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Neurosurgical aspects of unexplained unconsciousness.

Neurosurgical experiences and diagnostic difficulties with unconscious patients without diagnosis included cases of intracranial neplasia, cerebral arteriosclerosis, subdural hematoma, traumatic subcortical hemorrhage, subdural abscess, rheumatic encephalitis, spontaneous subarachnoid hemorrhage, subacute bacterial endocarditis and emboli, myocardial infarction and emboli, spontaneous subcortical hemorrhage, fat embolism, meningitis, drug intoxication, uremia, cases in which the cause of death was not clearly established, and phycomycosis of the central nervous system.

Adult↗

The fate of the unconscious in the human sciences.

In this essay the author seeks to answer some of the criticisms of Freud's central concepts, theories, and methods that have been raised by twentieth century philosophy. He argues that many of these concepts and theories, particularly the concept of the unconscious, represent indispensable assumptions shared by the human sciences, even when they are not directly addressed by them. Further, he argues that in Freud's ideas we find one of the most advanced positions in our understanding of culture, its illusions and discontents, and a profound attempt to bridge the distance between a description of social reality and its critical appraisal.

Cultural Characteristics↗

[Emergency conditions in ophthalmology. First aid in general practice and in the clinic. 3: Leading symptoms "results of injury"--"unconsciousness"--"diplopia"].

The emergency situations in ophthalmology are divided into the main symptoms (acute loss of sight, pain in the eye, "Red Eyes", injuries, unconsciousness, diplopia). Subjective symptom identification, diagnosis and current therapy are briefly outlined. For the general doctor the important preceding symptoms are emphasized as well as the prognosis according to clinical treatment.

Brain Injuries↗

Airway management in the transfer of the unconscious patient.

Thirty-one consecutive unconscious patients admitted to a specialist neurosurgical centre for computerised axial tomography and further management were reviewed with emphasis upon initial airway management. Fourteen patients had inadequate airway control on arrival and needed immediate intubation. Six of this group developed pulmonary complications. The implications of this are discussed and certain recommendations made.

Adolescent↗

[A new method to estimate blood alcohol concentration from the breath of unconscious subjects (author's transl)].

The method of rebreathing and its particular importance to the estimation of blood alcohol concentration (BAC) are described. A face mask with an accompanying valve chamber to which a collection bag was attached proved to meet the requirements arising from the physiological exchange processes in rebreathed air. Practical tests in the laboratory revealed excellent agreement between the values obtained by direct measurements of breath alcohol by means of an IR-Spectrophotometer and those from stored samples. The application of the method described is of particular importance in cases of unconscious and benumbed patients, of sleeping and uncooperative patients and those with collapsed veins suspected of heavy alcohol intoxication. It has been proven to be an essential aid in differential diagnosis since it allows instantaneous determination and continuous monitoring of the BAC-level which aids in the observation of the reduction of this level. This was demonstrated in practice with 9 patients at the alcohol emergency clinic in Mainz on the carnival "Rosenmontag".

Alcoholic Intoxication↗

Sibling loss as an organizer of unconscious guilt: a case study.

A case is described in which the death of a sibling in childhood organized a profound unconscious sense of guilt, a repetitive need for self-punishment, and a negative therapeutic reaction in analysis. The various meanings of the patient's negative therapeutic reaction are discussed, along with the question of why this event came to have such pathologic impact on his character.

Anxiety↗

Referring to the unconscious: a philosophical critique of Schafer's action language.

Schafer's attack on metapsychology and his attempt to erect an alternative to it depends on a strategy of replacing other sources of agency (for example, introjects, the superego, resistance, the emotions, and so on) by translating these terms into discourse about the person. This process of elimination appears to leave the person as sole agent who acts for reasons and who is not acted upon by these fragmentary psychic agents which, rather, are viewed as aspects of the person's own activity. However, the concept of the person is inadequate for the purpose. Conceptually, it is confused because its sphere of application cannot be circumscribed, and because the "translation" of unconsciously-determined acts is only metaphorical. Empirically, "the person", regarded as general explanatory theory applicable to all behaviour other than that which is biologically or reflexively induced, cannot cope with commonplace clinical phenomena. The scheme of Schafer's argument makes it appear that there are few alternatives to the kind of redescription he advocates, but an examination of his treatment of the emotions reveals that the philosophical assumptions underlying his argument profoundly restrict the range of psychological questions which may be asked and the kind of psychoanalytic theory which might be constructed.

Emotions↗

Unconscious symbiotic fantasy: a ubiquitous therapeutic agent.

Evidence is presented that supports the proposition that the deliberate or inadvertent activation of unconscious fantasies of symbiotic gratification can have an ameliorative effect on psychopathology of various kinds. The evidence includes (1) clinically based reports scattered in the psychoanalytic literature on the role of symbiotic gratification in everyday living, in nonanalytic therapies viewed as effecting transference improvements, in meditation, in group activity therapies, and in psychoanalytic treatment, and (2) data from a large number of laboratory experiments coonducted with double-blind procedures and other stringent investigatory controls. In addition to providing powerful support for the clinically derived proposition, the laboratory results allow for extending that proposition and for a more precise delineation of the fantasy that produces symptom amelioration, which when expressed in its verbal form, is most often conveyed by the words Mommy and I are one.

