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Triangulation, one's own mind and objectivity.

Some psychoanalysts now hold that an intersubjective model of the mind and of the analytic situation renders the ideas of truth, reality and objectivity obsolete. Arguing from a position of sympathy with this model, the author contends that nevertheless both a real, shared, external world and the concept of such a world are indispensable to propositional thought, and to the capacity to know one's own thoughts as thoughts, as a subjective perspective on the world. Without the idea of an objective world with which we are in touch and which we attempt to be more-or-less objective about, any so-called intersubjectivist model collapses into the one-person paradigm. The author traces a certain developmental line in twentieth-century philosophy that supports an intersubjective view, a line that shows the place of the normative ideas of truth and falsity, right and wrong, in the advent of mind; it attempts to disentangle the concept of truth from an authoritarian view that was implicit in Descartes; it points out connections, and a difference, between the view of triangulation that it argues for and the views espoused by a number of psychoanalysts. Some implications of this intersubjectivist position for psychoanalytic practice are considered; for instance: the interrelations between the analyst's third-person knowledge of her patient, and the patient's developing understanding of himself; and what the concept of unconscious fantasy presupposes.

Child↗

The analyst's subjectivity and the analyst's objectivity.

The author suggests that, increasingly, contemporary psychoanalysts have been acknowledging and examining the intersubjectivity of the clinical encounter and that this trend has sometimes been misunderstood as necessitating the conclusion that objectivity is impossible to achieve in clinical psychoanalysis. In contrast to this, the author proposes a pragmatic definition of the analyst's objectivity that is entirely consistent with acceptance of the analyst's irreducible subjectivity, and illustrates his view by means of a clinical example. He suggests that objectivity concerns both objects and objectives, and indicates that a pragmatic conception of objectivity is employed throughout modern science. He explains why he regards psychoanalysis as a science, rather than as a hermeneutic discipline. He takes up the way in which implicit positivist assumptions can disadvantageously influence our thinking about the relation between an analyst's subjectivity and an analyst's objectivity. Finally, he discusses the important role of consensus in objectivity generally and in psychoanalytic objectivity particularly, as well as some of the differences that exist among analysts with regard to the specific objectives that take priority in clinical work.

Adult↗

On borderline phenomena.

The author describes his struggle to resolve some theoretical and technical problems posed by borderline patients. For this he has made use of an ancient Indian myth of King Trishanku taken from Bhagwat Puran--the Hindu Book of Genesis. He has tried to demonstrate, step by step, how fruitfully this myth has helped him to understand such patients. Special emphasis has been laid on the language used by borderline patients. The contrary and apparently meaningless nature of this language is likened to the formulation of King Trishanku's unique desire, 'to go to heaven without actually dying'. The author then proceeds to show that this language is not quite as meaningless as it appears to be--that it is the result of a complicated system of projective identification devised by these patients to manipulate their objects in order to achieve their own omnipotent ends. Detailed clinical examples are given to describe the handling of the problems of appropriation, manipulation and consequent suspended state of such patients. Taken from three different stages of various analyses these examples show how a very slow and gradual change was brought about in the mental structures of the patients treated by the author.

Adult↗

Psychopathology and primitive mental states.

The author discusses the psychoanalytic concept of primitive mental states, arguing that normal primitive mental states contain omnipotent fantasies that in an adult would be classified as delusions and hallucinations, but also contain sufficient reality sense to allow the infant to learn through experience that its omnipotent unconscious fantasies are not real, but only ordinary unconscious fantasies. Psychopathology of the type requiring psychoanalytic treatment is connected to persistent unconscious omnipotent fantasies (delusions). It is not the result of a regression to a normal primitive mental state, since in a normal primitive mental state, such delusions and their resultant inhibitions, symptoms and anxieties are gradually and spontaneously overcome through learning from experience. The unconscious delusions related to psychopathology persist because they are insulated from the effects of the learning from experience that would ordinarily convert them into unconscious fantasies by the use of transformations in hallucinosis, reversal of perspective and realistic projective identification by the psychotic part of the personality. Together, these mechanisms distort experience in such a way that reality appears to confirm, not challenge, the delusions, making learning impossible. The theory that psychopathology is due to a regression or fixation to a normal primitive mental state acts as a defence against the awareness that the mental states associated with current psychopathology are not like normal primitive ones, and that they differ from normal primitive mental states by containing forces that are sufficiently destructive of learning from experience to have prevented the patient's mental state from evolving in a normal fashion.

