As Loewald pointed out, cogently, the basic view of external reality in psychoanalytic theory is negative. Accordingly, Freud’s perspective consists of a reality that exceeds the baby’s integrative capacities (Loewald, 1980, p. 23). It depicts as the norm an excessive influx of external reality that corresponds to the economics of trauma and is inflicted by an environment that does not adjust to the infant’s phase of development. Infancy and trauma go hand in hand, which leads Loewald to conclude that psychoanalysis “has not recognized, in its dominant current, that psychoanalytic theory has unwittingly taken over much of the obsessive neurotic’s experience and conception of reality and has taken it for granted as ‘the objective reality’” (Loewald, 1980a, p. 30) He contrasts the historic view, “the idea of an alien, hostile reality (a finished product imposed on the unsuspecting infant, from there on and forever after)”, with “the integrated, dynamic, reality (forever unfinished) on the elaboration and organization of which we spend our lives” (Loewald, 1980a, p. 32). This reality was historically and erroneously linked to the father, to whom submission is necessary:
The Sonics had their problems stopping other teams from scoring. They gave up at least
150 points in each of five games during the season. In one of those games, the Philadelphia
76ers scored 160 points.
The Sonics traded Hazzard to the Atlanta Hawks before their second season. In return they received Lenny Wilkens, a savvy point guard who was entering his 10th season in the
NBA. The Sonics showed some improvement and won 30 games
1968–69. Rule had an even bigger season. He averaged 24 points per game to rank sixth in the league. He also averaged 11.5 rebounds per game.
Wilkens, the team’s All-Star player that year, scored 22.4 points per game. His 8.2 assists per game were second best in the NBA. Still, the team was going through growing pains.
The Sonics endured a stretch of
OKLAHOMA CITY THUNDER
After Bob Rule suffered a serious leg injury early in the 1970–71 season with Seattle, he was no longer the star forward/center he had once been. Rule played a few more years in the NBA, but he was out of the league by 1974. After two seasons of averaging 24 and 24.6 points per game for Seattle, Rule averaged 15.1 points per game in 1971–72, most of which he played for the Philadelphia
Although Ubuntu supports a wealth of different applications, spanning
just about any subject you can think of, there are still occasions when it
may not completely meet your needs. For example, OpenOffice.org is a fully
featured office suite, providing all the functions you would expect and that
exist in other similar applications such as Microsoft Office. And it can
even read and write Office files. But it isnt totally compatible with
Office, because many documents display and print differently in the two
And why should OpenOffice.org be fully
compatible? Its a completely different program thats been independently
developed and approaches things in different ways that are completely
logical in its own frame of reference. Once you get used to it, you can
produce documents, spreadsheets, and presentations that are easily the equal
of any you can create in Office.
But what if you have to collaborate on documents with someone who uses
Office, while you use OpenOffice.org? You will almost certainly find that
you both introduce changes that dont display correctly on each others
computers. They may be little things like changed tab settings, different
page lengths, and so on, but these little things are also time-consuming to
Thinking creatively about continuing professional development
Gavin Newby and Stephen Weatherhead
Continuing professional development (CPD) is necessary and healthy in any modern healthcare system to ensure safe, effective, and up to date practice. It is vital at any stage in anyone's career; whether you are wet behind the ears or a wizened old hack. Ensuring practitioners recognise the importance of CPD and follow auditable programmes of knowledge updating forms the backbone of professional regulation and governance. Furthermore, it helps to encourage the best possible care for the people who access our services.
It is important to accept that in the real world of the modern UK healthcare economy, CPD can seem something of a tall order. It can feel like walking a tightrope when trying to balance the “core” aspects of one's role (e.g., face-face client sessions, writing letters and reports) with fulfilling one's developmental needs and professional interests in the context of straitened financial times. This can be particularly poignant when in the “conscious incompetence” phase of Maslow's developmental model (Maslow, 1987), a phase in which perhaps most of us spend most of our time.
A central goal of the clinical interaction between physician and patient is the gathering of information that will contribute to the patient’s proper evaluation and care. In the case of neurobehavioral disorders, deficits due to brain dysfunction can be recognized only after a thorough assessment of behavior has been completed. Many of the clinical data, of course, are elicited with a medical history, physical examination, elemental neurological examination, and appropriate laboratory, neuroimaging, and neuropsychological testing, but the assessment of mental status offers a particularly revealing, if challenging, portion of the clinical encounter. The mental status evaluation is in fact a foundation of behavioral neurology (Strub and Black 1993; Cummings and Mega 2003).
Experience in clinical medicine teaches that every disorder has a history. That is, the symptoms endorsed by a patient—or, as is true of many neurobehavioral disorders, described by informed observers—are the key phenomena of the clinical problem and highlight its beginning and evolution until the clinical encounter takes place. History-taking is a crucial component of clinical care, and seasoned clinicians can often be confident of a diagnosis solely on the basis of focused and informed elicitation of the history. The mental status examination is of course necessary and often discloses much additional useful detail, but in many cases this examination is confirmatory of what the clinician is already suspecting from the history. This principle holds as true for neurobehavioral disorders as for any others in medicine.