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Hawkins C, Kealy D. Readiness and Personality Disorders: Considering Patients' Readiness for Change and Our System's Readiness for Patients. Harv Rev Psychiatry 2024; 32:70-75. [PMID: 38452287 DOI: 10.1097/hrp.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
ABSTRACT The culture around personality disorder treatment has changed drastically in the past generation. While once perceived as effectively untreatable, there are now numerous evidence-based treatment approaches for personality disorders (especially borderline personality disorder). The questions, however, of who should be matched to which treatment approach, and when, remain largely unanswered. In other areas of psychiatry, particularly substance use disorders and eating disorders, assessing patient treatment readiness is viewed as indispensable for treatment planning. Despite this, relatively little research has been done with respect to readiness and personality disorder treatment. In this article, we propose multiple explanations for why this may be the case, relating to both the unique features of personality disorders and the current cultural landscape around their treatment. While patients with personality disorders often face cruel stigmatization, and much more work needs to be done to expand access to care (i.e., our system's readiness for patients), even gold-standard treatment options are unlikely to work if a patient is not ready for treatment. Further study of readiness in the context of personality disorders could help more effectively match patients to the right treatment, at the right time. Such research could also aid development of strategies to enhance patient readiness.
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Affiliation(s)
- Connor Hawkins
- From Department of Psychiatry, University of British Columbia (Drs. Hawkins and Kealy); Vancouver Coastal Health, British Columbia, CA (Dr. Hawkins)
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52
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Musicò A. "Masked dissociation": the many faces of technology. Am J Psychoanal 2024; 84:111-118. [PMID: 38424251 DOI: 10.1057/s11231-024-09439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
After briefly explaining the concepts of dissociation and repression and discussing the new interest that the concept of dissociation has acquired within the actual psychoanalytic panorama, the author explains the concept of a dissociative continuum and presents Peter Goldberg's theory on somatic dissociation. Starting from this model, she proposes an interpretation of the use of technology, and especially of the internet, as a dissociative modality that helps separate the mind from the body, one that allows the maintenance of personal security-a concept dear to Sullivan-through physical distance. The implications of this point of view are discussed.
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Affiliation(s)
- Alessia Musicò
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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53
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Olarte SW. Fifty Years of Change: A Shared Journey. Psychodyn Psychiatry 2024; 52:25-45. [PMID: 38426757 DOI: 10.1521/pdps.2024.52.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.
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54
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Charles M. Somatization and symbolization. Am J Psychoanal 2024; 84:57-78. [PMID: 38424252 DOI: 10.1057/s11231-024-09441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Psychoanalysis had its origins in an era when feelings that could not be recognized by the mind were being manifested in the body. Psychoanalysis works towards resolving this type of split by recognizing the existence of a dual language structure that includes both body and mind as constituents of the fabric of embodied meanings. The field of psychosomatics helps to provide keys to this language, marking the essential, patterned truths that are recognized at very basic levels and increasingly organize our perceptions as we make sense of the world. In disrupting the integration of embodied meanings, trauma impedes identity development. For some patients, learning to make meaning from somatic symptoms is an important adjunct to coming to know their own embodied experience. Two cases will be offered in which somatic symptoms provided important information that was channeled through the analytic experience as a way of making sense of what otherwise remained unknown.
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55
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Aviram RB. The outsider phenomenon and the need to belong. Am J Psychoanal 2024; 84:42-56. [PMID: 38499743 DOI: 10.1057/s11231-024-09433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
The outsider phenomenon is an existential pathology interrelated with the need to belong. It is a group related experience that has developmental foundations. W. R. D. Fairbairn (1952), was one of the first psychoanalysts who systematically challenged Freudian theory, and located the human experience within social relationships. Fairbairn (1935) suggested that the family is the first social group, leading to affiliations with important groups external to the family. This paper extrapolates from Fairbairn's ideas about schizoid character, which is an interpersonal experience, to group experiences in a family and with identity groups. Fairbairn's notions about the unavoidable activation of schizoid processes may help us understand what makes the outsider experience so pervasive.
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Affiliation(s)
- Ron B Aviram
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Rousso Bldg., Bronx, NY, 10461, USA.
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56
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Stiefel F, Bourquin C, Wild B, Schellberg D, Michaud L. Oncology clinicians' feelings towards patients presented in supervision: A pre-post assessment using the feeling word checklist. Psychooncology 2024; 33:e6318. [PMID: 38429990 DOI: 10.1002/pon.6318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/31/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Clinical supervision of oncology clinicians by psycho-oncologists is an important means of psychosocial competence transfer and support. Research on this essential liaison activity remains scarce. The aim of this study was to assess the impact of supervision on oncology clinicians' feelings towards patients presented in supervision. METHODS Oncology clinicians' (n = 23) feelings towards patients presented in supervision were assessed with the Feeling Word Checklist (FWC). The FWC was filled in by supervisees prior and after their supervision sessions (n = 91), which were conducted by experienced supervisors (n = 6). Pre- post-modification of feelings was evaluated based on a selection of FWC items, which were beforehand considered as likely to change in a beneficial supervision. Items were evaluated on session level using t-tests for dependent groups. Composite scores were calculated for feelings expected to raise and feelings expected to decrease and analysed on the level of supervisees. RESULTS Feelings related to threats, loss of orientation or hostility such as "anxious", "overwhelmed", "impotent", "confused", "angry", "depreciated" and "guilty" decreased significantly after supervision, while feelings related to the resume of the relationship ("attentive", "happy"), a better understanding of the patient ("empathic"), a regain of control ("confident") and being "useful" significantly increased. Feeling "interested" and "calm" remained unchanged. Significant increase or decrease in the composite scores for supervisees confirmed these results. CONCLUSIONS This study demonstrates modification of feelings towards patients presented in supervision. This modification corresponds to the normative, formative, and especially restorative function (support of the clinician) of supervision.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Laurent Michaud
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne and University of Lausanne, Lausanne, Switzerland
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57
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Wanza C, Rief W, Doering BK. The Inventory of Social Expectations in Bereavement: Development and psychometric validation of a new instrument. DEATH STUDIES 2024:1-11. [PMID: 38424671 DOI: 10.1080/07481187.2024.2318592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Negative expectations concerning social interactions contribute to feelings of loneliness. Since loneliness is one of the most pronounced challenges for bereaved individuals, we investigated grief-specific social expectations and its association with loneliness and grief severity. Initially, we developed an Inventory of Social Expectations in Bereavement (ISEB). Its factorial and psychometric validity was then tested in a bereaved sample (N = 344; 28.3 ± 11.1 years; 74.4% female). A two-factor solution for the scale fit the data best (factor 1: "relationship to others," factor 2: "relationship to the deceased") and demonstrated good psychometric validity. Higher ISEB-levels were associated with higher levels in grief severity and loneliness. The results suggest that individual social expectations affect the experience of loneliness after the loss of a significant other. The ISEB assesses these expectations time-efficiently and provides a basis for therapeutic interventions. Expressing expectations as probabilistic beliefs about the future renders them amenable for corrective experiences in clinical practice.
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Affiliation(s)
- Caroline Wanza
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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58
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Doubková N, Heissler R, Sanders E, Preiss M. In the shadow of dissidence: exploring the experiences of descendants of Czechoslovakian dissidents. Front Psychol 2024; 15:1310238. [PMID: 38445052 PMCID: PMC10913190 DOI: 10.3389/fpsyg.2024.1310238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction The Communist Party's reign in Czechoslovakia (1948-1989) saw the persecution of thousands of individuals. The State Security campaign "Asanace" (meaning "sanitation") was conducted to expel critics of the regime from the country using psychological and physical terror. Although stories of dissidents are frequently presented in public spaces, little is known about the experiences of their children. Methods To address this gap, we conducted interpretative phenomenological analyses of semi-structured in-depth interviews with five adult descendants of Czechoslovakian dissidents. Results Our analyses revealed that while participants appreciated and were inspired by their parents' dissident activities, they tend to distance themselves from it in order not to live in their parents' shadow. Furthermore, for them, the "Asanace" campaign primarily meant emigration, which in turn affected their sense of self and (national) identity dispersion. Consequently, they experienced feelings of being uprooted and different. Furthermore, they faced challenges acculturating. However, they also recognized their resilience as being rooted in their migration experience and the legacy of their parents' dissidence. Discussion By highlighting intergenerational differences and the impact of family legacy on individuals' strengths and weaknesses, this study contributes to our understanding of the psychological consequences of living in, escaping from and adjusting to life beyond oppressive regimes.