Adult↗

The medium can obscure the message: young children's understanding of video.

In the first few years of life, children acquire a great deal of general information through symbolic media, including television. Here we explored whether very young children would use information presented via video to solve a retrieval problem. The children watched on a monitor as a toy was hidden in the room next door. A group of 2 1/2-year-olds was very successful at finding the hidden toy based on the televised hiding event, but a group of 2-year-olds was not. Substantially better performance was achieved by other 2-year-olds who either watched the hiding event directly through a window or who believed they were watching directly (but were in fact looking at the monitor through the window). These results (like those from other symbolic media such as models and pictures) indicate that very young children have difficulty using a symbolic representation as a source of information about an existing situation.

Age Factors↗

Structure, stability, and development of young children's self-concepts: a multicohort-multioccasion study.

A new, individual administration procedure for assessing multiple dimensions of self-concept for young children 5-8 years of age (Marsh, Craven, & Debus) was the basis of this study. We expanded this application in a multicohort-multioccasion (MCMO) study that provides simultaneous multicohort comparisons (cross-sectional comparisons of different age cohorts) and longitudinal comparisons of the same children on multiple occasions. There was reasonable support for predictions that reliability, stability, factor structure, and the distinctiveness of the SDQ factors would improve with age (a between-group age cohort comparison) and from 1 year to the next (a longitudinal comparison), and that small gender differences were reasonably stable over age. Consistent with the proposal that children's self-perceptions become more realistic with age, Time 1 (T1) teacher ratings were more highly correlated with student self-ratings at T2 than T1 and contributed to the prediction of T2 self-concept beyond effects mediated by T1 self-concepts. The results support and expand the surprisingly good support for the multidimensionality of self-concept responses for very young children using this procedure.

Age Factors↗

Mothers' perceptions of the care-by-parent program prior to hospital discharge of their preterm infants.

PURPOSE: This research was conducted to gain an understanding of the care-by-parent experience for mothers of preterm infants. DESIGN: Phenomenologic methodology was used to explore the experiences of six mothers. Each participant slept overnight with her infant in a private hospital room. The mother assumed responsibility for her infant's care, knowing that nursing staff assistance was available if needed. Interviews were conducted on the following day and again after the infant had been home at least four days. SAMPLE: The participants were six mothers of preterm infants. MAIN OUTCOME VARIABLE: Mothers' experiences as they assumed responsibility in caring for their preterm infants away from the intensive care nursery. RESULTS: Findings revealed that the care-by-parent experience gives the mother an opportunity to assume full responsibility for her preterm infant's care, tests the reality of caregiving, helps her learn about caregiving activities and her infant's patterns of behavior, and confirms her readiness for independent parenting and the infant's readiness for discharge home. These findings confirm the benefits of rooming-in prior to discharge of preterm infants and provide guidelines for discharge planning.

Attitude to Health↗

Dreams and reality monitoring.

Experiment 1 tested the counterintuitive prediction that memories for one's own dreams should not be particularly easy to discriminate from memories for someone else's dreams. Pairs of people reported dreams to each other that they had either dreamed, read, or made up the night before. On a test requiring subjects to discriminate events they had reported from those reported by their partner, subjects had more difficulty with real dreams than with dreams they read or made up. Experiment 2 provided evidence that real dreams do not simply produce overall weaker memories; the deficit for dreams was eliminated with more time to respond and with more detailed cues. In addition, subjects' ratings of various characteristics of their memories (e.g., vividness, personal relevance) indicated that dreams were not generally weaker or impoverished. The results are interpreted within the framework for reality monitoring described by Johnson and Raye (1981): Memories for real dreams are proposed to be deficient in conscious cognitive operations that help identify the origin of information generated in a waking state. At the same time, real dreams are embedded in a network of supporting memories that can be drawn on for reality monitoring decisions under appropriate circumstances. Finally, a comparison of recognition and recall indicated that dreams may leave persisting memories that are difficult to access via free recall.

