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The Nicholas Young phenomenon involves an immediate shift in dreams to more regressive mental functioning whenever, in the manifest ideational content, the dreamer or protagonist crosses a topographical boundary or threshold (spatial translation). This phenomenon thus furthers the regression typical in dreams. Eight examples of the Young phenomenon are presented. An attempt to explain this highly specialized phenomenon addresses dreams in series, or dream sections in series, and refers to Scherner’s Law, which covers their sequential trend toward regression. Referring to the mind’s self-observing capacity, Silberer’s “symbolism of the threshold” is invoked to explain the spatial translation of the Young phenomenon.

Objective The present study was performed to identify factors associated with a Bacille Calmette–Guérin (BCG) inoculation site change in patients with Kawasaki disease (KD). Methods Among patients who had received BCG vaccination and treatment for KD at our hospital from 2005 through 2016, 177 patients born in 2005 through 2016 were enrolled. The patients were divided into those with (n = 83, change group) and without (n = 94, no-change group) a BCG site change, and the patient demographics, clinical severity, blood examination results, and echocardiographic findings were compared between the two groups. Results The change group was younger at onset and had a shorter interval from vaccination to onset. A BCG site change was observed in patients who developed the onset of KD symptoms from 31 to 806 days after BCG vaccination. Multivariate analysis showed that the interval from vaccination was closely and positively associated with the BCG site change (hazard ratio = 0.995, 95% confidence interval = 0.993–0.997). Conclusion A BCG site change in patients with KD is most closely associated with the interval from BCG vaccination to onset.

In an eye-tracking experiment, we examined how readers comprehend indirect replies when they are uttered in reply to a direct question. Participants read vignettes that described two characters engaged in dialogue. Each dialogue contained a direct question (e.g., How are you doing in Chemistry?) answered with an excuse (e.g., The exams are not fair). In response to direct questions, such indirect replies are typically used to avoid a face-threatening disclosure (e.g., doing badly on the Chemistry course). Our goal was to determine whether readers are sensitive during reading to the indirect meaning communicated by such replies. Of the three contexts we examined, the first described a negative, face-threatening situation and the second a positive, non-face threatening situation, while the third was neutral. Analysis of reading times to the replies provides strong evidence that readers are sensitive online to the face-saving function of indirect replies.

Traditional psychoanalytic theories of development hold that the adult neurotic can regress, or has already regressed, to the childhood arrests and/or fixations in which his pathology originated. More recent critiques have called this possibility into question. It is unlikely that anyone can roll back the additions and modifications of lifespan development in a full-fledged return to the needs, wishes, and anxieties of childhood. By regression, though, some analysts mean not a full-fledged return to an earlier developmental phase, but a non–phase-specific slip into primitive fantasies and defenses. The operational term, in this particular variation, is not regression but primitive. The shift from the depressive to the paranoid-schizoid position is, for instance, considered not a phase-specific regression but a regression to primitive forms of mentation. The psychoanalytic conception of the primitive originated in Freud’s reading of late nineteenth and early twentieth century anthropology. Freud and later Klein believed that the neurotic regresses to a psychological childhood, which in turn preserves the thought patterns of our prehistoric ancestors. Although this proposition and the underlying principle of recapitulation have been disproven, its traces are nonetheless preserved in what are termed the primary processes and primitive defenses. A tradition of theoretical critique and developmental research, however, shows that the primary processes and primitive defenses are not in fact primitive. That is, they are neither evolutionarily nor developmentally primary in human life. By implication, psychoanalysis should discard the term primitive and adopt a lifespan approach to the processes it describes.

The term regression refers to the idea that a person can return to earlier phases of mental development and the primitive modes of functioning associated with them. A core concept in both conflict and deficit models of development, the idea has nonetheless come under increasing scrutiny from critics who argue that it misleads us into a genetic fallacy whereby we reduce the issues of adolescent and adult development to their childhood precursors. Inderbitzen and Levy (2000) suggest that we focus on transformations, or shifts, in mental organization, instead of on regressions. But discarding the concept of regression has theoretical implications: to adopt instead a focus on shifts in mental organization we must (1) consider our object of study to be the meaning-making person, not isolated instincts or needs; (2) understand conscious and unconscious mental life to be embedded in the here-and-now relational field; and (3) adopt a lifespan model of development. The aim here is to outline a theoretical framework in which we can more fully explore the possibility of discarding “regression” in favor of a focus on transformations in the developmental present.

Recent Web apps have spurred excitement around the prospect of achieving speed reading by eliminating eye movements (i.e., with rapid serial visual presentation, or RSVP, in which words are presented briefly one at a time and sequentially). Our experiment using a novel trailing-mask paradigm contradicts these claims. Subjects read normally or while the display of text was manipulated such that each word was masked once the reader’s eyes moved past it. This manipulation created a scenario similar to RSVP: The reader could read each word only once; regressions (i.e., rereadings of words), which are a natural part of the reading process, were functionally eliminated. Crucially, the inability to regress affected comprehension negatively. Furthermore, this effect was not confined to ambiguous sentences. These data suggest that regressions contribute to the ability to understand what one has read and call into question the viability of speed-reading apps that eliminate eye movements (e.g., those that use RSVP).

Suffering is commonly seen as an unconscious effort to alleviate painful feelings of guilt. However, suffering also aims at averting loss of ego functions and hence loss of mental stability. This second function of suffering is discussed in the light of Freud’s observations of characters wrecked by success and Weiss’s ideas about mutual love as a threat to mental stability. Hawthorne’s portrayal of Arthur Dimmesdale in The Scarlet Letter (1850), biographical material about the author, material from his diaries, and material from a psychotherapy case and an analysis illustrate the function of suffering to preserve mental stability in the face of heightened success and happiness. Hawthorne, it is argued, intuitively grasped this function of suffering in his novel.

