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CHAPTER SIX. Evolving patterns of parental containment of a young child communicating through not eating or speaking

Jeanne Magagna Karnac Books ePub

Jeanne Magagna

The development of symbolic functioning, the development of language, and the capacity for play are all influenced by the way in which the child’s caregivers, usually the parents, respond to the child’s needs. Obviously the young child’s way of interacting with the parents influences the arousal of tender feelings in them, and elicits their benign and attentive care-giving responses. My philosophy incorporates the notion that parental work should accompany all individual therapeutic work with a child. Parents are with a young child at least 17 hours daily and potentially can be very well placed to effect deeper and more lasting transformation in the child’s personality. For this reason, it is important that they be helped to do so via family therapy or parental therapy, accompanying individual psychotherapy, and perhaps speech therapy for the child. This chapter describes family and parental psychotherapy when a child has difficulty with both speaking and eating. (Feeding/eating difficulties often accompany difficulties in speaking.) I shall examine three types of parental containment of a child’s anxieties and show how psychotherapy can facilitate a transition to a type of parental containment that aids the development of the young child’s psychological capacities to speak and to eat. This therapy represents the type of therapy that can accompany individual child psychotherapy in the presence of the mother, as described in Chapter Seven.

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Medium 9780253009227

4 - A Future for Whom? Passing on Billboard Liberation

Alison Kafer Indiana University Press ePub

Passing on Billboard Liberation

[Advertising] is a world that works by abstraction, a potential place or state of being situated not in the present but in an imagined future with the promise to the consumer of things “you” will have, a lifestyle you can take part in.

—Marita Sturken and Lisa Cartwright, “Consumer Culture and the Manufacturing of Desire”

“SUPER MAN,” THE billboard exclaims, the unfamiliar gap between the two words emphasizing both the noun and its adjective. Below this phrase is the word “STRENGTH,” followed by the imperative “Pass It On.” At the bottom, in small print, runs the name and web address of the organization behind this public relations campaign: Values.com/Foundation for a Better Life. The “super man” referenced in the caption is, of course, the late Christopher Reeve, the white actor who starred in a series of Superman films in the 1980s before becoming a quadriplegic in a riding accident in 1995. A black-and-white photograph of Reeve's head and shoulders consumes the left half of the billboard; the only marker of Reeve's disability is the ventilator tube that is just visible at the bottom of the frame. Reeve smiles slightly, looking thoughtfully into the camera and the eyes of passersby.

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Medium 9781855753778

2 Situating Anorexia

Susie Orbach Karnac Books ePub

Anorexia nervosa, first reported by Richard Morton in 1694,1 has shown a dramatic rise during the past twenty years, and more especially in the last decade.2 It is no longer a physician’s curiosity. Nearly every branch of medicine and psychiatry, including dentistry, gastroenterology, and gynaecology, meets with anorectics in the course of regular practice, and many areas of medicine now contribute to the growing body of literature being assembled about the etiology, course and treatment of anorexia nervosa. This account of anorexia, together with the explanation offered for its recent dramatic rise, builds on work in women’s psychological and social development within two areas of scholarship: theoretical and clinical work on the construction of a feminine psychology,3 and theoretical and clinical work on earing problems in general.4

The rise in the incidence of anorexia nervosa provides us with an unusually visible example of the way in which psychic structure and symptom formation are determined by three factors: the social climate of a period; particular models of parenting; and the attempt of each generation to find its place in the world. This section of the book examines how these influences interact and how the tensions within each one are expressed. In trying to explain the features of this distress symptom, I will draw on sociological evidence important in explaining its locus.

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Medium 9781780648583


Butler, C.D. CABI PDF


Climate Change, Food and Energy:

Politics and Co-benefits

Ole Faergeman

Department of Cardiology B, Aarhus University Hospital,

Aarhus, Denmark

Can we make actual in our minds the sometimes urgent things we say we know?

(Wendell E. Berry, 2012 Jefferson Lecture, National

Endowment for the Humanities, 23 April 2012)

24.1 Introduction

The many manifestations of climate change are closely related to how billions of people obtain their food as well as their fuel. One relationship is bidirectional. Obtaining food and fuel contributes to climate change, and climate change and what we do about it affects the production of food and fuel. Another is the causal relationship between climate change and human disease.

It has at least two facets. Climate change can be a cause of human diseases such as malnutrition and certain infections, whereas other diseases such as the most common forms of cardiovascular disease share causes with climate change.

