The objective of this study was to assess the beliefs of parents of youth soccer players about Chronic Traumatic Encephalopathy, concussion, and retirement from sport decisions and compare them to those of concussion-specialized clinicians. An electronic survey was completed by parents of youth club soccer players and concussion-specialized clinicians located in a large U.S. urban center. Parents believed more strongly in the causal relationship between concussions and CTE, and between CTE and harm than did clinicians. Parents who (...) themselves had participated in sport at a high level had more conservative beliefs than other parents about the number of concussions after which an athlete should retire from contact or collision sport. Results are discussed in the context of ethical risk communication between clinicians and parents. This includes the importance of communicating information about CTE to parents and youth athletes in an understandable way so that they can make informed choices about contact and collision sport participation. Further research is encouraged to evaluate approaches of communicating evidence about CTE to a diverse population of families of youth athletes. (shrink)

Postmortem evidence of chronic traumatic encephalopathy (CTE) in the brains of American National Football League players who suffered concussions while playing have intensified concerns about the risks of concussion in sport.1 Concussions are frequently sustained by amateur and professional players of Australia’s three most popular football codes (Australian football, rugby league, and rugby union) and, to a lesser extent, other contact sports such as soccer. This raises major concerns about possible long-term neurological damage, cognitive impairment and mental (...) health problems in players of these sports. (shrink)

Current discussions about concussion in sport are based on a crucial epistemological question: whether or not we should believe that repetitive mild Traumatic Brain Injury causes Chronic Traumatic Encephalopathy. This epistemological question is essential to understanding the ethics at stake in treating these cases: indeed, certain moral obligations turn on whether or not we believe that mTBI causes CTE. After discussing the main schools of thought, namely the CTE-sceptic position and the CTE-orthodox position, this article examines (...) the concussion debate in sport and asks if its current articulation helps to answer whether or not we should call for responsive, ethical action. (shrink)

Head injuries are an inherent risk of participating in the major collision sports played in Australia. Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic (...) traumatic encephalopathy. We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare. (shrink)

In recent years, Pop Warner, the world’s largest youth football organization, has seen its numbers decline. This decline is due to concerns about new research establishing a link between football and chronic traumatic encephalopathy, a debilitating neurodegenerative disease. Hundreds of thousands of parents are now struggling with a difficult ethical issue: should kids play football? Since parents have an obligation to help children develop the capacities required for autonomous choice, the risks posed by football establish a strong (...) presumption against allowing kids to play the game. I consider whether this presumption can be defeated by the arguments for allowing kids to play dangerous sports offered by John Russell in his papers ’The Value of Dangerous Sport’ and ‘Children and Dangerous Sport and Recreation’. While Russell does not argue that kids should be permitted to play football, and agrees that some sports may be too risky for children, he argues that kids should often be allowed to participate in.. (shrink)

Chronic traumatic encephalopathy resulting from head hits and concussions is an unfortunate illness that has affected numerous football players, especially in the National Football League. Many of my fellow players suffer from this problem, and many have died prematurely because of it. I make some suggestions for improving the situation for retired and current players.

In this paper, we explore the issue of the elimination of sports, or elements of sports, that present a high risk of brain injury. In particular, we critically examine two elements of Angelo Corlett’s and Pam Sailors’ arguments for the prohibition of football and Nicholas Dixon’s claim for the reformation of boxing to eliminate blows to the head based on the empirical assumption of an essential or causal connection between brain injuries incurred in football and the development of a degenerative (...) brain disease known as chronic traumatic encephalopathy ; and John Stuart Mill’s rejection of consensual domination. We present four arguments to contest the validity of Corlett, Dixon’s and Sailor’s positions. Specifically, we argue that certain autonomy-based arguments undermine paternalist arguments for reform; the nature of the goods people pursue in their lives might justify their foregoing future autonomy; Mill’s argument against consensual domination draws on ambiguous and arbitrary distinctions; the lack of consensus and empirical evidence regarding CTE arising from brain injuries in sport underdetermines calls for reform. We conclude that these proposals for reforming or eliminating sports with high risks of brain injuries are not well founded. (shrink)

Postmortem research on the brains of American tackle football players has revealed the presence of chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by repeated head trauma. Repeated concussion is a risk factor for CTE, raising ethical concerns about the long-term effects of concussion on athletes at risk for football-related concussion. Of equal concern is that youth athletes are at increased risk for lasting neurocognitive and developmental deficits that can result in behavioral disturbances and diminished academic (...) performance. In this article, we consider evidence of the effects of concussion in youth athletes, and discuss ethical duties to youth athletes and how these duties might be satisfied, given the intrinsic risks of football. Finally, we evaluate potential strategies for reducing concussions in junior football, and recommend the optimal strategy for reducing brain injury to an acceptable level while still making available the benefits of football participation for youth athletes. (shrink)

Concussions in professional sports have received increased attention, which is partly attributable to evidence that found concussion incidence rates were much higher than previously thought. Further to this, professional hockey players articulated how their concussion symptoms affected their professional careers, interpersonal relationships, and qualities of life. Researchers are beginning to associate multiple/repeated concussions with Chronic Traumatic Encephalopathy, a structural brain injury that is characterized by tau protein deposits in distinct areas of the brain. Taken together, concussions impact (...) many people in the sporting community from current and former professional athletes and their families to medical and health professionals and researchers. In light of the growing awareness and sensitivity towards concussions, the purpose of this paper is to provide recommendations that are designed to improve player safety in professional hockey and address the ethical issues surrounding these suggestions. (shrink)

Concussive injuries to the head and brain are relatively common in the National Football League. This is not news, since the issue has been covered in many articles in the popular press and many news specials on television. As an NFL offensive lineman for 13 years, I suffered a huge number of hits to the head — an estimated 215,000 at least. Nevertheless, I have fared better than many of the players of my era: many suffered from chronic (...) class='Hi'>traumatic encephalopathy. For example, some of my fellow Hall of Fame players from that era, Mike Webster, Jim Ringo, John Mackey, and Joe Perry, all suffered from CTE and all are now deceased. I count myself lucky that the main malady affecting me after those many blows to the head is a 60% hearing loss in my left ear — probably due to undiagnosed concussions and particularly to thousands of head slaps by defensive players, whose first hit after the snap was often a right-handed blow to the helmet's open hole over my left ear. (shrink)

in 2017, a study of the brains of former football players returned some of the most damning evidence to date of the inherent dangers of the game. Of 111 former NFL players' brains examined post-mortem, 110 were found to have the damage associated with chronic traumatic encephalopathy, a brain disease causing serious emotional and behavioral problems—and, often, premature death. That football is physically risky has been known virtually since its advent; what the newest studies suggest is that (...) its dangers are much more extensive than previously imagined, and much harder to avoid than had been hoped.Such findings add urgency to the ethical problems that football raises: How can one justify... (shrink)

Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global protocols for (...) dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways. (shrink)

Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from (...) their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy, and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings. which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping. (shrink)

Participation in sports such as football puts youth athletes at high risk of injury. helmets cannot protect players from the possibility of traumatic brain injury, and repeated concussive injuries can lead to chronic traumatic encephalopathy later in life. in light of such facts, the morally appropriate role of physicians who treat patient-athletes comes into question. i argue that pediatricians ought to be committed to a high level of shared decision making, whereby their goal, rather than being (...) to provide the medically best advice (which, let’s be honest, would be to not play football at all), would be to provide the medically best advice in light of patients’ honestly professed plans and goals. if patient-athletes see their doctor as an ally, who wants them on the field as much as they want to be there, they will be more likely to trust their pediatrician to help in the realization of those goals, even if they report an injury. while this approach could feel like a medical betrayal, in that the physician could feel complicit in helping a patient to continue engaging in high-risk behavior, i argue that medical outcomes will be better than if patientathletes see physicians as an obstruction to their athletic goals. (shrink)

IntroductionEspecially in the chronic phase, individuals with traumatic brain injury may still have impairments at the discourse level, even if these remain undetected by conventional aphasia tests. As a consequence, IwTBI may be impaired in conversational behavior and disadvantaged in their socio-communicative participation. Even though handling discourse is thought to be a basic requirement for participation and quality of life, only a handful of test procedures assessing discourse disorders have been developed so far. The MAKRO Screening is a (...) recently developed screening tool designed to assess discourse impairments. The test construction is based on psycholinguistic frameworks and the concept of macro-rules, which refer to cognitive functions responsible for organizing and reducing complex information in discourse.AimThe aim of our study was to investigate discourse processing in IwTBI in different tasks and to assess problems in communicative participation in the post-acute and chronic phase. In this context, we also aimed to analyze the influence of the severity of the initial impairment and the verbal executive abilities on the discourse performance. Additionally, the impact of macrolinguistic discourse impairments and verbal fluency on perceived communicative participation was targeted in our analysis.MethodsData from 23 IwTBI and 23 healthy control subjects have been analyzed. They completed two subtests of the MAKRO screening: Text production and Inferences. Discourse performance was examined in relation to measures of semantic fluency and verbal task-switching. Socio-communicative problems were evaluated with the German version of the La Trobe Communication Questionnaire.ResultsIwTBI showed lower test results than the control group in the two subtests of the MAKRO-Screening. Difficulties in picture-based narrative text production also indicated greater perceived difficulties in communicative participation. We also found that the subject’s performance on the MAKRO-Screening subtests can partly be explained by underlying dysexecutive symptoms and the severity of their injury. The preliminary results of our study show that cognitive-linguistic symptoms in IwTBI are also evident in the chronic phase. These can be detected with procedures referring to the discourse level, such as the MAKRO-Screening. The assessment of discourse performance should be an integral part in the rehabilitation of IwTBI in order to detect cognitive-linguistic communication disorders and to evaluate their impact on socio-communicative participation. (shrink)

The aim of this paper is to familiarize the reader with the concept of psychological energy, and the role it plays in deepening our understanding of psychosocial adaptation to traumatic life events and, more pointedly, the onset of chronic illness and disability. In order to implement this aim, the following steps were undertaken: First, a brief historical review of the nature of energy, force and action, as traditionally conceived in the field of physics, is provided. Second, an overview (...) of PE is presented, with a shared emphasis on both its historical underpinnings and its present conceptualizations in the fields of social, health and rehabilitation psychology. Particular emphasis is placed upon applications of PE in the domains of adaptation to stress, trauma and CID onset. Third, reviewed are measuring instruments that have been traditionally applied to the assessment of the nature, content and magnitude of PE and its dynamics. Finally, new perspectives are offered on the dimensional structure, processes and dynamics, assumed to undergird PE, its underlying conceptual similarities to physical energy, and its potential and deeper link to the process of psychosocial adaptation in the aftermath of experiencing trauma and CID. (shrink)

On January 5, 2019, the Associated Press reported that a woman thought to have been in the vegetative state for over a decade gave birth at a Hacienda HealthCare facility. Until she delivered, the staff at the Phoenix center had not noticed that their patient was pregnant. The patient was also misdiagnosed.Misdiagnosis of patients with disorders of consciousness in institutional settings is more the norm than the exception. Misdiagnosis is also connected to a broad and extremely significant change in the (...) understanding of the vegetative state—a change that the field of bioethics has not yet fully taken into account. In September 2018, the American Academy of Neurology, the American College of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research issued a comprehensive evidence‐based review on disorders of consciousness and an associated practice guideline on the care of these patients. These landmark publications update the 1994 Multi‐Society Task Force Report on the Vegetative State, which subcategorized the persistent vegetative state as either persistent (once the vegetative state lasted one month) or permanent (once the vegetative state lasted three months after anoxic injury or twelve months after traumatic injury). Noting that 20 percent of patients thought to be permanently unconscious might regain some level of consciousness, the new guideline has eliminated the permanent vegetative state as a diagnostic category, replacing it with the chronic vegetative state. (shrink)

Over 40 years of research have shown that traumatic brain injury affects brain volume. However, technical and practical limitations made it difficult to detect brain volume abnormalities in patients suffering from chronic effects of mild or moderate traumatic brain injury. This situation improved in 2006 with the FDA clearance of NeuroQuant®, a commercially available, computer-automated software program for measuring MRI brain volume in human subjects. More recent strides were made with the introduction of NeuroGage®, commercially available software (...) that is based on NeuroQuant® and extends its utility in several ways. Studies using these and similar methods have found that most patients with chronic mild or moderate traumatic brain injury have brain volume abnormalities, and several of these studies found—surprisingly—more abnormal enlargement than atrophy. More generally, 102 peer-reviewed studies have supported the reliability and validity of NeuroQuant® and NeuroGage®. Furthermore, this updated version of a previous review addresses whether NeuroQuant® and NeuroGage® meet the Daubert standard for admissibility in court. It concludes that NeuroQuant® and NeuroGage® meet the Daubert standard based on their reliability, validity, and objectivity. Due to the improvements in technology over the years, these brain volumetric techniques are practical and readily available for clinical or forensic use, and thus they are important tools for detecting signs of brain injury. (shrink)

