“MY RESISTING GETTING WELL”: NEURASTHENIA AND SUBCONSCIOUS CONFLICT IN PATIENT‐PSYCHIATRIST INTERACTIONS IN PREWAR AMERICA

This study examines experiences of individual patients and psychiatrists in the Henry Phipps Psychiatric Clinic at Johns Hopkins between 1913 and 1917. The dynamics of these patient‐psychiatrist interactions elucidate the well‐known conceptual shift in explanations of mental illness during the twentieth century, from somatic models rooted in the logic of “neurasthenia” and damaged nerves to psychodynamic models based on the notion of “subconscious conflict.” A qualitative analysis of 336 cases categorized as functional disorders (a catchall term in this period for illnesses that could not be confirmed as organic diseases), shows that patients explained their symptoms and suffering in terms of bodily malfunctions, and, particularly, as a “breakdown” of their nervous apparatus. Psychiatrists at the Phipps Clinic, on the other hand, working under the direction of its prominent director, Adolf Meyer, did not focus their examinations and therapies on the body's nervous system, as patients expected. They theorized that the characteristic symptoms of functional disorders—chronic exhaustion, indigestion, headaches and pain, as well as strange obsessive and compulsive behaviors—resulted from a distinct pathological mechanism: a subconscious conflict between powerful primal and social impulses. Phipps patients were often perplexed when told their physical symptoms were byproducts of an inner psychological struggle; some rejected the notion, while others integrated it with older explanations to reconceptualize their experiences of illness. The new concept also had the potential to alter psychiatrists' perceptions of disorders commonly diagnosed as hysteria, neurasthenia, or psychoneuroses. The Phipps records contain examples of Meyer and his staff transcending the frustration experienced by many doctors who had observed troubling but common behaviors in such cases: morbid introspection, hypochondria, emotionalism, pity‐seeking, or malingering. Subconscious conflict recast these behaviors as products of “self‐deception,” which both absolved the sufferer and established an objective clinical marker by which a trained specialist could recognize functional disorder. Using individual case studies to elucidate the disjunction between patients' and psychiatrists' perspectives on what all agreed were debilitating illnesses, this analysis helps to illuminate the origins of a radical transformation in psychiatric knowledge and popular culture in the twentieth century—from somatic to psychodynamic explanations of mental illness.     

Interobserver and test-retest reliability of Rothbart's Infant Behavior Questionnaire

Forty-five Swedish couples ( N =90) independently completed a translation of Rothbart's Infant Behavior Questionnaire (IBQ) when their infants were 3 and 8 months of age. There was greater agreeement between mothers and fathers at 8 than at 3 months, perhaps because fathers became more involved as their children grew older. At neither age was agreement as great as that reported by Rothbart (1981) in the USA. Parents did not agree on the dimensions Duration of Orienting and Soothability. In the eyes of both parents, there was significant, although modest, stability over time on most dimensions of infant temperament. There was least perceived stability in Distress to Approaching Stimuli (Fear). These results suggest that the IBQ (even in a Swedish translation) may be a reliable and valid way of measuring parental perceptions of infant temperament.     

Stability and change in parental attitudes following an infant's birth into traditional and nontraditional Swedish families

Fifty-one Swedish couples were interviewed in the last trimester of their first pregnancy and again when their infants were 5 months old. Twenty-five of the couples indicated that the mothers would be primary caretakers throughout the first year (traditional families) whereas the other 26 couples said that the fathers would be primary caretakers for between 1 and 6.5 months during the year (nontraditional families). Analyses showed that the value of parenthood and the value of work were stable from the first (prenatal) to the second (postnatal) interview, although prenatally-anticipated paternal involvement was only marginally correlated with actual paternal involvement. Subjects agreed with their spouses when asked about the same issues, suggesting that the constructs had some validity. Parenthood and work were more highly valued by nontraditional parents than by traditional parents. Degree of paternal caretaking was positively correlated with the fathers satisfaction with and value of parenthood and negatively correlated with their resentment of the infant. Correlations differed somewhat among traditional and nontraditional mothers and fathers. Fathers were more involved with "difficult" sons and "easy" daughters than with "easy" sons and "difficult" daughters.     

Self-Determination, Wellbeing, and Threats of Harm

David Rodin argues that the right of national‐defence as conceived in international law cannot be grounded in the end of defending the lives of individuals. Firstly, having this end is not necessary because there is a right of defence against an invasion that threatens no lives. However, in this context we are to understand that ‘defending lives’ includes defending against certain non‐lethal threats. I will argue that threats to national‐self determination and self‐government are significant non‐lethal threats to the wellbeing of individuals that can justify lethal defensive force. Therefore the end of defending individuals can ground a right of national‐defence against a ‘bloodless invasion’. Secondly, Rodin argues that defending lives is not a sufficient condition for military action to be national self‐defence, because humanitarian intervention is military action to defend individuals, and such action is in deep tension with national self‐defence. I will argue that a reductive account, grounded in claims of need and threats of harm, can justify principles of both intervention and non‐intervention on the same grounds; that is, protecting the wellbeing of individuals.