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PubMed1978

Natural history of male psychological health: VI. Correlates of successful marriage and fatherhood.

The author examines the relationship between quality of object relations and health on the basis of data from a prospective 35-year follow-up of 95 men selected for health. Judges blind to other data made independent ratings of physical health at 52, childhood environment, psychopathology, and maturity of defenses. These ratings were highly correlated with independent ratings of high school social adjustment, adult friendship patterns, marital satisfaction, and outcome of children. The author speculates that the capacity for object relations may be a relatively stable dimension of adult personality--a continous that stretches from mature, generative mental health to schizophrenia.

Adult↗
PubMed1980

Psychosis in a peasant society: social outcomes.

Several clinicians have theorized that somatic and residential treatments have an untoward effect on the eventual outcome of major mental illness. To test this hypothesis, the author studied social coping behavior of mentally ill people in Laos, a predominantly peasant society with no psychiatrists or psychiatric hospitals. The Lao folk term baa ("crazy" or insane) was used in determining cases. Social factors studied included legal problems, family contact, sociability, friendship, communal activities, sexuality, and work. Results indicated that levels of social function in this sample were quite limited. The author concludes that social disability associated with chronic psychosis cannot be ascribed totally to diagnostic labeling or institutionalization.

Adolescent↗
PubMed1988

Perceived personal networks as mediators of stress reactions.

The evacuation of an Israeli community in the Sinai peninsula afforded an unusual opportunity to study the longitudinal relationships between personal network characteristics and psychosocial adjustment. Friendship network characteristics proved highly stable longitudinally but were poor predictors of long-term adjustment. The kinship network characteristics before relocation were better predictors, despite the fact that kin were not actually present in the community before relocation. These data support a hypothesis that the perception of social embeddedness rather than the actual availability of social supports mediates reactions to stressful life events.

Adaptation, Psychological↗
PubMed1990

Outcome of patients with chronic affective disorder: a five-year follow-up.

Patients with major depression, mania, or schizo-affective disorder that had been present without remission for 2 years or more at intake (N = 129) were followed prospectively for 5 years, as were 580 patients who had been ill for shorter periods at intake. Despite very substantial durations of episode, three-quarters of the chronic patients recovered, although recovery occurred much later in the follow-up period than it did among the nonchronic patients. Factors associated with recovery were less severe illness at intake, lack of psychotic features, good friendship patterns in adolescence, and, most important, a relatively high maximum level of functioning in the 5 years preceding intake.

Adolescent↗
PubMed1996

Gender, type of treatment, dysfunctional attitudes, social support, life events, and depressive symptoms over naturalistic follow-up.

OBJECTIVE: The present study investigated gender differences in depressive symptoms during a naturalistic follow-up for outpatients with major depressive disorder in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Specifically, the study investigated whether gender interacted with type of treatment received, dysfunctional attitudes, life events, or social support to predict severity of depressive symptoms. In addition, aspects of these psychosocial factors (need for approval, interpersonal life events, and close friendships), hypothesized to be more salient for women, were examined to determine if they had a differential impact on level of depressive symptoms in men and women. METHOD: Assessments conducted 6, 12, and 18 months after treatment included measures of depressive symptoms, dysfunctional attitudes, current life events, and social support. Data were available for 188 subjects (134 women and 54 men). Regression analyses were conducted to examine whether gender as a main effect, or interacting with dysfunctional attitudes, life events, social support, or subtypes of these variables, predicted cross-sectional or longitudinal measures of depressive symptoms during follow-up. RESULTS: A consistent finding of the study was that over the 18 months of this naturalistic follow-up, there were no main effects for gender or any significant interactions involving gender and any of the variables of interest. The study demonstrated that life events and social support were related to severity of depressive symptoms for both genders. CONCLUSIONS: Despite differential prevalence rates of major depression for men and women, findings do not support a different process in outcome of illness for men and women.

Adult↗
PubMed2002

Rebellious Rhapsody: Metal, Rap, Community, and Individuation.

