Sex differences and the epidemiology of depression

This article reviews the evidence for differing rates of depression between the sexes in the United States and elsewhere during the last 40 years, and then critically analyzes the various explanations offered. These explanations include the possibility that the trends are spurious because of artifacts produced by methods of reporting symptoms, or that they are real because of biological susceptibility (possibly genetic or female endocrine), psychosocial factors such as social discrimination, or female-learned helplessness.

The brain as a dream state generator: an activation-synthesis hypothesis of the dream process

Recent research in the neurobiology of dreaming sleep provides new evidence for possible structural and functional substrates of formal aspects of the dream process. The data suggest that dreaming sleep is physiologically determined and shaped by a brain stem neuronal mechanism that can be modeled physiologically and mathematically. Formal features of the generator processes with strong implications for dream theory include periodicity and automaticity of forebrain activation, suggesting a preprogrammed neural basis for dream mentation in sleep; intense and sporadic activation of brain stem sensorimotor circuits including reticular, oculomotor, and vestibular neurons, possibly determining spatiotemporal aspects of dream imagery; and shifts in transmitter ratios, possibly accounting for dream amnesia. The authors suggest that the automatically activated forebrain synthesizes the dream by comparing information generated in specific brain stem circuits with information stored in memory.

The developmental psychopathology of self-injurious behavior: compensatory regulation in posttraumatic adaptation

This article utilizes a developmental psychopathology framework to explicate one pathway, originating in childhood traumatic experience, toward the development of self-injurious behavior (SIB). The descriptive psychopathology of SIB is summarized first, followed by an overview of theoretical interpretations of SIB within psychoanalytic, neo-analytic, behavioral, and biological paradigms. Building on these empirical and theoretical foundations, a developmental psychopathology framework is used to model the development of SIB in the aftermath of childhood traumatic experience, particularly maltreatment. In this model, maltreatment undermines positive adaptation at motivational, attitudinal, instrumental, emotional, and/or relational levels of competence. In turn, vulnerabilities in the child's adaptive resources necessitate the application of alternative regulatory and relational strategies, such as self-injury, to the negotiation of contemporaneous and prospective developmental issues. The article concludes with a discussion of the empirical and clinical implications of a developmental understanding of SIB as a compensatory regulatory strategy in posttraumatic adaptation.

On holding and containing, being and dreaming

Winnicott's concept of holding and Bion's idea of the container-contained are for each of these analysts among his most important contributions to psychoanalytic thought. In this light, it is ironic that the two sets of ideas are so frequently misunderstood and confused with one another. In this paper the author delineates what he believes to be the critical aspects of each of these concepts and illustrates the way in which he uses these ideas in his clinical work. Winnicott's holding is seen as an ontological concept that is primarily concerned with being and its relationship to time. Initially the mother safeguards the infant's continuity of being, in part by insulating him from the 'not-me' aspect of time. Maturation entails the infant's gradually internalizing the mother's holding of the continuity of his being over time and emotional flux. By contrast, Bion's container-contained is centrally concerned with the processing (dreaming) of thoughts derived from lived emotional experience. The idea of the container-contained addresses the dynamic interaction of predominantly unconscious thoughts (the contained) and the capacity for dreaming and thinking those thoughts (the container).

Dreaming and episodic memory: a functional dissociation?

The activity that takes place in memory systems during sleep is likely to be related to the role of sleep in memory consolidation and learning, as well as to the generation of dream hallucinations. This study addressed the often-stated hypothesis that replay of whole episodic memories contributes to the multimodal hallucinations of sleep. Over a period of 14 days, 29 subjects kept a log of daytime activities, events, and concerns, wrote down any recalled dreams, and scored the dreams for incorporation of any waking experiences. While 65% of a total of 299 sleep mentation reports were judged to reflect aspects of recent waking life experiences, the episodic replay of waking events was found in no more than 1-2% of the dream reports. This finding has implications for understanding the unique memory processing that takes place during the night and is consistent with evidence that sleep has no role in episodic memory consolidation.

Childhood experiences associated with the development of borderline personality disorder

In time, mental health professionals will understand the etiology of BPD more fully. Although enormous strides have been made in the past decade, research into the multifactorial basis of BPD is still in its infancy. In particular, studies of children at high risk for developing BPD are needed. For now, the author suggests that one can admire patients with BPD for the integrity with which they have dealt with their pain. After all, not many people remain so loyal to and so respectful of such disheartening childhood experiences.

A concerned critique of psychoanalytic education

The author explores some central problems in contemporary psychoanalytic education. He compares strengths and limitations of the two dominant models of psychoanalytic training, the traditional Eitingon model and the French model, and reviews current efforts to modify these models in order to overcome their limitations. In examining problems common to both educational systems, the author highlights the following issues: a tendency to infantilise psychoanalytic candidates, a persisting trend towards isolation from the scientific community, a lack of consistent concern for the total educational experience of candidates, authoritarian management and a denial of the effects of external, social reality on psychoanalytic education. Proposed solutions to these problems include: a stress on 'step-by-step' evaluation of candidates' progression, a greater emphasis on the cognitive aspects of seminars and supervision, particularly, a systematic exploration of the psychoanalytic method and its applications, a re-examination of the usefulness of the function of the training analyst status, an integration of teaching and practical experience in systematic research, and the incorporation of contemporary educational methods as part of the strengthening of the academic ambience of psychoanalytic institutes. The author concludes with a list of fifteen questions that may provide a quick indication of how for a psychoanalytic institute has progressed with the work of educational innovation.

