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PubMed1995

The psychological, political, and economic realities of brain injury rehabilitation in the 1990s.

Gans, in 1983, detailed the prevalence, causes, and implications of hate in the rehabilitation setting, and offered suggestions for therapeutic responses to it. Mullins, in 1989, noted that during the 1980s rehabilitation became a rapidly expanding, increasingly privatized, big business, with seemingly limitless opportunities for advancement and profit. He asserted that during those years hate had been joined by power, envy and greed in the rehabilitation setting. The present article builds upon the two earlier ones and reviews recent events and their effects, including: the continued development of rehabilitation as a business, the national economic slow down, the health-care crisis, the rise of managed care, the fear that rehabilitation workers feel for their jobs, and the loss of control that people feel throughout rehabilitation. Suggestions for improving the current situation are offered to clinicians, administrators, insurers, and educators, and all are urged to do what they know is right.

Brain Damage, Chronic↗
PubMedDate not supplied

Helicobacter pylori and gastroesophageal reflux disease: friends or foes?

Gastroesophageal reflux disease (GERD) is responsible for a high proportion of digestive symptoms attributable to the upper gastrointestinal tract. Helicobacter pylori (H. pylori) is the main etiologic factor in chronic gastritis and gastroduodenal ulcer disease, but its relation with GERD has not yet been established. The aim of this paper is to review the relationship between H. pylori and GERD, trying to answer the question whether a nexus of "friendship" or "hate" exists between them. Although H. pylori may, in theory, represent a cause for GERD, available data suggest that the infection is not a risk factor for the development of GERD, and the microorganism could even represent a protective factor against this disease. The antisecretory effect of proton pump inhibitors (PPIs) seems to depend on the presence of the infection and H. pylori eradication has, therefore, negative consequences on the efficacy of antisecretory drugs (although its possible clinical relevance, precisely in patients with GERD, remains unknown). Moreover, H. pylori eradication in patients with duodenal ulcer disease is associated in some studies, but not in others, with a higher incidence of GERD, although the reported reflux esophagitis is usually mild. It can be concluded, from these data, that investigating or treating H. pylori infection is not recommended in patients with GERD (when these patients do not need PPI maintenance therapy). Finally, it has recently been recommended to eradicate H. pylori infection in those patients with GERD needing long-term treatment with omeprazole, as some studies have reported that this drug induces, in presence of the microorganism, an atrophic gastritis, with the consequent theoretic risk of gastric cancer. However, several arguments against this attitude can be postulated, and noteworthy are the following: many studies suffer important methodological defects, several authors report contrary results, and the possibility that H. pylori could play, as previously mentioned, a protective role against GERD. It may be concluded, therefore, that the indication of eradicating H. pylori in patients with GERD and maintenance therapy with PPIs, although supported by several arguments, cannot be considered as definitively established. In conclusion, H. pylori and GERD seem to have, in any case, a "friendly" relationship, although it may be transformed into one of "hate" when PPIs enter the scene.

Anti-Ulcer Agents↗
PubMed1975

Self-protections in the narcissistic transference.

This is a study of two patients who had what might be considered classical examples of narcissistic transferences. They were both severely disturbed persons and one could decompensate into a disruptive psychosis. Consequently it is not surprising that their transference projections would be consonant with their primitive orientations. They projected hateful and hating parts of the self onto the analyst. But within all this hatred was a part of the self that had the potential to achieve good things for the patient. I believe the latter is a special feature of narcissistic transferences that has revieved very little emphasis and a feature that may cause us to view such patients and their projections somewhat more optimistically in terms of their potential for growth and treatability.

Adult↗
PubMed2002

Developing partnership promotes peace: group psychotherapy experiences.

Partnerships are often optimal processes for interpersonal growth. The ability to have and keep a partner in mind should, therefore, be thought about and learnt. Although reciprocity, some symmetry, and mutual give and take are important aspects of partnerships, this article emphasizes a partners ability to process difficulties for the other as an aid to growth. The containment and elaboration of distress in partnerships is discussed using three examples of such potential relationships. The emotional beginning of a partnership, whether starting from love, working relationship or from hate, is the focus of the article. Individual, dyadic, and group aspects as separation-individuation and containment processes are described as contributing to partnership-building. The ability of a therapy group to process splitting and projecting phenomena are discussed. Co-therapists seem to have to work through painful conflicts between themselves to develop the therapists' containment abilities inside a functional partnership. Supervision may help process these emotional hardships. Within families, mothers could contribute to a better processing of their sons violence shared through infant dreams, which represent an effort to cope with inner and outer aggression. Growth-promoting aspects of dream telling as potential partnerships in families and groups are discussed. Finally, partnership building between hating foes is exemplified by the efforts made by participants in Israeli and Palestinian peace dialogues. In groups, interpersonal development may be furthered by helping participants mutually contain and be contained, enabling partnership opportunities to grow after love and sympathy are over.

Conflict, Psychological↗
PubMed1991

Variations in the analytic holding environment.