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Medium 9781855759077

CHAPTER FOUR: Separation difficulties and parental input

Maria Pozzi Monzo Karnac Books ePub


In this chapter, I describe two families, the first one in greater detail than the second one. Both these cases have been published elsewhere in modified versions. The two families could have been easily included in the chapter on bereavement and loss, reflecting the fact that many problematic situations are rooted in a difficulty in negotiating depressive feelings and mourning.

The first case is about a little girl, the only child in the family, who was unable to separate from her mother and to start nursery school. Her mother was also stuck with issues of separation and could not contain her daughter’s distress.

The second case is about a little boy who could not separate from his mother to go to nursery, and the mother who was unable to help him because she had not mourned the death of a previous baby.

The Health Visitor had referred Poppy and her mother directly to me, after having attended a discussion group for Health Visitors. She felt unable to go any further with this family, the Greens, as I shall call them. In her letter, the Health Visitor wrote that, already at the age of eight months, Poppy would become very upset when strangers looked at her, so that the developmental checks were difficult to complete. Poppy was three years and four months old at the time of the referral. She was so deeply distressed when left by her mother at the nursery that her mother had given up taking her there.

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Medium 9781855755161

11 The relationship between what the psychoanalyst hears and what the dermatologist sees

Jorge Ulnik Karnac Books ePub

In “Pathways of mutual influence”, Freud suggests that every modification in the field of biological needs and functions can have an influence on the erogenicity linked to the particular organ that carries out these functions. And likewise, every alteration in an organ’s erogenicity can also affect its biological functions (1905a, pp. 205, 206). If we were to take the skin as an example, we could say that dry skin which has not received the necessary hydration, or sunburnt skin which has not received the necessary solar protection, could both participate in different ways from normal skin in what Freud calls the general current of sexual instinct. And vice versa, highly erotized skin, or in contrast, minimally stimulated skin could become ill in different ways: generating itching, becoming infected with herpes, showing blisters or even eczema (see Chapter 3, section 3.3).

A patient who had a strongly eroticised pharyngo-nasal area used to say that he liked grappa, an alcoholic drink which produced in him a feeling of warmth on the palate that rose up like fire to his nose. In addition, he had nasal polyps and used to snore at night. He had a laser operation to burn away part of his soft palate in order to allow him to inhale more air through the respiratory tract and thus stop snoring. The result was a large inflammation in the area, which later became infected, causing his throat to ache and sting. The snoring persisted. Additionally, he found it very difficult to enjoy life, in particular the things he liked most, as if he were unable to find what brought him pleasure “palatable”. The bucco-nasal mucus, the need to breathe and to swallow, and the erotogenic difficulty of tasting things all followed pathways of mutual influence.

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Medium 9781855753600

3. The therapist’s inner instruments

Janine Sternberg Karnac Books ePub

In order to examine what the experience of infant observation might contribute to the equipment of a psychoanalytic psychotherapist, it is necessary first to examine which capacities and skills are considered to be relevant for a therapist. However, these issues are not well addressed in the literature, which makes it all the more important to draw a distinction between capacities and skills. I understand “capacities” to refer to the qualities of the personality, the generalized approach of the practitioner; “skills” (I am using “skills” and technique as synonymous), on the other hand, could be translated as the individual tools that are used within the session. Skills may on occasion exist without the underlying capacities, and skills can certainly be practised and honed. Obviously there are ways in which the two interact: for example, the capacity to bear uncertainty and wait for something to emerge may display itself in the session in the therapist’s silence and lack of questioning. However, I think we can be clear that being silent and not questioning may not in itself mean that the practitioner has the capacity to bear uncertainty. Because technique arises from and is closely interwoven with capacities, it is difficult to write about them separately in a cogent way. Some skills are readily understandable applications of capacities, whereas others are not. We might question whether, for example, a particular way of listening is a skill or a capacity. In this chapter I have concentrated on capacities and note the technique that arises directly out of them; in chapter 4 I address those aspects of technique that seem less closely tied up with capacities.