The case against neuropsychoanalysis. On fallacies underlying psychoanalysis' latest scientific trend and its negative impact on psychoanalytic discourse

The authors offer a critical examination of the claims of the proponents of the growing neuropsychoanalytic trend, that neuroscientific findings are relevant and important for the development and justification of psychoanalytic theory and practice. They bring to light some of the intuitions that have led to the popularity of the neuropsychoanalytic claims and the fallacies that underlie these claims and intuitions. They argue that it is crucial at this time to articulate the case against the neuropsychoanalytic trend because, underlying the debate over the relevance of neuroscience to psychoanalysis, there lies a struggle over the essential nature of psychoanalytic theory and practice. Relying on a biologistic perspective, whereby only what is biological is real, this new trend in effect offers a vision of psychoanalysis that limits the significance of the unique psychoanalytic concern with the understanding of meanings and the role of discourse in discerning and justifying these meanings.

The "something more" than interpretation revisited: sloppiness and co-creativity in the psychoanalytic encounter

Features of dynamical systems thinking can illuminate insufficiently recognized levels of psychoanalytic process. A central aspect of dynamical models is that changes in complex systems are unpredictable and arise out of the interaction of elements. Examination of the moment-by-moment micro-foreground, or local level, of psychoanalytic sessions led to the conclusion that indeterminacy and surprise are inherent properties of intersubjective systems. This indeterminacy, or sloppiness, comprises several interrelated features of the dialogue: "fuzzy" intentionalizing, unpredictability, improvisation, variation, and redundancy. Audiotaped transcripts of two analytic sessions illustrate how these sloppy features generate unpredictable and potentially creative elements that contribute to psychotherapeutic change.

Entitling art: Influence of title information on understanding and appreciation of paintings

There is evidence that presenting titles together with artworks affects their processing. We investigated whether elaborative and descriptive titles change the appreciation and understanding of paintings. Under long presentation times (90 s) in Experiment 1, testing representative and abstract paintings, elaborative titles increased the understanding of abstract paintings but not their appreciation. In order to test predictions concerning the time course of understanding and aesthetic appreciation [Leder, H., Belke, B., Oeberst, A., & Augustin, D. (2004). A model of aesthetic appreciation and aesthetic judgments. British Journal of Psychology, 95(4), 489-508] in Experiment 2, abstract paintings were presented under two presentation times. For short presentation times (1 s), descriptive titles increased the understanding more than elaborative titles, whereas for medium presentation times (10 s), elaborative titles increased the understanding more than descriptive titles. Thus, with artworks a presentation time of around 10 s might be needed, to assign a meaning beyond the mere description. Only at medium presentation times did the participants with more art knowledge have a better understanding of the paintings than participants with less art knowledge. Thus, it seems that art knowledge becomes significant, if there is sufficient time to assign a meaning and the present studies reveal the importance of considering the time course in aesthetic appreciation.

Mobilizing fundamental modes of development: empathic availability and therapeutic action

A positive developmental thrust becomes mobilized by virtue of therapeutic action. This thrust is specified in terms of a set of fundamental modes of development that are biologically prepared and have been identified through recent research. The modes are first apparent in infancy and continue throughout life. The setting conditions which allow for the fundamental modes of development to be reactivated are provided by the therapeutic relationship. It is hypothesized that the empathic availability of the therapist enables these modes to operate as powerful background influences. Developmental aspects of empathy and of availability highlight the importance of adult regulatory functions and the construction of shared meaning.

Narcissism and Childhood Recollections: A Quantitative Test of Psychoanalytic Predictions

Different psychotherapeutic theories provide contradictory accounts of adult narcissism as the product of either parental coldness or excessive parental admiration during childhood. Yet, none of these theories has been tested systematically in a nonclinical sample. The authors compared four structural equation models predicting overt and covert narcissism among 120 United Kingdom adults. Both forms of narcissism were predicted by both recollections of parental coldness and recollections of excessive parental admiration. Moreover, a suppression relationship was detected between these predictors: The effects of each were stronger when modeled together than separately. These effects were found after controlling for working models of attachment; covert narcissism was predicted also by attachment anxiety. This combination of childhood experiences may help to explain the paradoxical combination of grandiosity and fragility in adult narcissism.

Empathic understanding: a review of the concept and some theoretical considerations

A review of the psychoanalytic literature shows that empathy has always played an important part in the practice of psychoanalysis, but that as a concept it has not been well understood. This confusion and a certain mistrust of empathy that it engenders were traced to an incomplete understanding of the meaning of the term, and to the lack of an affect theory that could explain the communication involved in the empathic process. These problems were examined and suggestions for their resolution were made. A line of affective development that culminated in empathic understanding was proposed. An operational approach to empathy was described and the role of empathy as the basis for and the prelude to psychoanalytic interpretation was discussed.