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.     

Ordinance influences individuals' perceptions towards prospects of social circumstance but not the status quo: An experimental field study on sexual minorities issues in Japan

Scientific evidence shows that institutional decisions can change individuals' private attitudes towards relevant issues. However, little is known about their effect on individuals' perceptions of social norms. This intriguing question has gained the attention of scholars. Nonetheless, the findings are primarily observed only in samples of the Western, Educated, Industrialised, Rich, and Democratic countries, leading to doubts about their generalisability. This study experimentally tested residents' (N = 411) reactions to the new Tokyo ordinance prohibiting discrimination against sexual minorities enacted on October 5, 2018, and tested whether it dispelled self–other discrepancies regarding tolerance towards sexual minorities (i.e., pluralistic ignorance). The results showed that exposure to information about enactment increased future perceptions of support and understanding of sexual minorities. By contrast, private attitudes, perceptions of current social norms, and willingness to speak out did not change. Willingness to speak out was indirectly enhanced through increased perceptions of gaining future support. Furthermore, Tokyo residents overestimated other residents' negative attitudes towards sexual minorities. However, even when informed of the new ordinance, this self–other discrepancy in intolerance towards sexual minorities was not corrected. These findings suggest that institutional decisions can shape the perception of social norm change in the future beyond Western countries.     

Competing interests: The need to control conflict of interests in biomedical research

Individual and institutional conflict of interests in biomedical research have becomes matters of increasing concern in recent years. In the United States, the growth in relationships — sponsored research agreements, consultancies, memberships on boards, licensing agreements, and equity ownership — between for-profit corporations and research universities and their scientists has made the problem of conflicts, particularly financial conflicts, more acute. Conflicts can interfere with or compromise important principles and obligations of researchers and their institutions, e.g., adherence to accepted research norms, duty of care to patients, and open exchange of information. Disclosure is a key component of a successful conflict policy. Commitments which conflict with a faculty member's primary obligations to teaching, research, administrative responsibilities, or patient care also need attention. Institutional conflict of interests present different problems, some of which are discussed in an analysis of an actual problem posed by two proposed clinical trials. This paper is adapted from a lecture presented to a Symposium on Scientific Integrity, Warsaw, Poland, 23 November 1995. Daniel Steiner was Vice-President and General Counsel of Harvard University (1972–92) and in that capacity became familiar with conflict of interest issues. He is currently Counsel to the Boston law firm. Ropes and Gray, and is Adjunct Lecturer in Public Policy at the John F. Kennedy School of Government. Harvard University.     

AN ECOBEHAVIORAL EXAMINATION OF A SIMPLE STRATEGY FOR INCREASING MEALTIME LANGUAGE IN RESIDENTIAL FACILITIES

Typically in large residential facilities for retarded persons, meals are served in an institutional style that does not appear to encourage appropriate peer interactions. An ecological program alternative is serving meals in a family style. The present study was designed to examine both the feasibility of serving family style meals and the effects of family style meal service on mealtime language. Five retarded young adult male residents, who had some conversational skills and appropriate table manners, participated in this study. The experimental design involved a multiple baseline analysis across meals (dinner, lunch, and breakfast). Observers coded the youths' mealtime verbalizations according to the type, content, and direction of the verbalizations and they recorded the length of the meals. The analysis of the verbalization data indicated that during family style meals the participants spoke substantially more often than during institutional style meals. Increases in peer-directed conversation about the meals primarily accounted for the verbalization changes. Family style serving also resulted in the youths spending more time with their meals. In addition, social validation measures suggested that the family style procedures were preferred by the consumers (participants, staff, and concerned community members).     

New assessment systems for residential treatment,management, research,and evaluation: A symposium

An introduction and overview are presented to new observational assessment systems for ongoing assessment and monitoring of both staff and resident (client or patient) functioning in residential treatment programs for emotionally disturbed and mentally retarded adults.Preparation of articles and the research and development on which the articles are based was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from the Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.A symposium presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979.     

Systems use to objectify program evaluation,clinical, and management decisions

The utility of the observational assessment systems at different levels — from local clinical to systemwide management — is outlined. An overview is provided of TSBC information applied to individualized problem identification and programming/monitoring, discharge and competency determinations, and both absolute and comparative program evaluation. The utility of SRIC information for prgoramming/monitoring and for staff training and evaluation is outlined in addition to the applied uses of the information of the assessment systems in combination. Once implemented, the continuous data from the systems allow for empirically based self-corrective improvements in the quality of mental health services while automatically providing a basis for legal documentation and accurate cost/effectiveness comparisons of mental health programs.Preparation of this article and the research and development on which the article is based were supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from The Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

People with severe and profound intellectual disability: Nurse carer experiences in a South African setting

We explored nurse carer experiences with people with severe and profound intellectual disability in a care and rehabilitation centre in South Africa. Informants were a convenience sample of 10 nurses (females = 7; males = 3; mean years of service = 7.8, SD = 4.8 years). They completed an unstructured interview on their care provision experiences. The data were thematically analysed using Tesch’s method of open coding. Findings resulted in the following three themes to characterise the nurse carer experiences: compassion, person-centred care, and importance of parent involvement. Compassionate and person-centred care is fundamental to the establishment of a therapeutic relationship between nurse carers and people with severe and profound intellectual disability.     

Structural support,networking and individual survival: career changes in Italy and Spain

Southern European countries, like Italy and Spain, have been severely affected by the recent economic crisis. This has affected their labour market in terms of increased unemployment, while many of those in employment feel more insecure. As a consequence, many individuals turn to education as a step to making a career change. The opportunities and hindrances stemming from socio-economic institutions such as vocational education and training (VET) and higher education, labour market regulations and career guidance are highly influential in the ways in which individuals manage their career transitions and engage in lifelong learning. This article outlines the structural conditions in the two countries in respect to career guidance provision and reflects, based on individual accounts of mid-career workers, how individuals negotiate the system.     

The dual aspect of fantasy: Flight from reality or imaginative realm? Considerations and hypotheses from clinical psychoanalysis1

This paper discusses the view that fantasizing, understood as a flight into fantasy, belongs to a type of mental functioning distinct from imaginative fantasy. From this the idea emerges, proposed by Winnicott, that withdrawal into fantasy assumes a dissociative quality, which is formed early on as a defensive solution following the loss of hope in object relations. Such a defence becomes the foundation for a dangerous enclave in which the individual ends up enclosing himself, experiencing an illusory self-sufficiency. In this perspective, the author maintains that the flight into fantasy must be understood as a risk factor for the draining of the self or for a crystallization into psychopathological structures, becoming an automatic activity of 'non-thought' that substitutes for the working-through processes necessary for the development of the mind. The paper investigates this psychopathological dynamic, which was already present in Breuer and Freud's writings, examining subsequent contributions of various authors. Clinical material (of both children and adults) illustrates how the flight into fantasy may take the form of an anti-relational realm of the mind, compromising the operations necessary to the integration of psychic life. There is also a discussion of which therapeutic tools may help the patient to gradually abandon the withdrawal in favour of an authentically nourishing relational nature.