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ObjectiveIndividuals with temporal lobe epilepsy (TLE) often experience diminished quality of life (QoL). Although comorbid depression is one of the most recognized predictors of poor QoL in TLE, impairments in verbal memory (VM) and executive functioning (EF), have also been identified as risk factors, independent of other biological and psychosocial factors. In this study, we examine the contribution of depression, VM, and EF to QoL in 52 well-characterized medically-refractory TLE patients.MethodsQuality of life was assessed with the Quality of Life in Epilepsy (QOLIE-31) questionnaire and depression symptomatology was evaluated with the Beck Depression Inventory-II (BDI-II). Tests of VM included the California Verbal Learning Test-Second Edition and the Wechsler Memory Scale-Third Edition, Logical Memory and Verbal Paired Associates subtests. Tests of EF included the D-KEFS Category Switching and Color Word Interference Tests, and the Trail Making Test. Using these measures, a principal component (PC) was derived for VM and for EF. Hierarchical multiple linear regression analysis was used to evaluate the unique contributions of BDI-II Score, VM PC, and EF PC to the QOLIE-31 Total Score, while controlling for important clinical and demographic variables. Post-hoc analyses were also performed to examine the contribution of each variable to specific QOLIE subscales.ResultsOf the clinical variables, only number of antiepileptic drugs contributed to QOLIE scores. As expected, severity of depressive symptoms was the most significant predictor of QOLIE Total Score, explaining 43.4% of the variance in total QoL. The VM PC did not contribute to the QOLIE Total Score. Rather, our EF PC emerged as an important predictor of QoL, explaining an additional 5% of the variance, after controlling for clinical variables, depression severity, and VM performance.SignificanceThese findings suggest that a combination of clinical, affective, and cognitive factors influence QoL in patients with TLE. Designing interventions with careful attention to depression and EF may be needed to optimize QoL in patients with refractory TLE and potentially other epilepsy syndromes.

BackgroundMolecular markers of WHO grade II/III glioma are known to have important prognostic and predictive implications and may be associated with unique imaging phenotypes. The purpose of this study is to determine whether three clinically relevant molecular markers identified in gliomas-IDH, 1p/19q, and MGMT status-show distinct quantitative MRI characteristics on FLAIR imaging.MethodsSixty-one patients with grade II/III gliomas who had molecular data and MRI available prior to radiation were included. Quantitative MRI features were extracted that measured tissue heterogeneity (homogeneity and pixel correlation) and FLAIR border distinctiveness (edge contrast; EC). T-tests were conducted to determine whether patients with different genotypes differ across the features. Logistic regression with LASSO regularization was used to determine the optimal combination of MRI and clinical features for predicting molecular subtypes.ResultsPatients with IDH wildtype tumors showed greater signal heterogeneity (p = 0.001) and lower EC (p = 0.008) within the FLAIR region compared to IDH mutant tumors. Among patients with IDH mutant tumors, 1p/19q co-deleted tumors had greater signal heterogeneity (p = 0.002) and lower EC (p = 0.005) compared to 1p/19q intact tumors. MGMT methylated tumors showed lower EC (p = 0.03) compared to the unmethylated group. The combination of FLAIR border distinctness, heterogeneity, and pixel correlation optimally classified tumors by IDH status.ConclusionQuantitative imaging characteristics of FLAIR heterogeneity and border pattern in grade II/III gliomas may provide unique information for determining molecular status at time of initial diagnostic imaging, which may then guide subsequent surgical and medical management.

