Showing papers in "British Journal of Medical Psychology in 1995"

Why do psychiatrists neglect religion

Abstract: This paper analyses a number of possible reasons why modern psychiatry has neglected the therapeutic effects of religious beliefs. The gap which exists between psychiatry and religion is a relatively recent phenomenon and is partly related to psychiatry's progress in elucidating the biological and psychological causes of mental illness, rendering religious explanations superfluous. In addition, it is often assumed that religious attitudes are inevitably linked with phenomena such as dependence and guilt which are frequently seen as undesirable. Psychiatrists and psychologists tend to be less religiously orientated than their patients, which may further increase the professional's idea that religious beliefs are associated with disturbance. However, it has long been suspected that a positive relation exists between religion and mental health, and recently, the psychology of religion has provided empirical support for this idea. Psychiatry faces the challenge to accommodate this evidence into theory and practice.

Psychopathology and personal agency: Modernity, culture change and eating disorders in South Asian societies

Abstract: The cultural contribution to psychopathology may become more salient in situations of social change, but it remains difficult to distinguish individual agency among wider social and economic transitions, such as 'modernization' or simply 'culture change', which carry the potential for recourse to new patterns. Eating disorders, a biosocial pattern once identified exclusively with European societies, do occur among South Asian women including those living in the West. This seems not just a simple appropriation of contemporary Western ideals of female morphology--the 'fear of fatness'-but a reassertion of an instrumental strategy of self-renunciation in situations of experienced constraint.

Pornography and the paedophile: Is it criminogenic?

Abstract: There are few case-study-based reports of the role of pornography in the lives of sex offenders in contrast with numerous studies of a survey and statistical nature. Very little is known about the ways in which offenders process pornographic and other erotic materials as part of their offending patterns. The research reported in this study was based on case studies of fixated paedophiles in a private clinic for sex offenders. The men were interviewed about a range of matters including their offending, their psychosexual histories, pornography, fantasy, and sexual abuse in childhood. Commercial pornography was rarely a significant aspect of their use of erotica although some experience of such materials was typical of the men. Most common was 'soft-core' heterosexually oriented pornography. Explicit child pornography was uncommon. However, offenders also generated their own 'erotic' materials from relatively innocuous sources such as television advertisements, clothing catalogues featuring children modelling underwear, and similar sources. In no case did exposure to pornography precede offending-related behaviour in childhood. All of the offenders had experienced childhood sexual abuse by adults or older peers. The relationship of these findings to previous research and implications for legislation are noted. Language: en

Life-events and the course of chronic fatigue syndrome.

Abstract: Life-events have been implicated in the onset and course of various illnesses. The present study examined their role in chronic fatigue syndrome, in the context of the ongoing illness. Using the PERI list, events experienced during the past year were elicited in interviews with 130 patients. The analyses were restricted to those events implying moderate or major life change, and separate analyses were carried out for positive and negative events. Positive events were found to be associated with lower scores for fatigue, impairment, anxiety and depression, as assessed at the time of the life-events interview, and these relationships were also significant when prior scores at the beginning of the year were statistically controlled. Negative life-events were associated with higher anxiety, but were unrelated to the other measures. It was concluded that positive life-events and experiences may contribute to the process of recovery in chronic fatigue syndrome, though their occurrence may also be facilitated by a preceding lifting of symptoms.

The ideas and experiences of pregnancy and childbirth of Asian and non‐Asian women in East London