The concept of the holding environment has been used previously to characterize the treatment needs of severely regressed patients (Winnicott, 1963b). This holding of dependence is contrasted with the holding needs of narcissistic, apparently disengaged patients (Modell, 1976). The present paper considers the type of holding required by difficult, borderline patients. It is suggested that these borderline patients need a holding of their ruthlessness and rage, and also of analytic self blame. Clinical vignettes describe the holding of an anxiously demanding and of an overtly hateful borderline patient. The patient in a holding environment evokes widely divergent countertransference reactions. These range from maternal nurturing feelings with extremely dependent patients (usually those emerging from profoundly schizoid states), to feelings of annihilation with narcissistic patients and of deep self doubt, anger and destructive wishes with demanding or hateful borderline patients. In the treatment of narcissistic and borderline patients, the holding environment metaphor may help the analyst tolerate these difficult countertransference feelings. Clinical examples of each type of countertransference reaction are presented.

Adult↗
PubMed1987

Some experience in psychotherapy with suicidal patients.

Changes in actual relationships and self-esteem are of particular importance. The therapist must be more direct, personal and interrogating than is the case with other types of patients, especially with regard to the suicidal fantasies and acts, i.e., plans and methods. The author emphasizes the importance of identifying hateful countertransference reactions in the therapist, and points out just how these can be controlled, and used constructively as means of understanding the more subconscious aggressive feelings of the patient, which are projected on to the therapist. There is often a fragile balance between trust, realistic agreement and the availability of the therapist with regard to out-patients, and limit-setting of admission to emergency wards. An important aspect with regard to consultations with hospitalized patients is always to ask questions and employ direct communication about suicidal intentions and risks; further, no secrecy or vagueness about these matters should be permitted at ward meetings or in group work. The therapist must be open and direct, informing the patient as to just how he looks upon suicide as a mindless act, which once and for all destroys totally the interests and goals of the patient. It is also essential to work all the time on countertransference reaction in the staff, both the anxiety and the hate. The post mortem work after a successful suicide must include fellow patients, staff members and the family.

Aggression↗
PubMed1980

[An interesting mistake by S. Freud].

In a letter to his fiancée, Martha, S. Freud mentions the names of three Jewish festivals, but not that of the fourth, the joy-of-the-law, which is reminiscent of his own name. This omission (Freudian slip) leads us deep into Freuds problematic nature: not only to his own personal complex (his attitude toward his name), but also to his penchant to superstition (fear of death and death wishes) as well as to his hate of religion, for which the hate for his father forms the basis.

Austria↗
PubMed1994

Barriers to love between patient and analyst.

Analysts tend to avoid the full range and force of love and hate in themselves and in their analysands. Such affective constriction in the analyst interferes with full analysis of patients' defenses against passionate feelings, loving and hating. I contend that our analytic ego ideal tends to encourage constriction and discomfort with our loving feelings for analysands. My intention is not to advise analysts to love their patients, but to focus carefully on mutually constructed barriers that serve to prevent loving feelings in the analytic setting. I describe some of my loving feelings toward two analysands and some of the obstacles with which I had to struggle in order to preserve such feelings for the sake of these patients' analytic growth and change.

Adult↗
PubMed1993

On the clinical usefulness of the concept of death instinct.

Freud's concept of the death instinct is often considered as a purely biological speculation, and very few psychoanalysts consider it useful in clinical work. Yet Freud was led to it by purely clinical problems. Klein used Freud's concept of the duality of instinct in her clinical work, but mainly she addressed herself to the conflict between love and hate of the object, considering hate as an expression of the deflected death instinct. I contend that the death instinct from the beginning is directed at both the perceived object and the perceiving self, resulting in such phenomena as pathological projective identification, described by Bion. The defences against the death instinct create vicious circles leading to severe pathology. I try to show in some clinical examples how analysing those vicious circles, and confronting the death instinct in the stable setting of analytic work, can lead to a mobilisation of the life forces in the patient.

Adult↗
PubMed1996

Freud and Ferenczi: trauma and transference depression.

The author recounts how Ferenczi's original technical and theoretical advances in the treatment of 'difficult' cases have become part of the stock-in-trade of psychoanalysis and its metapsychology despite the fact that Freud took issue in particular with Ferenczi's re-evaluation of the concept of trauma. Drawing liberally on the published correspondence, the author contends that these advances stemmed from Ferenczi's own need to work through his mother complex, which had not been adequately tackled in his analysis with Freud and led to his reproaches to Freud for not having analysed his negative transference and his reactivated primary depression, which later became transference depression. These difficulties drove him to distress, confusion and hate. The author considers that Ferenczi introduced new concepts in the hope of extracting himself from this transference impasse. His helplessness led to the 'wise baby'; his confusion yielded the 'confusion of tongues'; and, lastly, his hate produced the 'introjection of the adult's guilt', arousing in the child the 'terrorism of suffering', 'splitting' and "fragmentation'.

Adult↗
PubMed1998

Race-related stress among Asian American veterans: a model to enhance diagnosis and treatment.

