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Narcissism as a motivational structure: the problem of personal significance.

An understanding of individual life is contingent on understanding not only man's traditional motivations but also the individual strategy for resolving the problem of personal insignificance. Man's sense of personal insignificance comes from two primary experiences: (a) the developmental experience with its increasing awareness of separation and loss, transience, and the sense of lost felt perfectibility; and (b) the increasing cognitive awareness of the immutable laws of biology and the limitations of the self and others in which idealization gives way to painful reality. Each individual seeks narcissistic reparation through the elaboration of a personal narrative or myth, a story, which gives one's life a feeling of personal significance, meaning, and purpose. What is relevant is not the presence or absence of a myth or personal narrative but within which myth one chooses to live one's life. Myths are not explanations rooted in scientific evidence but rather are belief systems lived as if they were truths. Myths provide the individual with a personal sense of identity, and they confirm and affirm memberships in a group or community, and provide guidelines and an idealized set of behaviors within which to operate. Lastly, they may endorse an explanation for the mysterious universe. Three motivational strategies in which the aim is to create a personal myth or personal narrative that ensures a sense of personal significance are described in this article: (a) transcendental or spiritual myths, (b) group or interpersonal myths, and (c) humanistic or personal myths.

Achievement↗

The use of narcissism as a motivational structure to resolve the problem of personal significance: implications for treatment of narcissism.

Shaw's article discusses universal existential despair and how we reorganize by a narcissistic motivational structure, which informs clinicians when working with less constructive or adaptable narcissistic motivational structures. Generally, within the self devaluing perceptions and behavior of despair are the seeds of an enlivening life force that the clinician can promote within a relational context. The relational psychotherapeutic experience transforms the rigid, maladaptive, self-defeating attempts motivated in dealing with various forms of despair into a more flexible, adaptable, organizing, and enlivening expression of the self.

Adolescent↗

Physiotherapy students' professional identity on the edge of working life.

Market expectations of physiotherapists reflect changing demands of health care for client centred, community based management of chronic disease in an ageing population. This study forms a component part of a longitudinal study of students' socialization throughout their education programme examining the outcome of professional identity throughout professional socialization processes. The aim of this study was to explore characteristics of graduating physiotherapy students' professional identity before leaving the University. An interview guide, agreed between the Swedish and UK researchers, was used to focus the semi-structured interviews. The phenomenon of professional identity of 18 students was studied through their perceptions of their role, practice, vision, beliefs and scope of practice as physiotherapists. A phenomenographic approach was taken to analysis and identified three qualitatively different categories of professional identity as a physiotherapist which are described as the Empowerer, the Educator and the Treater. A variation of concepts in professional identity at graduation questions the extent to which educators consider how they guide the development of professional identities which fit the expectations of stakeholders and which are able to respond to promotion and development of the profession of physiotherapy in the changing fields of health care over future years.

Delivery of Health Care, Integrated↗

Fleeing the fire: transformation and gendered belonging in Thai HIV/AIDS support groups.

By the turn of the millennium, HIV had infected nearly one million people in Thailand. A large number of support groups now exist throughout the country. These groups have emerged as the primary forum through which having HIV is negotiated and normalized in Thai society. This is done by allowing members to publicly refashion their sense of self and its appropriate place in the world. However, the moral and social space created by support groups is not without its own structuring principles. The discursive strategies that shape support groups are embedded within local moral economies and frameworks of meaning. Gender and social identity are significant factors that influence the benefits to be gained from belonging. To date, women markedly outnumber men in most groups, and many members regard masculinity as a constraining factor on male participation. Within support groups, unwillingness to join is considered one reason for the perception that men with HIV seem to die sooner than do women with HIV. Clinically true or not, this belief has major ramifications.

Anthropology, Cultural↗

Toward building a composite of college student influences with body art.

Body piercing and tattooing flourish on American campuses. The theoretical framework of symbolic interaction and subculture identity were used to examine two similar studies (methods, sample, and tools) for building a composite of influences associated with body art and further understand the psychosocial dimensions. In data from Armstrong, Owen, Roberts, and Koch (2002a, 2002b), and the described study within, four groups of college students (N=908) were formed; those without tattooing (n=419, 81%), and with tattooing (n=97, 19%), and those without body piercing (n=247, 55%) and with body piercing (N=145, 32%). Influences (purpose, image, identity, cues, barriers, family, friends) were examined. All four student groups reported a positive image for the body art. Friends provided major support, whereas family were not as influential. Uniqueness was important, with the major purposes "I just wanted one, express myself, feel unique, be myself, I don't need to impress anyone anymore, and it helps me feel independent."

