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Overview: the female physician and her marriage.

Previous research has addressed the marital problems of male but not female physicians. The author reviews the literature on women in medicine, reports findings on 16 female physicians with dysfunctional marriages whom he saw as patients, and describes several problem areas: delayed help seeking, self-blaming attitude toward subjective symptoms, ambiguity in self-image, "passivity" in marital communication, role strain, unmet needs in husbands, bilateral competitiveness, and problems with intimacy and sexuality. The author emphasizes a biopsychosocial approach to treatment and discusses transference-countertransference issues.

Adjustment Disorders↗

Group therapy with anorexic and bulimic patients: implications for therapeutic intervention.

The incidence of anorexia nervosa and bulimia has increased markedly during the last decade. Although numerous studies have appeared regarding the dynamics of the eating-disordered patient, few have attempted to link the unique pathology of these patients to specific psychotherapeutic interventions. This paper is based on the authors' experience as co-therapists with a group of eating-disordered patients over an eight months' period. It addresses itself to therapeutic interventions related to the particular dynamics of bulimics and anorexics.

Anorexia Nervosa↗

Men's changing social roles in the 1990s: emerging issues in the psychiatric treatment of men.

In the last two decades, men's social roles have changed to incorporate the increasing time they spend with their families, their greater concern about adult children's leaving or returning home, and alternative sexual preferences and life-styles. One related development is the increased amounts of psychiatric distress reported by men in recent years. Mental health professionals should be familiar with these and other complex issues specific to men and with how such issues might manifest themselves in psychotherapy.

Double Bind Interaction↗

Double binds and the reproductive and mothering experiences of HIV-positive women.

In spite of the increasing number of young women infected with HIV in the United States, little is known about the reproductive and mothering experiences of these women. The purpose of the grounded-theory research discussed in this article was to describe the reproductive and mothering experiences of HIV-positive women. Twenty HIV-positive women participated in 31 in-depth interviews. The grounded-theory method was used for data analysis. A communication pattern known in the psychiatric literature as a double bind was discovered to be a basic social psychological problem that affected the women's experiences with reproduction and mothering. An understanding of the power and influence of these double binds permits health care professionals to plan patient-centered programs and to individualize care specifically for HIV-positive women.

Adaptation, Psychological↗

Plasma bikunin as a favorable prognostic factor in ovarian cancer.

PURPOSE: Bikunin is a multifunctional glycoprotein, which mediates suppression of tumor cell invasion and metastasis. The measurement of bikunin levels in the tissue of patients with malignant diseases has been introduced as a new and simple diagnostic tool for the evaluation of prognosis. The high bikunin expression in ovarian cancer tissue would enable the use of soluble bikunin protein present in the circulation of ovarian cancer patients as a biomarker of disease. PATIENTS AND METHODS: We developed a double-antibody immunoassay for bikunin and detected its presence in normal human circulation. We quantified, by enzyme-linked immunosorbent assay and/or immunoblot assay bikunin in sera from 200 healthy women (controls), 200 patients with benign gynecologic diseases, and 327 patients with ovarian cancer before surgical removal of the tumor. RESULTS: When the values of bikunin corresponding to the median were used as the cutoff value (11.5 microg/mL), low plasma bikunin was strongly associated with late-stage, suboptimal debulking with large residual tumor (> 2 cm) and low response to chemotherapy. The median survival time of the patients with a high bikunin level was more than 60 months as compared with 26 months among those with low bikunin level (P = .002). This difference corresponded to a 2.2-fold increased risk of dying for the lower plasma bikunin patients (hazard ratio, 0.45; P = .023) and remained significant in multivariate analysis (hazard ratio, 0.63; P = .041). CONCLUSION: Preoperative plasma bikunin concentration is a strong and independent favorable prognostic marker for ovarian cancer.

Biomarkers, Tumor↗

Drugs and double binds: racial identification and pharmacogenomics in a system of binary race logic.

People respond to drugs in different ways depending on their genotype. Some geneticists and medical researchers have suggested using race as a substitute for genotype in prescribing medication. Overall, individuals resist the prescription of medication based on race, but some minority individuals, although indicating resistance and suspicion, ultimately choose race-based medication. This can be explained by the operation of Burkean identification in a system of binary race logic. Although individuals resist race-based medication and recognize race is not a legitimate genetic category, their identification with a racial-ethnic group places them in a double bind between choosing race-based medication or denying their racial identification.

Double Bind Interaction↗

Wives' reactions to learning that their husbands are bisexual.

Interviews with 33 women, plus data from 70 more, explored wives' reactions to being informed by their husbands that their husbands were bisexual, the consequences of disclosure, and the factors determining those reactions and consequences. Findings suggest that wives struggled less with the homosexuality itself than with problems of isolation, stigma, loss, cognitive confusion and dissonance, and lack of knowledgeable, empathic support or help in problem solving. Moreover, faulty assumptions about "disclosure" seem to have led to serious misconceptions about the wives, on the part of husbands, researchers, and therapists alike. These misconceptions and the "realities" are discussed.

Adult↗

An experimental study of psychoanalytic theories of depression.