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Affiliation(s)
| | | | - Edel Sanders
- School of Psychology, University of New York in Prague, Prague, Czechia
| | - Marek Preiss
- National Institute of Mental Health, Klecany, Czechia
- School of Psychology, University of New York in Prague, Prague, Czechia
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59
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Moudatsou M, Stavropoulou A, Rovithis M, Koukouli S. Evaluation of Online Counseling through the Working Experiences of Mental Health Therapists Amidst the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:495. [PMID: 38391870 PMCID: PMC10888081 DOI: 10.3390/healthcare12040495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to reflect on mental health professionals' experiences with online counseling during the COVID-19 pandemic, as well as their perceptions and recommendations for the future. The method of qualitative research with semi-structured interviews was used. The sample consisted of 17 mental health professionals working in the public or private sectors. A framework analysis revealed four main themes, namely (a) the evaluation of online counseling; (b) comparing in-person and online counseling; (c) factors influencing the effectiveness of online counseling; and (d) suggestions for the future use of online counseling. Most therapists reported that their overall experience with online counseling was positive. The main advantages cited were the accessibility for everyone and the reductions in time, money, and distance. Its primary drawbacks included less nonverbal communication, the inability to employ certain therapeutic tools, problems with confidentiality, lack of experience, and technical difficulties during online sessions. Its effectiveness depends on contextual factors and factors related to the therapeutic process itself. Organizational planning, training, and a solid implementation strategy may help ensure that this communication medium is used to its fullest potential. In addition, the possible utilization of remote counseling combined with in-person psychotherapeutic intervention methods will provide solutions for the future, especially in crisis situations.
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Affiliation(s)
- Maria Moudatsou
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
| | - Areti Stavropoulou
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
- Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
- Faculty of Health, Science, Social Care and Education, Kingston University, London KT2 7LB, UK
| | - Michael Rovithis
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
- Department of Business Administration and Tourism, School of Management and Economics Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Sofia Koukouli
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
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60
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Camic PM, Sullivan MP, Harding E, Gould M, Wilson L, Rossi-Harries S, Grillo A, McKee-Jackson R, Cox SM, Stott J, Brotherhood EV, Windle G, Crutch SJ. 'Misdiagnosed and Misunderstood': Insights into Rarer Forms of Dementia through a Stepwise Approach to Co-Constructed Research Poetry. Healthcare (Basel) 2024; 12:485. [PMID: 38391860 PMCID: PMC10887667 DOI: 10.3390/healthcare12040485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/13/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
This study investigated co-constructed research poetry as a way to understand the lived experiences of people affected by rarer dementia and as a means to use poetry to convey those experiences to healthcare professionals. Using mixed methods, 71 people living with rarer dementia and care-partners (stakeholders) contributed to co-constructing 27 poems with professional poets; stakeholders' verbatim words were analysed with descriptive qualitative analysis. Stakeholders were also surveyed and interviewed about their participation. Healthcare professionals (n = 93) were surveyed to elicit their responses to learning through poetry and its acceptability as a learning tool. Poems conveyed a shared narrative of different aspects of lived experience, often owing to atypical symptoms, misunderstandings by professionals, lack of support pathways, and a continuous struggle to adapt. Stakeholder surveys indicated it was a valuable experience to both co-create and respond to the poems, whilst group interviews revealed people's experiences of the research poetry were characterised by reflection on lived experience, curiosity and exploration. Healthcare professionals' responses reinforced poetry's capacity to stimulate cognitive and affective learning specific to rare dementia support and prompt both empathy and critical thinking in practice. As the largest poetry-based study that we are aware of, this novel accessible approach of creating group poems yielded substantial information about the experiences and needs of those affected by rarer dementia and how poetry can contribute to healthcare education and training.
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Affiliation(s)
- Paul M Camic
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Martha Gould
- Independent Researcher, North Bay, ON P1B 8L7, Canada
| | - Lawrence Wilson
- Independent Researcher, Sonic Studios, Rye, East Sussex TN31 7NY, UK
| | - Sam Rossi-Harries
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Roberta McKee-Jackson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Susan M Cox
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Gill Windle
- Ageing and Dementia @ Bangor, Dementia Services Development Centre, School of Health Sciences, Bangor University, Bangor LL57 2EE, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
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61
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Tatum AK, Flicker SM, Peralta I, Kubicki RJ. Initial Motivations for Engaging in Polyamorous Relationships. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:629-644. [PMID: 38097872 DOI: 10.1007/s10508-023-02750-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/11/2023] [Accepted: 11/08/2023] [Indexed: 02/07/2024]
Abstract
Polyamory is a relationship style in which partners consensually agree to engage in sexual and/or emotional relationships with concurrent partners. Compared with other forms of consensual non-monogamy (CNM), polyamory practitioners tend to report greater relationship satisfaction and less jealousy. However, the unique motivations leading people to engage with polyamory are less understood. Previous research has examined motivations for engaging in CNM relationship styles, in general, but no research has focused exclusively on the motivations of polyamory practitioners. The present study draws on the open-ended responses of 63 U.S. American adults who reported previous or current engagement in at least one consensually polyamorous relationship. Thematic analyses revealed four themes guiding participants' initial motivations for polyamory engagement: values alignment, relationship factors, external triggers, and sexuality. The study's themes are discussed in the context of self-determination theory and situated in the existing body of CNM and polyamory research. Directions for future research provide next steps for examining outcomes associated with specific polyamory motivations.
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Affiliation(s)
- Alexander K Tatum
- Department of Counseling Psychology, Social Psychology, and Counseling, Ball State University, 1613 W Riverside Ave., Muncie, IN, 47303, USA.
| | - Sharon M Flicker
- Department of Psychology, Sacramento State University, Sacramento, CA, USA
| | | | - R J Kubicki
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Civitarese G. Intuition and we-ness in Bion and post-Bionian field theory. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2024; 105:13-39. [PMID: 38470284 DOI: 10.1080/00207578.2023.2247051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 03/13/2024]
Abstract
"Intuition" is probably the most frequently used term in all Bion's writings. However, in order to understand its role in his thought it is essential to give it the clearest possible definition. The thesis of this article is that by intuition Bion means a "specific" psychoanalytic concept. It is thus possible to extract intuition from the vague and mystifying reading of it by some authors, whic runs the risk of falling into an empty "intuitionism". For Bion, intuition is a psychoanalytic function of the analyst, the principal factors of which are the various expressions of dream-thought and insight. Furthermore, within the frame of the post-Bionian theory of the analytic field, the author suggests adding to these factors the use of the "we" vertex (or we-ness), i.e. to regard virtually every fact of analysis as co-created. The aim is to make the very concept of "field" more accessible. Compared with the metaphor of the analytic field, the concept of we-ness has both greater clinical versatility and greater pregnancy on the metapsychological plane. Indeed, it more directly reflects a radically social conception of human subjectivity: what is known in contemporary speculative thought - in J-L. Nancy, for example - as the "ontology of we".
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Affiliation(s)
- Giuseppe Civitarese
- Italian Psychoanalytic Society (SPI), American Psychoanalytic Association (APsaA), Pavia, Italy
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63
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Deahl M, Andreassen M. Psychiatric colonialism, PTSD and the Western psychiatric diagnostic tradition . . . is one man's food another man's poison? Int J Soc Psychiatry 2024; 70:36-39. [PMID: 37638706 PMCID: PMC10860350 DOI: 10.1177/00207640231193286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Sadly, much of the world is no stranger to Psychological Trauma, particularly in poorer areas with poor health infrastructure. Western Aid Organisations frequently deploy to such areas bringing with them a western psychiatric tradition of nosology and therapy which may not be appropriate in other cultures. We argue that imposing a western system of diagnosis and treatment may not only undermine local culture but may also be bad for the patient. We discuss this with reference to the WHO's Mental Health Gap initiative (MHGap).
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Affiliation(s)
- Martin Deahl
- Centre for Affective Disorders, Kings College London, London, UK
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64
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Piers RJ, Black KC, Salazar RD, Islam S, Neargarder S, Cronin-Golomb A. Equal Prevalence of Depression in Men and Women with Parkinson's Disease Revealed by Online Assessment. Arch Clin Neuropsychol 2024; 39:92-97. [PMID: 37401380 DOI: 10.1093/arclin/acad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Identifying persons needing mental health services is hampered by stigma-related underreporting of symptoms, especially by men. Men with Parkinson's disease (PD) consistently report lower rates of depression than women in in-person studies. We predicted that online anonymity would elicit more gender-based parity in depression endorsement. METHOD We administered the Beck Depression Inventory-II (BDI-II) online to 344 participants with PD (52% women). Depression was defined as BDI-II score >13 and/or use of antidepressant medications. RESULTS Overall depression prevalence was consistent with in-person studies, but with no significant difference between men and women. CONCLUSIONS Online methods may circumvent barriers to depression identification in men with PD.