Music can be a powerful force and tool in the life of an adolescent. It forms a social context and informs the adolescent about the adult world through the lens of artists' lives, language, and presence as models. Allegiance to a form of music is allegiance to those who make it, a way to friendship and kinship, and a road to personal identity through belonging. In their relationships formed through music, teens can create a sense of community that may be lacking in the life of family. The rebellious music of earlier generations has given rise to complex musical genres, rap and heavy metal, that are strong in defiance and controversial in their violent and sexual content. What do these musical affiliations tell us about certain segments of adolescent development and culture? The authors consider this question by exploring the form and content of the music while using it to illuminate psychodynamic and psychosocial aspects of adolescent development.

Journal Article↗
PubMedDate not supplied

Napoleon Dynamite: Asperger's disorder or Geek NOS?

Napoleon Dynamite, the quirky hit film from 2004, is a fascinating portrayal of a teenager with social difficulties. The character Napoleon provokes intriguing diagnostic questions in distinguishing between mental illness and the spectrum of normal behavior. He demonstrates several symptoms of Asperger's disorder, yet he also challenges the notion that children and adolescents with Asperger's spectrum disorders will not be accepted or understood. He forms genuine, connected friendships, and fans of the movie appear to celebrate his quirkiness rather than ridicule his oddities. The authors explore the extent to which cultural issues have an impact on psychiatric phenomenology, as well as the potential treatment issues for someone with his apparent social challenges. Finally, the authors offer possible explanations for Napoleon's immense popularity, especially among adolescents. With the rise of computer technology, our culture has fully embraced the idea of what has come to be called "geekdom," and the authors consider the idea that Napoleon's popularity may be a more rural equivalent for this phenomenon. The success of the movie appears to be related to a genuine celebration of Napoleon himself.

Asperger Syndrome↗
PubMed1993

Adolescence, social development, and psychotherapy.

Based on a clinical theory that guides an interpersonal approach to adolescent psychotherapy, the author advances the proposal that there is a developmental sequence of the capacity for relatedness from early to late adolescence: from a stage of Detachment in Relatedness through Disappointment in Relatedness to Mature Relatedness. In this paper, evidence from several broad-based studies of the social development of normal adolescents is presented in support of this proposal. These studies have attempted to track the developmental changes in intimacy, peer conformity, and qualities of friendship.

Adolescent↗
PubMed1994

Critical incidents in psychotherapy.

The critical-incident technique was used to obtain a list of patient behaviors that create special difficulties for the psychotherapist. The list was prepared by a group of seven clinicians during a series of meetings. Included in the list were such items as: insulting the therapist; coming late to the session; threatening suicide; and offering gifts. The list was given to 21 experienced psychiatrists who were asked to rate both the importance and the frequency of occurrence of each incident in their experience. The critical incidents could be divided into five major categories: threat of harm from the patient; criticism of the therapist or the therapy; occurrence of a major life crisis; attempts by the patient to seek friendship or seduction, and miscellaneous incidents, such as being consistently late. When ratings by the experienced psychiatrists were compared with those of 10 third-year psychiatric residents, it was found that the inexperienced psychiatrists in almost every case rated the incident as less important and more frequent than did the experienced clinicians. In terms of implications, knowledge of critical incidents in psychotherapy may provide a source of material for training purposes, may enable the development of modeling procedures for training in communication skills, and may encourage supervisors to focus attention on important therapeutic issues.

Adult↗
PubMed2000

Neurological dysfunction, psychic conflict, and psychotherapy.

Clinical experience of psychotherapists is getting more and more circumscribed by the boundaries of theoretical references. The Freudian "psychic treatment" for neurosis got its impetus from the friendship between Sigmund Freud and Ludwig Binswanger, the phenomenological psychiatrist. This relationship laid the foundation for the references of psychoanalytic psychotherapy in Europe. Then, the Freudian conception of actual neurosis led to a psychosomatic approach. Later, the study of narcissistic neurosis opened up to borderline patients. Today, scientific and medical progress greatly influence psychopathological research and the way we look at our patients and their requests. These changes come from the patients' sayings and their expectancy of well-being. At the same time psychotherapists have to take a new look at their theoretical references. On the one hand, a dynamic concept for psychotherapy is necessary for integrating the phenomenologic approach into psychoanalysis, and providing the understanding of situations emerging in neurological dysfunction. On the other hand, psychotherapists pay more attention to the different actors contributing to a pathology (Who is suffering? What about the life-partner or the relatives?). These changes lead to a new look into the processes of identification as well as the notion of identity. This article discusses these influences on psychotherapy and clinical research showing how clinical situations get ahead of theoretical references.

