Nymphea: from psychic breakdown to the emergence of subjectivity

In the first part of the paper the author presents an account of the analysis of a woman who is psychically extremely disturbed. This clinical presentation focuses on the unfolding of the transference process, and on the countertransference difficulties encountered during the course of the treatment which lasted more than ten years. In the second part of the paper the author proposes a theoretical approach to the breakdown experienced by the patient, and puts forward the hypothesis that there was insufficient differentiation between her internal objects and the archetypes, and that this prevented the development of symbolization. The author proposes the idea of a collapse between internal and external objects, which destroys the space necessary for representation and symbolization that normally arise between the two poles of the object. The account of this transference process between the analyst and the patient is thus seen as the account of the (re)construction of true internal objects, and of the resumption of a symbolic process to make possible the development of subjectivity.     

Exploring an integrative model of infant behavior: what is the relationship among temperament, sensory processing, and neurobehavioral measures?

Traditionally, developmental psychology, occupational/physical therapy, and behavioral pediatrics view similar infant behaviors from temperament, sensory processing, or neurobehavioral theoretical perspectives. This study examined the relations between similar and unique summary scores of three infant assessments (Early Infancy Temperament Questionnaire - EITQ, the Infant Sensory Profile - ISP, and the NICU Network Neurobehavioral Scale - NNNS) in a healthy sample of 100, one-month-old infants. A Principal Components Analysis of selected subscale scores derived from the three assessments suggested a three-factor model. Temperament and sensory summary scores had the strongest relations on two factors: Sensory-Affective Reactivity and Engagement. A third factor had strong relations between state regulation and motor competence. This new integrative model also validates an existing model and expands explanation of infant behavior across disciplines and methods which have significant implications for assessment, intervention, and management practices.     

Immobility reaction at birth in newborn infant

Objective

To describe an immobility reaction (IR) that was not previously reported at or immediately after birth in human newborns.

Method

We analyzed 31 videos of normal term vaginal deliveries recorded from Time 0 of birth defined as the as the moment that lies between the birth of the thorax and the pelvis of the infant. We searched for perinatal factors associated with newborn's IR.

Results

IR at birth was observed in 8 of the 31 newborns. The main features of their behavior were immobilization, frozen face, shallow breathing and bradycardia. One of the 8 newborns had sudden collapse 2 h after birth. We found significant relationships between maternal prenatal stress (PS) and IR (p = .037), and a close to significant one between infants’ lividness at Time 0 and IR (p = .053). The first breath of the 31 newborns occurred before and was not associated with the first cry (p < .001).

Discussion

The main features of IR at birth are similar to those of the universal most severe response to severe stress or danger. The relationship with PS suggests that children who had IR at birth might be at risk for similar disorders as those associated with PS. Sudden neonatal collapse of one of the IR newborns needs further research to determine if they are at risk for sudden infant death syndrome.

Conclusion

This first report of an IR reaction at birth in human infants could open up new paths for improving early neonatal care. Further research is needed for maternal PS, stress hormones, umbilical cord blood pH measurements in IR newborns. The challenge of education and support for parents of IR newborns is outlined.     

Dibs: In search of self

Abstract

Some ten years ago, while I was training towards ordination as a minister in the Church of England, close friends in the village where I lived took me to a talk given by Michael Jacobs to celebrate the 10th anniversary of the founding of CCC, the Cambridgeshire Consultancy in Counselling, on whose training course my friends, Jenny and David, were then studying.     

Effects of baby massage on neonatal jaundice in healthy Iranian infants: A pilot study

ObjectiveTo evaluate the effects of baby massage on transcutaneous bilirubin levels and stool frequency of healthy term newborns.MethodsThis Pilot study was conducted on 50 healthy newborns in Valiasr Hospital of IKHC. The infants were randomly allocated to two treatment (massage) and control group. The massage group received massage therapy (according to Touch Therapy) for four days from the first day postnatal while the control group received routine care. Main variable studied were transcutaneous bilirubin level (TCB) and stool frequency which were compared in two groups.ResultsThere were 50 newborns in the study 25 in each group (50%). There was a significant difference in the TCB levels between two groups (p = 0.000) with those in the massage group having lower bilirubin levels. As for the stool frequency there was a significant difference in two groups on the first day showing more defecation in the control group (p = 0.042) which on the consequent days was not significant and the frequencies were almost similar.ConclusionMassage group had a lower transcutaneous billirubin levels compared to the control group, thus, these pilot results indicate that massaging the newborns can be accompanied by a lower bilirubin level in the healthy term newborn.     