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Affiliation(s)
- Ryan J Piers
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kelly C Black
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Samia Islam
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Rodriguez J, Radjack R, Moro MR, Lachal J. Migrant adolescents' experience of depression as they, their parents, and their health-care professionals describe it: a systematic review and qualitative meta-synthesis. Eur Child Adolesc Psychiatry 2024; 33:1-19. [PMID: 35301589 DOI: 10.1007/s00787-022-01971-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
Migrant youth are vulnerable and face a risk of internalised disorders such as depression. This qualitative meta-synthesis explores migrant adolescents' experience of depression. 14 studies (7 qualitative studies and 7 case reports) were selected after a systematic search of PubMed, Embase, Scopus and PsycInfo. Their quality was assessed with the Critical Appraisal Tool (CASP) for qualitative studies and the Joanna Briggs Institute (JBI) checklist for case reports. The analysis identified six themes describing the experience of depression among migrant adolescents: (1) the vulnerability factors underlying depressive distress, before, during and after migration; (2) the subjective experience of depression, combining symptoms associated with a form of depression common in the West with symptoms more common in other cultures; (3) two types of aetiological hypotheses to make sense of their distress; (4) attitudes adopted in response to distress; (5) experience of care, especially reasons discouraging investment in care; and (6) impairment of identity construction by breaks in cultural transmission and intergenerational conflicts. The threat of losing their connections both at the interpersonal (connection to family, peers and community) and intrapsychic levels (construction of identity) is inherently linked to migrant adolescents' experience of depression. We propose to adapt Brandenberger's 3C model (communication, continuity of care, and confidence) for the care of young migrants to promote a therapeutic alliance, foster construction of a coherent bicultural identity, and support the family.
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Affiliation(s)
- Juliette Rodriguez
- APHP, Hôpital Cochin, Maison de Solenn, 75014, Paris, France.
- Université de Paris, Paris, France.
| | - Rahmeth Radjack
- APHP, Hôpital Cochin, Maison de Solenn, 75014, Paris, France
- Université de Paris, PCPP, 92100, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, 75014, Paris, France
- Université de Paris, PCPP, 92100, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Jonathan Lachal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Université Clermont Auvergne, 63000, Clermont-Ferrand, France
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66
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Huang Y, Lü W. Nonlinear Moderation Effect of Vagal Regulation on the Link between Childhood Trauma and Adolescent Internalizing and Externalizing Symptoms. J Youth Adolesc 2024; 53:217-228. [PMID: 37689613 DOI: 10.1007/s10964-023-01860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
Childhood trauma is a leading early adverse environment that increases psychopathological symptoms. Respiratory sinus arrhythmia (RSA) suppression to challenges as a marker of self-regulation is found to linearly moderate the link between early adverse experiences and psychopathological symptoms, but yielding mixed findings. The present study examined the relationships between childhood trauma and internalizing and externalizing symptoms via a 1.5-year longitudinal design and the quadratic moderation effect of RSA suppression on these relationships among adolescents. In November 2021 (T1), the final sample of 275 Chinese adolescents (Mage = 12.94, SDage = 0.79; 49.82% females) completed the short form of Childhood Trauma Questionnaire and the Achenbach Youth Self-Report-2001 and underwent a speech task during which their baseline RSA and stress exposure RSA were obtained. In June 2023 (T2), 251 adolescents completed the Achenbach Youth Self-Report-2001. Results showed that childhood trauma at T1 was positively correlated with internalizing and externalizing symptoms at T1 and T2. RSA suppression to stress quadratically moderated these associations, such that adolescents with moderate rather than higher or lower RSA suppression had the least internalizing and externalizing symptoms at T1 and T2 when exposed to childhood trauma. The findings suggest that moderate RSA suppression to stress as a marker of optimal vagal regulation buffers the risk of developmental psychopathology from early adverse experiences.
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Affiliation(s)
- Yefei Huang
- School of Psychology, Shaanxi Normal University, Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, Shaanxi Key Research Center for Children Mental and Behavior Health, Xi'an, China
| | - Wei Lü
- School of Psychology, Shaanxi Normal University, Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, Shaanxi Key Research Center for Children Mental and Behavior Health, Xi'an, China.
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Drozdov VO. Characteristic features of patients with myopia depending on the expressiveness of anxiety/depression. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:902-908. [PMID: 39008575 DOI: 10.36740/wlek202405104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Aim: To determine the peculiarities of character traits of patients with myopia at different levels of anxiety and depression. PATIENTS AND METHODS Materials and Methods: 30 patients with moderate myopia and mild myopic astigmatism in both eyes were examined. The "Kettel Test" was used to study the characteristics of the patient's character, and the Hospital Anxiety and Depression Scale was used to assess the levels of anxiety and depression. All examined patients were divided into 3 groups: the 1st group with a normal level of anxiety, the 2nd group with subclinical anxiety/depression, the 3rd grоup with clinically pronounced anxiety/depression. Mathematical processing of the research results was carried out using the methods of mathematical statistics. RESULTS Results: Characteristic features of patients with myopia include conservatism, restraint, subordination, anxiety, developed imagination and high self-control. In half of people with myopia, anxiety/depression is subclinically determined, and in a third - clinically expressed anxiety/depression is observed. In the absence of anxiety in patients with myopia, the main character traits were conservatism, restraint, subordination, sufficient normative behavior, high self-control, and self-confidence; in the presence of subclinical anxiety - sufficient self-control and normative behavior, sociability, developed imagination, conservatism; with clinically expressed anxiety and depression - developed imagination, anxiety, significant normative behavior, conservatism, restraint, subordination. CONCLUSION Conclusions: Studying the characteristic features of patients with myopia is necessary to clarify the peculiarities of the formation of the internal picture of the disease, the etiopathogenesis of the formation of nosogenies due to this pathology, and the development of individual psycho-corrective programs for such patients.
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García-Cabrera AM, Suárez-Ortega SM, Gutiérrez-Pérez FJ, Miranda-Martel MJ. The influence of supervisor supportive behaviors on subordinate job satisfaction: the moderating effect of gender similarity. Front Psychol 2023; 14:1233212. [PMID: 38222844 PMCID: PMC10785647 DOI: 10.3389/fpsyg.2023.1233212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
This paper analyses the influence that different supervisor supportive behaviors have on subordinate job satisfaction, while considering the gender of individuals involved (supervisor and subordinate). The empirical evidence provided by a sample of 29,833 subordinates from 35 European countries collected by Eurofound through the European Working Condition Survey allows us to assert the following. First, subordinate job satisfaction depends on their perceptions about the supportive behaviors provided by their supervisors in terms of respect, giving recognition for a job well done, coordinating work, helping get the job done, and encouraging the professional development of the subordinate. Second, job satisfaction is affected by supervisor gender, although in the opposite direction as hypothesized, such that when the supervisor is a woman, subordinates report lower job satisfaction. Third, also contrary to our expectations, supervisor-subordinate gender similarity reduces, rather than increases, subordinate job satisfaction. Fourth, gender similarity, as expected, weakens the impact of several supervisor supportive behaviors on this job satisfaction (i.e., giving recognition, coordinating work, helping get the job done, and encouraging development). In terms of practical implications, this work suggests that it is advisable for supervisors to show supportive behaviors toward subordinates. In addition, because demonstrating respect at work is not moderated by gender similarity and seems to be the most impactful supportive behavior for enhancing job satisfaction, supervisors should pay particular attention to the respect of subordinates.