Adolescent↗

Stigma: barrier to mental health care among ethnic minorities.

This paper explicates the stigma of mental illness as it is experienced by four ethnic minority groups in the United States. Concerns about prejudice and discrimination among individuals who suffer burdens related to mental illness are delineated. It is proposed that ethnic minority groups, who already confront prejudice and discrimination because of their group affiliation, suffer double stigma when faced with the burdens of mental illness. The potency of the stigma of mental illness is one reason why some ethnic minority group members who would benefit from mental health services elect not to seek or adequately participate in treatment. The combination of stigma and membership in an ethnic minority group can impede treatment and well-being, creating preventable and treatable mortalities and morbidities. The article concludes with recommendations for research and health policy implications.

Black or African American↗

Returning to productive activities: Perspectives of individuals with long-standing acquired brain injuries.

PRIMARY OBJECTIVE: The primary objective of this study was to understand how intrinsic and extrinsic factors influence productive involvement over time. RESEARCH DESIGN: Given this relatively unexplored area of study, an interpretive research paradigm was incorporated using the grounded theory methodology. METHODS AND PROCEDURES: Six participants were recruited based on inclusion criteria. They had been living with a brain injury for an average of 14 years. The primary method of data collection was semi-structured interviews, which was supplemented by programme reports to enhance methodological triangulation. RESULTS: The results revealed that factors influencing involvement in productive activities over time were conceptually linked to learning about one's capacity. These factors involved: an opportunity to try, support and feedback from others, experimenting, and participants' appraisals of themselves. CONCLUSIONS: Recommendations for clinical practice include incorporating the postulates of the social cognitive theory in rehabilitation and moving from a deficits approach towards a strengths model of practice.

Adaptation, Psychological↗

Cultural connection and transformation: substance abuse treatment at Friendship House.

This research investigates the transformational experiences of Native Americans during the course of their retraditionalization and treatment for drug and alcohol dependence. Twelve graduates of the residential treatment program at Friendship House in San Francisco were interviewed about the kind and quality of their healing experiences in this particular program which provides a comprehensive matrix of Native American medicine as well as Western models of psychological treatment. The purpose of this study was to understand and document the experience of substance abuse recovery from the perspective of the Native Americans in treatment. Twelve themes emerged from the data analysis: feeling cared for; spiritual experience; insight; making a commitment; empowerment/self-esteem; releasing emotional pain; remorse; reconnecting to traditional values; forgiveness; relief; safety; and gratitude.

Acculturation↗

The efficacy of the social norms approach to substance abuse prevention applied to fraternity men.

Students tend to overestimate the amount of alcohol consumed among their peers and often drink to that imaginary level. The social norms strategy, designed to correct norm misperceptions, has been correlated with a decrease in reported consumption in the general college population. However, it has had little or no impact among Greek students, the group that consumes the most alcohol. The authors investigated and subsequently found three possible flaws in the application of the social norms strategy that may account for the failure to decrease binge drinking among fraternity men: there is no predominant, healthy drinking norm in this population; students are influenced more by people within their network(s) than by others; and binge drinking is the norm in this group and may serve to perpetuate the problem. The findings, though preliminary, provide the first step in developing interventions beyond the social norms approach to address binge drinking among fraternity men.

Adult↗

A test of the perceived norms model to explain drinking patterns among university student athletes.

The author tested the ability of perceived drinking norms to discriminate among drinking patterns in a sample of National Collegiate Athletic Association (NCAA) Division I student athletes. He used an anonymous questionnaire to assess 297 athletes, representing 18 teams, at a public university in the Midwest. Alcohol use patterns showed considerable variation, with many athletes (37.1%) abstaining during their season of competition. A discriminant function analysis revealed that higher levels of alcohol involvement are disproportionately found among athletes who began drinking regularly at an early age. Perceived drinking norms were less important in the discrimination of student athlete drinker groups. Women and those with higher grade point averages were somewhat more likely to refrain from in-season drinking than other survey respondents.

Adult↗

Results of a social norm intervention to prevent binge drinking among first-year residential college students.

The effects of a primary prevention social norm intervention on binge drinking among 1st-year residential college students were examined. Six hundred thirty-four students attending a medium-sized public university in the South were randomly assigned to receive a two-phase social norm intervention or the standard campus psychoeducational prevention program. At posttest, no differences were found between intervention and control group students on any of the alcohol use and alcohol-use risk factor measures. Significant subgroup differences were found by stage of initiating binge drinking behaviors, for frequency of alcohol use, F(3, 507) = 3.69, p = .01; quantity of alcohol use, F(3, 507) = 2.51, p = .05; and social norms, F(3, 505) = 2.53, p = .05. These findings suggest the need for tailoring social norm binge drinking interventions to students' stage of initiating heavy drinking and carefully monitoring for potential negative, as well as positive, effects of norm-based prevention messages.