Biliary atresia (BA) is the leading indication for pediatric liver transplantation. Rhesus rotavirus (RRV)-induced murine BA develops an obstructive cholangiopathy that mirrors the human disease. We have previously demonstrated the “SRL” motif on RRV’s VP4 protein binds to heat shock cognate 70 protein (Hsc70) facilitating entry into cholangiocytes. In this study, we analyzed how binding to Hsc70 affects viral endocytosis, intracellular trafficking, and uniquely activates the signaling pathway that induces murine BA. Inhibition of clathrin- and dynamin-mediated endocytosis in cholangiocytes following infection demonstrated that blocking dynamin decreased the infectivity of RRV, whereas clathrin inhibition had no effect. Blocking early endosome trafficking resulted in decreased viral titers of RRV, whereas late endosome inhibition had no effect. After infection, TLR3 expression and p-NF-κB levels increased in cholangiocytes, leading to increased release of CXCL9 and CXCL10. Infected mice knocked out for TLR3 had decreased levels of CXCL9 and CXCL10, resulting in reduced NK cell numbers. Human patients with BA experienced an increase in CXCL10 levels, suggesting this as a possible pathway leading to biliary obstruction. Viruses that use Hsc70 for cell entry exploit a clathrin-independent pathway and traffic to the early recycling endosome uniquely activating NF-κB through TLR3, leading to the release of CXCL9 and CXCL10 and inducing NK cell recruitment. These results define how the “SRL” peptide found on RRV’s VP4 protein modulates viral trafficking, inducing the host response leading to bile duct obstruction. NEW & NOTEWORTHY In this study, we have determined that the presence of the “SRL” peptide on RRV alters its method of endocytosis and intracellular trafficking through viral binding to heat shock cognate 70 protein. This initiates an inflammatory pathway that stimulates the release of cytokines associated with biliary damage and obstruction. [ABSTRACT FROM AUTHOR]

Taking my trip to a maternity ward to visit my newborn niece as a "clinical case," I visit the phenomenon of digitally surveilling neonates with the self-same devices that were designed to enforce the house-arrest of would-be felons whose noisy place in the cultural imaginary has rendered the neonate's ankle a transgenerational "risk object" in the unconscious collective. In conversation with the ever-emergent genre known as autotheory, I invite the reader to be an accomplice as I "dramatize my unsettlement" contrasting autotheory with Laplanchean "self-theorization" via interludes about temporality, expertise, birth, gender, race, and place that come to life in the tale of The Stork. [ABSTRACT FROM AUTHOR]

With the republication of Adrienne Harris' classic essay, "You must remember this" (Harris, 2009), Psychoanalytic Dialogues continues our new feature, Après Coup. By putting a paper from the early years of the journal in conversation with contemporary readers and writers, we hope to dive into the ways in which psychoanalysts forge relationality in spaces of complexity and contradiction over time, as our experiences- collective, dyadic, or solitary – are always nonlinear and multiply configured. This Apres Coup includes commentaries by Cleonie White, Ph.D. Ken Corbett, Ph.D. Shubha Herlekar, Psy.D. MFT, Victor Donas, M.D. Donnel Stern, Ph.D. and Giuseppe Civitarese, M.D. Ph.D. [ABSTRACT FROM AUTHOR]

Psychoanalytic Dialogues is proud to present a groundbreaking panel on autotheory that pairs Leigh Lyndon's essay, The Ice is Melting, with responses by Gila Ashtor, Masha Borovikova Armyn, Adam Blum, and Maxine Chung Chow. In this brief introduction, autotheory is introduced to frame an emergent conversation that launches from the page, through the potential space carved by readers and writers, to forge an ever more open-source mode of sharing personal experience. [ABSTRACT FROM AUTHOR]

The article discusses the historical hierarchy and division of tasks among mental health practitioners in the United States, particularly in psychoanalytic settings. It highlights the role of psychiatrists as team leaders and primary investigators, social workers as attending to systems, and psychologists as data scientists. The article emphasizes the need to move away from these hierarchical structures and embrace diversity in personal and professional backgrounds and practices. It also explores the themes of belonging, home, and transformation in the context of a chaotic and unsettled world. The article includes personal reflections, autotheoretical essays, and discussions on the work of Adrienne Harris. [Extracted from the article]

With the republication of Muriel Dimen's classic essay, "Deconstructing difference: Gender, splitting, and transitional space" (Dimen, 1991), Psychoanalytic Dialogues launches a new feature, Après Coups. By putting a paper from the early years of the journal in conversation with contemporary readers and writers, we hope to dial into the ways psychoanalysts forge relationality in spaces of complexity and contradiction over time. In this dialogue, we see queerness speaking in and to the psychoanalytic frame. The Après Coups includes commentaries from Virginia Goldner, Ph.D., Ann D'Ercole, Ph.D. & Jack Drescher, M.D., Ph.D., Stephen Hartman, Ph.D., June Lee Kwon, Ph.D., and Julie Leavitt, M.D. [ABSTRACT FROM AUTHOR]