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Affiliation(s)
| | - Sonia María Suárez-Ortega
- Faculty of Economics, Business and Tourism, University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
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Ong CX, Foo YY, Compton S. The impact of human cadaveric dissection on professional identity formation in medical students. BMC MEDICAL EDUCATION 2023; 23:970. [PMID: 38114993 PMCID: PMC10731900 DOI: 10.1186/s12909-023-04913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND As technology advances, some schools are moving away from human cadaveric dissection to teach anatomy, leading to concern regarding the possible loss of a professional identity building experience. This study explored the role of dissection in students' professional identity formation. METHODS A mixed-methods study was conducted using survey methodology and semi-structured interviews of medical students at an American-style graduate-entry medical school in Singapore. The questionnaire adopted the conceptual framework of the Ring Theory of Personhood and the MacLeod-Clark Professional Identity Scale was used to measure professional identity, followed by semi-structured interviews of students using Braun and Clarke's six-phase reflexive thematic analysis. RESULTS Respondents did not differ substantively from non-respondents by age, nationality, or ethnicity, and year of entering medical school, however, they were slightly more female dominant. The number of hours of hands-on participation in dissection showed no significant relationship (r2 = 0.010; p = 0.424) with professional identity formation measured by the MacLeod-Clark Professional Identity Scale. Despite the survey results, semi-structured interviews revealed rich and nuanced findings suggesting the influence of dissection in participants' professional identity formation through deepening students' appreciation of humanistic values and enhancing their notions of patients' personhood. Notably, students without dissection experience did not express these sentiments and were orientated towards knowledge acquisition. CONCLUSION While our findings do not suggest that dissection strongly impacts students' professional identity formation, students shared thought-provoking experiences which suggest some level of its contribution. Careful consideration of this phenomenon should be exercised prior to removing dissection in favour of technological alternatives.
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Affiliation(s)
- Ci Xin Ong
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore.
| | - Yang Yann Foo
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Scott Compton
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
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Safeer AA, Hussain I, Abrar M, Shabbir R. Omnichannel Retailing in Light of Psychological Factors: A Mediated Model. Psychol Res Behav Manag 2023; 16:5069-5088. [PMID: 38144233 PMCID: PMC10748540 DOI: 10.2147/prbm.s442274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose Retail businesses have been seeing dramatic changes in the last decades. It has evolved from single-channel retailing to omnichannel retailing, providing a seamless shopping experience to customers. Customers armed with modern technology are creating challenges for retailers and forcing them to create an omnichannel environment. So, implementing an omnichannel retailing strategy is a big challenge for retail managers in the age of modern technologies. Retailers could evaluate consumers' usage intention of omnichannel retailing based on technological and psychological factors. However, research based on psychological factors is limited in the prevailing literature on omnichannel retailing. Based on the Motivational Model (MM) and Big-Five Factors (BFF) of personality traits, the study tried to fill the gap regarding the influence of psychological factors on omnichannel usage intention. Methods A sample of 724 respondents through a structured questionnaire from a developing economy. The target population of the current study was internet users, as they might be prospective Omni shoppers in the near future. Relationships were tested through Structural Equation Modeling (SEM) with AMOS 23. Results Results revealed that personality traits directly correlate with omnichannel usage intention, while motivations (intrinsic and extrinsic) partially mediate these relationships. Moreover, the results of the current study also revealed that the personality traits extraversion, agreeableness, and conscientiousness are vital antecedents of behavioral intention. Intrinsic and extrinsic motivations positively impact consumers' usage intention, while extrinsic motivation partially mediates intrinsic motivation and consumers' usage intention. Additionally, full mediation prevails in the association of consumers' usage intention and personality traits (emotional stability and Openness to experiences). Originality The domino effects provide a solid theoretical milestone in understanding the phenomenon of omnichannel retailing strategy and facilitates marketing managers to design channel strategies for emerging economics.
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Affiliation(s)
- Asif Ali Safeer
- Business School, Huanggang Normal University, Huanggang, People’s Republic of China
| | - Iqbal Hussain
- Lyallpur Business School, Government College UniversityFaisalabadPakistan
| | - Muhammad Abrar
- Lyallpur Business School, Government College UniversityFaisalabadPakistan
| | - Rizwan Shabbir
- Lyallpur Business School, Government College UniversityFaisalabadPakistan
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Harrang C, Civitarese G. Interview with Giuseppe Civitarese, MD, PHD, July 2014. Am J Psychoanal 2023; 83:520-527. [PMID: 38052998 DOI: 10.1057/s11231-023-09429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Caron Harrang
- LICSW, 2510 6th Avenue, Unit 2208, Seattle, WA, 98121, USA.
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Abstract
In this thought-provoking exploration, the author examines Grotstein's seminal work, "The Seventh Servant: The Implications of a Truth Drive in Bion's Theory of 'O'" (2004), and its relevance to the psychoanalytic concepts of truth and lies. Drawing on Bion's K-link and Klein's epistemophilia, the paper argues that Grotstein's concept of a "truth drive" is part of a transformative paradigmatic shift in psychoanalysis, emphasizing a focus on ontology and the process of being with the analysand. The commitment to truth in psychoanalytic practice demands ongoing examination, open-mindedness, and a willingness to embrace bodily sensations, proto-emotions, and new thoughts. Grotstein proposes that the truth drive is a universal human force that compels individuals towards emotional growth and explains why analysands can accept the analyst's interpretation of painful psychical realities. The intersection between curiosity and evolving 'O' exceeds epistemophilia, bridging knowledge and the unknown for optimal truth-seeking. The paper briefly explores the connections between Heidegger's "Dasein," "Aletheia," and Foucault's "Parrhesia," further supporting Grotstein's discovery. Additionally, it addresses the challenge of distinguishing healthy truth pursuit from pathological manifestations and presents a captivating clinical vignette illustrating Grotstein's response to this question. Finally, the paper delves into Bion's puzzling observation that all thoughts as ordinarily known are lies, augmenting the notion of universal emotional truth and its complexities in the clinical context.
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Affiliation(s)
- Caron Harrang
- LICSW, FIPA, BCPsa, 2510 6th Avenue, Unit 2208, Seattle, WA, 98121, USA.
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73
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Lishner Freud E, Berant E. Holocaust communication, attachment orientation and distress among descendants of female holocaust survivors. FAMILY PROCESS 2023; 62:1655-1670. [PMID: 36582137 DOI: 10.1111/famp.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
The multiple studies that have examined the transgenerational transmission of Holocaust trauma from survivors to their descendants have yielded inconsistent results. These can be attributed to differences in assessment tools and to individual differences between survivors, such as their specific experiences during the Holocaust. This study examined the differences between daughters and granddaughters of female Holocaust survivors (HS) of concentration camps (CCS) versus survivors of other circumstances (ghettos, concealment, etc.; OCCS) in terms of communication about their mothers' or grandmothers' Holocaust trauma (Holocaust communication), their attachment orientations, and their psychological distress. The sample was composed of 79 dyads of daughters of HS and their own daughters, divided into two groups according to the survivors' Holocaust experiences (CCS-47 dyads; OCCS-32 dyads). The findings indicated that daughters of CCS reported a higher number of conversations about the Holocaust with their mothers, perceived their mothers as more distant during Holocaust communication, and reported more guilt feelings than daughters of OCCS. Holocaust communication between daughters and granddaughters was characterized by shorter conversations, and granddaughters perceived their mothers as sadder in the CCS group than in the OCCS group. No difference between groups was found in Holocaust communication between survivors and their granddaughters. No difference was found between groups in their psychological distress. The granddaughters of CCS scored higher on attachment anxiety than the other group. Most of the significant differences between groups were linked to subtle differences in the characteristics of communication and in the inter-personal sphere.
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Affiliation(s)
- Eve Lishner Freud
- Department of Psychology, Ramat Gan and Baruch Ivcher School of Psychology, Interdisciplinary Center, Bar Ilan University, Herzliya, Israel
| | - Ety Berant
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
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Abstract
This paper explores the contemporary trend towards relativization and perversion of truth increasingly prominent in American culture, which, in Bion's terminology (1970), has become an ever more hospitable "home to the lie." The anti-COVID vaccine movement emerging in the United States in 2021, and its related network of conspiracy theories, is presented as an example. To make sense of these phenomena the author presents clinical vignettes illustrating (1) Bion's (1970) notions of catastrophic change, the lie/thinker relation, and the messianic idea; (2) Freud's (1921) thinking on group leaders; and (3) Matte-Blanco's (1975) bi-logical theory of mind. According to Bion, the lie is mobilized to avoid the psychological upheaval associated with catastrophic change. The author suggests that developments in American life experienced as threatening catastrophic change provide a hospitable environment for the lie, making the recognition of truth more elusive. In line with Matte-Blanco's bi-logical theory, the author suggests that creation of opportunities for dialogue giving weight to both conscious and unconscious ways of thinking is necessary for re-establishing a culture of truth.
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Affiliation(s)
- Nancy C Winters
- , 2250 NW Flanders Street, Ste 212A, Portland, OR, 97210, USA.
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Affiliation(s)
- Caron Harrang
- LICSW, FIPA, BCPsa, 2510 6th Avenue, Unit 2208, Seattle, WA, 98121, USA.
