Psychoanalytic observations on the pathology of depressive illness: selected spheres of ambiguity or disagreement

This paper has two general sources: my own clinical psychoanalytic work extending over about four and one half decades; and consideration of certain outstandingly influential ideas in our literature: first, those of the pioneer contributors, and then those of certain more recent writers, whose views have sometimes exhibited important differences from those widely held in the past. I try to evaluate the two groups--in their occasional overlapping and important divergences, in relation to my own clinical experience. A certain general position of my own emerges from such process inevitably; but it is far from "revolutionary." Indeed, the contrary is more largely true. In extreme anticipatory condensation--what I do propose, from my own reflections, is the preeminent importance of an archaic characterological core in depressive illness.

Primary health care for whom? Village perspectives from Nepal

Over the last decade, many developing nations have embraced Primary Health Care (PHC) within their national health plans. PHC, in contrast to earlier approaches to national health development, emphasizes community participation and basic health care for the poorer segments of society. The research reported here finds that in the enthusiasm for the PHC concept in Nepal, important sociocultural processes have been overlooked. This paper describes the relationship between certain sociocultural factors and PHC activities in rural Central Nepal. It reveals a contradiction between the stated PHC intentions to address local interests and promote community participation on the one hand, and the actual approach taken on the other hand. Specifically it argues that PHC is encountering problems in Nepal for three reasons: (1) PHC fails to appreciate villagers' values and their own perceived needs. In particular, PHC is organized primarily to provide health education, whereas villagers value modern curative services and feel little need for new health knowledge. (2) PHC views rural Nepali culture only pejoratively as a barrier to health education. Alternatively, local cultural beliefs and practices should be viewed as resources to facilitate dissemination and acceptance of modern health knowledge. (3) In attempting to incorporate Nepal's traditional medical practitioners into the program, PHC has mistakenly assumed that rural clients passively believe in and obey traditional practitioners. In fact, clients play active roles and are themselves in control of the therapeutic process. Thus, instead of attempting to recruit traditional practitioners to do its work, PHC should recognize the precedent for community participation in Nepal's traditional medical system and develop the respect for villagers' own ideas and values that traditional practitioners already possess.

Inexpensive double-antibody fluoroimmunoassay for aminoglycoside antibiotics, phenytoin, and theophylline in serum

We describe simple, clinically useful double-antibody fluoroimmunoassays for amikacin, gentamicin, tobramycin, theophylline, and phenytoin. The fluorescent tracers were prepared by conjugation to fluorescein isothiocyanate; the antisera were raised in rabbits. A simple filter fluorometer and disposable culture tubes are used. The tracer, sample, and first and second antibodies are combined and incubated at room temperature for 30 min. A precipitation-acceleration buffer is added, the samples are centrifuged, and the fluorescence of the supernate is measured directly in the assay tube without decantation. Interferences, usually negligible, can be corrected for by use of a sample blank. Results compare favorably in performance with various commercially available RIA and enzyme immunoassays.

Inexpensive double-antibody fluoroimmunoassay for aminoglycoside antibiotics, phenytoin, and theophylline in serum

We describe simple, clinically useful double-antibody fluoroimmunoassays for amikacin, gentamicin, tobramycin, theophylline, and phenytoin. The fluorescent tracers were prepared by conjugation to fluorescein isothiocyanate; the antisera were raised in rabbits. A simple filter fluorometer and disposable culture tubes are used. The tracer, sample, and first and second antibodies are combined and incubated at room temperature for 30 min. A precipitation-acceleration buffer is added, the samples are centrifuged, and the fluorescence of the supernate is measured directly in the assay tube without decantation. Interferences, usually negligible, can be corrected for by use of a sample blank. Results compare favorably in performance with various commercially available RIA and enzyme immunoassays.

Hierarchy and food in Nepalese healing rituals

An analysis of food transactions in a Nepalese village provides an interpretation of the cultural place of illness within high caste Hindu traditions. In several realms of village social life, rules of food transfer simultaneously mark hierarchical relationships between people and symbolize an interdependency among them. In these contexts, food transactions stress the importance of preserving hierarchy, reinforcing interdependence, and thereby maintaining a social framework within which exchanges of goods and services can harmoniously take place. But in the realm of illness, food use and references to food suggest conflicts or breakdowns in these kinds of interdependent relationships and ordered exchanges. I suggest that there is a fundamental conflict in village society since the local concern with human interdependency is set in a milieu of a sharply perceived scarcity of valued resources. This conception that human beings are interdependent for access to scarce goods introduces an element of danger into the system of exchange and opens a potential for disharmony in social relations. A cultural recognition of this danger is again reflected in the use of food, specifically in illness ideology and curing rituals. In this examination, illness emerges as the culturally apprehended outcome of some inevitable conflicts in the village social order.

Some thoughts on the "here and now" in psychoanalytic technique and process

This paper consists of a series of reflections on the "here and now" in analysis, stimulated by recent renewed interest in the subject. The subject is considered briefly in historical perspective. In addition to the central issue of transference interpretation, a broader conception of current process is briefly examined. The entire "here and now" complex is viewed as dynamically indispensable to the effective reconstruction of the past. The critical role of the transference neurosis is stated. Certain dynamic and technical desiderata are developed. The importance of adequate attention to the patient's "reality" is emphasized in its multiple references.

Remarks on certain unique conditions of human aggression (the hand, speech, and the use of fire)

I have tried to single out for study, from the limitless complexity of human physical and mental life, three decisively fundamental elements, which, individually and synergistically, in biological and psychological spheres, have contributed importantly to the distinctiveness of human aggressive behavior and psychology and their transformations. These are: (1) the remarkable development of the human hand; (2) the primordial role of human speech, especially in drive economy; (3) the purposive utilization of fire. The pervasive dynamic importance of human orality and its vicissitudes, in relation to its phylogenetic background, has been stressed throughout. In this connection, the revolutionary role of fire has been brought into drive-economic relationship with the other two critical human instrumentalities. It is suggested that in its myriad roles, ranging from cooking to the prodigious function of sacrifice in human history and psychology, the decisive position of the role of fire in the emergence and development of homo sapiens may conceivably include a significant "overdetermining" position among the multiple elements conditioning the appearance of human speech and language.

Effects of Three Conditions of Administration on Bem Sex Role Inventory Scores

In order to assess the validity of the technique employed in selecting items for the Bern Sex Role Inventory (BSRI) 58 male and 62 female undergraduates took the BSRI under three different sets of instructions. Both males and females were able to produce extremely masculine and extremely feminine BSRI profiles which differed (p < .01) from their own BSRI profiles. The results support Bem's (1974) assertion that the BSRI Masculinity and Femininity scales are comprised of items which are consistent with widely held sex-role sterotypes.

Some problems and potentialities of present-day psychoanalysis

In a critical review of the current historical situation of psychoanalysis and its unique problems, the author considers a variety of specific but interacting factors. The potentialities for advance as therapy and science, their interrelationship, and the possible channels for such advance are examined. The social, clinical, and scientific importance of derivative 'psychotherapies' and of rationally flexible boundaries of 'indication' are discussed. As differentiated from rational conservatism, the phenomenon of analysts' irrational resistance to potential change in basic tenets of technique or theory is held to be a critically formidable impediment to the further development of psychoanalysis.