Fantasy↗

[Dream interpretation as access to the unconscious?--An experimental psychological evaluation].

An experiment was carried out to test Freud's assumption that the elements of the manifest dream are in particular closeness to the repressed unconscious and that free associations starting from them should therefore encounter quickly successively growing resistance. 30 female subjects were asked to associate to parts of their own dreams and of those of a control subject. Skin conductance reactions (SCR) were assessed during these procedures. The areas below the SCR curves, considered as a measure for psychophysiological activation, were significantly greater during associations to own dreams. In addition, SCR values rose significantly more often in the course of associations to the persons' own dreams than to those of other subjects. The correlation between subjectively perceived emotionality and integrated SCR values proved to be high. This justifies the use of the variable as an indicator of affective arousal. Although the experimental condition was necessarily only a rather incomplete realisation of the psychoanalytic situation, our results clearly support Freud's theory.

Adult↗

[Talking to an "unconscious" patient?].

In our every day practice in intensive care unit, we have the constant worry to join words to our care, is it towards conscious our unconscious patients. This paper is the issue of a work of listening and thinking over from the nursing team, to the testimony of a patient who was in our unit for three months. This person was in the coma for long weeks, and he tells us afterwards about how he experienced this trial.

Communication↗

[Brief analytic essay on unconscious forces facilitating transgenerational repetition of physical or sexual abuse].

Transmission of abusive conduct is mainly determined by unconscious guilt and identification with the aggressor. The abused child is bound to split the parental object. The hostile side is eclipsed due to dependence and regression. Therefore deprived of the hated object, the guilt surges forcefully with the role reversal of the following generation. The former victim, whose identifications with the aggressor are actuated, discharges his guilt by projective identifications with the new victims. The ongoing splitting perpetuates the pathology of the relation.

Adult↗

The Kore complex: the myths and some unconscious fantasies.

Drawing on ancient legends involving the goddesses Demeter and Kore/Persephone, this study describes highly overdetermined unconscious fantasies associated with the acute anxieties and conflicts of separation-individuation. These fantasies, often aggressive in nature, involve condensation of generational and gender roles, and of oral and genital motifs. It is suggested that the pre-oedipal child of either sex experiences itself as a 'kore' (Greek for 'girl'), that is, as feminine in primary identification with the mother, and that the set of anxieties underlying these fantasies may therefore be called the Kore complex, a developmentally earlier counterpart of the Oedipus complex.

Adolescent↗

[The unconscious within institutions: the pleasure!].

Through its rules and laws, every therapeutic institution provides patients with structuring. Due to relations of transference and counter-transference, therapists are faced with the concept of unconscious. Whereby the psycho-dynamic view and questioning it entails, institutional therapies raise to an increased respect for patients and a new dimension of pleasure.

Countertransference↗

[Examination and observation of the unconscious patient].

The old neurological art of careful examination and detailed description of an unconscious patient delivers a vivid picture of cerebral functions and deficiencies. Daily medical practice, however, demands immediate information with measurable and easily comparable numerical values. This requirement is best satisfied by the current proven and universally accepted 'Glasgow Coma Scale'. Dispensing with the terms: somnolent, soporous and comatose, the GCS numerically marks the depth of the disturbances of consciousness, which, recorded in a graph, indicate the fluctuations of consciousness. The registration of the depth and duration of clouded consciousness is a decisive criterion for the prognosis.

Cognition Disorders↗

Penetrating injuries in the Vietnam war. Traumatic unconsciousness, epilepsy, and psychosocial outcome.

The WF Caveness Vietnam Head Injury Study includes over a thousand men who survived penetrating head injuries during the Vietnam War and on whom detailed medical and follow-up data are available. This population offers unique opportunities for the study of recovery from brain injury and of brain structure-function relationships. The authors briefly review long-term outcome in this cohort with respect to traumatic unconsciousness, post-traumatic epilepsy, and elements of psychologic and psychosocial function, including returning to work.

Affect↗

Some observations on post-coma unawareness patients and on other forms of unconscious patients: policy proposals.

The concern of this paper is with various forms of unconsciousness. Special attention will be given to patients in PCU commonly termed as Persistent Vegetative State (PVS). I reject the term PVS, arguing that for ethical reasons we should strive to resort to terminology that does not offend the patients and their loved ones. I further urge hospitals not to cease treatment of PCU patients younger than 50 years old within a period of less than two years. This is especially true for patients who entered a state of unawareness due to traumatic causes. The two-years waiting period should be regarded as the minimum period of evaluation before foregoing hopes for patients' rehabilitation and return to some form of cognition. I provide data and human stories from the Israeli experience to substantiate this argument.

Adolescent↗