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Abstract
The paper explores the concept of truth in Bion's theory and in the post-Bionian context of the analytic field. Truth is addressed on three levels: epistemological, metapsychological, and clinical. Bion criticizes positivism in psychoanalysis, and the same vertex when it appears in psychoanalysis itself, stating that the search for truth at all costs is similar to the arrogance and stupidity of the psychotic part of the personality. He revolutionizes the analytic concept of truth by orienting it to the function of the emotional linking between analyst and patient rather than to content. Post-Bionian analytic theory further develops these concepts. In a field or radically intersubjective perspective, the author emphasizes the shift from an "I/you" perspective to a "we" perspective. The treatment is less about the abstract search for supposed truths and more about the truth being expressed in the process of emotional and affective attunement.
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Stern EM. Art is Patient: A Museum-Based Experience to Teach Trauma-Sensitive Engagement in Health Care. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:481-501. [PMID: 37505360 DOI: 10.1007/s10912-023-09810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/29/2023]
Abstract
Psychological trauma is ubiquitous, an often hidden yet influential factor in care across clinical specialties. Interdisciplinary health professions education is mobilizing to address the importance of trauma-sensitive care. Given their attention to complex human realities, the health humanities are well-poised to shape healthcare learners' responses to trauma. Indeed, many such arts and humanities curricula propose narrative exercises to strengthen empathy, self-reflection, and sensitive communication. Trauma, however, is often unwordable, fragmentary, and physically encoded, incompatible with storying methods. This article presents a recent innovation, the Art is Patient seminar series, which focuses on aesthetic exercises to help learners access and share non-verbal, embodied, and relational responses to art. Based in an art museum context, it provides successive experiences of approaching, witnessing, and engaging with visual art as an analogue to developing trauma-sensitive relationships. Reflections on the process locate the seminar vis-à-vis health humanities practices, aesthetics, and trauma-informed approaches.
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Affiliation(s)
- Eva-Marie Stern
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Abstract
This paper explores how the allure of magical thinking and groupthink contrasts with intuition of emotional truth. Since truth can terrify, the author suggests that a longer learning curve is needed to apprehend what Bion (1970a) called the "evolving O" of the analytic session. Traumatized patients are described as dream weavers who spin webs of partial truths and lies around their true selves. For the analyst, untangling these webs involves what Bion (1970b) calls an "act of faith." Clinical material is presented to show how groupthink and other concretions of thought can, under favorable circumstances, be transformed on the wings of psychic truth. Alternatively, uncontained violent emotions can become calcified, creating a carapace over the chrysalis of the patient's true self. The author concludes that the analyst's desire for a particular treatment outcome can unwittingly lead to the formation of an adhesive web where healthy analytic culture becomes a cult. Paradoxically, it is only when there is equal attention to emotional truth and lies that a trajectory of growth is likely to evolve.
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Affiliation(s)
- Stan Case
- LICSW, PhD, FIPA, 7500 212th Street SW, Suite 105, Edmonds, WA, 98026, USA
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Abstract
When reality is too much to bear, bodymind unity can fracture, creating self-deceptions, distortions, and disguises of emotional experience that amount to unconscious lies. Without clarity regarding what is real and what is imaginary, emotional truth is difficult to discern. Lies disrupt the development of a subjective sense of self, making it difficult to trust sensations, emotions, or thoughts. In the absence of this trust, a patient may form a delusion that they do not exist. Working psychoanalytically with patients traumatized in infancy and early childhood requires the analyst to experience a somatic link between herself and the patient, thereby enabling a process that was inhibited and, in some cases, nearly aborted to resume functioning. Clinical material is presented illustrating a negative hallucination of not existing following an emotional experience that could not be borne as well as bodymind dissociation that separated the patient's psychic pain from her childhood narrative. The author concludes that these methods of coping with trauma prevent the grieving necessary for truth to become bearable and the mind to grow.
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Abstract
Background: How people face mortality is a crucial matter for medicine. Yet, there is not a coherent and comprehensive understanding of how people can process the experience such that it is not traumatic. Methods: This article offers a "logic model" of how existential maturation occurs, using analogies from cell biology to explain the process. Results: This model depicts 10 mechanisms that together deal with mortality-salient events. Collectively, they are termed the existential function, which is seen as an innate, ever-evolving, integral part of the mind. An operational boundary selectively manages how realities are taken in. Processing is initiated with other essential people, ushering in reiterative steps of listening, finding, exploring, making meaning, and adjusting. The result is adaptive, integrated, mortality-acknowledging dispositions of mind. The process allows quality of life at the end of life and healthy mourning; impediments to it make for existential suffering and complicated grief. Conclusions: This conceptual model describes how people can face mortality. Its merit depends on its source in human experience, its explanatory power, its ability to guide people as they face mortality, and its ability to stimulate productive perspectives. It is therefore offered as an invitation for discussion, research, revision, and evolution.
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Affiliation(s)
- Linda Emanuel
- Supportive Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Medical Group, Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Chicago Psychoanalytic Institute, Chicago, Illinois, USA
- Boston Psychoanalytic Society and Institute, Newton, Massachusetts, USA
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Stefana A, Gamba A. Making the Best in a Bad Job: A Psychoanalytic Perspective on Communication with Children and Adolescents with Severe Physical Condutions. THE PSYCHOANALYTIC QUARTERLY 2023; 92:463-497. [PMID: 38032764 DOI: 10.1080/00332828.2023.2269940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/08/2023] [Indexed: 12/02/2023]
Abstract
Ill children/adolescents who suffer from severe organic diseases have to cope with their inner experiences, therapies, and the global burden of the disease. Although sometimes depression, anger, and death anxiety are openly encountered in medical settings, other times they can be partially hidden by a reactive and defensive path. In these scenarios, psychoanalysis is challenged to contribute the best comprehension of the intimate communication, maybe hidden, and the needs of the ill patients to express themselves. The best way a child can talk about himself is through spontaneous creativity. The adult's task is to facilitate the creation of an empty space and to recognize the child's mode of communication. There may be intense emotional reactions that the adult has to tolerate to not move the patient towards an over-adaptation. These over-adaptations entail the child being forced to feel good or have fun, thereby causing them to escape from their inner experience. The loss of the child's reality forms an additional burden to the child. The most valid indicator of this attitude is the ability to not take counterphobic attitudes but to allow the depression to be shared in a contact space between the child's true self and the perceived environment.
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Affiliation(s)
- Alberto Stefana
- Alberta Stefana Corso Giacomo Matteotti 40, 25122 Brescia, Italy
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Liguori F, Saraiello E, Calella P. Premenstrual Syndrome and Premenstrual Dysphoric Disorder's Impact on Quality of Life, and the Role of Physical Activity. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2044. [PMID: 38004093 PMCID: PMC10673441 DOI: 10.3390/medicina59112044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Most women who menstruate experience various physical, psychological, and behavioral changes during the period between ovulation and menstruation. This study focuses on defining and diagnosing premenstrual disorders, distinguishing between premenstrual symptoms (PS), PMS, and premenstrual dysphoric disorder (PMDD). It highlights the prevalence of these conditions and their impact on women's quality of life, including social, occupational, and psychological aspects. Furthermore, the study examines the role of physical activity, particularly aerobic exercise, in managing premenstrual symptoms. Several systematic reviews are cited, suggesting that regular physical activity can effectively reduce both physical and psychological symptoms associated with PMS. In conclusion, the management of PMS involves a multifaceted approach, with exercises, dietary modifications, stress management, cognitive-behavioral therapy, and medications all playing roles. Physical activity, especially aerobic exercise, has been found to be an effective non-pharmacological therapy for alleviating PMS symptoms and improving overall well-being. However, more research is needed to determine the optimal type and dosage of exercise for individual women with PMS.
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Affiliation(s)
| | | | - Patrizia Calella
- Department of Medical, Movement Sciences and Wellbeing, University of Naples “Parthenope”, 80133 Naples, Italy; (F.L.); (E.S.)
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DesRoches D, Mattheisen M, Plessen KJ, Pagsberg AK, Marin-Dragu S, Orr M, Meier SM. The Impact of Parental Mental Health Diagnoses, Trauma, and Coping Mechanisms on Their Children's Well-Being. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01626-6. [PMID: 37957447 DOI: 10.1007/s10578-023-01626-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
The transgenerational effects of parental diagnoses, trauma and coping mechanisms on children's internalizing symptoms are not well understood. In a population-based study of 933 families combining data from a web-based survey and the Danish registers, we used an online survey of parents to examine how parental diagnoses, trauma and coping mechanisms affect the development of internalizing symptoms in children aged 6 to 18 years. To account for attrition, we used inverse probability weights in our regression models. Children of parents diagnosed with depression or anxiety displayed more internalizing symptoms than children of controls. Similarly, children of parents who experienced multiple trauma had significantly more internalizing symptoms. In contrast, we observed significantly fewer internalizing symptoms among children of parents who felt they could cope well. The protective effect of parental coping persisted even after adjusting for parental diagnoses or trauma. Interventions boosting parental coping mechanisms might help to prevent the development of internalizing symptoms in children even among patients who have been diagnosed with depression or anxiety or experienced a high trauma load.