Many feminist researchers have been critical of the psychiatric category of borderline personality disorder 1 and have emphasized the gendered nature of the diagnosis. It is estimated that people diagnosed with BPD comprise 1 to 2 percent of the general population in the United States in a given year, and that women represent 75 percent of those diagnosed.2 Critics have argued that the diagnosis reinforces double-binds for women and pathologizes traits associated with both conventional femininity, such as emotionality, dependency, and (...) self-destructiveness, and unconventional femininity, such as rebelliousness and sexual promiscuity (Lester 2013; Potter 2009; Shaw.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Cultural Context of Post-traumatic Stress DisorderCarolyn Smith-Morris (bio)Keywordspost-traumatic stress disorder (PTSD), culture, medical anthropology, fight-or-flight responseIn his Clinical Anecdote, Dr. Christopher Bailey gamely imagines the evolutionary underpinnings of his patient's distressing lack of war wounds. As part of a careful and engaged discussion of care for his suffering patient, Dr. Bailey suggests that our evolved fight-or-flight response to the alarms of the African savannah may be (...) at work in Colin's distress. The fight-or-flight response is something of great interest to anthropologists, who rely on Darwin's theory of evolution to explain much in human experience. According to Dr. Bailey's application of the theory, Colin's visceral response to threat is protective in the presence of danger, but destructive (particularly to his mental health) in the absence of such challenges. So Dr. Bailey considers whether we may have an evolved “need” for threat, and that Colin's trauma is in part related to the lack of such threat in his wartime experience.According to Darwin's ideas, evolved traits may be adaptive but may also simply be random appearances that have not yet produced cause for evolutionary eradication. The fight-or-flight response, or any of the hypothalamic–pituitary–adrenal axis events initiated under either acute or chronic stress, is therefore occurring in Colin's reactions to everyday frustrations, to wartime exposures, and even during the stressful nontrauma of feeling “wimpy.” Dr. Bailey's idea about an evolved need for threat is tautological. That need is not biological, but cultural.Although post-traumatic stress disorder is medically real, it is an event that develops in a particular place and time. Likewise, gender roles that demand scar battles and trophies of a certain form are culturally determined. Culture is central to this anecdote: a culture-specific occurrence of post-traumatic stress disorder and culturally driven gender roles for men, especially warriors. Stress is indeed present in Colin's life: our postindustrial culture's separation from everyday death and violence make episodes like war and combat all the more shocking or traumatic; the lack of social recognition for his service also seems to be one of Colin's stressors. Both the shock of warfare and the trauma of his social invisibility are as vivid to his evolutionarily informed body as is the presence of a crouching lioness in the room. So it is the host of cultural expectations, and his inability to mobilize social and cognitive resources to respond to them, that is wounding Colin. Talk therapy should draw out these cultural details [End Page 235] and, as Dr. Bailey has already begun to do, emplot Colin into a more heroic (his)story of his service to our nation.Related ArticlesFeature Article: Clinical Anecdotes: A Painful Lack of WoundsCommentary: The Nature of Proof in PsychiatryCommentary: Truth and Healing a Veteran's DepressionCommentary: Inappropriate RegretCommentary: The Cultural Context of Post-traumatic Stress DisorderCommentary: Explication or Explanation?Commentary: The Importance of What Psychiatrists Care AboutCommentary: Mourning or MelancholiaResponse: A Painful Lack of ConnectionCarolyn Smith-Morris Carolyn Smith-Morris is an Associate Professor in the Department of Anthropology at Southern Methodist University in Dallas, Texas. Her work focuses on chronic disease and the health impacts of culture change and acculturative stress in North America. She is engaged in several research programs among migrating Mexican workers, among poor African-Americans in Dallas, and for the Gila (pronounced Hee-la) River Indian Community of Southern Arizona, a tribe that suffers from the highest recorded rates of type 2 diabetes in the world. She also holds a research fellowship with the Foundation for Community Empowerment, serves on the Board of the Society for Medical Anthropology, and is a fellow in the Society for Applied Anthropology. She published Diabetes Among the Pima in 2006 and has several articles detailing her applied research on diabetes, reproduction, health care ethics, and end-of-life care. She can be contacted via e-mail at: [email protected], C. 2009. A painful lack of wounds. Philosophy, Psychiatry, & Psychology 16, no. 3:223–224. [End Page... (shrink)

Differential tractography and correlation tractography are new tractography modalities to study neuronal changes in brain diseases, but their performances in detecting neuronal injuries are yet to be investigated in patients with mild traumatic brain injury. Here we investigated the white matter injury in mTBI patients using differential and correlation tractography. The diffusion MRI was acquired at 33 mTBI patients and 31 health controls. 7 of the mTBI patients had one-year follow-up scans, and differential tractography was used to evaluate injured (...) fiber bundles on these 7 patients. All subjects were evaluated using digital symbol substitution test and trail making test A, and the correlation tractography was performed to explore the exact pathways related to the cognitive performance. Our results showed that differential tractography revealed neuronal changes in the corpus callosum in all 7 follow-up mTBI patients with FDR between 0.007 and 0.17. Further, the correlation tractography showed that the splenium of the corpus callosum, combined with the right superior longitudinal fasciculus and right cingulum, were correlated with DSST in the acute mTBI patients. The cognitive impairment findings in the acute stage and the longitudinal findings in the corpus callosum in the chronic stage of mTBI patients suggest that differential tractography and correlation tractography are valuable tools in the diagnostic and prognostic evaluation of neuronal injuries in mTBI patients. (shrink)

