Memory: Between traumatic shock and psychic historicization

‘I want to erase him from my memory,’ she said, ‘his eyes, his eyes staring at me … they are there every night, his hand … every night it hits me again and again …’. On the basis of these few words taken from the therapeutic work with Keltoum, the author reflects theoretically and clinically on the place of memory in a traumatism: a fixed memory, a ‘frozen image’, the signs of a traumatic compulsion to repeat, are the expressions of a process of psychic disorganization but also of a ‘symbolized and symbolizing’ memory anticipating a possible historicization of this memory, of a path, therefore, towards a resolution of the trauma resulting from a process of psychic integration and reorganization.     

地震伤截肢纪实与感悟

笔者亲身经历了“5·12”四川汶川8．0级特大地震中救治地震伤员的医疗工作,结合相关的创伤性截肢的一些经验和一些感悟,初步分析了地震伤员的创伤性截肢的特点、原因以及创面处理的一些措施和原则,以期与同道共同探讨类似突发性、群发性伤害事件中更加有效的救治措施。     

亚低温在重型颅脑损伤患者救治中的应用与思考

重型颅脑损伤是致死、致残的主要原因之一。亚低温（MHT）的应用为重型颅脑损伤患者的救治提供了新的思路和方法,国内外多个临床试验证实了其在救治中的有效性和实用性。本文结合国内外相关诊疗指南、循证医学证据和文献,辩证探讨了MHT在重型颅脑损伤患者救治中的适应证及机制、操作方法及时间窗、并发症及临床决策问题。     

The death drive: Conceptual analysis and relevance in the Spanish psychoanalytic community1

Based on a six‐year doctoral research, the author carries out a historical, epistemological and paradigmatic assessment of the controversial concept of the death instinct. The author analyses this notion’s speculative nature; its relation with the second principle of thermodynamics; the feasibility of a return to an inorganic state; the death drive’s metaphorical and isomorphic uses, as well as its theoretical and doctrinaire approaches; its relationship with repetition compulsion and masochism; the influence of Freud ’s scientific background on its formulation; and its context‐dependent meaning. Although this paper stems mainly from the theoretical aspects of the study, it also offers some clinical thoughts on the basis of a clinical vignette. The author stresses the underlying healing aspects of repetition in the analytic situation. Next, he presents concise comments on his empirical research on the current professional usage of the death drive in the Spanish psychoanalytical community. This research covered more than 27% of Spanish psychoanalysts (IPA) and psychotherapists (EFPP). The essay’s conclusions point to the ambiguous character of the death drive concept and its literal unacceptability and the absence of consistent arguments for its acceptance.     

Post‐traumatic functional recovery and reorganization in animal models: A theoretical and methodological challenge

Studies addressing cerebral functional localization face methodological and theoretical problems. Lesion experiments expect that when a functionally specialized structure is missing, its function can be deduced from the resulting impairments. Mostly, however, initial impairments are partially or fully eliminated through functional recovery. Apparently, such a recovery contradicts the notion of functional localization. In order to understand the mechanisms of recovery, improved methodology and a new theoretical framework are required. Insights into the mechanisms of recovery can be achieved by using “challenge” techniques, where functionally recovered individuals are exposed to organic and behavioral challenges, e.g. pharmacological manipulations or additional lesions, as well as modified test situations. Using such methods, a number of principles of functional recovery have emerged. We evaluate some of the available theories of post‐traumatic recovery against these principles and find that none of them can account for the principles. Finally, we present a new conceptual framework – the Reorganization of Elementary Functions (REF) model. This model reconceptualizes the term “function”, suggests mechanisms of post‐traumatic reorganizations, and resolves the contradiction between localization and functional recovery.     

Trauma‐focused CBT with maltreated children: A clinic‐based evaluation of a new treatment manual

The effectiveness of a locally developed trauma‐focused cognitive behavioural therapy (TF‐CBT) program for maltreated children with post‐traumatic stress disorder (PTSD) was examined across different therapists in a child protection clinic setting. An earlier phase of the research piloting the program had provided promising results. This second phase involved two studies evaluating the completed TF‐CBT manual delivered by (a) the developer and (b) other therapists. A single‐case multiple‐baseline design was used to demonstrate the controlling effects of the treatment on PTSD symptoms and child coping. Eight 9–13‐year‐old abused children with PTSD were treated. Positive outcomes support the effectiveness of the TF‐CBT program delivered by both the developer and other therapists. The study design and methodology were robust enough to confirm empirically the clinically beneficial effects and potential for this new program. It was also apparent, however, from study limitations, including missing data for some patients, that there are a number of challenges in carrying out such research in a busy child protection service setting with multiply‐abused patients. This paper considers implications and ways forward for engaging in empirically supported practice as well as future development and research.     

Trauma‐Informed Supervision: Clinical Supervision of Substance Use Disorder Counselors

Substance use disorder counselors are at risk of experiencing burnout, vicarious trauma, and secondary traumatic stress. These phenomena can lead to counselor impairment. The authors describe how trauma‐informed supervision can mitigate the risks of impairment for substance use disorder counselors.     

Healing Together

As part of the World Council of Churches’ pilgrimage of justice and peace, the Just Community of Wo/Men organized the “Walking Her-Story” activity as a gender response. These have remained pilgrim team visits that focus on listening to the stories of wo/men young and old and particularly addressing gender injustice specifically as expressed in sexual and gender-based violence. This article focuses on the process triggered by such stories in Burundi, Democratic Republic of the Congo, Nigeria, and South Sudan that became the midwife that gave birth to Healing Together – an ecumenical resource for faith- and community-based counselling of those psychosocially wounded by injustice and violence. Rooted in the understanding of mission as healing and wholeness, the stories listened to became a cry for healing and wholeness. The process and product benefited from the richness of my being an ethicist of care nurtured by my ubuntu (communitarian) ethical background, trained in Healing of Memories’ facilitation and as a student of Franklian logotherapy. I worked with survivors of injustice and violence, post-traumatic stress disorder healing facilitators, and church leaders through the council of churches in Nigeria, Sierra Leone, and South Sudan.     

Life‐events and post‐traumatic stress in a sample of English adolescents

The aim of the present study was to investigate the lifetime prevalence of negative life‐events and their association with post‐traumatic stress in English adolescents. Of the 427 adolescents surveyed, 360 (84%) endorsed at least one negative event. Respondents were asked to complete the Impact of Event Scale (IES: Horowitz, Wilner and Alvarez, 1979) for each event that they endorsed. For boys, highest levels of post‐traumatic stress were found in those who had experience of a ‘family member with a drink or drugs problem’, followed by ‘parental separation or divorce’, ‘life threat to family member’, and ‘life‐threat to self ’. For girls, highest levels of post‐traumatic stress were found in those who had experienced ‘attack or physical assault to self ’, followed by ‘family member with drink or drugs problem’, ‘parental separation or divorce’, and ‘life threat to family member’. These data suggest that moderate levels of post‐traumatic stress are present in around one fifth of adolescents who have experienced one of these events and that community levels of post‐traumatic stress in adolescents may be higher than previously thought. Copyright © 2000 John Wiley & Sons, Ltd.