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Affiliation(s)
- Danika DesRoches
- Department of Psychology/Neuroscience, Dalhousie University, Halifax, NS, Canada
| | | | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Matt Orr
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sandra Melanie Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
- IWK Health Centre Department of Psychiatry & Specific Care Clinics, 5850/5980 University Ave, PO Box 9700, Halifax, NS, B3K 6R8, Canada.
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Herman R, Clark T. It's not a virus! Reconceptualizing and de-pathologizing music performance anxiety. Front Psychol 2023; 14:1194873. [PMID: 38022988 PMCID: PMC10667921 DOI: 10.3389/fpsyg.2023.1194873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Music Performance Anxiety (MPA) is one of the most widespread and debilitating challenges facing musicians, affecting significant numbers of performers in terms of both their personal and professional functioning. Although numerous interventions exist to target MPA, its prevalence remains unchanged since the first large-scale studies of the 1980s, indicating that available interventions are having limited impact. This review synthesizes and critiques existing literature in order to investigate possible reasons for the limited efficacy of current approaches to managing MPA. Key concepts discussed include conceptual and methodological challenges surrounding defining MPA, theoretical perspectives on MPA's etiology and manifestation, and the coping strategies and interventions used to manage MPA. MPA has predominantly been investigated pathologically and defined as a negative construct manifesting in unwanted symptoms. Based on this conceptualization, interventions largely seek to manage MPA through ameliorating symptoms. This review discusses possible reasons why this approach has broadly not proved successful, including the issue of relaxation being both unrealistic and counterproductive for peak performance, issues associated with intentionally changing one's state creating resistance thus exacerbating anxiety, and focusing on the presence of, rather than response to, symptoms. Despite 50 years of research, MPA remains an unsolved enigma and continues to adversely impact musicians both on and off the stage. Reconceptualizing MPA as a normal and adaptive response to the pressures of performance may offer a new perspective on it, in terms of its definition, assessment and management, with practical as well as theoretical implications.
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Affiliation(s)
- Rebecca Herman
- Centre for Performance Science, Royal College of Music, London, United Kingdom
| | - Terry Clark
- Mount Royal Conservatory, Calgary, AB, Canada
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85
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M Moran P, Coates R, Ayers S, Olander EK, Bateson KJ. Exploring interprofessional collaboration during the implementation of a parent-infant mental health service: A qualitative study. J Interprof Care 2023; 37:877-885. [PMID: 36440978 DOI: 10.1080/13561820.2022.2145274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/01/2022] [Indexed: 11/30/2022]
Abstract
We examined interprofessional working in a newly implemented parent-infant mental health service team supporting families experiencing bonding and attachment difficulties. The aim was to identify forms of interprofessional work undertaken, barriers and facilitators of this work, and families' and healthcare professionals' perceptions of it. Semi-structured interviews were carried out with 21 stakeholders (5 parents, 4 team clinicians, 9 service referrers, 3 service commissioners) and were analyzed thematically. Interprofessional activities identified included building the service team's cohesion and shared practice, building partner networks, interagency communication, coordination of roles, and raising awareness of infant mental health and parent-infant relationship needs. Enablers and barriers to interprofessional working were broadly consistent with findings from previous studies of related services, but with additional emphasis on consultative work as an enabler. Healthcare professionals reported benefiting from the case consultations and training on infant mental health provided by the service team. Parents reported that good interprofessional working enhanced satisfaction and engagement with the service. Findings indicate the centrality of interprofessional working for parent-infant mental health teams, with implications for future service implementation, service development, and understanding of mechanisms by which such services may influence family outcomes.
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Affiliation(s)
- Patricia M Moran
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Rose Coates
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Ellinor K Olander
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
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86
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Scalabrini A, De Amicis M, Brugnera A, Cavicchioli M, Çatal Y, Keskin K, Pilar JG, Zhang J, Osipova B, Compare A, Greco A, Benedetti F, Mucci C, Northoff G. The self and our perception of its synchrony - Beyond internal and external cognition. Conscious Cogn 2023; 116:103600. [PMID: 37976779 DOI: 10.1016/j.concog.2023.103600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
The self is the core of our mental life which connects one's inner mental life with the external perception. Since synchrony is a key feature of the biological world and its various species, what role does it play for humans? We conducted a large-scale psychological study (n = 1072) combining newly developed visual analogue scales (VAS) for the perception of synchrony and internal and external cognition complemented by several psychological questionnaires. Overall, our findings showed close connection of the perception of synchrony of the self with both internal (i.e., body and cognition) and external (i.e., others, environment/nature) synchrony being associated positively with adaptive and negatively with maladaptive traits of self. Moreover, we have demonstrated how external (i.e., life events like the COVID-19 pandemic) variables modulate the perception of the self's internal-external synchrony. These findings suggest how synchrony with self plays a central role during times of uncertainty.
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Affiliation(s)
- Andrea Scalabrini
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy.
| | | | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Yasir Çatal
- The Royal's Institute of Mental Health Research & University of Ottawa. Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, Ontario K1Z 7K4, Canada; Department of Cellular and Molecular Medicine University of Ottawa, Ottawa, Canada
| | - Kaan Keskin
- Ege University Faculty of Medicine, Department of Psychiatry, 35100 Bornova-İzmir, Turkey
| | - Javier Gomez Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER‑BBN), Valladolid, Spain
| | - Jianfeng Zhang
- Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518055, Guangdong Province, China
| | - Bella Osipova
- Moscow State University of Psychology and Education (MSUPE)
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Francesco Benedetti
- University Vita- Salute San Raffaele, Milan, Italy; Psychiatry & Clinical Psychobiology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clara Mucci
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Georg Northoff
- University Vita- Salute San Raffaele, Milan, Italy; The Royal's Institute of Mental Health Research & University of Ottawa. Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, Ontario K1Z 7K4, Canada; Mental Health Centre, Zhejiang University School of Medicine, Tianmu Road 305, Hangzhou, Zhejiang Province 310013, China; Centre for Cognition and Brain Disorders, Hangzhou Normal University, Tianmu Road 305, Hangzhou, Zhejiang Province 310013, China.
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87
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Haimila R, Muraja E. A Sense of Continuity in Mortality? Exploring Science-Oriented Finns' Views on Afterdeath. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:38-65. [PMID: 34407669 PMCID: PMC10568951 DOI: 10.1177/00302228211038820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endorsement of science might entail a belief in "secular death", in which an individual faces annihilation as the bodily functions cease. In this article, we examine what science-oriented individuals think happens to humans after death. Does endorsement of science entail views on human annihilation or do people also express continuity beliefs? The open-ended responses of 387 Finns were analysed. The respondents were recruited online via organisations that promote science and research. The results suggest that while science-oriented Finns mainly endorsed annihilation and secular death, some also expressed (mostly nonreligious) views on continuation, e.g., in social bonds and nature. Secular forms of continuity were more likely mentioned by unbelievers, while theist respondents relied primarily on afterlife beliefs.
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Affiliation(s)
- Roosa Haimila
- Study of Religion, Department of Cultures, Faculty of Arts / Doctoral Programme in Theology and Religious Studies, Faculty of Theology, University of Helsinki, Finland
| | - Elisa Muraja
- Faculty of Theology, University of Helsinki, Finland
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88
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Khan R, Hodges BD, Martimianakis MA. Constructing "Burnout": A Critical Discourse Analysis of Burnout in Postgraduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S116-S122. [PMID: 37983404 DOI: 10.1097/acm.0000000000005358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE In 1974, Dr. Herbert Freudenberger coined the term burnout. With the creation of the Maslach Burnout Inventory in 1984, burnout went from a pop psychology term to a highly studied phenomenon in medicine. Exponential growth in studies of burnout culminated in its adoption into the International Classification of Diseases-11 in 2022. Yet, despite increased awareness and efforts aimed at addressing burnout in medicine, many surveys report burnout rates have increased among trainees. The authors aimed to identify different discourses that legitimate or function to mobilize burnout in postgraduate medical education (PGME), to answer the question: Why does burnout persist in PGME despite efforts to ameliorate it? METHOD Using a Foucauldian discourse analysis, this study examined the socializing period of PGME as an entry point into burnout's persistence. The archive from which the discourses were constructed included over 500 academic articles, numerous policy documents, autobiographies, videos, documentaries, social media, materials from conferences, and threads in forums including Reddit. RESULTS This study identified 3 discourses of burnout from 1974-2019: burnout as illness, burnout as occupational stress, and burnout as existentialism. Each discourse was associated with statements of truth, signs and signifiers, roles that individuals play within the discourse, and different institutions that gained visibility as a result of differing discourses. CONCLUSIONS Burnout persists despite effort to ameliorate it because it is a productive construct for organizations. In its current form, it depoliticizes issues of health in favor of wellness and gives voice to the challenge of making meaning from the experience of being a clinician.