This article addresses theoretical principles and clinical descriptions of the phenomenon of race-related stress and trauma experienced by Asian American Vietnam veterans. A conceptual model of race-based stress is presented, comprised of five principles, by which to understand mental health difficulties that can arise in regard to race-based stressors. The model describes (a) the relationship between life threat and physical similarity to the "enemy," (b) the relationship between fear and prejudice, (c) dehumanization as it impacts race hate and combat indoctrination, (d) additive life threat related to exploitation of one's physical similarity to the "enemy," and (e) race-based remorse. The article delineates factors affecting treatment seeking and disclosure of race-based stresses, guidelines for interviewing veterans about race-related events and ethnic self-worth, and the harmful effects of race hate.

Acculturation↗
PubMed2005

The other side of Oedipus.

The Oedipus complex has been understood as a series of conflicts between feelings of love and hate (sexuality and aggression) in the relationship between the child and his/her parents. This article presents a different view, defining oedipal struggles as conflicts between love and care, sexual desires and self- and object-preservative needs. The crucial conflict the child has to deal with is: to love the one and nevertheless to preserve the other (the rival). Further, the author distinguishes between monolithic conflicts, which are conflicts between different objects of one drive's strivings, and binary conflicts, which involve the objects of both basic drives. In three illustrative examples, she shows that monolithic conflicts can indicate a regressive movement, while binary conflicts tend to foster a progression in the analytic work.

Aggression↗
PubMed2003

Symbolic, relational, and ideological signifiers of bias-motivated offenders: toward a strategy of assessment.

Developmental, ideological, and behavioral characteristics of 58 convicted hate crime offenders were examined. Ratings on the Psychopathy Checklist: Screening Version, HCR-20, and Bias Motivation Profile (BMP) were made via record review. Offense characteristics were rated on the Cornell Aggression Index and Cormier-Lang Crime Index. Results indicated that offenders with higher BMP scores engaged in more instrumental (i.e., premeditated) aggression and targeted racial-ethnic minority victims. Significant within-group variation in the prominence of offender bias motivation on the BMP was observed.

Adolescent↗
PubMed1984

Abuses of the borderline diagnosis: a clinical problem with teaching opportunities.

The authors identify six ways in which the borderline diagnosis is commonly abused to express countertransference hate, mask imprecise thinking, excuse treatment failures, justify the therapist's acting out, defend against sexual clinical material, and avoid pharmacologic and medical treatment interventions. The paper focuses on diagnostic abuses that trainees present to clinical supervisors and educators. It attempts to show educators how to discern these abuses and turn them into teaching opportunities. These abuses are seen not only in trainees; they also occur in the professional community as a whole. Clinicians should expect the same diagnostic rigor of themselves that they expect of their students.

Acting Out↗
PubMed2006

Evaluating an Interpersonal Model of Depression among adults with Down syndrome.

The Interpersonal Model of Depression (IMD) based on the Theory of Human Relatedness (Hagerty, Lynch-Sauer, Patusky, & Bouwsema, 1993) is evaluated among adults with Down syndrome. One hundred subjects participated, with 32% having elevated depression scores and 40% stating they felt lonely. The relationship between depression, perceived social support, loneliness, and life satisfaction is statistically significant, F(6, 172) = 4.36, p < .001. Loneliness, social isolation, loss of sense of well-being, self-hate, and social withdrawal are important interpersonal manifestations and represent increasing levels of depression. Social and emotional loneliness are two dimensions of loneliness. The IMD provides a framework to assess depression in this population. Research on the efficacy of depression treatment based on the IMD is needed.

Adult↗
PubMed1975

Three strands of narcissism.

The development of narcissism is usually studied from the standpoint of the drives, or more specifically of the libido. This paper considers narcissism from the standpoint of the ego and seeks to delineate separate developmental lines. From this point of view, a variety of forms may be distinguished which are ordinarily structured during the oedipal period. It is postulated that narcissism cannot be considered as truly separable from the vicissitudes of the love and hate of objects. This formulation makes possible consideration of recent observations concerning the 'narcissistic personality' without requiring major new economic, structural, or dynamic metapsychological constructs.

Child Development↗
PubMed2004

Dynamical models of love.

Following a suggestion of Strogatz, this paper examines a sequence of dynamical models involving coupled ordinary differential equations describing the time-variation of the love or hate displayed by individuals in a romantic relationship. The models start with a linear system of two individuals and advance to love triangles and finally to include the effect of nonlinearities, which are shown to produce chaos.

Hate↗
PubMed1990

A new look at the theory of Melanie Klein.

This paper tried to show that Melanie Klein's theory can very profitably be viewed as a descriptive theory of strong emotions rather than an instinct or developmental theory. Furthermore, since in Klein's thinking feelings 'create' objects, the primacy of feelings in this theory is central. The paper contains a short chronological study of Klein's formulations of psychic phenomena in terms of affects. It is also maintained that the paranoid-schizoid and the depressive positions are constellations of affects and of reactions to them; that psychic development is essentially in terms of the capacity to tolerate feelings, and that the basic conflict in mental life is between feelings of love and hate and associated feelings. Such a view solves many of the conceptual difficulties of Kleinian theory and in addition promises rewarding insights into the world of feelings.

Affect↗