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[Adolescent development].

The specificities of the adolescent period are completion of somatic, sexual, emotional, cognitive, intellectual and social maturation. After having coped with this "existential crisis", the adolescents is able to accept new roles, a new identity. Offer described and characterized in detail three types of normal development of adolescents: continual development, accelerated development and precocious development. From the aspect of child and adolescent psychiatry all three described types of development are found in mentally healthy subjects who take life as an open chance.

Adolescent↗

Reducing fear in cancer survivors.

As more patients come to survive cancer, controlling their fear of its recurrence and minimising anxiety are important in re-establishing their quality of life. Combinations of therapies that acknowledge existential realities, encourage expression of feelings, identify irrational thoughts and promote self-helping behaviours are needed.

Cognitive Behavioral Therapy↗

[Experience with the Lüscher test in psychiatry (author's transl)].

A population of schizophrenic patients was compared with a control group by means of the 8 color test. The schizophrenics showed a depressive factor in the preference for brown and the rejection of yellow. Interchange of gray and black suggests destructive tendencies and lack of orientation in the schizophrenic psyche. Shifts of primary colors are interpreted as signs of introversion caused by the disease. In the gray test, which gives pointers to the existential situation, healthy subjects, schizophrenics, addicts and depressives were compared with each other. While depressives and schizophrenics showed a disordered contact with the environment which is compensated by screening off the environment increasingly, the schizophrenic test sample showed destructive tendencies and signs of loss of a sense of distance in addition to the disordered contact with the environment.

Color↗

One perspective on the Freud-Klein controversies 1941-45.

Comments on the complex relations obtaining between, on the one hand, tradition, innovations and existential perspective and, on the other, presuppositions about method, evidence and truth are prefaced by a review of the helpful and hindering attitudes and conduct of the three parties to these controversial discussions, the third group being the indigenous ('independent') British group. This group directed the process into productive channels against great odds. The subsequent history of psychoanalysis shows, in addition to increased organisational stability and tolerance in times of crisis, an evolving enrichment and refinement of theory and practice in all three groups. Those following Melanie Klein have developed further their own kind of ego-psychological emphasis, while those following Anna Freud and 'the Viennese' around her have developed a more inclusive theoretical and clinical perspective, one that makes more salient the influence of the very first years of life and early infantile aggression as well as accepting a broadening of the idea of transference to include child analysis. This history supports the view that pluralism in psychoanalysis has been of much benefit.

Austria↗

[Children and health. A questionnaire survey of 12-year-old children].

Medicalization, implying that solutions to everyday or existential problems are being sought within the framework of the health care system, seems to be increasing. Morbidity has been related to socioeconomic status. This study aims at finding out how children perceive their own health condition and whether this is related to socioeconomic conditions. 192 pupils aged 12 years from a rural district and from two districts of Oslo with different socioeconomical conditions reported their health condition during the last school term by means of a questionnaire. There was a high prevalence of complaints from the children. 33% reported insomnia, and 14% had frequent episodes of headache. Nearly 50% reported the presence of one or more chronic diseases. The health problems were not related to gender or nationality. Except for dental health, we found no relation between reported sickness and the children's socioeconomic background.

Child↗

[Influence of prematurity and intrauterine hypotrophy on development of infants in the Szczecin population].

Longitudinal evaluation of development at the infantile period involved 415 children, born during the period from 1985.12.01 to 1987.03.31 in two Obstetric Clinics, PMA, in Szczecin. The studied group comprised 108 eutrophic premature infants, 25 premature babies with hypotrophy, 116 full-term neonates with intrauterine hypotrophy. The control group was made up of 166 infants born at term, being eutrophic neonates. Physical development was analyzed on the basis of measuring 13 anthropometric parameters, determined in monthly compartments. Evaluation of psychomotoric development was performed by the aid of Denver's test in the 3, 6, 9 and 12 month of life. The accomplished studies have disclosed that delays in physical and psychomotor development persisted still in the 12th month of life in children of the investigated group as compared with the control one. Retardations in somatic development were more pronounced in children with hypotrophy, while disturbances in psychomotor development were recorded more frequently in premature infants, and involved spheres of locomotion and visual-motorial coordination. In the studied population the achievements in children's development were significantly correlated with the degree of maturity after birth, and past infectious diseases. Among the environmental factors, an essential influence was exerted by the education of parents, social-existential conditions of the family as well as cigarette-smoking by the mother.

Anthropometry↗

Potential for suicide and aggression in delinquents at Juvenile Court in a southern city.

Because juvenile delinquents rarely communicate their wishes for suicide or homicide appropriately to busy caretakers, some means to identify those juveniles at greatest risk of acting out was sought. Psychological examiners in a Southern city individually questioned 263 Juvenile Court offenders about whether they wished to be dead, to kill themselves, or to kill others; and also about their existential experiences, thoughts and feelings. Taking the data associated with each wish, we used stepwise multiple logistic regression to pinpoint experiences, such as substance abuse, that were associated with a high likelihood of verbalizing a wish for destructive behavior. These results included sexual abuse as a risk factor and the presence of a mother or grandmother as a protective factor, and led to recommending education of caretakers and forming a screening test.