Abstract: This study examined differences between the ideas and experiences of pregnancy and childbirth of Asian and non-Asian women giving birth in East London, and sources of variability in Asian women's accounts. In line with the findings of previous research, Asian women's ideas about diet in pregnancy, the gender of their children and postnatal care (e.g. the need for rest and recovery, and restrictions on their activities) were influenced by cultural beliefs and practices. However, in other ways Asian women demonstrated a strong commitment to Western maternity care. In contrast to some other studies Asian women wanted their husbands or partners present at delivery, indicating the extent to which traditional ideas are being modified. Qualitative analysis of Asian women's fuller accounts indicated that women subscribed to traditional practice as well as Western maternity care. Acculturation or familiarity with Western ideas about maternity care was associated with variability in Asian women's ideas and experiences, in line with previous research. However, in spite of frequent assumptions about its significance, religion was not associated with variability in Asian women's ideas and experiences. Parity, however, was a major variable, for Asian and for non-Asian women, suggesting that the first birth has different significance for parents than subsequent births. The implications for the provision of maternity care are discussed, especially the need to go beyond stereotypical views based on women's ethnicity or religion to consider the beliefs and preferences of women as individuals and their personal circumstances.

Therapist contributions to psychotherapeutic assimilation: an alternative to the drug metaphor.

Abstract: A psychotherapist's verbal interventions may be understood as promoting a client's eventual improvement by facilitating developmental change processes within the client. This approach is an alternative to the traditional search for statistical links between aggregates of therapist interventions and global outcome measures. Our approach employs models of clients' assimilation of problematic experiences within problem domains and therapists' implementation of theoretically specified aims. In an empirical illustration, one client's change within a particular problem domain and its links with therapist interventions were assessed qualitatively across the course of brief psychodynamic-interpersonal treatment.

Migration, traumatic bereavement and transcultural aspects of psychological healing: loss and grief of a refugee woman from Begameder county in Ethiopia.

Abstract: Post-traumatic stress disorder (PTSD), grief and bereavement may be manifested in a variety of ways in different populations and cultures. Following is the description of an Ethiopian immigrant woman from the county of Begameder whose baby died during the long exodus from Ethiopia and who, because of the different environmental conditions in 'the new land', could not undergo traditional purification rituals. Subsequently she suffered various cultural signs and symptoms of PTSD due to complicated bereavement and, on top of that, was seen as 'impure' by both her family and herself. For two years her symptoms were attributed to a severe form of bronchial asthma and she did not respond to treatment. When eventually brought to psychiatric attention, she was erroneously diagnosed as suffering from psychosis and treated inappropriately. Accurate anamnesis, combined with adequate counselling, provided the correct diagnosis, and a combination of supportive psychotherapy, traditional healing and purification rituals resulted in a resolution of the syndrome. Thirty months of follow-up showed that the results of the treatment were stable and satisfactory. The specific aspects of cultural manifestations of grief and mourning, the meaning of hallucinations not in the context of psychosis, purification rituals, the role of traditional healing among immigrants from a totally different culture, and the difficulties that helpers may have interpreting and making sense of the immigrants' behaviour and complaints are discussed.

Miscarriage experience and the role of support systems: A pilot study

Abstract: A pilot study was carried out with 24 women with the main aim of examining retrospectively the experience of miscarriage to indicate issues worthy of further investigation. It was found that the psychological sequelae following miscarriage appear to be similar to the bereavement process. Whilst social support from partners, relatives and friends was helpful, subjects did not perceive that support from professionals and the wider community was always adequate.

Life-events and psychiatric symptoms in a general psychiatry clinic: the role of intrusion and avoidance.

Abstract: Recent literature has been concerned with the relationship between life-events and psychological symptoms, and more particularly studies of communities subsequent to disasters have suggested the presence of intrusive cognitions to be a mediating variable. In this investigation new patients presenting to a general community psychiatric clinic over a four-month period completed a brief life-event scale, the Impact of Event Scale (IES) and the 28-item General Health Questionnaire (GHQ). Appropriate statistical methods were employed to model the intervening role of IES scores between numbers of life-events and subsequent psychiatric symptomatology. Data was collected on 48 subjects, for whom it was shown that IES score accounted for the reporting of psychiatric symptoms following adversity. It appeared to be the dimension of cognitive intrusion that mediated this effect, with cognitive avoidance occupying a subsidiary, reactive role. There was also evidence of specific relationships between intrusion and anxiety and somatic subscales of the GHQ, and between avoidance and depression. Despite small numbers and simple measures, the findings supported the post-disaster studies, and raises further questions about the emotional processing of adversity.

