Showing papers in "British Journal of Medical Psychology in 1979"

A Parental Bonding Instrument

Abstract: The view that those with obsessive compulsive disorder or obsessional personality have been exposed to overcontrolling and overcritical parenting is examined. Two measures of obsessionality (the Maudsley Obsessional-Compulsive Inventory and the Leyton Obsessionality Inventory) were completed by 344 nonclinical subjects. They also scored their parents on the Parental Bonding Instrument (PBI), a measure assessing perceived levels of parental care and overprotection, before and after controlling for levels of state depression, trait anxiety and neuroticism in the analyses. Those scoring as more obsessional returned higher PBI protection scale scores. Links with PBI care scale scores were less clear, essentially restricted to the Maudsley Inventory, and variably influenced by controlling other variables.

The dietary chaos syndrome: a useful new term?

Abstract: Following typical primary anorexia nervosa some subjects enter a state characterized by disordered eating behaviour and emotional instability whilst remaining at or above a normal weight. Other subjects may reach a similar position without having been in a state of anorexia nervosa. Surprisingly the state seems to lack a satisfactory name. The term 'Dietary chaos syndrome' is proposed.

The reasons people give for taking overdoses: A further inquiry.

Abstract: A representative sample of 41 cases of self-poisoning was studied in depth. In each case 'reasons' for taking the overdose, both stated spontaneously and chosen from a presented list, were recorded. The commonest spontaneous reason was the 'wish to die'. Nearly one-third indicated some non-suicidal purpose early in the interview and consistently denied suicidal intent subsequently. Apart from suicidal intent, reasons chosen from the list bore little resemblance to reasons that had been offered earlier in the interview and are therefore of uncertain relevance. Three psychiatric judges attributed reasons for each case based on common-sense criteria. Several reasons were seldom or never chosen by them; four were chosen frequently with good agreement, i.e. communicating hostility, influencing others, relieving a state of mind and suicidal intent. The first two were the most frequently chosen, attributed to 71 per cent and 54 per cent of cases respectively. They were the reasons chosen least frequently by the self-poisoners themselves. Of 23 (56 per cent) subjects indicating suicidal intent, 12 (29 per cent) were judged to be suicidal by psychiatrists. These were not clearly distinguishable on the basis of their original interviews, except that those judged suicidal tended to indicate suicidal intent early in the interviews. The clinical and research implications of these findings are discussed. Language: en

Crisis intervention: an experimental study of the effects of a brief period of counselling on the anxiety of relatives of seriously injured or ill hospital patients.

Abstract: This study was designed to examine the effects of anxiety levels, as measured by the Gottschalk & Gleser (1969) and the Viney & Westbrook (1976) content analysis scales, of a brief period of supportive counselling of relatives who arrived at a hospital emergency admitting ward with a seriously ill or injured patient. Verbal samples were taken for analysis from the subjects before and after a period of counselling (or a period of no counselling for the control group). The results showed that the initial anxiety levels for subjects in both groups was very high. For both the psychoanalytically oriented Gottschalk & Gleser anxiety scale and the Viney & Westbrook scale of cognitive anxiety there was a decrease in the level of anxiety for the counselled group compared with the non-counselled group. The results showed that such crisis intervention in hospitals for relatives who accompany patients to the hospital can reduce their very high levels of diffuse and generalized anxiety.

Agoraphobic women married to abnormally jealous men

Abstract: Of 36 married female agoraphobics treated by the author over a period of 3 years, seven were married to men who displayed abnormal jealousy. In all these cases the husbands' jealousy adversely influenced their wives' response to treatment, and improvement in wives was associated with increased morbidity in their husbands.

The patient's view of therapy

Abstract: Recent research has suggested an increasing rapprochement between behaviour therapy and psychotherapy, especially in terms of the patient's perceptions. Two hypotheses were tested in this study - (1) that patients would report 'relationship' or 'non-specific' factors to be more useful in treatment than behavioural or psychotherapeutic activities, and (2) that there would be no difference between patients who had received behaviour therapy and patients who had received psychotherapy with respect to the rated importance of non-specific, relationship-type activities. Forty-nine patients who had received either behaviour therapy or psychotherapy were asked to complete in retrospect a questionnaire relating to aspects of therapy which they found useful and 37 (76 per cent) completed questionnaires were returned. Both hypotheses were accepted, and the findings are now discussed in relation to the growing realization of the importance of 'non-specific' factors in therapy.