Adult↗

Understanding fraternity drinking: five recurring themes in the literature, 1980-1998.

In light of widespread concern about alcohol abuse on college campuses, the authors review the empirical literature concerning fraternity drinking published since 1980. The review is structured according to 5 themes that emerge from the literature: (a) the continuity between high school and college drinking, (b) the self-selection of heavy drinkers into environments that support heavy drinking, (c) the central role of alcohol in fraternity socialization, (d) the misperception of drinking norms, and (e) the enabling environment of the fraternity house. The literature is summarized for the benefit of those who wish to better understand the role of alcohol use in the fraternity system.

Alcohol Drinking↗

Patient perspectives of recovery in adolescent onset anorexia nervosa.

The aim of this qualitative study was to describe the patients' perspective of the recovery process from anorexia nervosa. On average 16 years after initial assessment at child and adolescent psychiatric clinics, 68 women were interviewed about what they attributed as important factors in the recovery process of their adolescent onset anorexia nervosa. The answers were coded using content analysis. Those having recovered (n = 58) were able to describe clear turning points in their history and mentioned as most important aspects in their recovery: friends, own decisions, activities, treatment, family of origin, and own family.

Activities of Daily Living↗

Social capital, participation and the perpetuation of health inequalities: obstacles to African-Caribbean participation in 'partnerships' to improve mental health.

OBJECTIVES: There has recently been much emphasis on the role of 'partnerships' between local community 'stakeholders' in strategies to redress health inequalities. This paper examines obstacles to participation in such partnerships by African-Caribbean lay people in local initiatives to improve mental health in a town in southern England. We present a 'social psychology of participation' which we use to interpret our data. Our work seeks to illustrate some of the micro-social mechanisms through which social inequalities are perpetuated, using Bourdieu's conceptualization of the role played by various forms of capital (economic, social, cultural and symbolic) in perpetuating social inequalities. DESIGN: Our empirical research consists of a qualitative case study of attitudes to participation in mental-health-related partnerships in a deprived community. In-depth interviews and focus groups were conducted with 30 local community 'stakeholders', drawn from the statutory, voluntary, user and lay sectors. RESULTS: While interviewees expressed enthusiasm about the principles of participation, severe obstacles to its effective implementation were evident. These included severe distrust between statutory and community sectors, and reported disillusionment and disempowerment within the African-Caribbean community, as well as low levels of community capacity. Moreover, divergent understandings of the meaning of 'partnership' suggested that it would be difficult to satisfy both community and statutory sectors at once. CONCLUSIONS: We suggest that disadvantaged and socially excluded communities are often deprived of the social resources which would provide a solid basis for their participation in partnerships with state health services. In the absence of efforts to remove such obstacles, and to generate the necessary resources for participation, partnerships may be 'set up to fail', leaving social inequalities to prevail.

Adolescent↗

World war II veterans, social support, and veterans' associations.

People use many different coping strategies to deal with their traumatic recollections. Twenty-five British World War II veterans were interviewed regarding the ways they used social support both during the war and in the years afterwards. The findings demonstrate that social support is used in fundamentally different ways. During the war comradeship was particularly important and even fifty years after the war comrades are still a valuable resource for discussing war experiences, and dealing with the emotional content of traumatic recollections. Veterans rely on wives and families to help deal with the more physical and practical elements of coping, but tend not to discuss their traumatic memories with them. The findings show that social support is an important lifelong coping strategy for World War II veterans.

Adaptation, Psychological↗

Associations between loneliness, depressive symptoms and perceived togetherness in older people.

This study explores the associations of loneliness with depressive symptoms in a five-year follow-up and describes how the six dimensions of perceived togetherness explain loneliness and depressive symptoms at baseline. The data were collected on 207 residents of Jyväskylä, central Finland, who at baseline in 1990 were aged 80; and 133 residents who at follow-up in 1995 were aged 85. Loneliness was assessed using a questionnaire item with four preset response options, perceived togetherness using the Social Provisions Scale, and depressive symptoms using the CES-D scale. A recursive structural equation model showed that in women but not in men, depressive symptoms predicted more experiences of loneliness. Those who were lonely were more depressed (CES-D score 16 or over) and experienced less togetherness than those who were not. Loneliness was explained by reliable alliance, social integration and attachment; and depressive symptoms were explained by guidance, reassurance of worth, reliable alliance and attachment. A common feature in both loneliness and depressive symptoms was a lower level of perceived emotional togetherness in social interaction.

Aged↗