Studies in adults with mental disorders suggest that the experience of early and chronic trauma is associated with changes in reward expectancy and processing. In addition, severe childhood trauma has been shown to contribute to the development of mental disorders in general. Data on effects of early childhood trauma on reward expectancy and processing in middle childhood currently appear insufficient. The present study aims to fill this research gap by examining the effects of developmental trauma disorder on reward expectancy (...) and processing in children aged 8–12 years, testing the hypothesis that children with multiple complex traumas exhibit altered reward processing as a result of prior disappointing reward experiences. One main feature of developmental trauma disorder is early experiences of multiple separation from important and close relationships alongside other experiences of emotional or physical harm. In the sequel children often show affect regulation disorders. To investigate this, we have developed an adapted version of the Monetary Incentive Delay Task, which examines children’s expectation of reward or frustration. In this first study, behavioral data will be collected from N = 40 children using this adapted version of the MID Task. Children in the experimental group will be recruited from youth welfare centers in Frankfurt a.M., Germany. Healthy control subjects will be recruited from after-school-care facilities. A brief trauma screening will be conducted for both groups, experimental and control. If children show signs of trauma, the presence of a developmental trauma disorder will be further delineated by a German translation of the Developmental Trauma Disorder Structured Interview for Children which was translated the first time in German by our research group. We hypothesize that children in the experimental group will be less accurate in performing the Monetary Incentive Delay Task because of their impaired emotion regulation skills due to emotional avoidance following developmental trauma. If the results of our initial behavioral study are promising, the MID task will be used in a future study to elucidate the relationship between trauma developmental disorder, reward expectancy and processing, and neurobiological processes in middle childhood. (shrink)

Chronic kidney failure is a serious somatic disease. Addressing the issue of living with a chronic disease means fully considering the patients’ entourage, their families, and those close to them, especially their children and spouses.Objectives: The present paper focuses on the couple’s psychological experience when one of them suffers from a chronic disease, in this instance kidney disease. In particular, how is the spouse affected by the treatment provided? The aim is not only to see how care (...) for sick people can be improved, but also, more specifically, how relatives and especially partners can receive attention.Methodology: A qualitative approach is not only adopted, being based on the psychotherapeutic follow-up of the partners of patients with chronic kidney disease, but also of the patients themselves, addressing the matter of their life as a couple. Three couples were considered, and two case studies are presented here. The issues that cut across these different situations are examined.Results and Discussion: Some couples show considerable resourcefulness. However, over the years, that capacity for adaptation and inventiveness can also be interrupted by the periods of greater suffering and even despair, especially when the somatic pathology becomes chronic. Many spouses talk about how living with a sick partner weighs down on them, causing severe fatigue. Some aspects of the illness can also become traumatic. The disease regularly disrupts the daily life of the couple and the family. This leads to a reworking of family relations. Each couple has its own history with the condition. As it emerges, it can disrupt the bonds of filiation, especially when the illness is hereditary. Making psychological care more accessible to the partners involved constitutes a major challenge for our hospital care systems. (shrink)

Metabolic dysfunction is a ubiquitous underlying feature of many neurological conditions including acute traumatic brain injuries and chronic neurodegenerative conditions. A central problem in neurological patients, in particular those with traumatic brain injuries, is an impairment in the utilization of glucose, which is the predominant metabolic substrate in a normally functioning brain. In such patients, alternative substrates including ketone bodies and lactate become important metabolic candidates for maintaining brain function. While the potential neuroprotective benefits of ketosis have (...) been recognized for up to almost a century, the majority of work has focused on the use of ketogenic diets to induce such a state, which is inappropriate in cases of acute disease due to the prolonged periods of time (i.e., weeks to months) required for the effects of a ketogenic diet to be seen. The following review seeks to explore the neuroprotective effects of exogenous ketone and lactate preparations, which have more recently become commercially available and are able to induce a deep ketogenic response in a fraction of the time. The rapid response of exogenous preparations makes their use as a therapeutic adjunct more feasible from a clinical perspective in both acute and chronic neurological conditions. Potentially, their ability to globally moderate long-term, occult brain dysfunction may also be relevant in reducing lifetime risks of certain neurodegenerative conditions. In particular, this review explores the association between traumatic brain injury and contusion-related dementia, assessing metabolic parallels and highlighting the potential role of exogenous ketone and lactate therapies. (shrink)

Considerations of well-being or flourishing include Maslow’s and Rogers’ concepts of self-actualisation and actualising tendency. Recent empirical findings suggest that only a modest proportion of the population might be considered to be flourishing. Separate findings focused upon the nature and determinants of post-traumatic growth identify it as comparable to flourishing, and facilitated by supported accommodation to the trauma. This can be understood as reflecting self-actualisation. Empirical findings such as these provide ontological stability to a set of phenomena that share (...) much with ancient teachings extolling redemption through suffering. This framework challenges conventional healthcare policies and practices, but in ways that offer insights into how patient-centred approaches to chronic illness and disability might be better conceived and enabled. It also throws into doubt the rectitude of an economic model built around services and products designed to provide easy access to sources of immediate gratification. (shrink)

Patient autonomy and distributive justice are fundamental ethical principles that may be at risk in liver transplant units where decisions are dictated by the need to maximise the utility of scarce donor organs. The processes of patient selection, organ allocation and prioritisation on the wait list have evolved in a constrained environment, leading to high levels of complexity and low transparency. Regarding paternalism, opaque listing and allocation criteria, patient factors such as passivity, guilt, chronic illness and sub-clinical encephalopathy (...) are cited as factors that may inhibit patient engagement. Regarding justice, established regional, gender and race based inequities are described. The paradox whereby hepatologists both advocate for individual patients and discharge their duty of stewardship to apportion organs according to larger utilitarian principles is explored. Competing subjective factors such as physicians’ perception of moral responsibility, the qualitative nature of expert medical assessment and institutional or personal loyalty to re-transplantation candidates are described. Realistic limits of self-determination and justice are discussed, and possible future directions in terms of patient involvement proposed. (shrink)