The border between the paranoid-schizoid and the depressive positions in the borderline patient.

Abstract: In this paper some of the mental mechanisms deployed by borderline patients are described and illustrated with clinical material. It is suggested that the term borderline has three distinct but related meanings. First, it refers to a clinical category of patients, borderline between neurosis and psychosis who, while not frankly psychotic, tend to use psychotic mechanisms. Second, it refers to a metaphor representing the subjective experience of these patients who are unable to find a permanent identity but feel themselves sitting on the fence between a variety of different identities in a borderline position. Third, it can refer to a theoretical formulation of the level of development at which these patients function. I propose that in terms of mental mechanisms, they function as if on the border between the paranoid-schizoid and depressive positions as outlined by Melanie Klein. Some of the consequences of the failure to experience and work through depressive anxieties are discussed.

Some psycho-social consequences of multiple sclerosis: problems of social interaction and group identity.

Abstract: The study was concerned with the psycho-social consequences for married couples of multiple sclerosis being contracted by one of the partners In particular, problems of social interaction and group identity were explored In determining their mode of interaction with healthy people such couples can choose between normalizing, ie endeavouring to carry on their relationships with other people according to their pre-illness pattern, or of disassociating, ie turning away from former associates and seeking a new peer group among others with like affliction In nearly every case husband and wife agreed on the choice of stratagem, a majority of the couples forming the sample opting for disassociation Membership of the Multiple Sclerosis Society was much more usual among the disassociating couples than among those 'normalizing' The variables of age, sex, social class and severity of illness were not found to affect the mode of interaction, whereas place of residence and medical interest in them, as perceived by patients and their spouses, were influencing factors

The modification of personality disturbance in a therapeutic community for drug abusers.

Abstract: Two personality questionnaires, the MMPI and 16PF, were administered routinely to drug abusers admitted to a newly established hierarchical type of therapeutic community. Questionnaires were repeated at 6 and 12 months with those residents who remained. Comparison of the results with other studies suggests that drug abusers admitted to different treatment centres display a recognizable pattern of personality disturbance, characterized by a combination of neurotic, psychopathic and psychotic elements and an unusual degree of willingness to admit to socially undesirable traits. Twenty-five per cent of residents stayed longer than 6 months. They showed a significant reduction in measured personality disturbance, and at 1 year anxiety was the only outstanding indication of disturbance. The relationship between these results, possible sources of bias and other indices of behaviour change is discussed.

Panic-fear research in asthma and the nuclear conflict theory of asthma; similarities, differences and clinical implications.

Abstract: Recent research with the MMPI panic-fear scale has identified personality traits implicated in the psychological maintenance of the medical intractability of asthma. Intensity of prescribed medication, length of hospitalization, and rates of rehospitalization have been found to relate to MMPI panic-fear scores independent of the objective medical severity of the illness as indexed by longitudinal pulmonary functions. In the present study, MMPI panic-fear scores are related to separation and protection conflicts arising in childhood. While the nuclear conflict theory of asthma maintains that such conflicts occur in nearly all asthmatics and form a genetic component of the asthma, the present study finds that childhood separation and protection conflicts occur in a minority of patients, but may be instrumental in maintaining the medical intractability of the illness.

