Working with the entitled patient

Entitled patients are described as those who derive gratification from indiscriminate and intense interpersonal relationships and who unconsciously do everything they can to resist the limits that psychoanalytic psychotherapy imposes on them. In this paper the dynamics of entitled patients are explained. Case histories illustrate the difficulties and significance of setting therapeutic limits on such patients.     

Bilingualism and adult differences in inhibitory mechanisms: evidence from a bilingual stroop task

The present investigation examined the functioning of inhibitory mechanisms in younger and older bilinguals using a bilingual version of the Stroop test. The study predicted different patterns of age related decline in inhibitory mechanisms (inter- and intralingual interference) in bilinguals depending on their level of proficiency. Consistent with expectations, older bilinguals were slower when they responded in their non-dominant language. Furthermore, older unbalanced bilinguals showed greater interlingual interference when they responded with their second language to visual stimuli written in their dominant language. Balanced bilinguals showed equivalent interference effects between all conditions. These findings suggest that manipulating two languages may enhance the efficiency of inhibitory mechanisms.     

A hierarchy of cortical responses to sequence violations in three-month-old infants

The adult human brain quickly adapts to regular temporal sequences, and emits a sequence of novelty responses when these regularities are violated. These novelty responses have been interpreted as error signals that reflect the difference between the incoming signal and predictions generated at multiple cortical levels. Do infants already possess such a hierarchy of violation-detection mechanisms? Using high-density recordings of event-related potentials during an auditory local–global violation paradigm, we show that three-month-old infants process novelty in temporal sequences at two distinct levels. Violations of local expectancies, such as perceiving a deviant vowel “a” after repeated presentation of another vowel i-i-i, elicited an early auditory mismatch response. Conversely, violations of global expectancies, such as hearing the rare sequence a-a-a-a instead of the frequent sequence a-a-a-i, modulated this early mismatch response and led to a late frontal negative slow wave, whose cortical sources included the left inferior frontal region. These results suggest that the infant brain already possesses two dissociable systems for temporal sequence learning.     

Plea for a Measure of Imagination: Commentary on Paper by Harvey Peskin

In responding to Harvey Peskin's important paper, “Man Is a Wolf to Man,” I further deconstruct his proposition “what therapeutic neutrality is to psychic reality, the therapeutic witness is to the recovery of social reality.” This statement calls into question two principles of the orthodox Freudian canon, one theoretical and one technical. Beyond the stimulus barrier, traumatic reality collapses psychic reality, conscious and unconscious fold into one another, reality and fantasy merge, and nightmares are made flesh. In attempting to impose psychic reality on a traumatic experience, then, classical psychoanalysts disavow a significant portion of human experience. Technically, the analyst's neutrality or failure to acknowledge the significance of historical reality condemns the survivor to further dehumanization as her dehumanizing experiences go unmarked in treatment. Peskin contends that the need to have experience validated, to have a witnessing analyst before an interpreting one, arises not only in matters of extreme traumatization but in everyday life. Illustrating the importance of this claim with an example from my own life, I propose that extreme traumatization takes a different kind of therapeutic engagement, one that is beyond professional obligation; a moral imperative that requires imagination when recognition is not enough. I add a further caveat that in cases of extreme traumatization, rather than privileging a search for psychic reality or even historical reality, some contemporary analysts privilege an exploration of the treatment relationship, failing to recognize that in such cases historical reality must initially take precedence over an emphasis on the intersubjective.     

Ethical,legal and societal considerations on Zika virus epidemics complications in scaling-up prevention and control strategies

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus (ZIKV) complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized.     

Spontaneous number discrimination of multi-format auditory stimuli in cotton-top tamarins (Saguinus oedipus)

Studies using operant training have demonstrated that laboratory animals can discriminate the number of objects or events based on either auditory or visual stimuli, as well as the integration of both auditory and visual modalities. To date, studies of spontaneous number discrimination in untrained animals have been restricted to the visual modality, leaving open the question of whether such capacities generalize to other modalities such as audition. To explore the capacity to spontaneously discriminate number based on auditory stimuli, and to assess the abstractness of the representation underlying this capacity, a habituation-discrimination procedure involving speech and pure tones was used with a colony of cotton-top tamarins. In the habituation phase, we presented subjects with either two- or three-speech syllable sequences that varied with respect to overall duration, inter-syllable duration, and pitch. In the test phase, we presented subjects with a counterbalanced order of either two- or three-tone sequences that also varied with respect to overall duration, inter-syllable duration, and pitch. The proportion of looking responses to test stimuli differing in number was significantly greater than to test stimuli consisting of the same number. Combined with earlier work, these results show that at least one non-human primate species can spontaneously discriminate number in both the visual and auditory domain, indicating that this capacity is not tied to a particular modality, and within a modality, can accommodate differences in format.     

Perceptual constraints and the learnability of simple grammars

Cognitive processes are often attributed to statistical or symbolic general-purpose mechanisms. Here we show that some spontaneous generalizations are driven by specialized, highly constrained symbolic operations. We explore how two types of artificial grammars are acquired, one based on repetitions and the other on characteristic relations between tones ("ordinal" grammars). Whereas participants readily acquire repetition-based grammars, displaying early electrophysiological responses to grammar violations, they perform poorly with ordinal grammars, displaying no such electrophysiological responses. This outcome is problematic for both general symbolic and statistical models, which predict that both types of grammars should be processed equally easily. This suggests that some simple grammars are acquired using perceptual primitives rather than general-purpose mechanisms; such primitives may be elements of a "toolbox" of specialized computational heuristics, which may ultimately allow constructing a psychological theory of symbol manipulation.     

Seeing double,being double: longing,belonging, recognition,and evasion in psychodynamic work with immigrants

Psychically immigrants live double lives, simultaneously dwelling in the world they have left and the world in which they live, and into which most try to fit to avoid the alienating experience of being “other”. Doubleness is not a conscious act, but it is a preconscious counterpoint to just about every social interaction. I argue that successful psychodynamic treatment allows immigrants to take the doubleness for granted, in effect seeing double and being double. In this way they come to effortlessly privilege one self-state over the other. The recognition and acceptance of competing self-states proves transformative in any treatment, but never more so than in working with immigrants who contend with several culturally competing selves in their daily lives and seek one relationship in which they can all be seen and heard. I describe treating an immigrant who, when I began to work with her, excelled at seeing double, but being double posed a terrifying dilemma. At least two self-states were engaged in a tug of war; she feared that the winner would take all.     

Electrophysiological evidence of phonetic normalization across coarticulation in infants

The auditory neural representations of infants can easily be studied with electroencephalography using mismatch experimental designs. We recorded high‐density event‐related potentials while 3‐month‐old infants were listening to trials consisting of CV syllables produced with different vowels (/bX/ or /gX/). The consonant remained the same for the first three syllables, followed (or not) by a change in the fourth position. A consonant change evoked a significant difference around the second auditory peak (400–600 ms) relative to control trials. This mismatch response demonstrates that the infants robustly categorized the consonant despite coarticulation that blurs the phonetic cues, and at an age at which they do not produce these consonants themselves. This response was obtained even when infants had no visual articulatory information to help them to track the consonant repetition. In combination with previous studies establishing categorical perception and normalization across speakers, this result demonstrates that preverbal infants already have abstract phonetic representation integrating over acoustical features in the first months of life.