The role of the father in parental postnatal mental health

Abstract: Contrary to idealized images of parenthood, the months immediately following childbirth are characterized by enhanced rates of parental mental illness and filicide. In this paper we consider fathers and their role in the postnatal well-being of the parturient couple. The process of becoming a father is influenced by not only the man's internal and external experiences of 'father', but also the woman's, since the new infant's relationship with father is mediated by mother and her conjugal relationship with father. When a couple's prenatal relationship is based on a system of shared parental constructs involving a denigrated father and overvalued mother and a concomitant intolerance of the idea of a creative (Oedipal) couple, they will experience particular difficulties in adjusting to the new family configuration. In working with individuals or couples who have experienced post-partum psychological difficulties it is important to remember that not only maternal imagos but also paternal and conjugal ones need to be addressed.

A case study of female genital self-mutilation in schizophrenia.

Abstract: A case of deliberate genital self-mutilation in a woman with familial schizophrenia is presented. Such behaviour, though well recognized in females with severe personality disorders, is extremely rare in female psychotics. The genital mutilation may be partially understood as a consequence of delusionally motivated action against a background of low self-esteem, premorbid body-image preoccupation, forced early sexual activity and hence profound ambivalence towards adult sexuality. Dealing with this constructively was hampered by a cognitive style characterized by impaired reasoning and reality testing. Tests of reasoning, judgement and reality testing showed deficits, and computed tomography revealed dilatation of the left frontal ventricular system. Both neuropsychological and psychodynamic factors appeared to be of relevance in this case.

Male genital self-mutilation : a case report

Abstract: A review of the literature on self-mutilation of male genitalia and/or auto-castration reveals that they are infrequent and usually related to psychoses or toxic states. In this report the authors present a case of a 17-year-old non-psychotic Japanese male who mutilated his genitalia under clear consciousness because of a conflict over his frequent masturbation.

Post-adoption incest and phenotypic matching: experience, personal meanings and biosocial implications

Abstract: Recent changes in British law have enabled adults who were adopted when young to trace their biological relatives. The reported frequency of incestuous sentiments and relationships in these reunions, together with the individual experiences and the meanings which are attached to them, challenge fundamental assumptions of both Westermarck's and Freud's theories. Post-adoption incest is characterized experientially by a romantic search for attachment followed by a recognition of oneself in the other. The question of incest has been fundamental to biosocial theories of individual and cultural development. Some revisions are proposed, principally that adult sexual interests remain constrained both by early attachments and later phenotypic matching, reinforced by personal contingencies and cultural rules.

The paradoxical power of the depressed patient: a problem for the ranking theory of depression.

Abstract: The social ranking (or social competition) theory of depression suggests that the capacity for episodes of depressed mood evolved as a mechanism for inhibiting challenge. Depressed mood induces the sufferer to accommodate to low social rank, or to losing in social competition, or to adopting the one-down position in a complementary relationship (Price, 1991; Price, Sloman, Gardner, Gilbert & Rohde, 1994; Sloman, Price, Gilbert & Gardner, 1994). Thus depressed patients should be observed to forego the privileges of high rank and of winning, such as exercising social power and getting their own way. However, several commentators have noted that depressed patients often seem to be very powerful, and even appear to use their depression to manipulate others. This paper attempts to reconcile the theory to such observations.

Transference and counter-transference variations in the course of the cognitive-analytic therapy of two borderline patients: the relation to the diagrammatic reformulation of self-states.

Abstract: The cognitive-analytic therapy of two patients with borderline personality disorder is described. Patients and therapists completed post-sessional questionnaires which yielded measures of transference and counter-transference. The relation of changes in these to the sequential diagrammatic reformulation of the patients' self-states is considered.

Differentiation between patients with schizophrenia and borderline disorders in the Percept-genetic Object-Relation Test, PORT.