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Affiliation(s)
- Rabia Khan
- R. Khan was a doctoral student, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Brian David Hodges
- B.D. Hodges is a clinical psychiatrist and professor, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Athina Martimianakis
- M.A. Martimianakis is professor, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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89
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Simpson SG, Navot L. Differentiating authentic versus pseudo vulnerability in therapeutic practice. Front Psychiatry 2023; 14:1200981. [PMID: 38025480 PMCID: PMC10643190 DOI: 10.3389/fpsyt.2023.1200981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
The importance of empathy and attuned care as key ingredients in therapeutic healing has been widely recognized. However, empathy that is delivered in ways that are misaligned with the client's clinical presentation and emotional states or 'modes' can have the opposite effect, reinforcing unhelpful coping patterns, and hindering recovery. In this theoretical development paper, it is proposed that 'pseudo vulnerability' is an important yet overlooked source of therapeutic impasses, often resulting in unremitting clinical problems, and poor clinical outcomes. A range of commonly occurring pseudo vulnerable presentations are described, including Complaining Protector, Attention/Recognition Seeking, and Self-Pity/Victim, with the addition of a new mode Helpless Surrenderer. Guidance on differentiating pseudo vulnerable modes from each other and from the authentic Vulnerable Child mode are delineated via characteristic clinical presentations and typical therapist countertransference reactions. Methods for managing pseudo vulnerability to facilitate access to underlying authentic vulnerability are described.
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Affiliation(s)
- Susan G. Simpson
- UniSA Justice & Society, University of South Australia, Adelaide, SA, Australia
- NHS Forth Valley, Larbert, United Kingdom
| | - Limor Navot
- SafePath Institute, Epen, Netherlands
- U-center, In-Patient Clinic, Epen, Netherlands
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90
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Liu Y, Liu Y, Zhang W, Xue ZQ, Zhang FX, Xu WG, Zhuang WJ. Screening of genes interacting with high myopia and neuropsychiatric disorders. Sci Rep 2023; 13:18347. [PMID: 37884635 PMCID: PMC10603034 DOI: 10.1038/s41598-023-45463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical studies have demonstrated an association between high myopia (HM) and neuropsychiatric disorders; however, the underlying mechanism of the association is not clear. We used whole exome sequencing (WES) in combination with the Genetic Variants Classification Criteria and Guidelines published by the American College of Medical Genetics (ACMG) and bioinformatics analysis to clarify the interrelationship between candidate genes. Causative genes for ocular diseases (45.38%) followed by neuropsychiatric disorders (22.69%) accounted for the highest proportion of genes that exhibited high pathogenicity in HM patients were found. Four pathogenic gene mutations were identified according to ACMG guidelines: c.164_165insACAGCA and c.C1760T in POLG, c.G1291A in COL5A1, and c.G10242T in ZNF469. Three causative genes for neuropsychiatric diseases, PTPRN2, PCDH15 and CDH23, were found to fall at the HM locus. The above results suggest that these genes may interact in high myopia and neuropsychiatric diseases.
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Affiliation(s)
- Yang Liu
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Yang Liu
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Wen Zhang
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Zhong-Qi Xue
- Department of Ophthalmology, Affiliated Hospital of Qingdao Binhai University, Qingdao, China
| | - Fang-Xia Zhang
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Wei-Gang Xu
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China.
| | - Wen-Juan Zhuang
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China.
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91
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Bäckersten C, Molander U, Benkel I, Nyblom S. "What it is like to be human": The existential dimension of care as perceived by professionals caring for people approaching death. Palliat Support Care 2023:1-6. [PMID: 37859430 DOI: 10.1017/s1478951523001554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Existential/spiritual questions often arise when a person suffers from a serious and/or life-threatening illness. "Existential" can be seen as a broad inclusive term for issues surrounding people's experience and way of thinking about life. To be able to meet patients' existential needs, knowledge is needed about what the existential dimension includes. The aim of this study was to investigate how professionals caring for people with life-threatening disease perceive the existential dimension of care. METHODS This study is based on a mixed method design utilizing a digital survey with open- and closed-ended questions. Descriptive statistics were applied to closed-ended questions and a qualitative descriptive approach was used for the responses to the open-ended questions. Healthcare professionals at specialized palliative care units, an oncology clinic and municipal healthcare within home care and a nursing home in Sweden answered the survey. RESULTS Responses from 77 professionals expressed a broad perspective on existential questions such as thoughts about life and death. Identifying existential needs and performing existential care was considered a matter of attitude and responsiveness and thus a possible task for any professional. Existential needs centered around the opportunity to communicate, share thoughts and experiences, and be seen and heard. Existential care was connected to communication, sharing moments in the present without doing anything and was sometimes described as embedded in professionals' ordinary care interventions. The existential dimension was considered important by the majority of respondents. SIGNIFICANCE OF RESULTS This study indicates that with the right attitude and responsiveness, all professionals can potentially contribute to existential care, and that existential care can be embedded in all care. The existential dimension of care can also be considered very important by health professionals in a country that is considered secular.
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Affiliation(s)
- Carl Bäckersten
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulla Molander
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Benkel
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stina Nyblom
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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92
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Wu J, Yu J, Qu K, Yin J, Zhu C, Liu X. Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report. Front Psychiatry 2023; 14:1257984. [PMID: 37886119 PMCID: PMC10598681 DOI: 10.3389/fpsyt.2023.1257984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
Background Serotonin syndrome has been recognized as a serious adverse reaction to antidepressants and is characterized by sudden or severe autonomic nerve dysfunction and neuromuscular symptoms. Without an accurate diagnosis and prompt treatment, serotonin syndrome progresses rapidly and can be life-threatening. It is usually related to the dose of 5-hydroxytryptamine drugs, and the dose is the basis for diagnosis. Therefore, serotonin syndrome induced by low-dose antidepressants rarely occurs, and clinicians are more likely to misdiagnose patients who take low-dose antidepressants with similar symptoms. Here, we present a case study of serotonin syndrome caused by a relatively low dose of escitalopram, which is not common in past references. Case summary The patient was a 74-year-old Asian woman with a 42-year history of schizophrenia. After 6 weeks of antidepressant treatment, our patient presented with characteristic myoclonus in the lower limbs and closed eyes with fluttering. Initially, she was misdiagnosed with neuroleptic malignant syndrome (NMS) due to antipsychotic medication and was treated accordingly, even with discontinuation of clozapine. However, her symptoms persisted, and then therapeutic drug monitoring was initiated with the involvement of a clinical pharmacist. Eventually, she was diagnosed with serotonin syndrome due to escitalopram levels reaching the warning level. Subsequently, the patient's treatment was modified, and her clinical outcome was satisfactory without any other serious adverse reactions. Gene detection was also performed, and a cytochrome P450 enzyme (CYP) 2C19-mediated interaction between low-dose escitalopram and clopidogrel seems to be a possible mechanism. Conclusion Data on this is extremely scarce, and to the best of our knowledge, serotonin syndrome caused by low-dose antidepressants has not yet been discussed to any great extent in the literature. Our case provides more clinical experience in the treatment of serotonin syndrome.
