: The Case of Blood Sugar Measurement

Diagnostic devices do more than just passively register facts. They intervene in the situations in which they are put to use. The question addressed here is what this general remark may imply in specific cases. To answer this question a specific case is being analysed: that of the blood sugar measurement device that people with diabetes may use to monitor their own blood sugar levels. This device not only allows the patients concerned to better approach normal blood sugar levels, but alters what counts as normal in the first place. Using the device may shift people's attention away from their physical sensations towards the numbers measured, but it may also help them to increase their own physical self-awareness. Self-monitoring finally (something that the devices have made possible) makes patients less dependent on professionals, but it requires them to engage in self-disciplining and binds them to the outcomes of their measurement activities: their own blood sugar levels.     

The Impact of Personality and Religion on Attitudes toward Alcohol among 16–18 Year Olds in Northern Ireland

Background: Previous research demonstrates a negative relationship between attitude toward alcohol and religiosity. However, what is less apparent is if this relationship may, at least in part, be a function of individual differences in personality, as previous research has demonstrated a relationship between certain measures of personality and both attitude toward alcohol and attitude toward religiosity. The aim of the present study was to explore the impact of personality and the relative efficacy of different markers of religiosity in predicting attitude toward alcohol among a sample of 16–18 year olds in Northern Ireland. Method: The Francis Scale of Attitude toward Alcohol (Francis, 1992c. Drug and Alcohol Dependence, 31, 45–50) was administered alongside the Abbreviated Revised Eysenck Personality Questionnaire (Francis, Brown, & Philipchalk, 1992. Personality and Individual Differences, 13(4), 443–449), the Francis Scale of Attitude toward Christianity (Francis & Stubbs, 1987. Personality and Individual Differences, 8, 741–743) and measures of frequency of personal prayer and church attendance among a sample of 243 16- to 18-year-old sixth-form students in Northern Ireland. Results and conclusion: The data demonstrate that a more prohibitive attitude toward alcohol was correlated with lower psychoticism scores (tendermindedness) and a more positive attitude toward Christianity. Multiple-regression analyses confirm the importance of attitude toward religion in predicting individual differences in attitude toward alcohol.     

A Lesson from My Father

Simple acts can heal. And God is present in those simple and humble acts. The following is a true story that illustrates these truths, told from the perspective of eyewitness, son, and physician.     

Concordant Spiritual Orientations as a Factor in Physician--Patient Spiritual Discussions: A Qualitative Study

Objectives: To understand the impact of physicians and patients religious/spiritual orientation on discussions of spiritual issues. Methods: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. Results: Respondents expressed that similar belief systems facilitate patient–physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. Conclusions: Our respondents view spirituality similarly to other aspects of the physician–patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.     

The Middle Passage,Trauma and the Tragic Re-Imagination of African American Theology

African American Christian consciousness developed in response to the traumatic field in which African American subjectivity took shape. The expression of the faith in the African American tradition is fundamentally tragic as a consequence. The Middle Passage is the existential and symbolic nodal point of this experience. There is a sense in which African Americans remain very much on the water; marginalized and suspended between worlds. There is a deeper sense in which the African American situation and response reflects the condition of modernity and post-modernity in the sense that it is hardly more than modernity becoming conscious of itself. A thorough examination and exploration of its significance is essential to developing a theology that adequately expresses African American Christian consciousness. This paper is an attempt to lay out, what I think, are some of the basic components of the experience and the bare outlines or orientation of such a theology grounded in it.