We investigated the role of Bruton's tyrosine kinase (Btk) in FcepsilonRI-dependent activation of mouse mast cells, using xid and btk null mutant mice. Unlike B cell development, mast cell development is apparently normal in these btk mutant mice. However, mast cells derived from these mice exhibited significant abnormalities in FcepsilonRI-dependent function. xid mice primed with anti-dinitrophenyl monoclonal IgE antibody exhibited mildly diminished early-phase and severely blunted late-phase anaphylactic reactions in response to antigen challenge in vivo. Consistent with this finding, cultured mast cells derived from the bone marrow cells of xid or btk null mice exhibited mild impairments in degranulation, and more profound defects in the production of several cytokines, upon FcepsilonRI cross-linking. Moreover, the transcriptional activities of these cytokine genes were severely reduced in FcepsilonRI-stimulated btk mutant mast cells. The specificity of these effects of btk mutations was confirmed by the improvement in the ability of btk mutant mast cells to degranulate and to secrete cytokines after the retroviral transfer of wild-type btk cDNA, but not of vector or kinase-dead btk cDNA. Retroviral transfer of Emt (= Itk/Tsk), Btk's closest relative, also partially improved the ability of btk mutant mast cells to secrete mediators. Taken together, these results demonstrate an important role for Btk in the full expression of FcepsilonRI signal transduction in mast cells.

Muriel Dimen penned many introductions to books and panels. In this essay that became the first chapter of Reading with Muriel Dimen/Writing with Muriel Dimen: Experiments in Theorizing a Field, I follow Dimen's manner of hopscotching among self-reflection, mentoring, and theory building. I riff on Dimen's call for a new genre of psychoanalytic text and read Dimen's 1986 memoir/novel, Surviving Sexual Contradictions, finding Dimen fomenting revolution on the page as in the consulting room, where paradox and contradiction spark innovation in personal, interpersonal, and professional space. I challenge the genre of editor's introduction to put personal narrative to political task (here, the story of my decision to shift the focus of this volume from collected works to collective writing). I place Dimen in conversation with authors whose lens trained on race during the years she pursued gender. In the vulnerability that Dimen bravely forded as she turned to the study of sexual boundary violations in her late work, I find permission to call for psychoanalytic publishing to go tilt-o-whirl in service of revolution in the field. [ABSTRACT FROM AUTHOR]

The article discusses the concept of arriving and not arriving alone, as well as the importance of being counted in various aspects of life. It explores the obstacles, challenges, risks, and rewards of belonging and changing one's circumstances. The issue of Psychoanalytic Dialogues presented in the article includes panels that delve into the questions of arriving at new emotional, material, political, and social places and what counts in those situations. The article also highlights the work of David Eng and Shinhee Han on racial melancholia and their exploration of the Asian triple consciousness. Additionally, it discusses Stephen Hartman's examination of digitally surveilling neonates and the politics of theory, as well as the papers by Bettina von Lieres and Afarin Kohan on political activation and trauma work. The article concludes by emphasizing the intersections of politics, action, and trauma and the potential for psychoanalysis to shed light on these areas. [Extracted from the article]

The article discusses the use of autotheory, a literary genre that reflects on the author's own embodiment to explore the interplay between relational experience and theory in forming subjectivity. The author argues that autotheory can be used to hold and expose the structuring and expression of subjectivity, as well as the ongoing interplay of body and mind. The article also references the work of Muriel Dimen, a feminist psychoanalyst who incorporated autobiography into relational technique. Dimen's writings explored gender, sexuality, and the complexities of identity, and anticipated the emergence of nonbinary identities. The article suggests that Dimen's work remains relevant and valuable in understanding and navigating contemporary discussions of gender and identity. [Extracted from the article]

Hepatoblastoma is the most common malignant liver tumor of childhood, with liver transplant and extended resection used as surgical treatments for locally advanced tumors. Although each approach has well-described post-operative complications, quality-of-life outcomes have not been described following the two interventions. Long-term pediatric survivors of hepatoblastoma who underwent conventional liver resection or liver transplantation at a single institution from January 2000–December 2013 were recruited to complete quality-of-life surveys. Survey responses for the Pediatric Quality of Life Generic Core 4.0 (PedsQL, n = 30 patient and n = 31 parent surveys) and Pediatric Quality of Life Cancer Module 3.0 (PedsQL-Cancer, n = 29 patient and n = 31 parent surveys) were collected from patients and parents. The mean total patient-reported PedsQL score was 73.7, and the parent-reported score was 73.9. There were no significant differences in scores on the PedsQL between patients who underwent resection compared to those who underwent transplantation (p > 0.05 for all comparisons). On the PedsQL-Cancer module, procedural anxiety scores were significantly lower for patients who underwent resection as compared to transplant (M = 33.47 points less, CI [−60.41, −6.53], p-value 0.017). This cross-sectional study demonstrates that quality of life outcomes are overall similar among patients receiving transplants and resections. Patients who received a resection reported worse procedural anxiety. [ABSTRACT FROM AUTHOR]