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Affiliation(s)
- Jianhong Wu
- The Affiliated Mental Health Center, Jiangnan University, Wuxi, China
- Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jiao Yu
- The Affiliated Mental Health Center, Jiangnan University, Wuxi, China
- Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Kankan Qu
- The Affiliated Mental Health Center, Jiangnan University, Wuxi, China
- Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jiajun Yin
- The Affiliated Mental Health Center, Jiangnan University, Wuxi, China
- Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Chunming Zhu
- The Affiliated Mental Health Center, Jiangnan University, Wuxi, China
- Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Xiaowei Liu
- The Affiliated Mental Health Center, Jiangnan University, Wuxi, China
- Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
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93
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Deng J, Xu Y, Li Q, Yang W, Deng H. The relationship between psychological capital, patient's contempt, and professional identity among general practitioners during COVID-19 in Chongqing, China. PLoS One 2023; 18:e0287462. [PMID: 37812597 PMCID: PMC10561861 DOI: 10.1371/journal.pone.0287462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/06/2023] [Indexed: 10/11/2023] Open
Abstract
General practitioners are crucial in the primary healthcare system as well as for epidemic prevention and control. However, few researchers have examined their professional identity. This study investigated the current status of the professional identity of general practitioners in Chongqing, China and explored the effects of psychological capital and patient's contempt on their professional identity. From December 2021 to January 2022, randomized cluster sampling was used to conduct a cross-sectional online self-assessment questionnaire survey among general practitioners in Chongqing. In total, 2,180 general practitioners working for more than one year were selected. General practitioners' sense of professional identity, mental health, and sense of patients' disrespect were measured using the Professional Identity Scale, Psychological Capital Questionnaire, and Patient's Contempt Questionnaire. Sociodemographic characteristics were also collected. A multiple linear regression model was used to analyze the association between professional identity, psychological capital, and patient's contempt. The average score for professional identity among general practitioners was 53.59 (SD = 6.42). The scores for self-efficacy, hope, resilience, and optimism (subscales of psychological capital) were 26.87 (SD = 5.70), 26.47 (SD = 5.74), 26.97 (SD = 5.55), and 26.86 (SD = 5.59), respectively. The score for perceived contempt was 34.19 (SD = 7.59). An average monthly income greater than CNY 8,000 (β = 1.018, p < 0.001), work tenure of more than 15 years (β = 0.440, p = 0.001), hope (β = 0.249, p < 0.001) and a higher optimism score (β = 0.333, p < 0.001) were positively correlated with professional identity. Having a bachelor's degree and above (β = -0.720, p = 0.014), an administrative role (β = -1.456, p < 0.001), self-efficacy (β = -0.122, p < 0.001), and higher patient's contempt (β = -0.103, p < 0.001) were negatively associated with professional identity. General practitioners in Chongqing demonstrated high professional identity and a strong psychological status during the COVID-19 pandemic. Psychological capital and patient's contempt were associated with professional identity. To improve general practitioners' professional identity, stakeholders should promote practitioners' mental health and physician-patient relationships in China.
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Affiliation(s)
- Jingzhi Deng
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yang Xu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qiaoya Li
- Department of General Practice, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Wen Yang
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Huisheng Deng
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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94
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Levendosky AA, Turchan JE, Luo X, Good E. A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum. J Clin Psychol 2023; 79:2439-2451. [PMID: 37310149 DOI: 10.1002/jclp.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.
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Affiliation(s)
- Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Joshua E Turchan
- Counseling and Psychiatric Services, Michigan State University, East Lansing, Michigan, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, USA
| | - Evan Good
- Austen Riggs Center, Stockbridge, Massachusetts, USA
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95
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Volkan VD. Large Group Identity, Psychological Borders, and Unofficial Diplomacy. Int J Group Psychother 2023; 73:336-349. [PMID: 38446611 DOI: 10.1080/00207284.2023.2290612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
The current paper is an invited keynote from the 2023 Connect conference of the American Group Psychotherapy Association. The author describes the large group identity and how it develops alongside the individual self. Barriers to coexistence among groups is explored as well as ways of fostering peace.
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96
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Wein S. Sex, an antidote to death. Palliat Support Care 2023; 21:937-938. [PMID: 36164993 DOI: 10.1017/s1478951522001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Simon Wein
- Palliative Care, Davidoff Cancer Center, Petach Tikvah, Israel
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97
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Bachner-Melman R, Rom R, Lev-Ari L, Shachar-Lavie I, Krispin O, Tolmacz R. Relational attitudes in adolescent girls with and without a diagnosis of anorexia nervosa or atypical anorexia nervosa. J Eat Disord 2023; 11:166. [PMID: 37737193 PMCID: PMC10515418 DOI: 10.1186/s40337-023-00896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/19/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN). METHODS Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology. RESULTS Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology. CONCLUSIONS Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.
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Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel.
- School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Roni Rom
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Iris Shachar-Lavie
- Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Orit Krispin
- Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Rami Tolmacz
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
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98
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Vyshka G, Elezi F, Mana T. Importance of methodological considerations in documenting psychological trauma. World J Methodol 2023; 13:166-169. [PMID: 37771868 PMCID: PMC10523242 DOI: 10.5662/wjm.v13.i4.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2023] [Accepted: 06/27/2023] [Indexed: 09/20/2023] Open
Abstract
The documentation of psychological trauma is obviously a challenge to clinicians while they are diving deep into remote events related to their clients or patients. The potential role of psychological trauma in the early developmental stages, and even the existence of adverse childhood experiences, is important to prove, yet it is difficult to do so. A diverse range of methods have been applied, all of which presumably benchmark a big therapeutic step; however, these enthusiastic methods frequently do not last for long. While hypnosis supporters, Freudian and Neo-Freudian disciples can be acute enough to enhance and uncover suppressed memories, modern psychiatry relies mostly on diversely structured interviews. Functional magnetic resonance and its related subtleties might help, but the questions that remain unanswered are numerous and confusing. Connecting early experiences with long-term memory while identifying psychological trauma its importance for the individual's growth trajectory; thus, it remains an intriguing issue.
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Affiliation(s)
- Gentian Vyshka
- Biomedical and Experimental Department, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
| | - Fatime Elezi
- Service of Psychiatry, University Hospital Center “Mother Teresa”, Tirana 1005, Albania
| | - Tedi Mana
- Service of Psychiatry, University Hospital Center “Mother Teresa”, Tirana 1005, Albania
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99
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Lefkowitz B, Houdmont J, Knight A. A systematic review of dentists' psychological wellbeing during the COVID-19 pandemic. Br Dent J 2023:10.1038/s41415-023-6232-8. [PMID: 37666986 DOI: 10.1038/s41415-023-6232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/14/2023] [Accepted: 05/03/2023] [Indexed: 09/06/2023]
Abstract
Background The COVID-19 pandemic presented significant challenges to healthcare workers worldwide, including the effect on the psychological wellbeing of dentists.Aims To evaluate the impact of the early phases of the pandemic on the psychological health, long-term wellbeing and clinical service provision of dentists, as well as the identification of the key risk and protective factors for adverse mental health outcomes (MHOs) in this group.Methods A systematic review of cross-sectional studies (n = 53) from public and private dentistry sectors was employed to delineate the risk and protective factors for adverse MHOs.Results Self-reports from these studies (1 December 2019 to 31 December 2021), involving 45,671 dentists worldwide were analysed. Study findings were classified according to their psychological impact (as risk or protective factors), categorised as 'operational' or 'organisational' and subdivided into 'psychosocial', 'occupational', 'sociodemographic' and 'environmental' elements. A GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of evidence score was calculated for all the identified factors.Conclusions This review confirmed the negative impact of the pandemic on the MHOs of dentists worldwide. Pivotal risk factors included fear of infection, transmission to families, lack of personal protective equipment and possible direct contact with infected patients. Enhanced infection control protocols, individual resilience and organisational support were identified as important protective factors.
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Affiliation(s)
- Brett Lefkowitz
- School of Life Course and Population Sciences, King´s College London, London, SE1 1UL, United Kingdom
| | - Jonathan Houdmont
- School of Medicine, University of Nottingham, B Floor, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, United Kingdom
| | - Alec Knight
- School of Life Course and Population Sciences, King´s College London, London, SE1 1UL, United Kingdom.
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100
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Smolar AI. The role of groups during individual development and within the clinical dyad. Am J Psychoanal 2023; 83:320-348. [PMID: 37553524 DOI: 10.1057/s11231-023-09412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
The author proposes that group identifications have been under-appreciated by individual psychodynamic psychotherapists in their conceptualization of normative individual development. He identifies the routes by which the child begins to internalize small and large groups during the early years of identity formation. Through individual therapy vignettes, the author suggests modifications to customary technique so that developmental shortcomings in group attachment security can be shored up. He offers some guidelines for the individual therapist so that group experiences are accounted for as the clinical narrative is written. Finally, he distinguishes patients who may require additional group-level interventions to address their avoidance of group participation.
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Affiliation(s)
- Andrew I Smolar
- , 300 E. Lancaster Ave., #209, Wynnewood, Philadelphia, PA, 19096, USA.
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