Mental hospital experience, classroom instruction and change in conceptions and attitudes towards mental illness

Abstract: Changes in conceptions and attitudes towards mental illness and the mentally ill were investigated in Israel. Questionnaires were presented to 69 student nurses, assessing stereotyped image, authoritarianism, social restrictiveness, benevolence, mental hygiene ideology and interpersonal aetiology before and after psychiatric affiliation in two kinds of mental hospitals, or before and after classroom instruction only. The findings lend cultural generality to previous observations and demonstrate that: (a) classroom instruction is ineffective as an agent of change; (b) practical experience involving personal confrontation with mental patients in a progressive psychiatric hospital, which contradicts the stereotyped image of mental patients and inculcates positive attitudes towards them, results in a change to a more professional scientific orientation and a more humane, accepting and liberal attitude; (c) under hospital conditions which support the stereotyped conception and authoritarian restrictive attitudes, the confrontation will result in preservation, even consolidation and strengthening, of the stereotyped image and undesirable attitudes towards mental patients. The findings were discussed and the implications for training programmes were drawn.

Cultural differences in body perception during pregnancy.

Abstract: A longitudinal study of body image change during pregnancy was conducted to test what aspects of body perception are sensitive to psychological change. Fifty-five black and 30 white women who were primiparous, less than 4 months pregnant and at least 17 years old, were interviewed during their first and third trimester as well as 6 weeks post partum. Awareness of one's stomach as measured by the Stomach Focus score of the Body Focus Questionnaire was sensitive to body changes which accompany pregnancy. However, the black women did not change in awareness of their stomachs following delivery as the white women did. The Body Distortion Questionnaire revealed that the black women felt most distorted at 9 months of pregnancy but the white women declined in body distortion. Both groups reported less distortion following parturition. Thus, cultural as well as psychological and physiological factors influence the way in which the body is perceived and experienced during pregnancy.

Compensation-neurosis and the psycho-social requirements of the family.

Abstract: This paper discusses the application of basic theories of family functioning to understanding the syndrome consisting of abnormal-illness behaviour centred around a recompensable illness or injury. It sets out the socio-cultural matrix out of which it arises and postulates that compensation-neurosis may be viewed as a homeostatic response of the family system when major psycho-social requirements are not being met and the family is under stress or in crisis. It looks at two common paradigms of compensation-neurosis as met in the rehabilitation unit of a large hospital, and at the application of the theory, and gives further examples of homeostatic adjustments to meet family requirements such as those of attachment. It also uses group and inter-group dynamics to further clarify the syndrome in psycho-social terms. It goes on the discuss the implications of these theories for prevention and management of this difficult syndrome.

A method of structured brief psychotherapy.

Abstract: Structured brief psychotherapy is a method of organizing treatment along problem-solving lines. The features of this method are the selection of problem areas, the translation of insight into specific activity, the structuring of psychodynamics and a concentration on termination events. The method is illustrated by clinical examples.

Mystical experience, spiritual knowledge, and a contemporary ecstatic religion.

Abstract: A contemporary ‘enthusiastic’ religion, the Divine Light Mission (DLM), was studied by the authors in an attempt to elucidate some of the psychological factors underlying the burgeoning appeal of this charismatic religious sect for American youth. The DLM is constituted of followers of the Guru Maharaji, an Indian who first came to the United States in 1972 at the age of 14. Method. The study was conducted both by means of individual interviews of DLM members and through the administration of a questionnaire to 119 randomly selected converts. Results. The modal respondent was a single white between 21 and 25 years of age, who had some college experience, had been a member for one to two years, and was living in communal residence with other members. Mystical experiences, analogous to an acute circumscribed hallucinatory episode, were found to be a central factor in the conversion of some of the adherents to the DLM. These mystical experiences along with regularly practiced meditation appeared to be of considerable importance in reinforcing the belief system (especially the acquisition of ‘knowledge’ a state of communion with the ‘divine presence’) for members of the DLM. Discussion. The psychology of mystical conversion experiences is reviewed and an explanation for the central importance of the ‘knowledge’ in the DLM is developed through the concept of affect functioning as cognition. The relationship and similarity of the DLM to other ‘enthusiastic’ religions such as Pentecostalism and 17th century Quakerism is examined illustrating the persistent historical appeal of such inspirational sects. The combination of a powerful group solidarity, the presence of a charismatic leader, and the occurrence of dramatic mystical conversion experiences are seen to be potent factors in providing this sect with its appeal for contemporary youth.

Exhibitionism - a biological hypothesis.