The article discusses the process of producing a peer-reviewed journal and the importance of representing a range of voices and perspectives within the field of psychoanalysis. The concept of "holding the center" is explored, which involves fostering controversy and comparative thought while respecting different theoretical schools and interpretations of core concepts. The article also highlights the diverse and chaotic world in which we live and the need to feature a variety of voices to stretch beyond complacency and demagoguery. The issue of Psychoanalytic Dialogues presented in the article includes panels on topics such as splitting, the more-than-human in psychoanalytic theory, the work of Françoise Dolto, and the impact of socio-political trauma on the psyche. [Extracted from the article]

In his beautiful mediation on the sights and sounds that crest in waves of oceanic feeling, Adam Blum challenges a false binary between intuiting the moment and understanding the moment – and, by extension, being in love and knowing love. With attention to how temporality inheres differently during listening and seeing, I describe how psychoanalysts and anthropologists differently locate structure in the manner of being in time that their method posits. Surfers and yoga practitioners span perception immersively – as does Blum – such that listening and seeing, being and knowing, inhere as union, in an Ocean that, when encountered in the simultaneity of possibility and constraint which translates as the love fellow surfers share, joins accomplices in the arc of history at the peak of momentum, as a community vested with the challenge of the next climactic wave. [ABSTRACT FROM AUTHOR]

The document is an introduction to Issue 34:1 of Psychoanalytic Dialogues, written in November 2023. The authors acknowledge the recent conflict between Hamas and Israel and the impact it has had on communities worldwide, including within the field of psychoanalysis. They emphasize the importance of dialogue and recognition of the Other in the face of intergenerational trauma. The issue includes papers that explore topics such as enactment in therapy, the analyst's mortality, and working with traumatized Afghan students. The authors hope that these papers will facilitate a transformative dialogue for readers. [Extracted from the article]

Author(s): The ENCODE Project Consortium; Analysis Coordination; Ewan Birney (corresponding author) [1]; John A. Stamatoyannopoulos (corresponding author) [2]; Anindya Dutta (corresponding author) [3]; Roderic Guigó (corresponding author) [4, 5]; Thomas [...]

The regions of human chromosome 22 bound by Single Transducers and Activators of Transcription (STAT)1 and STAT2 in interferon-treated cells are identified using chromatin immunoprecipitation and DNA microarray analysis. Results demonstrate that the DNA-binding behavior of STAT1 homodimers is not conserved between the different interferon treatment conditions.

This article, titled "Introduction," discusses the concept of splitting as a defense mechanism in psychoanalysis. The concept was first elaborated by Melanie Klein in her 1946 article, "Notes on Some Schizoid Mechanisms." Splitting refers to the separation or division of positive and negative experiences within the developing ego. Since Klein's formulation, other theorists have explored this concept in relation to borderline personality functioning, the development of endopsychic structure, and responses to unbearable experiences. The article highlights the relevance of splitting in understanding issues such as othering, whiteness, racism, and socio-cultural divides. The authors have invited various psychoanalytic thinkers to reflect on their use of the concept in clinical practice and in understanding the current world and professional communities. [Extracted from the article]