Adult↗

Labor ward workload waxes and wanes with the lunar cycle, myth or reality?

Objective: To test the validity of the statement "We are busy because it is getting close to the full moon" often heard on labor ward, by analysis of birth statistics in relation to lunar cycles.Method: Data for births from spontaneous onset labors for 12 lunar cycles from January 1 to December 31, 1994 was analyzed. Births resulting from induced labors were excluded. Birthrate for each day of the lunar cycle from new moon to full moon (ascending lunar phase) and from full moon to new moon (descending lunar phase) were analyzed using Pearson correlation coefficient. Birthrate at full moon was compared to that at new moon and that at mid ascending lunar phase was compared with that at mid descending lunar phase using t test.Results: There were 3706 spontaneous births during the study period. The average daily birthrate was 10.58 with standard deviation (SD) of 1.27. There was no statistically significant difference in the daily birthrate between the ascending and the descending lunar phases, r = -0.21. Statistical analysis showed no significant difference in the number of births at full moon as compared to that at new moon, P =.44. No difference was found on comparison of number of births during the mid ascending phase to that at the mid descending lunar phase, P =.84.Conclusion: Scientific analysis of data does not support the belief that the number of births increases as the full moon approaches, therefore it is a myth not reality.

Journal Article↗

Fantasy and reality distinction of congenitally blind children.

40 congenitally blind and 40 sighted children were tested for fantasy-reality distinctions of real and imagined objects and the development of concepts of darkness, hidden objects, space, dreams, emotions, facial expressions, size, and height. Analysis indicated that the blind children distinguished between contents of fantasy and reality, although they were less sure about the reality status of the objects. The sighted group gave more reality responses than the blind group for the concepts of dreams and hidden objects, but the remaining concepts were somewhat the same. Cognitive development explained in terms of theory formation may not explain the development of young blind children completely. Their knowledge that contents of fantasy are not real may be obtained through interpersonal experiences that are publicly shared.

Blindness↗

A prospective randomized study to test the transfer of basic psychomotor skills from virtual reality to physical reality in a comparable training setting.

OBJECTIVE: To test whether basic skills acquired on a virtual endoscopic surgery simulator are transferable from virtual reality to physical reality in a comparable training setting. SUMMARY BACKGROUND DATA: For surgical training in laparoscopic surgery, new training methods have to be developed that allow surgeons to first practice in a simulated setting before operating on real patients. A virtual endoscopic surgery trainer (VEST) has been developed within the framework of a joint project. Because of principal limitations of simulation techniques, it is essential to know whether training with this simulator is comparable to conventional training. METHODS: Devices used were the VEST system and a conventional video trainer (CVT). Two basic training tasks were constructed identically (a) as virtual tasks and (b) as mechanical models for the CVT. Test persons were divided into 2 groups each consisting of 12 novices and 4 experts. Each group carried out a defined training program over the course of 4 consecutive days on the VEST or the CVT, respectively. To test the transfer of skills, the groups switched devices on the 5th day. The main parameter was task completion time. RESULTS: The novices in both groups showed similar learning curves. The mean task completion times decreased significantly over the 4 training days of the study. The task completion times for the control task on Day 5 were significantly lower than on Days 1 and 2. The experts' task completion times were much lower than those of the novices. CONCLUSIONS: This study showed that training with a computer simulator, just as with the CVT, resulted in a reproducible training effect. The control task showed that skills learned in virtual reality are transferable to the physical reality of a CVT. The fact that the experts showed little improvement demonstrates that the simulation trains surgeons in basic laparoscopic skills learned in years of practice.

Clinical Competence↗

Chemosensitivity testing in gynecologic oncology--dream or reality?