Abstract: Twenty-four male genital exhibitionists were interviewed in detail and followed up for periods of from 1 to 5 years. Biographical, attitudinal and behavioural data obtained from them were examined with a view to providing information about the aetiology of this behaviour. The evidence presented and discussed is consistent with the hypothesis that exhibiting represents the expression of an innate disposition. Exhibitionism is found to be widespread and patterned in form, to have a driven quality and to coexist with a variety of personality types. This hypothesis is further developed by discussion of anthropological and ethological data.

An analysis of contemporary East African folk psychotherapy.

Abstract: In an effort to identify the characteristics of folk psychotherapy that could account for its tenacity in East Africa, a total of 31 Tanzanian shamans were studied. It was found that patients with emotional problems make use of both the folk and Western therapists and that a clear conceptual distinction is made between the services offered. The range of techniques used, style of service delivered, and the fundamental (or underlying) model of causation were all analysed. It was concluded that folk therapy is an effective approach to psychosocial disorders which, in the future, should be considered a dynamic supplement to Western practices. Additionally, based on the appeal of the medicine man, new directions for Western psychotherapy were suggested.

Overt and covert personality traits associated with coronary heart disease.

Abstract: Some authors suggested the existence of contradictory traits in the personality pattern associated with coronary heart disease: while presenting overt, active, adult-like traits, coronary subjects would be, at a more covert or repressed level, characterized by passive and infantile tendencies. To test this hypothesis, coronary and control subjects were submitted to three types of personality questionnaire, each of them measuring the same four personality traits (seclusion, impulsiveness, dependence and passivity) which, in the adult individual, are considered by Murray's (1938) theory of personality as persisting from infancy. No difference appeared between the two groups on type 1 questionnaires, describing behavioural features of individuals outwardly displaying the four traits. On type 2 questionnaires, describing tastes and similar areas less subject to social norms, coronary subjects revealed themselves higher than control subjects for passivity (P less than 0.05). and dependence (P less than 0.05). Similarly, they were higher for passivity (P less than 0.05), dependence (P less than 0.001) and impulsiveness (P less than 0.05) on type 3 questionnaires describing symptoms expected to occur occasionally among adults having such traits. Supplementary scales also showed coronary subjects to be more ego-defensive (P less than 0.001) and more self-assertive (P less than 0.05) than controls. These data were considered as supporting the hypothesis.

Counter-transference problems in hospital practice.

Abstract: The care of the sick involves hospital staff in distressing emotional predicaments. Limitations in medical knowledge and resources and adverse social conditions of patients make staff feel helpless. The sense of helplessness gives rise to guilt, anger and resentment which affect the actions of staff towards their patients. The anxiety of a patient and his family may affect the feelings and action of hospital staff. In this paper I am particularly concerned with understanding the reactions of hospital staff in the light of the psychoanalytical concept of the counter-transference. I shall describe what may occur when the unconscious needs of patients are effectively communicated to their doctor and the doctors then act out their patients' unconscious needs.

The relation of guilt and other feelings to the diagnosis of depression.

Abstract: This paper reports a re-evaluation of seven sets of findings appearing in the research literature. The findings were derived from questionnaire studies of feelings of guilt and other feelings in diagnosed depressives and other psychiatric groups. The publications did not provide sufficient information to evaluate important inconsistencies in the findings. However, an examination of the structure and content of the questionnaires which were used made it possible to account for the discrepancies. There were three main conclusions. The first was that the only way to minimize the ambiguity of questionnaire responses was to avoid the use of multiple-item scales and only to use single-item questions which were constructed as simply as possible. The second was that depressives were not much different from other people in the degree of outwardly and inwardly directed hostility. The third was that, while guilt feelings, with certain provisos, tended to be associated with the diagnosis of depression, other feelings appeared to be both more prominent in and more strongly associated with depression. These feelings consisted of increments in feelings of loss, in the most general sense of the word, and decrements in general positive pleasant feelings.

Modification of deviant sexual behaviour: the need for a comprehensive approach.

