Recognition of selfhood as struggle

The experience of selfhood is that of struggle, between conflicting demands, inevitable dilemmas, and shifting allegiances toward deciding what is for us. The complex nature of this struggle often makes the boundaries between health and sickness ambiguous. Therapeutic work is significantly dependent on the capacity to engage with such struggles. This is illustrated by two striking examples of successful work, as well as my own two analyses, and other clinical material.     

Weight and health status of inner city African American children: Perceptions of children and their parents

Poor socioeconomic status and African American (AA) ethnicity contribute to an increased risk of obesity for many inner city children. One hundred and forty six AA children and 108 AA parents attending an inner city health fair completed surveys regarding perceptions of their own (or their child's) weight and the impact of weight on health. The children were measured and their body mass indexes were calculated. Thirty-seven percent of the child respondents (n = 52) were at risk of overweight or overweight; of these, 67% perceived themselves as normal weight, and 77% thought their weight was healthy. Weighing more was felt to be healthy by 17% of children and 29% of parents. Of 39 parents whose children were at risk of overweight or overweight, 68% felt their child's weight was normal and 80% thought it was healthy. These results suggest that inner city AA children and their parents often do not recognize being overweight or the health implications of being overweight.     

Longitudinal Behavioral and Academic Adjustment in Children with HIV Infection

This study investigated; the behavioral adjustment and academic status of children with HIV infection through serial evaluations over a ten-year period. The parents of children were assessed with Achenbach Child Behavior Checklist Parent Forms and the children were administered the Woodcock-Johnson Tests of Academic Achievement at regular intervals as part of their treatment in the HIV Program of a children’s hospital. Children with HIV were found to have behavioral adjustment within normal limits over time. Aggressive behavior was noted to decrease over time. Academic achievement mirrored IQ status, unlike other studies, which have reported poorer achievement than expected for IQ. Math skills appeared to improve over time. Thus, these findings suggest children with HIV infection did not show significant behavioral disturbance across time, however, aggressive behavior appeared to decrease. Academic achievement was stable over time.     

The American Impact on Psychoanalysis

This paper discusses what the author feels are the principal American influences on contemporary psychoanalysis. These include a growing tendency for nonhierarchical relationships in treatment, some extension of freedom of speech to clinicians, a place for management in the structuring of clinical relationships, and an increasing emphasis on aspirations and the future.