An Application of the Concept of the Therapeutic Alliance To Sadomasochistic Pathology

This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66889/2/10.1177_00030651980460031301.pd

Response of a Lake Michigan coastal lake to anthropogenic catchment disturbance

A paleolimnological investigation of post-European sediments in a Lake Michigan coastal lake was used to examine the response of Lower Herring Lake to anthropogenic impacts and its role as a processor of watershed inputs. We also compare the timing of this response with that of Lake Michigan to examine the role of marginal lakes as ‘early warning’ indicators of potential changes in the larger connected system and their role in buffering Lake Michigan against anthropogenic changes through biotic interactions and material trapping. Sediment geochemistry, siliceous microfossils and nutrient-related morphological changes in diatoms, identified three major trophic periods in the recent history of the lake. During deforestation and early settlement (pre-1845–1920), lake response to catchment disturbances results in localized increases in diatom abundances with minor changes in existing communities. In this early phase of disturbance, Lower Herring Lake acts as a sediment sink and a biological processor of nutrient inputs. During low-lake levels of the 1930s, the lake goes through a transitional period characterized by increased primary productivity and a major shift in diatom communities. Post-World War II (late 1940s–1989) anthropogenic disturbances push Lower Herring Lake to a new state and a permanent change in diatom community structure dominated by Cyclotella comensis . The dominance of planktonic summer diatom species associated with the deep chlorophyll maximum (DCM) is attributed to epilimnetic nutrient depletion. Declining Si:P ratios are inferred from increased sediment storage of biogenic silica and morphological changes in the silica content of Aulacoseira ambigua and Stephanodiscus niagarae . Beginning in the late 1940s, Lower Herring Lake functions as a biogeochemical processor of catchment inputs and a carbon, nutrient and silica sink. Microfossil response to increased nutrients and increased storage of biogenic silica in Lower Herring Lake and other regional embayments occur approximately 20–25 years earlier than in a nearby Lake Michigan site. Results from this study provide evidence for the role of marginal lakes and bays as nutrient buffering systems, delaying the impact of anthropogenic activities on the larger Lake Michigan system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43091/1/10933_2004_Article_1688.pd

A Metaheuristic Framework for Bi-level Programming Problems with Multi-disciplinary Applications

Bi-level programming problems arise in situations when the decision maker has to take into account the responses of the users to his decisions. Several problems arising in engineering and economics can be cast within the bi-level programming framework. The bi-level programming model is also known as a Stackleberg or leader-follower game in which the leader chooses his variables so as to optimise his objective function, taking into account the response of the follower(s) who separately optimise their own objectives, treating the leader’s decisions as exogenous. In this chapter, we present a unified framework fully consistent with the Stackleberg paradigm of bi-level programming that allows for the integration of meta-heuristic algorithms with traditional gradient based optimisation algorithms for the solution of bi-level programming problems. In particular we employ Differential Evolution as the main meta-heuristic in our proposal.We subsequently apply the proposed method (DEBLP) to a range of problems from many fields such as transportation systems management, parameter estimation and game theory. It is demonstrated that DEBLP is a robust and powerful search heuristic for this class of problems characterised by non smoothness and non convexity

Cognitive and psychiatric symptom trajectories 2–3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK

Background COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2–3 years, and whether symptoms at 2–3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2–3 years were associated with occupation change. People with lived experience were involved in the study. Findings 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2–3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16–1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2–3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2–3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0–48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0–17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2–3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6–31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04–2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21–1·98] for every point increase in CCI-20). Interpretation Psychiatric and cognitive symptoms appear to increase over the first 2–3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19. Funding National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research

Officer training and the quest for efficiency in the Royal Canadian Navy 1939-1945

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN025801 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Wilfred Bion's Letters to John Rickman (1939–1951)Introduction

This is a collection of 29 letters, 27 from Wilfred Bion to John Rickman, one addressed to Mrs Rickman and one from Rickman to Bion. These letters have been fully transcribed, annotated and published for the first time and offer a rare glimpse into the blossoming relationship between the two men and the gradual emergence of Bion's intellect through his work in War Office Selection Boards (WOSBs), the Northfield Military hospital and the exploratory groups at the Tavistock Clinic.Through this material it becomes evident that Bion's fascination with the work undertaken at WOSBs had more to do with the social ramifications of the principles and ideology applied there rather than with particular techniques per se, such as ‘leaderless groups’. Furthermore, the reader becomes witness to Rickman's profound influence on Bion's analytic work and in cultivating his interest in therapeutic institutions, ultimately leading to their groundbreaking work at Northfield Military hospital. While Bion's descriptions of his post-war group work at the Tavistock Clinic offer the first signs of his unique theory and technique on the exploration of group dynamics. The continuation of their correspondence until Rickman's untimely death is a testament to their strong collegial and personal relationship which transcended analytical work and other professional engagements. </jats:p

Without mercy: The immediate impact of group size on lynch mob atrocity

Two independent research traditions have focused on social contributions to lynching. The sociological power threat hypothesis has argued that lynching atrocity will increase as a function of the relative number of African Americans. The psychological self-attention theory has argued that lynching atrocity will increase as a function of the relative number of mob members. Two series of analyses (one using newspaper reports and the second using photographic records) using different and nonoverlapping samples of lynching events rendered a consistent pattern of results: Lynch mob atrocity did not increase as a function of the relative numbers of African Americans in the county population but it did increase as a function of the relative numbers of mob members in the lynch mob. Discussion considers the implications of these results