Acting Out↗

The renaissance nurse: permeating clinical competence with the humanities.

In order to reclaim the "art" of nursing, educators need to prepare their graduates with human caring skills that draw from phenomenology, existentialism, and all segments of the humanities. Nurses of the future will be healers of the body and spirit. The authors discuss, from theoretical perspectives, how the humanities empower the student and offer suggestions for the integration of the humanities into lecture and clinical settings.

Aged↗

[Dying in the hospital. Medical and psychological aspects].

For a variety of reasons, the process of dying is taking place ever more frequently in the institution hospital. Apart from the fact that the problem of death continues to be a taboo subject, this is leading to medico-somatic and psychological problems for both the dying person and the so-called "helper". To enable the latter to deal with this existential challenge, he or she must undergo adequate preparation.

Adaptation, Psychological↗

Curative factors in the psychoanalyses of Holocaust survivors' offspring before and during the Gulf War.

In this paper, I have attempted to explore the curative effect of insight and relational factors in the analyses of Holocaust survivors' offspring before and during the Gulf War. A particular characteristic of children of survivors is their tendency to recreate their parents' experiences in their own life through concretization. An important analytic goal is to help these patients become aware of the unconscious meaning embedded in their acting out through increased insight, so they will be able to extricate themselves from the need to concretize and verbalize instead. The impact of the Gulf War on the children of Holocaust survivors was particularly strong. These patients reacted to the existential threat with feelings of impotence and terror, perceiving it as a repetition of the past. Thus, strengthening the ego forces became the focus of treatment during the war period, and this was facilitated by relational factors. Only near the end of the war was it possible to begin working through the regressive transferences evoked by the traumatic situation through increased insight, or to attempt to disentangle the present from the past through interpretation.

Adaptation, Psychological↗

[Is psychoanalytic psychotherapy an "alternative treatment method"?].

Psychoanalytic psychotherapy is a controversial treatment method even though it has an extensive theory and is widely used. Its assumptions continue to be challenged, especially by psychiatrists with a biologic-scientific orientation. Hence it is an appropriate model for examining the transitional area between textbook medicine and what are referred to as "alternative" treatment approaches. The historical development of psychiatry from the end of the 18th century was characterized on the one hand by the increasing influence of biological and technical methods of investigation and on the other by the increasing independence of the citizenry and societal acceptance of subjective emotional experience. The special contribution of Freudian psychoanalytic theory lies in its function as a medicator between these two approaches, whereby it develops analogies between the scientific knowledge of the time and psychic processes. At the same time it provides explanations of emotional illness that the individual can comprehend. This is what is unique about classical psychoanalysis and at the same time makes it problematic, as evidenced, for example, by the fact that so many different schools have developed. The integration of psychoanalysis in the form of psychoanalytic psychotherapy into textbook medicine gives the latter the advantage of being able to reach a clientele that in addition to wanting scientific-causal explanations also has a desire for existential interpretations of psychopathological states.

Complementary Therapies↗

Religiousness and hope in Hispanic- and Anglo-American women with breast cancer.

Religiousness has been associated with coping with cancer in the general population, but cultural influences have not been well explicated. The purpose of this study was to compare a sample of Hispanic-American women to a matched sample of Anglo-American women on selected religious variables and on a measure of hope. A sample of 25 Hispanic and 25 Anglo women diagnosed with breast cancer completed a hope scale, a spiritual well-being scale, and a religiousness scale and responded to selected demographic and medical questions. The only significant difference between the two groups was in intrinsic religiousness, with Hispanic women scoring higher (t = 2.07, df = 24, p < 0.05). Among Hispanics, neither intrinsic nor extrinsic religiousness was more important in predicting either existential well-being or hope. However, intrinsic religiousness was a more important predictor of religious well-being and total spiritual well-being than was extrinsic religiousness. Among Anglos, intrinsic religiousness was a stronger predictor of spiritual well-being and of hope. Religiousness may be an important variable affecting both the spiritual and the psychological health of women with breast cancer; this study also suggests cultural differences.

Adult↗

Behavioral science in family practice: an ethical imperative.

Behavioral science confronts at least three major problems within American medicine that must be overcome if the family physician of the future is to receive an adequate graduate education and maintain his professional integrity. Through increasing specialization, the once unified biological perspective of man was severely fragmented, and with increasing emphasis on the science of medicine, the disease process was objectified and reified. Twentieth century man joined his myth of technological mastery with medicine's desire to eliminate pain and suffering. This gave rise to the idea that life could be medically managed and existential dilemmas anesthetized. To overcome these problems behavioral science has two ethical issues to address in family medicine. First, behavioral science must restore the physician's sense of personhood by recognizing the person of the physician as the primary diagnostic and therapeutic "tool" of family practice. Second, behavioral science must help family practice refocus its professional responsibility on the social problems of the day. This will happen through a critical review of the custodial aspects of the physician's role and an emphasis on role innovation. Approaches to these two ethical issues at the Medical University of South Carolina family practice residency are described.