The lowering of bilirubin levels in patients with neonatal jaundice using massage therapy: A randomized,double-blind clinical trial

ObjectiveDue to the effects of massage on various laboratory parameters (including those related to jaundice) in infants and the expansion of existing studies to achieve effective and safe therapy in the treatment of neonatal jaundice, this study aimed to investigate the effect of massage on bilirubin levels in cases of neonatal jaundice.MethodsIn this study, 134 patients were randomly assigned to either an intervention group (massage combined with phototherapy, n = 67) or a control group (phototherapy only, n = 67). In both groups, serum total bilirubin level and frequency of daily bowel movements were measured and compared during each of the first four days of treatment.ResultsBaseline levels of bilirubin were similar between the two groups (P > 0.05). During the measurements obtained post-intervention, significant differences surfaces between the two groups in bilirubin levels and frequency of daily bowel movements (P < 0.05 for both). No significant relationship was observed during days 1 and 2 of massage therapy between daily frequency of bowel movements and serum bilirubin level (P > 0.05); this relationship became significant during the third and fourth days (P < 0.05).ConclusionMassage therapy combined with phototherapy is an effective method for reducing serum total bilirubin in infants with neonatal jaundice.     

Brazelton Neonatal Behavioral Assessment Scale: A psychometric study in a Portuguese sample

BackgroundThe Neonatal Behavioral Assessment Scale (NBAS, Brazelton &; Nugent, 1995) is an instrument conceived to observe the neonatal neurobehavior. Data analysis is usually performed by organizing items into groups. The most widely used data reduction for the NBAS was developed by Lester, Als, and Brazelton (1982).ObjectiveExamine the psychometric properties of the NBAS items in a sample of 213 Portuguese infants.MethodThe NBAS was performed in the first week of infant life (3 days ± 2) and in the seventh week of life (52 days ± 5).ResultsPrincipal component analyses yielded a solution of four components explaining 55.13% of total variance. Construct validity was supported by better neurobehavioral performance of 7-week-old infants compared with 1-week-old infants.ConclusionChanges in the NBAS structure for the Portuguese sample are suggested compared to Lester factors in order to reach better internal consistency of the scale.     

RELIGION‐AND‐SCIENCE DIALOGUE FROM THE VANTAGE POINT OF RELIGIOUS STUDIES

Loyal Rue suggests that religion is not about God as such but about the cultivation of personal and social well‐being. Religion may employ cultural resources that include concepts of supernatural agencies, but religion's essential functionalities are not dependent on that particular resource. I largely endorse Rue's view of religion and employ Rue as a guide to thinking through its consequences for the future of Christianity. For Rue, two challenges face Christianity: the erosion of confidence in personal‐god concepts and the ecological crisis engulfing the planet. In the face of these twin momentous changes, I suggest ways in which certain cultural tropes in the Christian matrix will rise to the fore and others will erode.     

Neonatal Euthanasia Is Unsupportable: The Groningen Protocol Should Be Abandoned

The growing support for voluntary active euthanasia (VAE) is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then one may conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child’s life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported.     

Attention and executive functioning profiles in children following perinatal arterial ischemic stroke

Perinatal arterial ischemic stroke (PAIS) is a form of childhood stroke; the majority of those affected experience neurologic sequelae, including motor, language and neurocognitive impairments. This study examines the attention and executive functioning (EF) profiles of children following PAIS, as well as the impact of age and sex. In this single-center cross-sectional study, 40 children aged 3 to 16 years (median age 7.2 years; 58% male) who have suffered a PAIS underwent a comprehensive neuropsychological battery to assess attention and EF. Parents completed behavioral questionnaires regarding real-world functioning. Composite scores were calculated for seven attention and EF domains (Attention, Working Memory, Verbal Retrieval, Inhibitory Control, Flexibility/Shifting, Planning/Organization, and Processing Speed). The results for all measured domains of attention and EF are significantly lower in the participants compared to the normative samples (p < .001), with the exception of Working Memory. However, increasing difficulty with Working Memory is associated with developing age. Older age at time of testing is also associated with a higher incidence of clinically-elevated attention deficit hyperactivity disorder (ADHD) symptoms. Sex is not associated with performance measures or parental report of functioning. The participants demonstrate mild-to-moderate attention and EF impairment compared to the normative population. Clinicians, families, and educators should be informed about the neurocognitive sequelae of PAIS and the need for close developmental surveillance in this population to identify vulnerable children and initiate appropriate therapeutic interventions in a timely fashion.