Abstract: Schizophrenics (12 males), borderline patients (12 males), and self-selected normal controls (11 males, 17 females) were compared using PORT (Percept-genetic Object-Relation Test), a projective test, diagnosis being on the basis of DSM-III and Kernberg's six descriptive borderline criteria. The aim of the study was to compare the three groups in order to distinguish the two clinical groups from the control group, but also to distinguish the borderlines from the schizophrenic patients with specified diagnosis. The two patient groups differed from the controls on 15 different PORT signs/patterns. In addition, the borderline patients and the three schizophrenics of unspecified diagnosis showed signs in PORT of dissolution anxiety, splitting, whole configuration (fusion) and sexualization as defence, which the schizophrenics with specified diagnosis did not, although catatonic/hebephrenic, simplex, and paranoid schizophrenics could be distinguished in the test. Characteristic of the schizophrenics was also diffusion of domains of object relationships. In a blind prediction study with PORT involving five male and five female patients with severe psychiatric disorders (diagnosed by DSM-III-R), borderline patients could also be distinguished satisfactorily from schizophrenics.

The elusive factor1 structure of the Inventory of Interpersonal Problems

Abstract: This paper reports data on the psychometric properties of the Inventory of Interpersonal Problems (IIP; Horowitz, Rosenberg, Baer, Ureno & Villasenor, 1988) obtained from a UK inner city sample of 286 out-patient clients presenting for cognitive analytic therapy or treatment in a sexual dysfunction clinic. The results are compared with those of Barkham, Hardy & Startup (1994): only moderate replication of their eight components in the raw data, and four bipolar components from analysis of ipsatized data were found. Split halves of the data were analysed and compared in order to explore the possible influences of clinical and demographic variables on the component structure.

The effects of varying information content and speaking aloud on auditory hallucinations.

Abstract: The aim of this study was to investigate why requiring hallucinating schizophrenic subjects to read aloud produces large reductions in reports of auditory hallucinations. In Expt 1 hallucinating subjects (N = 9) were required to sort cards quietly into one, two, four, 13 and 26 piles. It was shown that the large reductions in the reports of hallucinations produced by reading aloud could not be accounted for in terms of the information content of the task. In Expt 2 the subjects (N = 7) were required to place the cards into one or two piles quietly or whilst saying the colour of the card aloud. Sorting cards into two piles whilst saying the colour of the card produced the largest reductions in the reports of hallucinations. It was concluded that it was the requirement to make overt motor and verbal response that produced the large reductions in reports of auditory hallucinations in the reading-aloud task.

The process of coping with a gross anatomy exam during the first year of medical school

Abstract: A total of 42 freshman medical students were evaluated before a major exam, after the exam and before grades were announced and after grades were announced. They completed measures relating to mood, emotions, coping, social support and stakes. Significant time and academic performance differences were found in many domains.

Transpersonal processes: a bridge between object relations and attachment theory in normal and psychopathological development.

Abstract: This paper has three aims: (a) to present the further development of the concept of transpersonal processes and the bimodal theory of relational cognition; (b) to show how the bimodal concept illuminates developmental theory and facilitates the move from object relations theory toward a relational systems model; and (c) to show how the attachment paradigm and the notions of internal working models (Bowlby, 1973) and self-reflective capacity (Fonagy, 1991) are both congruent and synergistic with the transpersonal and bimodal concepts.

Power, boundaries, intersubjectivity.

Abstract: The first part of this paper is a brief overview of the keynote speech given by Jeffrey Masson at the Sixth Conference of the Society for Existential Analysis, London, entitled Issues of power in the psychotherapeutic relationship, in which Masson raised various questions about the assumptions of what constitutes the alleged inappropriate behaviour of therapists, and the boundaries of the professional role that must not be overstepped. These criticisms are begun to be addressed in this paper. The overall aim of this paper is to promote a sceptical and critical discussion of the psychotherapeutic relationship and a few of its founding assumptions.