We have mapped the chromosomal binding site distribution of a transcription factor in human cells. The NF-[kappa]B family of transcription factors plays an essential role in regulating the induction of genes involved in several physiological processes, including apoptosis, immunity, and inflammation. The binding sites of the NF-[kappa]B family member p65 were determined by using chromatin immunoprecipitation and a genomic microarray of human chromosome 22 DNA. Sites of binding were observed along the entire chromosome in both coding and noncoding regions, with an enrichment at the 5' end of genes. Strikingly, a significant proportion of binding was seen in intronic regions, demonstrating that transcription factor binding is not restricted to promoter regions. NF-[kappa]B binding was also found at genes whose expression was regulated by tumor necrosis factor [alpha], a known inducer of NF-[kappa]B-dependent gene expression, as well as adjacent to genes whose expression is not affected by tumor necrosis factor [alpha]. Many of these latter genes are either known to be activated by NF-[kappa]B under other conditions or are consistent with NF-[kappa]B's role in the immune and apoptotic responses. Our results suggest that binding is not restricted to promoter regions and that NF-KB binding occurs at a significant number of genes whose expression is not altered, thereby suggesting that binding alone is not sufficient for gene activation.

The article introduces the last issue of Psychoanalytic Dialogues for 2023. The three panels presented in this issue are rooted in the relational tradition of psychoanalysis, exploring topics such as mystical experiences and time travel in the treatment of psychopathy, the role of shame in cults, and the challenges of coming into being as a mother. The authors engage with innovative and new content, forms, and foci, contributing to the ongoing evolution and originality of Psychoanalytic Dialogues. The article invites readers to explore these panels and looks forward to the ideas and conversations that will emerge in the future. [Extracted from the article]

The article discusses the upcoming 53rd Congress of the International Psychoanalytic Association in Cartagena, Colombia. The conference will feature a roundtable panel on psychoanalytic journals and their approaches to the conference's social and eco-conscious theme. The article also explores the emic and etic approaches to psychoanalysis, as well as the evolving nature of relational psychoanalysis. It highlights several papers that will be featured in the journal, including one on mutual processes in the relational matrix and another on the impact of COVID on a poetic approach to treatment. Additionally, the article discusses a paper that examines racism and white rage in American evangelical culture, and the differing perspectives on working from an emic or etic position. The journal also introduces a new series called Après Coup, which presents previously published papers followed by current reflections from diverse authors. [Extracted from the article]

Mast cells derived from Bruton's tyrosine kinase (Btk)-defective xid or btk null mice showed greater expansion in culture containing interleukin-3 (IL-3) than those from wild-type (wt) mice. Although the proliferative response to IL-3 was not significantly different between the wt and xid mast cells, xid and btk null mast cells died by apoptosis more slowly than their wt counterparts upon IL-3 deprivation. Consistent with these findings, the apoptosis-linked c-Jun N-terminal kinase/stress-activated protein kinase (JNK) activity was compromised in these btk-mutated cells upon Fc[Epsilon]RI crosslinking or upon stimulation with IL-3 or with stem cell factor. p38 activity was less severely, but significantly, affected by btk mutation, whereas extracellular signal-regulated kinases were not affected by the same mutation. Btk-mediated regulation of apoptosis and JNK activity was confirmed by reconstitution of btk null mutant mast cells with the wt btk cDNA. Furthermore, growth factor withdrawal induced the activation and sustained activity of JNK in wt mast cells, while JNK activity was consistently lower in btk-mutated mast cells. These results support the notion that Btk regulates apoptosis through the JNK activation.

This is a case study of a family that survived genocide and a discussion of families and massive psychic trauma. This family, like many others from Bosnia-Herzegovina, was driven from their home by Serb forces - 'ethnically cleansed' - then eventually escaped to Croatia, and was later resettled in the United States. They were referred to us, a group of mental health professionals who established the Bosnian Refugee Trauma Program at the Yale Psychiatric Institute (YPI). We have done clinical, testimony, and research work with the refugee families from Bosnia who resettled in our region, described in part in prior reports (Weine, Becker et al. 1995a, 1995b; Weine and Laub 1995).

Inspired by Steven Knoblauch's paper, Fanon's Vision of Embodied Racism for Psychoanalytic Theory and Practice (this issue), I urge White analysts to (individually and collectively) pursue acts of self-examination that risk destabilizing routines and convictions that bind our practices to Whiteness. Among terms to be interrogated, mutual recognition, diversity, integration, vitalization, and resilience are queried for the violence that is evacuated into the phantomatic register in support of a White ongoing being. [ABSTRACT FROM AUTHOR]

