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Biomedical subjects

L Josephs

Publications and source records attributed to L Josephs.

10 recordsLinked to original sources
PubMed2001

The seductive superego: the trauma of self-betrayal.

The author describes a pathological manifestation of the approving superego that functions as a perversely seductive superego. In this process, the seductive superego rationalises and makes ego-syntonic a gratification of forbidden wishes that will result in unconscious punishment. The author argues that the seductive superego torments the self by teasing it with the presence of a tantalising but forbidden object of desire and then by inflicting shame on the self for its timidity, which prevents it from pursuing the object in spite of the dangers. He suggests that the seductive superego inflicts a betrayal trauma upon the self by unconsciously actualising a sado-masochistic fantasy of seduction, surrender and betrayal, along with a humiliating punishment for surrendering.

Freudian Theory↗
PubMed2000

Personal exposure to nitrogen dioxide and risk of airflow obstruction in asthmatic children with upper respiratory infection.

BACKGROUND: Several studies have linked air pollution by nitrogen dioxide (NO(2)) with increased hospital admissions for asthma in children. Exacerbations of asthma in children are often precipitated by upper respiratory infections. It is therefore possible that NO(2) increases the risk of airways obstruction when asthmatic children develop upper respiratory infections. METHODS: To test this hypothesis a sample of 114 asthmatic children aged 7-12 years were followed for a total of up to 13 months. Probable upper respiratory infections were identified by consensus review of daily symptom diaries, and episodes of airways obstruction from serial records of peak expiratory flow (PEF). Personal exposures to NO(2) were measured with Palmes tubes that were changed weekly. Generalised estimating equations were used to assess the relative risk (RR) of an asthmatic exacerbation starting within seven days of an upper respiratory infection according to estimated NO(2) exposure during the one week period from two days before to four days after the onset of the infection. RESULTS: The children were followed for an average of 34 weeks during which 318 upper respiratory infections and 224 episodes of reduced PEF were diagnosed. PEF episodes were much more likely to occur in the seven days following the onset of an upper respiratory infection than at other times. Estimated exposures to NO(2) at the time of infections were generally low (geometric mean 10.6 microg/m(3)). Compared with exposures of < or = 8 microg/m(3), exposures of >28 microg/m(3) were associated with a RR of 1.9 (95% confidence interval 1.1 to 3.4) for the development of an asthmatic episode within seven days of an infection. CONCLUSIONS: The findings give some support to the hypothesis that NO(2) increases the risk of asthmatic exacerbations following respiratory infections, even at relatively low levels of exposure. Further studies in populations with higher exposures would be useful.

Air Pollutants↗
PubMed2000

Self-criticism and the psychic surface.

It is postulated that the surface of the mind reflects a variety of shifting self-syntonic and self-dystonic contents striving to achieve a stable homeostatic balance. Shifts between self-syntonic and self-dystonic contents are seen to reflect an underlying intrasystemic conflict within the superego between conflicting superego injunctions. These shifts possess a cyclical quality, as self-syntonic contents become self-dystonic and as self-dystonic contents become self-systonic. This conceptualization of the psychic surface has implications for a comparative study of psychoanalytic technique and for implementing the technical recommendation to work from surface to depth. It is suggested that the analyst's interpretations become assimilated within cyclical processes of superego reaction and repair.

Conflict, Psychological↗
PubMed1997

The view from the tip of the iceberg.

In recent years there has been a growing interest in refining the technique of ego defense analysis. All of these approaches share in common an attempt to work closely with the patient's free associations, to interpret at a level that is accessible to the patient's consciously observing ego, and to avoid bypassing the analysis of the patient's most surface-level resistances in an effort to understand unconscious conflict. These innovations reflect a commendable effort to work in a way that is rigorously empirical, that respects the patient's autonomy, and that minimizes the pressure of the analyst's transferential authority in the patient's acceptance of the analyst's interpretations. Despite the undeniable value of these technical innovations, such approaches to ego defense analysis may inadvertently result in certain overemphases in technique that may unnecessarily constrain the analytic process. They may result in a sort of obsessive tunnel vision that is overly focused on small details to the exclusion of the larger picture. An approach that counterbalances the microscopic and the macroscopic analysis of ego defense is recommended.

Adult↗
PubMed1996

Women and trauma: a contemporary psychodynamic approach to traumatization for patients in the OB/GYN psychological consultation clinic.

Many patients referred to an OB/GYN psychological consultation clinic were found to be suffering from the emotional effects of early traumatization. Obstetrical and gynecological conditions possess a unique power to reactivate psychological damage originally engendered by trauma. A contemporary psychodynamic model of trauma and its sequelae proved useful in intervening psychologically and in helping these patients and their physicians to improve the management of their medical conditions. This model represents an effort to integrate: (1) Herman's (1992) conception of complex posttraumatic stress disorder, (2) character development in individuals with early traumatic experiences, and (3) Weiss and Sampson's (1986) formulations regarding "unconscious pathogenic beliefs"-the dread that one's worst unconscious fears will be confirmed. Two clinical cases-a pregnant teenager and a woman with hyperemesis gravidarum (excessive and persistent vomiting in pregnancy)-illustrate the frequent emergence of transference-countertransference dynamics centered around "blaming the victim" in work with these patients. Suggestions for therapeutic interventions in short-term consultation with these patients are articulated.

Adolescent↗
PubMed1995

Community study of role of viral infections in exacerbations of asthma in 9-11 year old children.

OBJECTIVE: To study the association between upper and lower respiratory viral infections and acute exacerbations of asthma in schoolchildren in the community. DESIGN: Community based 13 month longitudinal study using diary card respiratory symptom and peak expiratory flow monitoring to allow early sampling for viruses. SUBJECTS: 108 Children aged 9-11 years who had reported wheeze or cough, or both, in a questionnaire. SETTING: Southampton and surrounding community. MAIN OUTCOME MEASURES: Upper and lower respiratory viral infections detected by polymerase chain reaction or conventional methods, reported exacerbations of asthma, computer identified episodes of respiratory tract symptoms or peak flow reductions. RESULTS: Viruses were detected in 80% of reported episodes of reduced peak expiratory flow, 80% of reported episodes of wheeze, and in 85% of reported episodes of upper respiratory symptoms, cough, wheeze, and a fall in peak expiratory flow. The median duration of reported falls in peak expiratory flow was 14 days, and the median maximum fall in peak expiratory flow was 81 l/min. The most commonly identified virus type was rhinovirus. CONCLUSIONS: This study supports the hypothesis that upper respiratory viral infections are associated with 80-85% of asthma exacerbations in school age children.

Asthma↗