Two modalities of manic defences: Their function in adolescent breakdown

The aim of this paper is to explore two different modalities of manic defences and their specific underlying anxieties. I will describe the relation between these defences and the role of the superego and their specific function in adolescent breakdown. While one type of manic defence operates by the ego’s identification with a sadistic superego the other one operates via evacuation of a guilt-inducing superego. I will illustrate the proposed ideas with clinical examples from the analysis of two adolescents. This paper stresses the specific differences between these two modalities and the clinical importance of both identifying and addressing the enactment in the transference of the unconscious phantasies and anxieties (paranoid and depressive) that give rise to these two types of defences.     

Individual and institutional defences against primitive anxieties: Counselling in prison

Abstract

This paper describes a counsellor's attempts to understand the unconscious dynamics affecting the process of counselling women in prison. The social system of the prison serves to defend both prisoners and officers against powerful anxieties about the potential for sadistic attack originating from primitive states of mind, that is persecution, helplessness and destructiveness. The implications of the rigid means of defence are considered, and die role of unconscious guilt motivating the need for external punishment is briefly explored. Emphasis is placed on the role of splitting and projection in the management of potentially overwhelming feelings of guilt, and fear of punishment. The author develops the premise that there is in effect an institutional requirement that prisoners remain in the paranoid-schizoid position because of the feared consequences were they to experience depressive anxieties.     

Bereavement anxieties and health amongst the Australian-Italian Catholic community

This article is based on survey of 269 households in the state of Victoria, Australia. It elicits some useful guidelines for professional caregivers in relation to eight cultural/religious groups including Australian-born Christians and Arab-born Muslims. The focus here is upon the relationships between the Australian Italian community and personal health outcomes during bereavement. The following sub-strata are examined: community differences in relation to grief and loss practices and traditions; the value of religious communal support and counseling; symptomatological differences from psychosocial and educational perspectives; psychopathological/psychiatric symptoms and beliefs and practice concerning the afterlife. Significant differences were revealed between the sexes on such matters as health problems, grief expressions, psychosomatic manifestations, communication with the dead, beliefs in the afterlife and interpretation of the meaning of loss. Differences in these findings will assist professional caregivers who deal with families experiencing personal death loss to broaden their own perspectives on bereavement, offering specific counselling strategies and care-giving interventions.     

Microcosm–Macrocosm

Much has been learned in the 20th century about the impact of covert group dynamics on the individual, the family and small group on the micro level and about institutions, communities, national and international process on a macro level. However, as we enter the new millennium this knowledge seems dwarfed by the burgeoning of knowledge about the brain and biological approaches to disturbed human behavior, casting a worrisome shadow on the future of dynamic group therapies. This article explores the impact of socio-economic-political forces on mental health delivery systems from the vantage point of group process and therapy, and raises questions about possible interventions to restore a balance between social dynamics and biology.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

Prediction of end-of-life fears in COPD – hoping for the best but preparing for the worst

Objective: The diagnosis of a life-threatening illness can trigger end-of-life fears. Early studies show that end-of-life fears play an important role in chronic obstructive pulmonary disease (COPD). However, predictors of these fears have not yet been identified. This study investigated the relevance of socio-demographic variables, illness severity, psychological distress and disease-specific anxieties as predictors of end-of-life fears in COPD.

Design: A total of 131 COPD patients participated at two time points. Regression and mediation analyses, as well as cross-lagged panel analyses were conducted.

Main outcome measures: The participants completed questionnaires assessing end-of-life fears (Multidimensional Orientation toward Dying and Death Inventory), psychological distress (Hospital Anxiety and Depression Scale), and disease-specific anxieties (COPD Anxiety Questionnaire). Pulmonary function and a 6-min walk test served as measures of illness severity.

Results: Illness severity was not predictive of end-of-life fears. However, gender and psychological distress explained incremental variance. When disease-specific anxieties were included as additional predictors, psychological distress was no longer significant. Cross-lagged panel analyses mostly supported these results. Moreover, disease-specific anxieties mediated the association between psychological distress and end-of-life fears.

Conclusion: Administration and intensity of end-of-life care (especially concerning end-of-life fears) in COPD patients should be based not only on illness severity, but rather on psychological distress and disease-specific anxieties.     

The CARE System in Its Importance in Dealing with Today's Crises1

The CARE system is a gift from Mother Nature, we have it in our biological heritage; it enables us humans—as a basic gift—to help each other in a large, life-serving context, and thus also to counterbalance destruction. It is about a basic human ability, linked to typical behaviour, but also about a basic human need for connectedness. In this paper, I would like to show how the CARE system can be activated as a collective attitude. The CARE system is strengthened by positive emotions. We are currently being affected by many crises and this triggers fear. How can we deal with this better? Fear is countered with hope and the associated positive emotions such as joy, awe, kama muta and others. These emotions and feelings can be consciously encouraged and placed alongside the feelings of fear. But also, when we share the feelings of grief with each other, it triggers an attitude of CARE. We can grieve together for the various experiences of loss that we go through—but we can also imagine together how we envisage a future that is worth living for everyone. An attitude in the sense of CARING has been practised in friendship for thousands of years. It would therefore be possible to move away from an attitude of competing and outdoing, to an attitude not only of recognition, care, and solidarity in human interaction, but also in our connection with nature.