Hungarian analysts Tihamer Bakó and Katalin Zana describe the collapse of the social container in a homeland overwhelmed by COVID and ultra-nationalist rhetoric. Veronica Csillag contextualizes Bakó and Zana's observation revisiting two Soviet era films that chart the vicissitudes of the I We Reality i during World War II and its aftermath. George Bermudez reads Bakó and Zana's post-Bionian theorization of social dreaming from a community psychoanalysis perspective and then describes his own efforts to work in that clinical space. [Extracted from the article]

I Psychoanalytic Dialogues i is happy to present three papers by Sarah Schoen, Jean Petrucelli, and Susan Sands, originally presented at the IARPP 2022 meeting in Los Angeles. Schoen, Petrucelli, and Sands' work is noteworthy for its attention to lacunae inscribed in embodiment's intersubjective capacity. Schoen, Petrucelli, and Sands explore how interiority may or may not show itself on the body and, by extension, express interiority outwardly. [Extracted from the article]

Research has been conducted on human cromosome 22. The authors report the construction of DNA microarray which represents the unique sequences of this chromosome, and the use of the microarray for measuring global-transcriptional activity in placental poly(A) (super)+ RNA.

Taking the online symbol # ("hashtag") as my guide, I conceptualize mania as a psychic space where collective and individual registers of meaning collide at warp speed with the effect of highlighting the uneasy but recursive intertwining of individual and collective object relations. I coin the term ultrapsychic to describe the transpersonal flow of objects between the individual and the collective as brokered by human and non-human meaning-makers in an ultra-broadband society. Ultra-subjectivity highlights the affects, definitional problems and crossed-temporalities that are in play when individuals negotiate in the collective to locate themselves among others in an intersectional matrix. By reviewing the philosophy that gave rise to the hashtag as well as its transformation into a taxonomic symbol, I return to mania's uncanny collectivist quality and explore what happens when people who perceive themselves at-risk use a #cyberobject to risk self-disclosure in the collective. [ABSTRACT FROM AUTHOR]

We are also grateful to our teachers, supervisors, analysts, and mentors whose words in I Dialogues i nurtured our growth. We are so grateful to Jeff Jackson, our managing editor, for all the work he does to keep the journal on track, and to our colleagues at Taylor and Francis whose production team keeps the journal in print. We argue about form and content, engaging deeply in conversation about the future of psychoanalysis, psychoanalytic writing and, of course, our plans for the journal. [Extracted from the article]

Two protein-tyrosine kinases, Bruton's tyrosine kinase (Btk) and Syk, and members of the protein kinase C (PKC) subfamily of serine/threonine kinases play crucial roles in signal transduction through antigen receptors in B lymphocytes and high-affinity IgE receptors (Fc[Epsilon]RI) in mast cells. The present study provides genetic, biochemical, and pharmacological evidence that, on Fc[Epsilon]RI stimulation, Syk regulates Btk, and Btk selectively regulates the membrane translocation and enzymatic activity of PKC[Beta]I among the conventional PKC isoforms ([Alpha], [Beta]I, and [Beta]II) expressed in mast cells. Syk/Btk-mediated PKC[Beta]I regulation is involved in transcriptional activation of the IL-2 and tumor necrosis factor [Alpha] genes through the JNK pathway induced by Fc[Epsilon]RI stimulation. Accordingly, Fc[Epsilon]RI-induced production of these cytokines is inhibited by specific inhibitors of Btk and Syk, as well as broad-specificity inhibitors of PKC and a selective inhibitor of PKC[Beta]. Specific regulation of PKC[Beta]I by Btk is consistent with the selective association of Btk with PKC[Beta]I. Components of this signaling pathway may represent all attractive set of potential targets of pharmaceutical interference for the treatment of allergic and other immunologic diseases.

This essay describes the convergence of psychological and political experience in gay men's development of subjectivity. It explores a process whereby gay men recognize themselves to be gay like other gays and articulate their individual way of being gay through this act of recognition. Reification is introduced to describe the gay subject's encounter with objectified gayness-a task of individuation that is often overlooked. The psycho-political space where these acts of recognition and individuation occur is called 'Chelsea space,' here, so as to offer a way of thinking about substance use among urban, gay 'Chelsea Boys.' Case material is woven through the essay, and different degrees of substance use are understood to reflect different uses of the subject/object encounter that occurs in Chelsea space. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: ] KEYWORDS. Homosexuality, substance abuse, reification, psychoanalytic theory, gay substance abusers, recognition, Chelsea Boys