Brain↗
PubMed2003

Representations of therapists by patients with personality disorders.

The purpose of this study was to investigate attributes of mental representations of therapists by patients with specific personality disorders (PDs), schizotypal (STPD), borderline (BPD), avoidant (AVPD), and obsessive-compulsive (OCPD), and a comparison group with Major Depressive Disorder and no PD (MDD). The Therapist Representation Inventory-II (TRI) measured characteristics of participants' extra-session thoughts about their therapists. Results showed that patients with STPD had the highest level of mental involvement with therapy outside the session, missing their therapists and wishing for friendship, while also feeling aggressive or negative. Patients with BPD exhibited the most difficulty in creating a benign image of the therapist. Variables such as gender, co-occurring Axis I disorders, and amount of individual psychotherapy received were significant covariates for a number of analyses. The importance of understanding the internal dynamics of patients' thoughts about their treatment relationship was underscored.

Adolescent↗
PubMed2006

Developmentally impaired boys coming of age.

Psychotherapy for children with significant developmental impairments often focuses on specific, symptom-targeted treatments. While often effective, these treatments do not address the impaired view these children have of themselves. Adolescence and the struggles to come to terms with sexuality, present a unique opportunity for the psychodynamically oriented therapist to confirm what is normal and expand domains of relatedness. The cases of three boys are described in which the therapy played a vital role in normalizing their adolescent experiences. These boys carried diagnoses of Asperger's Syndrome, Aspergers's with Bipolar Disorder, and Multi-dimensionally Impaired. With more of a sense of normalcy about their drives, as well as the pressure of the drives themselves, these boys were able to establish both sexual and friendship relationships beyond expectations.

Adolescent↗
PubMed2006

Domains of discussion in psychotherapy: what do patients really want?

Little quantitative data exist on what the content of non-manualized psychotherapy in contemporary clinical settings actually is, and what patients and clinicians think it ought to be. This descriptive pilot study identified potential content areas to address in psychotherapy, quantified the relative importance of these domains of discussion to patients vs. clinicians, and attempted to measure the frequency with which these domains are actually addressed in current clinical practice at two academic, urban hospitals. The conteni areas assessed included health habits, avocations, work, family, friendships, community involvement, spirituality/religion, finance, sexuality, political activities, educational and cultural pursuits, and ethnicity/race. Overall, clinicians and patients agreed about the relative personal importance and importance to treatment of these content areas, and they rated work, family, friends, and sexuality as the most important domains of discussion for psychotherapy. Also, this sample of patients did not feel that clinicians undervalue the importance of religion and spirituality.

Adult↗
PubMed1979

Using the resources of AA in treating alcoholics in a general hospital.

At Cleveland Metropolitan General Hospital a small number of staff and a large number of volunteers from Alcoholics Anonymous have collaborated to meet the treatment needs of the community's alcoholics. Recovered alcoholics serve as volunteers staffing a friendship room, located close to the emergency room and open weeknights between 6 and 10 p.m. They also provide counseling on AA, escort patients to AA meetings, help in postdischarge follow-up, and act as casefinders in the community. The hospital staff have become more aware of problems of alcoholism and are better able to treat alcoholics and to provide counseling and referral services.

Alcoholics Anonymous↗
PubMed1996

Client outcomes in a three-year controlled study of an integrated service agency model.

OBJECTIVE: In a three-year controlled study, two California integrated service agency demonstration programs that combined structural and program reforms were tested to see if they produced improved outcomes for a cross-section of clients with severe and persistent mental illness. METHODS: Clients at an urban site and a rural site were randomly assigned to an integrated service agency program or to a comparison group who received the usual services. Data on client outcomes, were drawn from databases and client and family interviews. RESULTS: Compared with the comparison groups, clients served by the integrated service agencies had less hospital care, greater workforce participation, fewer group and institutional housing arrangements, less use of conservatorship, greater social support, more leisure activity, less family burden, and greater client and family satisfaction. Clients in the urban demonstration program, but not those in the rural program, did better than the comparison group on measures of financial stability, personal well-being, and friendship. At the urban site, 72.6 percent of clients participated in the work force during the three-year study period, compared with 14.6 percent of the clients in the comparison group. No differences were found at either site in rates of arrest and conviction and in self-reported ratings of self-esteem, symptoms, medication compliance, homelessness, and criminal victimization. The capitated costs for demonstration clients were much higher than the costs for services used by comparison clients. CONCLUSIONS: Three-year outcomes for a cross-section of clients with severe mental illness in the integrated service agencies were broadly favorable, but costs of services for those clients were high relative to costs for clients receiving the current standard of care.