People with disabilities are underrepresented in STEM fields, and all too often, they face isolation and ableism in academia. Uncharted is a collection of powerful first-person stories by current and former scientists with disabilities or chronic conditions who have faced changes in their careers, including both successes and challenges, because of their health. It gives voice to common experiences that are frequently overlooked or left unspoken. These deeply personal accounts describe not only health challenges but also the joys, sorrows, (...) humor, and wonder of science and scientists. With a breadth of perspectives on being disabled or chronically ill, these stories highlight the intersectionality of minoritized identities with the disability community. Uncharted features essays by contributors who are d/Deaf, blind, neurodivergent, wheelchair users, have experienced traumatic brain injuries, have blood sugar disorders, have rare medical diagnoses, or have received psychiatric diagnoses, among many others. In many cases, the scientific field is not fully accessible to them, and they frankly describe struggling as well as thriving alongside their conditions. This book serves as representation for scientists who have never felt comfortable disclosing their disability or who have never felt fully understood. The stories shared in this book seek to normalize medical conditions and disabilities in scientific culture, offering recommendations for how and why to improve access. Uncharted is vital and compelling reading for current and aspiring scientists who want to make their fields more inclusive and supportive for everyone. (shrink)

Objective: Mindfulness disposition is associated with various psychological factors and prevent emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining. Methods: An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis (...) was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relations between mindfulness and psychiatric symptoms. Results: Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = -0.504; p =.000). High negative correlations were found between mindfulness disposition and overall Global Severity Index (r = -.637; p =.000), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales. Discussion: Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem the post-traumatic psychopathological beginnings and preventing the onset of chronic mental disorders. (shrink)

According to theoretical work on epistemic injustice, baseless discrediting of the knowledge of people with marginalized social identities is a central driver of prejudice and discrimination. Discrediting of knowledge may sometimes be subtle, but it is pernicious, inducing chronic stress and coping strategies such as emotional avoidance. In this research, we sought to deepen the understanding of epistemic injustice’s impact by examining emotional responses to being discredited and assessing if marginalized social group membership predicts these responses. We conducted a (...) novel series of three experiments (Total N = 1690) in which participants (1) shared their factual knowledge about how a game worked or their personal feelings about the game; (2) received discrediting feedback (invalidating remarks), validating feedback (affirming remarks), or insulting feedback (general negative social evaluation); and then (3) reported their affect. In all three studies, on average, affective responses to discrediting feedback were less negative than to insulting feedback, and more negative than to validating feedback. Participants who shared their knowledge reported more negative affect after discrediting feedback than participants who shared their feelings. There were consistent individual differences, including a twice-replicated finding of reduced negative affect after receiving discrediting and insulting feedback for Black men compared to White men and women and Black women. Black men’s race-based traumatic symptom scores predicted their affective responses to discrediting and insulting feedback, suggesting that experience with discrimination contributed to the emotional processing of a key aspect of epistemic injustice: remarks conveying baseless discrediting of knowledge. (shrink)

Background We investigated the personal philosophies of eight persons with a tetraplegic condition (four male, four female), all living in Sweden with a chronic spinal cord injury (SCI) and all reporting a good life. Our purpose was to discover if there is a philosophical mindset that may play a role in living a good life with a traumatic SCI. Methods Two rounds of in-depth qualitative interviews were performed by the same interviewer, a philosophical practitioner by training (de Miranda). (...) The second round systematically covered the following elements: bodily sense, sense of self, sense of belonging, sense of the possible, sense of purpose and philosophical sense. This six-step method developed by de Miranda is called SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. Results All the interviewees, as a consequence of their trauma, reported having gone through a reinvention of themselves which implied questioning the meaning and purpose of their life in particular and life in general. A philosophical rather than realistic sense of the possible was abstracted toward teleological growth. All interviewees developed a sense of purpose based on self-interested altruism and solidarity with disabled peers. Conclusions To reinvent a good life with SCI, in addition to physical training and willpower, one needs to consider philosophical questions about the self and life, what Kant called the cosmic interests of reason: What may I hope? What must I do? What can I know? Our results indicate that we should, in the future, explore what the philosophical health approach may bring to rehabilitation processes in the months or years that follow the trauma. (shrink)

Healthcare workers who are on the front line of coronavirus disease 2019 and are also undergoing shift schedules face long work hours with few pauses, experience desynchronization of their circadian rhythm, and an imbalance between work hours effort and reward in saving lives, resulting in an impact on work capacity, aggravated by the lack of personal protective equipment, few resources and precarious infrastructure, and fear of contracting the virus and contaminating family members. Some consequences are sleep deprivation, chronic insomnia, (...) stress-related sleep disorders, and post-traumatic stress disorder. These sleep alterations critically affect mental health, precipitating or perpetuating anxiety, stress, and depression, resulting in the inability to regulate positive and negative emotions. Pre-existing sleep disorders are an important risk factor for the development and maintenance of PSTD when individuals are exposed to an important stressor such as a COVID-19 pandemic. At the same time, how an individual regulates the emotion associated with worries during daytime functioning impacts nighttime sleep, precipitating and perpetuating difficulties in sleeping. All of these changes in sleep and emotional regulation also alter the immune system. Sleep deprivation is commonly associated with chronic inflammatory diseases, due to the desynchronizations in circadian rhythms, causing possible psychophysiological disorders and impaired neuroimmune-endocrine homeostasis. From this perspective, we clarify in this article how sleep disorders affect the immune system and emotional regulation, explaining their phenomenological and neurobiological mechanisms, and discussing elements of cognitive and behavioral coping for health professionals to adopt and manage a healthier sleep pattern in the COVID-19 outbreak. (shrink)