Abstract: This paper gives four main lines of evidence to support the view that it is too simple to view sexual deviance as a problem of deviant arousal only. Firstly, clinical experience leaves the clear impression that sex offenders are not stable, well-adjusted men with a sexual arousal problem, but have difficulties in many areas of their lives. Secondly, research on human sexuality has resulted in a greater appreciation of the complexities of sexual behaviour. It is inconsistent to accept that ‘normal’ sexual behaviour is complex and varied but maintain that deviant sexual behaviour is just an inappropriate penile response. Thirdly, treatment studies aimed at modifying homosexual behaviour have found that changes in heterosexual measures are the most important. This suggests that for sex offenders most attention should be paid to increasing non-deviant arousal and interests. Fourthly, studies of sex offenders have consistently reported that they experience a wide variety of problems. It is unrealistic to consider the problem of deviant sexual behaviour in isolation from these other problems. It follows that comprehensive treatment programmes will be necessary, covering such problems as sexual dysfunction, anxiety, deficient social skills, inadequate sexual knowledge, poor self-control, lack of non-deviant sexual arousal as well as the presence of deviant sexual arousal.

An analysis of individual treatment on a token economy for chronic schizophrenic patients

Abstract: Fifty-one individually designed treatment programmes carried out over a 22 month period on a token economy ward for 12 female chronic schizophrenic patients were analysed. Level of withdrawal was found to be a critical factor in patients' response, both in terms of the rate and extent of improvement during the treatment stage, and presence or absence of deterioration during 'weaning' and follow up. No difference in response between type of behavioural problem and methods of treatment or weaning were found.

Preferences for behavioural, analytic and gestalt psychotherapy.

Abstract: This study investigated preferences for behavioural, analytic and gestalt psychotherapy among a sample of 40 SES class III and IV adult females and 67 college freshmen who had never been actual therapy patients. A scaled survey assessed general preference, preference given an imagined long-standing depressive disorder, preference given an imagined specific phobia, and preference for the therapist-patient relationship. Three audio tapes were designed, each describing one of the modalities. High inter-rater reliability and agreement were determined by three independent judges. Results showed that young females had a general preference for gestalt therapy. Young and old females, but not young males, significantly preferred behavioural therapy for a specific phobia. Under forced-choice conditions the group as a whole significantly preferred gestalt therapy. No differences were found for the relationship or preference given a depressive disorder. Preference was hypothesized as a cognitive structure with potential use in therapist-client matching.

Capgras: case study and reappraisal of psychopathology.

Abstract: A case of the Capgras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.

Locus of control and contraceptive knowledge, attitudes and practice.

Abstract: A series of 100 interviews with women attending ante-natal clinics at two Sydney public hospitals assessed their contraceptive knowledge, attitudes, and practice and locus of personal control (whether they believed they controlled their own lives). Multiple regression analyses showed that locus of control was significantly related to their attitudes to contraception, but not to their contraceptive knowledge or practice. The implications of that finding for family planning programmes and sex education are discussed.

Contrasting resources in disturbed and non-disturbed family systems.

Abstract: Previous research has shown that problems in family functioning and psychological disturbances in children are closely related. To increase understanding of this complex interaction the present review sets out to make explicit certain aspects of the relationship between child psychopathology and the quality of family life. The usefulness of the concept of resources for analysing major aspects of family functioning (contextual, intra-familial and extra-familial) is discussed within a systems framework and is then applied to a wide range of empirical studies which relate important features of family functioning to disturbed behaviour in children. It is found that interpersonal conflict in the lives of parents before marriage may severely constrain their own psychological development. When the psychological effects of such early disadvantage are amplified by marital conflict other family members are also affected. The notion of resources requires such disabilities to be assessed as well as directing attention to non-family interactions which offer compensating supports.

Transitional space in psychotherapy and theatre.

Abstract: Winnicott (1971 a) emphasized the importance of transitional space in play and psychotherapy, and hinted at its relevance in other areas of cultural experience. This paper compares and complements Winnicott's ideas with those of other writers and especially with the point of view of the theatre director. Both psychotherapy and theatre require a special frame or boundary; they both demand toleration of paradox and willing suspension of disbelief; and both involve repetition and re-enactment in the presence of the other.