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Medium 9781855750203

7. Changing from liaison to consultation in the course of clinical work: consultation in action

Robert Bor Karnac Books ePub

Through experience we have learned that it is helpful if clinical work is preceeded by consultation, wherever possible. In some cases, consultation can obviate the neccessity for further clinical work. A new referral provides an oportunity for changing the emphasis from liaison to consultation work. In the example set out below, a ward sister telephoned our counselling unit in the hospital and asked for one of the counsellors to come up to the ward as soon as possible. She would not provide any further information over the telephone as she said it was dificult to speak from the nurses’ station. It was a ward on which six months previously, there had been complications around counselling, testing and diagnosing a heterosexual man with HIV. In a case review, it was felt that if the counselling team had been involved in the case at an earlier stage, some of the management problems may not have been quite as serious. The first clue, therefore, from the new referral, was that there was considerable anxiety over the management of a similar case and that counsellors should be involved at a very early stage.

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Medium 9781576759448

CHAPTER SEVEN Following the Five Directions

Laura van Dernoot Lipsky Berrett-Koehler Publishers ePub

As you begin your journey, remember that you are not alone. Nearly every spiritual tradition has created stories or texts to guide the way. Any one of these might help you to arrive at answers that will allow you to benefit yourself and others to the fullest extent. For this book, I have created the Five Directions as a navigational tool. It is our compass: It will help us to continuously assess how we are doing and what we need.

In developing the Five Directions, I have drawn upon a vision of the world that was common to many early cultures in Asia, the Americas, and even in Europe. In addition to the four cardinal directions—north, east, south, and west—the ancients envisioned a fifth direction. This was sometimes seen as the core element that linked Earth to both the heavens and the underworld. It has been variously described as “the center,”“here,” or the “spiritual direction.”

The ancients understood this fifth direction to be integrally connected to the other four. In the modern world, we often think of north, east, south, and west as little more than the letters at the ends of arrows pointing our way across the earth’s terrain. To the earlier peoples, of course, each of the directions was linked to natural phenomena—and therefore with colors, materials, and seasons, as well as with their metaphorical qualities. East, for example, is the direction of dawn. To the Chinese, east was often associated with springtime, the colors green and blue, and wood; to the Cherokee nation, on the other hand, east was associated with the color red, reawakening from winter, and new life.

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Medium 9781855753983

CHAPTER THREE: The symbolic and the concrete: psychotic adolescents in psychoanalytic psychotherapy

Didier Houzel Karnac Books ePub

Julia Pestalozzi

Unique disturbances in symbolization are characteristic of the pathology of schizophrenia. Drawing on the case vignette of a psychotic adolescent, I discuss theoretical problems in the symbolization process in general and then in psychosis, in particular the relation between “concretism” as a thought disorder and other psychotic defences. The ability to symbolize, on the one hand, and to maintain sufficiently stable ego boundaries on the other, are examined in their relation. My clinical experience supports my hypothesis that there is a close relationship between the impairment of the symbolization process in the adolescent or adult psychotic patient and his/her inability to engage in symbolic play as a child. Special attention is paid to the role of early trauma and consequent pathology of object relations for disturbances of symbolic play in childhood. Regression to concrete thinking is understood as the chance of the psychotic patient to give some meaning to reality in an unreal, delusional world and as his/her last chance to communicate at all. Conclusions are drawn for psychoanalytic techniques in the treatment of patients who are deeply regressed in this respect. Special attention is given to the particular circumstances and challenges of adolescence and to providing psychoanalytic psychotherapy to adolescent psychotic patients.

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Medium 9781855758094

CHAPTER TWELVE: Diagnosing mental illness

W.M. Bernstein Karnac Books ePub

Scientific understanding progresses through three basic stages: description, prediction, and control. Careful observation and description of salient, palpable aspects of natural phenomena is where understanding begins. It is the “fire and water” stage: an Aristotelian differentiation of one thing from another. Once objects are defined, the questions become: “How are these things related in time and space?” “Are they in causal relationships?” This is where experimental science comes in. Galileo's experimental studies of gravity stand in contrast to Aristotelian methods based on the hope that describing every last detail on an object's surface will reveal some “essence” or truth lying underneath.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) contains descriptions of mental conditions. The first DSM was issued in 1952. It has been revised four times to date and a fifth revision is expected in 2013. The impetus for creating such a manual was the wide disagreement about what constituted “mental illness”. The old story was that if you had ten psychoanalysts examine the same patient you would get back ten different diagnoses. It made sense to try to develop reliable categories for psychiatric disorders.