Although prisons provide on-site primary care, the corrections system relies on external hospitals to provide a variety of healthcare services. Compared to the general population, incarcerated patients experience higher rates of chronic medical conditions, mental illness, substance abuse, cancer, traumatic brain injury, assault, and communicable disease. Certain specialties of clinicians are likely to encounter patients who are incarcerated, which makes it important for clinicians to understand how medical decision-making may differ when the patient is a prisoner. The corrections (...) system retains custody of inmates and is responsible for their welfare, including facilitating necessary medical care. However, this does not permit corrections personnel or a warden to automatically assume the role of the patient's medical decision-maker. Except for narrow exceptions, prisoners do not lose their rights to medical decision-making. In some instances, corrections staff or the prison warden have improperly asserted authority to act as the patient's medical decision-maker, such as when the patient lacks decision-making capacity. This violates ethical principles of bodily integrity, respect, and fairness. This paper provides an overview of medical decision-making for incarcerated patients, how surrogate decision-maker hierarchies apply to incarcerated patients without decision-making capacity, and special considerations for this subset of patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sweating the Small StuffTim CunninghamAs an emergency nurse, I often do not notice the small stressors as compared to the loads of intense physical and emotional suffering I witness while working at a level–one–trauma center. The horrendous deaths and injuries caused by gun violence, motorized vehicles, people in emotional distress and those suffering from chronic diseases build up on the mind as a veritable ‘scrapbook of nightmares.’ Emergency (...) providers know, in taking on this profession, that this is ‘all in a day’s work.’ Consequently, we put our selves at risk for emotional burnout as we bear witness to profound suffering while trying to improve lives.I see the traumas, the end–of–life decision making thrust upon families amidst a medical crisis and the other aspects of emergent suffering as bails of hay, against which I tried to build coping mechanisms in order to experience them but also be able to let go. For the most part I am confident to report that I have been able to work through major traumatic situations without belaboring the emotional residue. What I have failed to notice though are not the bails of hay, but individual straws of which they are made.A straw that nearly broke my back came to my pediatric emergency room as a 9–year–old girl who was involved in a low speed motor vehicle collision. She was restrained in the passenger seat; and although she was walking at the scene and crying, she was backboarded by EMS and placed in a cervical spine brace. On arrival to our emergency department she presented with normal vital signs and mutation. Her only complaint was diffuse abdominal pain. We preformed a FAST (Focused Assessment with Sonography for Trauma) exam, which was negative for free abdominal blood. Despite our efforts to make the patient comfortable, we were unable to ease her pain. The patient reported that her pain decreased after we took her off the backboard, but she still did not feel herself.Our attending and resident physicians decided that this child should have an abdominal computed tomography scan (CT) to rule out organ damage with subsequent bleeding. According to hospital protocol, this decision was within our standards of care. I stood by the family when the physician team discussed the plan of care and noticed the parents’ collective body language, which was troubled. I left the room with the physicians but not long after, the family subtly requested that I speak with them.The family was concerned about the radiation to which their child would be exposed. At the same time, they too were concerned about her abdominal pain and understood that a CT could confirm serious abdominal injury. They knew the gravity of the worst–case scenario and wanted to do what was best for their child.The mother asked me if this girl were my child what would I do.My first thought was: No CT, go home, watch her and return if symptoms worsen. My second thought conflicted with the first as I realized this was instruction that fell out of protocol differing from the opinions of the physician team. I paused before responding and found myself sputtering some pointless information about CT scans and mechanisms of injuries sustained from car accidents—I [End Page E9] was filling space, avoiding their question as I pondered the best answer.The girl’s parents told me that one was leaning towards the CT and the other against, they wanted my advice to make a decision. They pressed me saying, “What would you do.” Although I felt an uneasiness and nausea in that moment, I told them my truth, which was that I would go home without the CT.The family appeared relieved and I felt the sensation of stress leaving my body as if I had just taken a deep breath. Contented, but a daughter still with abdominal pain, the family left that evening with specific instructions to watch for adverse symptoms.In that moment, I felt like I had done the right thing but by the end of my shift I left work questioning my choice. I lost sleep that night because of... (shrink)

IntroductionFirst aiders are commonly exposed to different forms of traumatic event during their duties, such as Chronic Indirect Vicarious Exposure which refers to an indirect exposure to aversive details of the trauma. If the psychopathological impact of TE is well documented, the mental health of first aiders remains neglected. Therefore, our main objectives are to study the link between exposure to traumatic events and psychopathological outcomes and to quantify the rates of mental health disorders among first aiders.MethodOur (...) sample comprised of 53 volunteer first aiders with an average age of 32.4 years. Traumatic event exposure and mental health were assessed through a set of validated questionnaires completed online.ResultsRates of mental health outcomes were higher than within the general population. Females showed higher scores of post-traumatic stress disorder than males. PTSD scores were significantly correlated with all mental issues scores, apart from tobacco use and eating disorders scores. There was a significant correlation between the number of traumatic events and the years of experience. Exposure to traumatic events only correlated with nicotine dependency. No other correlation reaches statistical significance.DiscussionThe scores of all mental health outcomes were high; a surprising result, as volunteer first aiders are thought to be recruited for their strong dispositional cognitive and emotional abilities. The high levels of post-traumatic stress disorder and burnout, along with the prevalent anxiety and depression, highlight the need for greater psychosocial support. Resilience training and peer support would be useful interventions in this group. (shrink)

As a result of evolution, human babies are born with outstanding abilities for human communication and cooperation. The other side of the coin is their great sensitivity to any clear and durable violation in their relationship with caregivers. Infant sustained social withdrawal behavior was first described in infants who had been separated from their caregivers, as in Spitz's description of “hospitalism” and “anaclitic depression.” Later, ISSWB was pointed to as a major clinical psychological feature in failure-to-thrive infants. Fraiberg also described (...) freezing behavior as one of the earliest modes of infant defense in the face of adverse situations threatening the infant's ability to synchronize with caregivers. We hypothesize that ISSWB behaviors are associated with poor vagal brake functioning and that an impaired social engagement system is induced by an impoverished and/or dangerous environment. Recent research using animal models highlight the neurobiology and the genetics of the social Approach/Withdrawal Behavior in infants. The present paper is therefore a plea for social withdrawal behavior to be attributed a more important role as a major psychological defensive mechanism in infancy, and for research into early development and early intervention to make more practical and theoretical use of this concept, thus decreasing the challenge of translation in social neurosciences. This work presents several situations involving developmental hazards in which assessment of ISSWB by means of the Alarm Distress Baby Scale has proven useful, i.e., malnutrition, effects of major maternal depression and or traumatization, assessing social withdrawal in infants with an chronic organic illness or assessing ISSWB in out of home placed infants during parental visitation. Relationships between ISSWB and other biophysiological behavioral systems are discussed, particularly links with attachment processes and Porges's polyvagal theory. (shrink)