An outbreak of copycat fire raising

Abstract: A dangerous outbreak of fire setting occurred on two wards of a Bristol Psychiatric Hospital, in which six patients set eight fires over a five-week period. One was the Intensive Care Unit, the other an admission ward serving the inner city of Bristol. Five of the six patients had moved between the two wards. The sequence of fires is in part explained by 'copycat' behaviour. The fires were set at a time when the hospital was particularly vulnerable because of major service changes. We emphasize the institutional and situational variables that led to disturbed behaviour in a vulnerable group of individuals, with inadequate controls over tension and anxiety.

A clinical concept of the self: the experiential being.

Abstract: This paper proposes a clinical concept of the self as experiential being. Such a concept offers the triple advantage of being non-reductive, introducing experience as a clinical unit of analysis and intervention, and viewing a representational capacity to experience as a crucial element towards the construction of 'T'. The central importance of 'experience' in health and disorder is addressed, followed by a characterization of the processes of 'going through', the integration of 'experience' into 'I' and the processes of defence, which are viewed from the perspective of the experiential being. Experience, or 'going through', has five defining characteristics: awareness, motivation, linking, learning and evolution. The processing of 'experience' on two levels, the representational level and the level of the experimental being, leads to the integration of experience into "I'. The owning of experience, and not defence, is seen as the key factor in health and disorder. As the capacity to own experience, which includes the owning of defence, is the key to the road to health, it is argued that clinical intervention must focus on the person's capacity to own all his or her experiences.

Subject matter and poetic devices in psychotics' poetry

Abstract: It has long been supposed that there is a connection between the mental processes of psychosis and those of creativity. The present study aimed to investigate this idea by means of a comparison between the poetic output of psychotics and that of normals, taking as its starting-point the notion that if there are observable differences between these two groups in terms of subject matter and linguistic features, this would suggest that creativity and psychosis are not to be identified with each other. Eighty poems by contemporary, non-professional poets (40 by psychotics and 40 by normals) were analysed on 11 different dimensions. The two samples of poems were highly similar on most of the dimensions investigated. The main differences found were in the incidence of self-analysis as a theme, reference to proper names and specific locations, and in the proportion of metaphors which fell into the category 'psychological/physical'. The two latter differences appeared to be largely a product of the first. It was concluded that although 'normal' and 'psychotic' poetic activities are not identical, they are closely related. This may be either because general poetic creativity does have psychotic features, or because the poetic function of language was relatively spared in at least this sample of psychotics.

Family therapy with 'invisible families'.

Abstract: This paper describes a therapeutic model for working with children in the care system who have severe behavioural problems. The model is an extension of consultation work and was developed from clinical material. It links some of the theories about the internal conflicts of children to their family history and ways of consulting with the professional network, to give a coherent framework for action. The advantages and shortcomings of this model are discussed and some preliminary results are reported.

Case report: Psychological response of a woman with schizo‐affective disorder on discovering she had ovarian cancer

Abstract: Studies have shown that medical illness in those with psychiatric illness often exacerbates symptoms (Hall et al., 1981). This paper reports the case of a 53-year-old Chinese American woman with schizo-affective disorder who surprisingly had a remission in psychiatric symptoms on discovering she had ovarian cancer.

Musical responsiveness and blocked capacity for intimacy: a comparison of music and psychology students

Abstract: The hypothesis that music serves a compensatory emotional need, specifically that blocked capacity for intimacy would predict musical responsiveness, was examined in musicians and psychologists. Music and psychology students completed a musical preference scale and measures of personal relationships and capacity for intimacy. Degree of musical responsiveness was significantly related to a blocked capacity for intimacy in music students but these measures were non-significantly negatively related in psychology students. For the latter group, musical preference (i.e. degree of liking for different kinds of music) and measures of blocked capacity for intimacy were significantly negatively related to reported time spent listening to music. The results for music students are consistent with the Freudian hypothesis of sublimation and extend the work of Machotka in the realm of visual arts to that of music. The results for psychology students, however, indicate that for them music is not serving an aesthetic function in the sense defined by Wallach (1959). The most plausible explanation for the difference between music and psychology students is in terms of anxiety as a mediating variable.