Cell culture and animal models have played an essential role in the research of new principles of therapy. Many methods for the individualized testing of therapy sensitivity and resistance have been developed, for example, the clonogenic assay. Presently, the ATP-TCA is commercially available as a testing kit. This review gives an overview of the tumor samples that were tested in the oncologic laboratory in the Department of Obstetrics and Gynecology, Munich Grosshadern between 1993 and 2001. All target parameters show a clear trend in favor of sequential, dose-intensified Epirubicin/Paclitaxel therapy. If this trend remains valid for the total number of patients, a significant impact of this new principle of therapy can be expected. By individualized planning of therapy with ATP-TCA testing, therapy in the individual patient could already be performed by the examination of sensitivity in the preoperative biopsy specimen.

Adenosine Triphosphate↗

Conceptions of relationships in children with depressive and aggressive symptoms: social-cognitive distortion or reality?

This research tested skill-deficit and cognitive-distortion models of depression and aggression in 615 fifth- and sixth-grade children. Children completed a measure of their generalized conceptions of relationships in the peer domain and their level of depressive symptoms. Teachers completed measures of social competence, social status, and aggression. As anticipated, children with higher levels of depressive symptoms, either alone or in combination with aggression, demonstrated more negative conceptions of both self and peers than did nonsymptomatic children. Conceptions of relationships did not differentiate between aggressive and nonsymptomatic children. Children with depressive symptoms and children with aggressive symptoms displayed unique profiles of social competence deficits and problematic status in the peer group. Analysis of the accuracy of children's conceptions of relationships revealed support for both skill-deficit and cognitive-distortion models. Consistent with a skill-deficit model, children with depressive and depressive-aggressive symptoms were sensitive to actual differences in their social status. In contrast, aggressive children showed an insensitivity to social cues. Consistent with a cognitive-distortion model, children with depressive and depressive-aggressive symptoms had more negative conceptions than would be expected given their social status, whereas aggressive-unpopular children demonstrated a self-enhancement bias. These findings indicate the importance of integrated cognitive-interpersonal models of depression and aggression that incorporate multiple pathways among social-cognitive, interpersonal, and emotional functioning.

Affect↗

[Transmission of neurosurgical medical records through computers. Simple reality, considerable progress].

Tests on the transmission of view data processing images were undertaken for 5 months from two experimental micro-processing sites specialized in medical imagery and linked to the R.N.I.S. network. The aim of the research was to validate the equipment and the software, and to find a way of working with regard problems related to long-distance diagnosis. Using an everyday equipment like Apple Macintosh II fx, 75 files were transferred corresponding in 375 images (1% conventional X-ray, 5% digital angiography, 31% scanner and 63% M.R.I.). It has been found that the transfer of medical data is reliable (the images do not deteriorate), easy (less than 3 hours to be familiar with the program) and above all fast (actual transfer time: 8.72 Ko per second). Neurosurgeon and neuroradiologist writers talk about their experience in this field.

Computer Communication Networks↗

The psychological reality of the body schema: a test with normal participants.

Neuropsychological dissociations suggest the existence of a body schema, a representation of the spatial relations among body parts, not used for other spatial stimuli. Four experiments verify the psychological reality of the body schema in normal participants. In Experiments 1 and 2, proprioceptive information concerning one's own body position influences visual perception of others' body positions. Contrary to expectations, facilitation is observed rather than interference in the dual-performance task. Experiment 3 eliminates the possibility that the effect is due to a particular mnemonic strategy. In Experiment 4, this effect is shown to be specific to the perception of bodies, as opposed to other complex 3-dimensional forms.

Body Image↗

Do children really confuse appearance and reality?

Our understanding of many mental, social and physical phenomena hinges on a general understanding that appearances can differ from reality. Yet young children sometimes seem unable to understand appearance-reality dissociations. In a standard test, children are shown a deceptive object and asked what it really is and what it looks like. Many preschool children give the same answer to both questions. This error has been attributed to children's inflexible conceptual representations or inflexibility in representing their own changing beliefs. However, evidence fails to support either hypothesis: new tests show that young children generally understand appearance-reality discrepancies as well as fantasy-reality distinctions. These tests instead implicate children's failure to understand the unfamiliar discourse format of the standard test. This misunderstanding might reveal a subtler difficulty in making logical inferences about questions.

Child↗