Adult↗
PubMed1998

Does outreach case management improve patients' quality of life?

OBJECTIVE: This study examined whether enhancing standard aftercare with an outreach case management intervention would improve patients' quality of life. METHODS: A sample of 292 patients discharged from an inpatient psychiatry service at an urban general hospital were randomly assigned either to an intervention group (N = 147), which received outreach case management services in addition to standard aftercare service, or to a control group (N = 145), which received only standard aftercare services. The follow-up period was 15 to 52 months. Individuals in both groups were reinterviewed by an independent research team about 21.6 months after discharge. The groups were compared using 39 measures of quality of life. The interviews elicited information about patients' physical well-being and competence in performing activities of daily living; their emotional well-being as shown in emotional expressiveness, sadness, suicidal thoughts, and substance abuse; and their interpersonal relationships, living arrangements, friendships, income maintenance, and employment. RESULTS: No difference was found between the groups on any of the quality-of-life variables. CONCLUSIONS: Outreach case management was not associated with improved quality of life.

Activities of Daily Living↗
PubMed1995

Karl Abraham, Sigmund Freud, and the fate of the seduction theory.

Even after Freud had turned his attention away from the seduction theory of neurosogenesis, his close pupil and colleague, Karl Abraham, initially sought to investigate child sexual trauma further. In two of the very first articles on child sexual molestation, Abraham proposed that sexual abuse was particularly common among neurotic and psychotic patients as a result of a "traumatophilic diathesis," a trauma-related conceptual precursor of the repetition compulsion. In their correspondence, Freud trenchantly criticized many aspects of Abraham's papers on the subject of sexual trauma, in contrast to his public endorsement of Abraham's work in this area. For largely transferential reasons that this paper attempts to elucidate, Abraham did not encourage dialogue regarding persistent questions on the seduction issue, ceased publishing on that topic, and for some time controlled his apparently deep rankle over Freud's criticisms and failure to acknowledge Abraham's contribution to the concept of the repetition compulsion. Despite their close friendship and shared intellectual enthusiasm, Freud's response to Abraham's 1907 papers, as well as Abraham's almost uniformly positive disposition toward Freud, apparently prevented Abraham from further developing his observations and ideas on seduction and also lent background to their later clash. Subsequently, there was virtually no further psychoanalytic investigation of the subject of child sexual abuse until the issue arose briefly with Ferenczi in the early 1930s, and only occasionally after that for the next fifty years. The death of Abraham, and then Ferenczi, shortly after disputes with Freud may be among the factors that had an inhibiting effect on an earlier reconsideration of the seduction theory by others. Abraham's previously unheralded concept of traumatophilia has relevance to current clinical controversy regarding constitution and sexual trauma.

Austria↗
PubMed1983

Use of a seminar as an aid in helping interns care for dying children and their families.

An annual seminar held by the University of Colorado, Department of Pediatrics, is designed to assist interns to cope more effectively with the emotional strains of caring for dying patients and their families. In the seminar, interns are randomly divided into four small groups consisting of six interns, a chief resident, two pediatric faculty members, and a nurse or social worker from an intensive care unit. This paper reviews the resident evaluations of the seminar, as well as the results of a questionnaire which explored attitude formation toward death. Interns felt that the opportunity to discuss death and dying early in their training program helped them gain an understanding of their own feelings about death, which enabled them to cope better with the stress involved in caring for dying children. Additional benefits from the seminar included more effective interpersonal communication, the establishment of deeper and more meaningful friendships, and a stronger esprit de corps.

Attitude of Health Personnel↗