In this piece I discuss when care providers should not contact suicidal patients’ families to get collateral information from them or hospitalize patients over their objections. I suggest that when these patients are chronically suicidal, overriding these wants may be best in the short run but increase their net risk in the longer run. I also discuss in this regard how contacted families may become overprotective and how hospitalization can be traumatic. I present an alternative approach that can increase (...) these patients’ safety over the longer run and relate three practical approaches care providers may find useful: explaining their decisions to patients, monitoring their own fear, and instilling hope. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:PrefaceMary Jacobus (bio)Trauma theory, considered as a branch of psychoanalysis, focuses on the lasting effects on the psyche of events that—whether because of their devastating nature or because the psyche is unprepared or too immature to deal with them—cannot be integrated into the onward movement of patient’s lives. The trauma can never be undone; but perhaps the patient may be helped to live with, even mourn, its aftereffects. Some (...) approaches to trauma emphasize the event itself, along with the difficulty, and the need, to relive or re-present it. Some emphasize the structural nature of a trauma which may even be constitutive of subjectivity (castration anxiety, for instance, or primitive anxieties about separation and object loss). Still other approaches point to the meaning of the trauma to the individual, arguing that only by exploring the preexisting constellation of object relations can the significance of the trauma to that particular individual be understood. Trauma may plunge the survivor into never completed mourning, or replace an ordinary guilt with an unresolvable one. Whatever the different inflection of trauma theory, it derives its contours from psychoanalysis, past and present, and, in particular, from the impact on Freud and his successors of some of the most devastating and momentous historical events of modern times, including modern warfare, the Holocaust, and industrialization. But trauma theory also takes account of events that happen (both chronically and diachronically, so to speak) in the intimacy of the family and in the ambiguously interpersonal and social dimensions of sexuality, where events intersect with issues involving gender, power, and powerlessness as well as with preexisting psychic structures.The essays in this collection arise not only from the continuing engagement with trauma theory on the part of psychoanalysts in their clinical and therapeutic work with patients, but from the surge of interest in trauma theory viewed as a way to invest the study of literature with urgent concerns, at once topical and timeless, and to understand literariness itself. A number of essays included in this special issue focus on the notion of the archive, whether viewed as a form of record which remains in abeyance (Jonathan Elmer’s starting point for considering Jefferson’s encounter with the Native American past) or as the place of a misunderstanding, even destructiveness (the point of departure for Herman Rapaport’s reading of Derrida’s Archive Fever). Appropriately, this issue also includes a photo-essay by Laurie Sieverts Snyder, which represents not only a family archive but a collection of memories that inscribe a larger historical displacement and relocation. The intertwined evolution of trauma theory and war neurosis, and the consequent unsexing of trauma, can give rise to a post-Freudian inquiry into the writing of anxiety (such as we see in Lyndsey Stonebridge’s reading of the war novels of Henry Green, where war “is” sex). At the same time, we can glimpse how the belatedness of trauma not only gets recoded as suspension or “falling” but gives rise to a philosophic discourse of trauma (see Eleanor Kaufman’s reading of Perec’s W together with Cathy Caruth’s Unclaimed Experience). Given its centrality to contemporary literary-critical readings of trauma, it is not surprising that a number of essays should address Cathy Caruth’s work directly (many of the essays included here also do so indirectly). Her writing remains central to current literary and theoretical discussions of trauma, whether viewed as a phenomenology of trauma (as it is, for instance, by Eleanor Kaufman) or as a vantage point from which to define the modern predicament of mutually entangled histories, communities, and writings (this is how Petar Ramadanovic links Freud’s diasporic movement to the history of slavery and Toni Morrison’s Beloved). [End Page 3]The final section of this special issue returns trauma to the consulting room. Essays on pain (Mary Jacobus on the place of psychoanalysis “between” therapy and hermeneutics as represented by the writings of Wifred Bion) and melancholia (Angelika Rauch’s Kristevan essay on post-traumatic hermeneutics and problems in contemporary trauma therapy) pay particular attention to the question of interpretation in psychoanalysis. They also shift the discussion in the direction of contemporary post... (shrink)

Intimate partner violence is an important problem that has significant detrimental effects on the wellbeing of female victims. The chronic physical and psychological effects of intimate partner violence are complex, long-lasting, chronic, and require treatments focusing on improving mental health issues, safety, and support. Various psycho-social intervention programs are being implemented to improve survivor wellbeing. However, little is known about the effectiveness of different treatments on IPV survivors' wellbeing. For this purpose, we conducted a systematic review and meta-analysis (...) to assess the effectiveness of interventions on improving outcomes that describe the wellbeing of adult female survivors of IPV. We searched PubMed, PsycINFO, and Cochrane Library. We explored the effectiveness of available interventions on multiple outcomes that are critical for the wellbeing of adult female victims of IPV. To provide a broad and comprehensive view of survivors' wellbeing, we considered outcomes including mental health, physical health, diminishing further violence, social support, safety, self-efficacy, and quality of life. We reviewed 2,770 citations. Among these 25 randomized-controlled-study with a total of 4,683 participants met inclusion criteria. Findings of meta-analyses on interventions indicated promising results in improving anxiety [standardized mean difference −7.15, 95% confidence interval −8.39 to −5.92], depression, safety, violence prevention, health, self-esteem, social support, and stress management at the post-test. We found that empowerment plays a vital role, especially when treating depression and Post-Traumatic Stress Disorder, which are difficult to improve across interventions. We found mixed findings on self-efficacy and quality of life. The effects of IPV are long-lasting and require treatments targeting co-morbid issues including improving safety and mental health issues. (shrink)

For the last thirty years, the nation's mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery rendering them incapable of ensuring the safety, security, and recovery of their clients. The resulting organizational trauma both mirrors and magnifies the trauma-related problems their clients seek relief from. Just as the lives of people exposed to chronic trauma and abuse become organized around the traumatic experience, so too have our (...) social service systems become organized around the recurrent stress of trying to do more under greater pressure: they become crisis-oriented, authoritarian, disempowered, and demoralized, often living in the present moment, haunted by the past, and unable to plan for the future.Complex interactions among traumatized clients, stressed staff, pressured organizations, and a social and economic climate that is often hostile to recovery efforts recreate the very experiences that have proven so toxic to clients in the first place. Healing is possible for these clients if they enter helping, protective environments, yet toxic stress has destroyed the sanctuary that our systems are designed to provide.This thoughtful, impassioned critique of business as usual begins to outline a vision for transforming our mental health and social service systems. Linking trauma theory to organizational function, Destroying Sanctuary provides a framework for creating truly trauma-informed services. The organizational change method that has become known as the Sanctuary Model lays the groundwork for establishing safe havens for individual and organizational recovery. The goals are practical: improve clinical outcomes, increase staff satisfaction and health, increase leadership competence, and develop a technology for creating and sustaining healthier systems. Only in this way can our mental health and social service systems become empowered to make a more effective contribution to the overall health of the nation.Destroying Sanctuary is a stirring call for reform and recovery, required reading for anyone concerned with removing the formidable barriers to mental health and social services, from clinicians and administrators to consumer advocates. (shrink)