Behavioral Sciences↗

[2 basic problems of psychoanalytic psychotherapy and their philosophical revision].

The presupposition of the cartesian cogito provokes a ¿potential decrease of transcendental philosophy,¿ which means, that reevaluation of the scientific reflexive reason leads into a metaphysical evacuation. Original philosophical subjects develop into subjects of a scientific psychology respectively depth psychology. Two fundamental problems, resulting from this historical context of philosophy, should be described: Firstly the consciousness, which is objectivated and hardened as psyche by the influence of reflection. Secondly the unconsciousness, which seems like a hidden psychological entity with an indifferent essence. The effort to revise those two problems should be made by the use of phenomenological and existential philosophy. The intention of this revision is first to reintegrate the isolated reflexive consciousness in a field of consciousness and secondly to replace the confrontation with the unconsciousness by the dialogue with the fellow being.

Consciousness↗

Personal and situational factors in drug use as perceived by kibbutz youth.

Sixteen 17-year-old kibbutz members, seven of them smokers, and nine nonsmokers of hashish, assessed the probability that a young person of similar background would use drugs. Two sources of information were manipulated bifactorially: personal predisposition (curiosity, risk-taking, and existential meaning) and the level of group pressure to smoke hashish. It was found that hashish smokers assigned meaningful importance to a combined influence of the two factors, while the nonsmokers considered only group pressure to be important. A tool based on the measurement method examined in this study is proposed for predicting the probability of drug use among adolescents.

Adolescent↗

Chronic unhappiness. Investigating the phenomenon in family practice.

PURPOSE: To investigate the experience of chronic unhappiness as it presents in family practice. DESIGN: A descriptive, qualitative study of both patients and physicians using an existential phenomenologic approach. SETTING: Two village general practices in South Africa. PARTICIPANTS: Four patients who were difficult, "heartsink" patients, who gave their doctors an overwhelming feeling of exasperation and defeat. METHOD: We investigated the clinical records thoroughly and explored patients' relationships with others. Through interpretation and reflection, we tried to discover what role the doctor could play with these patients. FINDINGS: Chronic unhappiness was found to be not only a condition of life for the patients but also for the doctor. It was an important factor in the relationship they shared. Unhappiness was revealed in part by frequent visits by the patients, a constellation of negative feelings in the doctor, and difficult patient-doctor relationships. CONCLUSION: Chronic unhappiness is not "treatable" in the normal curative or therapeutic sense. This does not prevent our quest to diagnose and cure, but enlarges our horizons to recognizing and accepting our own human reactions to patients and understanding how we can meet their needs.

Attitude of Health Personnel↗

[First grade students in former East and West Berlin: socio-emotional adjustment and relation to attachment patterns of the children].

Adaptation to school of two samples of children (45 from East and 43 from West Berlin) grown up in two different political systems until the "Mauerfall" was studied over the first two school years using information from teachers in school and kindergarten, parents, and the children themselves. Cluster analysis revealed 3 patterns of adaptation behavior: the first subgroup (61% of the sample) showed no problems at all, for a second subgroup (22%) teachers reported more adaptation difficulties, whereas the third subgroup (17%) was rated by their mothers as distractible, hard to motivate and less sociable. Sex differences turned out to be more significant than political-system differences. Adjustment patterns to school were also related to the child's quality of attachment, to the reported number of stressful life events happened to the family, as well as to mother's and teacher's existential anxiety.

Affective Symptoms↗

[Learning to provide home care].

More and more social policies are directed at community-based care. As a result, a family member, usually a woman, is called upon to become the caregiver of the sick person at home. In the case of a female caregiver who finds herself providing home care to a recently diagnosed cancer patient, major existential problems must be resolved. Without professional training, this woman must assume major responsibilities for the daily needs of her family member. To maintain a certain degree of control, she must learn to deal with her new situation. Facilitating the learning process becomes an important part of the nurse educator's role. By applying the Knowles theory of adult learning, the nurse educator is better able to understand the learning patterns of adults faced with such problems. This model helps develop a better perception of the adult learner, a clearer vision of the learning involved, and a better understanding of the nurse's role as educator. Before providing information, the nurse takes into account the perceptions of the caregiver and focuses on the person herself--thus recognizing her uniqueness. She helps the learner to become aware of her learning needs, to explore her motivations and to share her experiences. Through her attitude, the nurse communicates her intellectual and emotional availability, and encourages the caregiver to rely on and use her expertise. While providing necessary assistance, the nurse educator is instrumental in allowing the caregiver to take control of her own learning.

Adult↗