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Medium 9781780642994

22 Nutrition Education and Food Security Interventions to Improve Complementary Feeding in Cambodia

Thompson, B., Amoroso, L. CABI PDF


Nutrition Education and Food Security

Interventions to Improve Complementary

Feeding in Cambodia

Nutrition and Consumer Protection Division (AGN),*† Agriculture and

Consumer Protection Department (AG)

Food and Agriculture Organization of the United Nations, Rome, Italy


Improving child feeding during the first 2 years of life is crucial for preventing and reducing chronic undernutrition and micronutrient deficiencies. This project aimed to improve food security (FS) and dietary diversity, with focus on infant and young child feeding between the ages of 6 and 23 months, in vulnerable rural households in Cambodia. It covered 356 households in nine provinces. Integrated with targeted FS actions, the formative research technique ‘Trials of improved practices’ (TIPS) was used to test the acceptability and feasibility of complementary feeding recipes, and involved families in making the best possible use of locally available resources, with emphasis on animal source foods, fruits and vegetables, and a little oil for improved child feeding. A total of 15 nutritionally improved recipes (rice based or sweet potato/taro based, enriched with a variety of readily available local foods) were developed. Approximately 70% of households achieved better dietary diversity using locally available foods 3–5 times a week. Items in a child’s diet increased from two to three food items to ten or more. Other notable achievements included the acquisition of knowledge and skills by mothers and caregivers, and information sharing with nonparticipants, suggesting a good potential for peer education by TIPs participants. The improved recipes and recommendations were disseminated to 9000 households during the period January to 30 April 2011 through community nutrition promoters trained by the project. The results support the need for combining dietary counselling with targeted FS actions aimed at increasing nutrient-dense local foods.

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Medium 9781780643960

6: The Continuing Co-evolution of Mycobacterium tuberculosis and Homo sapiens

Edited by H Mukundan, Los Alamos National Laboratory CAB International PDF


The Continuing Co-evolution of

Mycobacterium tuberculosis and

Homo sapiens

Clifton E. Barry III*

National Institutes of Allergy and Infectious Disease, Bethesda, USA

Introduction and Historical Context

Tuberculosis (TB) is a disease of antiquity, with evidence of human disease extending through most, if not all, of recorded human history. The oldest human remains to show evidence of disease were found in Turkey and dated to approximately 500,000 bp (Before

Present) (Kappelman et al., 2008). This specimen of Homo erectus displayed pathology consistent with TB meningitis on the endocranial surface of a frontal bone; although molecular evidence of infection was not obtained, leading other authors to question this diagnosis

(Roberts et al., 2009). Numerous studies have more conclusively identified TB DNA from somewhat more recent human remains from, for example: Egyptian mummies from 2050 bc to 500 bc (Zink et al., 2001, 2003); Peruvian mummies from 1000 bp (Salo et al., 1994);

Lithuanian skeletal remains from the 15th to

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Medium 9781937554637

3 Managing Financial Processes

R. Jennifer Cavalieri Sigma Theta Tau International ePub

Identifying and managing the financial aspects of a clinical trial is valuable regardless of whether an investigator is developing a study funded by the investigator’s “own time and dime,” negotiating with an industrial sponsor, or developing a budget for a research proposal to a federal agency. There are so many variables involved with budgets and payments that many investigators may just take a “best-guess” approach and deal with the consequences.

This chapter provides strategies for evaluating whether doing a study is feasible, tips on the contract process and the contract language, and examples of user-friendly research accounting tools for new investigators or finance administrators who are new to research. You will also find examples of how to gain a better understanding of site expenses and ways to leverage site resources. While there are no “one-size-fits all” approaches or processes, the real-world examples provided can help you understand the variables and customize a process for more control of research finances for your research site.

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CHAPTER TWO. “Milo was a normal boy”

Jeanne Magagna Karnac Books ePub

Milo’s mother

Milo was a normal healthy eight-year-old boy. Until…

The illness started as an apparently harmless ‘flu bug’, but within days had him writhing with pain, and calling out. He was admitted to hospital with suspected appendicitis, but not operated on. His illness was blamed on a “virus”. After a few days, he moved to a more specialised children’s hospital. He was in great distress, crying out, not eating and not taking interest in any activity. It was clear that the medical and surgical staff did not know what was the matter with him, although he had several physical tests. At this stage Milo was repeatedly calling out “I have a bad pain” and “It’s getting worse”. This was all he said, he could not converse, but clearly wanted us there to reiterate his distress, and to comfort him. I sensed irritation from everyone on the ward. Suddenly Milo whispered to us “It hurts to talk”, and went silent. His silence gave a certain relief to others on the ward. However, he resumed calling out as before on the following day. We were told that Milo had a psychological problem, and he was seen by a psychiatrist.

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