Working as a peacekeeper is associated with the exposure to acute and/or catastrophic events and chronic stressors. Hence, the meager literature about peacekeepers’ wellbeing has mainly analyzed Post-Traumatic Stress Disorder (PTSD). This study aims to deep the analysis of the wellbeing of peacekeepers military. Based on the few studies on this population, we hypothesized that Italian peacekeeper military officers and enlisted men (n = 167; 103 males, 6 females, 58 missing) exhibit lower levels of internalizing symptoms (i.e., PTSD, (...) depression, general anxiety, obsessions, and somatization) as compared to a control group (n = 60; 32 males, 28 females). Moreover, we hypothesized that peacekeepers have higher levels of psychological resources (i.e., self-efficacy, self-esteem, social support) and quality of life (i.e., higher life satisfaction and lower general stress). We compared the groups by means of MANOVAs on the subscales of the Psychological Treatment Inventory (PTI; Gori et al., 2015). We found that Italian peacekeepers have lower internalizing symptoms and higher levels of self-efficacy and self-esteem than the control group; however, no statistically significant differences were observed on perceived social support. Finally, peacekeepers have a higher quality of life: scores reflect higher life satisfaction and lower distress than the control group. This study is in line with previous literature supporting the claim that Italian peacekeeper military officers have sufficient psychological resources for coping with the stressful situations implied in peacekeeping missions. Future studies should deepen the analysis of the military’s psychological characteristics by comparing war veterans and peacekeeper military. (shrink)

Introduction: Not many writers have made suggestions about Saul’s mental state as reported in the Judaic-Christian bible. He became king under the tutelage of Samuel, a highly-respected prophet of the Israelite God, Yahweh. At some points during his reign, the biblical narrative depicted him as, at least, mentally unstable, if not decidedly insane. Modern-day writers, in some cases have provided lists of conditions, which purport to represent Saul’s psychological malady. None, however proves adequate or appropriate to encompass the complexity of (...) his behavior. The Safety-Oriented Personality Style (SOPS) or Phobicentric Psychopathology (PCP) appears to offer the best explanation of Saul’s psychological condition. Purpose: The main purpose of this paper is to offer a modern-day analysis/explanation of Saul’s apparently disturbed behavior. Evidence for the facts about Saul’s fascinating presentation is adduced both from the biblical passages and from present-day psychological theory. The previous explanations of the psychological disorder that plagued Saul, the first king of Israel, have focused on depression, post-traumatic stress disorder, hysteria, and bipolar disorder. The associated symptoms, however, have been vague and, in some cases, apparently unrepresentative of psychological nosology or, in general, they fail to conform to the prevailing nomenclature. Method: The present study introduces the Safety-Oriented Personality Style (SOPS) or Phobicentric Psychopathology (PCP), a relatively newly-unveiled chronic, anxiety-based disorder, to provide the “best” explanation of the ancient king’s perplexing conduct. Biblical passages pertaining to the topic provide the historical context of the events, which depict Saul’s provable psychopathology. Result: The evidence seems to clearly indicate that the explanation that Saul’s actions were mainly controlled by SOPS/PCP, a chronic anxiety disorder, is valid, applying most aptly to his reaction to David’s military and religious successes, and even to the recorded circumstances of his death. Conclusion: The historical account of Saul’s life and death, recorded primarily in the Christian bible, has remained intriguing, though somewhat esoteric. Probably as a result, its portrayal in the psychological literature has been scant. While the SOPS/PCP construct has apparently helped to provide grounds for diagnostic consensus that Saul’s problem was chronic anxiety, the newness of SOPS/PCP would tend to limit its purview. On a different but relevant level, the study also demonstrates the feasibility of common endeavors between the scientific and theological communities. (shrink)

_The Social Work Psychoanalyst's Casebook_ begins with an interview with Dr. Sanville, who reflects on her evolution as a social work analyst, theoretician, writer, teacher, and leader. These reminiscences are followed by accounts of nine analytic treatments, each of which offers an unusual window into what actually transpired between analyst and analysand during the treatment hours. These case studies concern particularly troubled, often traumatized patients-the very "hard to reach" or "difficult to treat" clients with whom social workers have long been (...) familiar. They include a reanalysis by the same analyst of a patient whose first therapy ended in a stalemate; an account of transference and countertransference phenomena during termination; a report on the analysis of a young woman who experienced both chronic and stress-related trauma; and an account of the special issues involved in the treatment of an aging woman. Most of the case studies reflect the influence of Dr. Sanville, whose work has long evinced the therapeutic imagination and disciplined creativity to which all the contributors aspire. Tthe contributors to this volume offer the salutary reminder that analytic work is built on a relationship of respect and empathy and that treatment success follows from the therapist's willingness to accommodate the unique needs of individual patients. In honoring Jean Sanville, _The Social Work Psychoanalyst's Casebook_ speaks to the robustness of a multidisciplinary approach to psychopathology that transcends the bounds of any single profession-an approach in which contemporary psychoanalysis is enlarged by the insights and emphases of social work just as social work is enriched by the clinical wisdom of psychoanalysis. (shrink)

The aim of the paper is the examination of the main objects of narrative psychology as related to the research of self-consciousness and personal identity. It focuses on experiencing of the Self and life. Contemporary psychological researches of traumatic events, e. g. chronic or fatal diseases, show the importance of experiencing the unity, meaningfulness, coherence in everyday life. Due to the trauma this feeling is lost and the basic presuppositions concerning the person and world brake down. The narration (...) of one’s own life story helps the individual to overcome the crisis, giving him a bit of „ontological security“. Thus he becomes able to reconstruct the feeling of meaning, order and continuity in his/her life. (shrink)

In recent years, there has been a rapidly increasing interest in self-management strategies in psychiatry and psychosomatic medicine. Among the conditions in which self-management is currently investigated in these contexts are bipolar disorder, depression, post-traumatic stress disorder, schizophrenia, attention deficit hyperactivity disorder, irritable bowel syndrome, chronic fatigue syndrome (Meng, Friedberg, &...