The crisis in Kosovo. The psychology of displacement.
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This study uses data collected in 1996 by the Swedish National Board of Health and Welfare. By means of interviews with 1980 foreign-born immigrants, an attempt was made to determine the impact of a) migration status (country of birth/ethnicity), b) exposure to violence, c) Antonovsky's sense of coherence, d) acculturation status (knowledge of Swedish), e) sense of control over one's life, f) economic difficulties, and g) education, both on psychological distress (using General Health Questionnaire 12) and psychosomatic complaints (daytime fatigue, sleeping difficulties, and headache/migraine). Iranians and Chileans (age-adjusted) were at great risk for psychological distress as compared with Poles, whereas Turks and Kurds exhibited no such risk. When the independent factors were included in the model, the migration status effect decreased to insignificance (with the exception of Iranian men). A low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties were strongly associated with the outcomes, generally accounting for a convincing link between migration status and psychological distress. Furthermore, a low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties in exile seemed to be stronger risk factors for psychological distress in this group than exposure to violence before migration.
STUDY DESIGN: The current prospective longitudinal study examined the predictive value of psychological, somatic and social variables for the prediction of the short- and long-term follow-up in 111 consecutively selected patients with acute radicular pain and a lumbar disc prolapse or protrusion. OBJECTIVES: The criteria for the therapy outcome were the intensity of persistent pain at the time of the discharge from the hospital and 6 months later and the application for early retirement at the 6 month follow-up. METHODS: As for the psychological predictors, we examined depression (Beck Depression Inventory BDI), daily hassles (Kiel Interview of the Subjective Situation KISS), pain coping strategies (Kiel Pain Inventory KSI), and Health locus of control (GKU). As somatic predictors, we assessed the duration of pain before treatment, previous operations, paresis, disc displacement, scoliosis, adipositas, treatment, and age. As social predictors, we assessed the social status, occupational characteristics, and the duration of inability to work. RESULTS: The results indicated that persistent pain was best predicted by a combination of somatic (degree of disc displacement), psychological (depression and the pain coping strategies avoidance behavior, endurance strategies, nonverbal pain behavior and search for social support), and social parameters (social status and sitting position) with a correct prediction in 86%. The application for early retirement at the 6 month follow-up was best predicted by depression and stress at work. CONCLUSIONS: The results lead to several hypotheses about biopsychosocial interrelations within the chronification of radicular pain and provide the clinician with a short screening instrument for early diagnosis of chronification.
High- and low-sexual responders to a double-entendre word association test were found to differ in defensive preference on the Defense Mechanisms Inventory. Low responders preferred avoidant defenses (reversal and principalization), and high responders preferred approach defenses (turning against object and projection). Results also suggested a consistency of defensive orientation over different situations.
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Five cases are presented of adolescent girls with severe problems in leaving home. Though the psychodynamics were similar (preoedipal conflicts in the separation-individuation phase), the psychopathology and underlying causative factors were different in each case. Factors to be considered in the initial diagnostic assessment are outlined. These include constitutional and congenital factors, the developmental history, maternal emotional illness, and gene-environment interactions. Various treatment modalities are described and illustrated. In four of the cases specific parameters were necessary, particularly behavioral technics and conjoint family therapy. The manner in which the analyst may serve, in cases amenable to psychoanalytic treatment, as transference object plus real object is discussed and illustrated.
Earlier descriptions of pathological grief are reviewed. From the study of recently bereaved widows major forms of pathological grief are outlined. These are suppressed or inhibited grief and distorted grief, including forms with extreme anger or extreme guilt. Other grief variants are noted. The management of pathological grief is outlined; specifically the encouragement of the expression of suppressed affects especially sadness, anger and guilt; as well as the going over of memories and feelings to do with the lost relationship. Consideration is given to: the establishment of the therapeutic contract; the specific exploration of the response to the death and the pre-existing relationship; resistances; interpretation of defences; assessment of progress of mourning; social network factors; termination; and transference and counter-transference.
Theories of aggressive and violent behaviour fall into a confusing range of categories. In this review, the author attempts to make sense of the different concepts and describes the theory that underpins each of them.
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In a sequence of events described as the "cooling out" process, an administrative conflict snowballed to an irrevocable stage resulting in an employee's dismissal. Such scapegoating reduces friction in the organization structure, but does not identify and resolve problems.
The dying patient experiences extraordinary emotional stress, as do the family and physician. Their distress is compounded by the fact that members of our society are poorly prepared to deal with death. The defenses that individuals mobilize to deal with their death-anxiety are often maladaptive. The psychiatrist, through the use of understanding of psycho-dynamics, can help herself or himself and then others in responding adaptively to the dying patient. Most medical schools all but ignore death education, despite the clear relevance of such teaching to their students. Psychiatric educators have a role to play in developing and implementing the psychological study of terminal illness in medical schools.
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