This study involves an application of a new methodology, subliminal psychodynamic activation, which can be used to experimentally test psychoanalytic "dynamic" propositions. It was found that with a sample of neurotically depressed female patients, there was a significant decrease in depression-related responses following the stimulation of a symbiotic gratification fantasy ("Mommy and I are one"). Subliminal symbiotic stimulation had been shown previously in studies with different populations (schizophrenics, homosexuals, phobics, alcoholics and overeaters) to have similar ameliorative effects. The current results point to the importance of symbiotic dynamics and the relationship dependent on a dominant other, rather than to the retroflexion of aggression in neurotic depression. This is in keeping with the formulations of Arieti (1959), Bemporad (1953), Horowitz (1980), and the senior author (Slipp, 1977). Hypotheses regarding the effects of stimulating fantasies involving success were not supported by the primary data, although secondary data (from correlational analyses) did provide some indirect support for the senior author's hypothesis. The "Autonomous Succeed" message ("Succeed for myself") did not reverse the depressive mood, possibly because autonomy was equated with abandonment. Relatively differentiated depressives tended to respond to the "Exploitative Succeed" ("Succeed for Father or Mother") messages with a decrease in depression, while depressives with a low level of self-object differentiation tended to respond with an increase in depression. For more differentiated depressives, performing for and giving over a part of the self to another is an adaptive style that insures the dependent relationship and bolsters the patient's weak self-image. However, with poorly differentiated depressives, giving over to another raises the threat of total annihilation, since the self is already diminished. These secondary data can be viewed, however, as only suggestive and need to be pursued in future studies. The results on symbiosis in this study add to the growing literature (summarized in Silverman, 1976, 1980) indicating that subliminal psychodynamic activation is a useful technique for investigating psychoanalytic formulations in the laboratory. It was Freud's overriding hope that psychoanalysis be firmly rooted as a behavioral science and this technique seems most promising as contributing toward that end.

Achievement↗

Judgments of emotion by nurses and students given double-bind information on a patient's tone of voice and message content.

We examined the communication process in a situation typical of the nursing setting by use of a double-bind communication. Our objective was to examine which of two cues in communications from a patient, tone of voice or verbal content, was more important in judging the speaker's emotional status and personality traits and in arousing the listening nurse's emotions. Subjects were 82 nurses who worked at the university hospital and 100 students who were studying at the Faculty of Nursing of the university. They were assigned into four groups at random, presented professionally tape-recorded scripts representing a patient's verbal report, and then completed a questionnaire concerning the speaker's emotional status as well as the listener's own emotional status. When the listeners judged the speaker's emotional status, they gave more attention to a negative emotional expression, and when the listeners formed an impression of the speaker's personality traits, they were influenced by the speaker's tone of voice rather than by the content of the speech.

Adult↗

Toward a phenomenology of trance logic in posttraumatic stress disorder.

Some induction procedures result in trance logic as an essential feature of hypnosis. Trance logic is a voluntary state of acceptance of suggestions without the critical evaluation that would destroy the validity of the meaningfulness of the suggestion. Induction procedures in real and simulated conditions induce a conflict between two contradictory messages in experimental hypnosis. In military induction the conflict is much more subtle involving society's need for security and its need for ethics. Such conflicts are often construed by the subject as trance logic. Trance logic provides an opportunity for therapists using the phenomenology of "presence" to deal with the objectified concepts of "avoidance," "numbing" implicit in this kind of dysfunctional thinking in Posttraumatic Stress Disorder. An individual phenomenology of induction procedures and suggestions, which trigger trance logic, may lead to a resolution of logical fallacies and recurring painful memories. It invites a reconciliation of conflicting messages implicit in phobias and avoidance traumas. Such a phenomenological analysis of trance logic may well be a novel approach to restructure the meaning of trauma.

Combat Disorders↗

Paradox in alcoholism.

This work focuses upon paradoxical aspects of alcoholism. Current information suggests that double-binding dynamics exist in alcoholism and that paradoxical life-style themes do contribute to alcoholism abuse. Emphasis in this paper is focused upon the utilization of paradoxical dynamics within a therapeutic framework. It is suggested that treatment interventions must effectively alter negative paradoxical patterns operating in the alcoholic's life-style. Recent clinical findings are cited, and therapeutic uses of paradoxical and reframing and interventions are discussed.

Alcoholics Anonymous↗

[Paradoxical situation in the organization of work: a threat for workers' mental health].

For the past decades, in a world of high competition, firms struggle to regain an advantage over foreign competition. Thus, new management trends, usually based on price reduction, high quality products and speed production are now part of strategic reorganization plans of high impact on work organization particularly in terms of large demands put on workers, and take a heavy toll on workers. Thus the incidence of mental health problems in the work place has risen sharply in recent years and currently counts as one of the leading causes of work absenteeism. A study based on the psychodynamic of work was conducted among machine operators working in a high-technology company in the aviation sector. Important management and technological transformations were recently introduced in the factory. The content analysis of the study shows that the work organization places the operator in a double bind situation. They are caught between an injunction where the capacity of making a high quality product is directly opposed to that demanding speed production. Moreover, severe and arbitrary sanctions are applied when the operators do not comply with either injunction. The operators are put in a deadlock situation that creates fear and anxiety. They are obliged to turn to defensive psychological strategies such as individualism and cheating. Those defensive strategies have negative impacts on social relationships.

Anxiety Disorders↗