A subgroup of children diagnosed with autism experience developmental regression featured by a loss of previously acquired abilities. The pathogeny of autistic regression is unknown, although many risk factors likely exist. To better characterize autistic regression and investigate the association between autistic regression and potential influencing factors in Chinese autistic children, we conducted an ambispective study with a cohort of 170 autistic subjects. Analyses by multiple logistic regression showed significant correlations between autistic regression and febrile seizures (OR = 3.53, 95% CI = 1.17-10.65, P = .025), as well as with a family history of neuropsychiatric disorders (OR = 3.62, 95% CI = 1.35-9.71, P = .011). This study suggests that febrile seizures and family history of neuropsychiatric disorders are correlated with autistic regression.

The Prader–Willi syndrome (PWS), a rare multisystem genetic disease, leads to severe disabilities, such as morbid obesity, endocrine dysfunctions, psychiatric disorders, and social disturbances. We explored the whole brain of patients with PWS to detect abnormalities that might explain the behavioral and social disturbances, as well as the psychiatric disorders of these patients. Nine patients with PWS (six males, three females; mean age 16.4 years) underwent a positron emission tomography (PET) scan with H215O as a tracer to measure regional cerebral blood flow (rCBF). The images were compared with those acquired from nine controls (six males, three females; mean age 21.2 years). A morphologic magnetic resonance imaging (MRI) was also performed in PWS patients, and their cognitive and behavioral skills were assessed with Wechsler Intelligence Scale for Children III and the Child Behavior Check List (CBCL). The MRI images showed no evident anatomic abnormalities, whereas PET scans revealed hypoperfused brain regions in PWS patients compared with controls, particularly in the anterior cingulum and superior temporal regions. We observed a significant relationship ( P

The author’s initial article on treatment preparatory to psychoanalysis (1983) challenged the long-held belief that a therapy with the same analyst would contaminate a subsequent analytic transference. The current article reconsiders the original process of transition from therapy to analysis and describes methods that can further its effectiveness. Although specific noninterpretive interventions to enhance preparation for analysis are rarely written about, they are discussed among colleagues and in supervision. Levy (1987) has described a bias against the description of strategic or tactical choices in analysis. It is increasingly clear that some patients’ fear of exposing shameful defectiveness underlies their resistance to entering analysis, as does the originally described fear of an uncontrolled regression. It is useful to delay interpretation until shame sensitivity can be assessed and modulated. In the past there was pressure to keep the preparatory therapy brief so that the analyst would not become too well known to the patient. Less concern about strict anonymity allows more time for the patient’s resistances to abate before the recommendation is made. Methods are described and clinical illustrations show how a deepening process can be fostered, how indications of readiness for the transition can be assessed, and when and how the recommendation can be made.

Autistic spectrum disorders encompass etiologically heterogeneous persons, with many genetic causes. A subgroup of these individuals has mitochondrial disease. Because a variety of metabolic disorders, including mitochondrial disease show regression with fever, a retrospective chart review was performed and identified 28 patients who met diagnostic criteria for autistic spectrum disorders and mitochondrial disease. Autistic regression occurred in 60.7% (17 of 28), a statistically significant increase over the general autistic spectrum disorder population (P < .0001). Of the 17 individuals with autistic regression, 70.6% (12 of 17) regressed with fever and 29.4% (5 of 17) regressed without identifiable linkage to fever or vaccinations. None showed regression with vaccination unless a febrile response was present. Although the study is small, a subgroup of patients with mitochondrial disease may be at risk of autistic regression with fever. Although recommended vaccinations schedules are appropriate in mitochondrial disease, fever management appears important for decreasing regression risk.

Parafoveal preview was examined within and between words in two eye movement experiments. In Experiment 1, unspaced and spaced English compound words were used (e.g., basketball, tennis ball). Prior to fixating the second lexeme, either a correct or a partial parafoveal preview (e.g., ball or badk) was provided using the boundary paradigm (Rayner, 1975). There was a larger effect of parafoveal preview on unspaced compound words than on spaced compound words. However, the parafoveal preview effect on spaced compound words was larger than would be predicted on the basis of prior research. Experiment 2 examined whether this large effect was due to spaced compounds forming a larger linguistic unit by pairing spaced compounds with nonlexicalized adjective–noun pairs. There were no significant interactions between item type and parafoveal preview, suggesting that it is the syntactic predictability of the noun that is driving the large preview effect.

A psychoanalyst faces the extraordinary demand of becoming instrumental in the psychoanalytic process. In the candidate's attempt to rise to that expectation, the first step is the training analysis. As the center-piece of psychoanalytic education, it is no ordinary analysis and bears special burdens intrinsic to its multiple functions and institutionalization. Recognizing the difficulties of both analytic education and analytic practice, Freud suggested that the analyst be periodically reanalyzed; for many, reanalysis is integral to their analytic development. Indeed, an analyst is actually never "made" but is always "in the making," developing and maturing in life and in practice. Reanalysis serves to focus elements of transference and resistance, rework defenses, facilitate more extensive regression in the service of the ego, deepen emotional integration, rework those elements of psychoanalysis itself that have been incorporated into defensive structure, and further the maturation of the analyzing instrument. If analysis is our most powerful mode of initial education, reanalysis is the most powerful form of continuing education. That remarkably little attention has been paid to reanalysis is testimony to the infantile fantasies that remain invested in our personal analyses.

Several reports indicate that autism spectrum disorder is associated with increased rate of head growth in early childhood. Increased rate of growth may index aberrant processes during early development, may precede the onset of symptoms, and may predict severity of the disease course. We examined rate of change in occipitofrontal circumference measurements (abstracted from medical records) in 28 boys with autism spectrum disorder and in 8 boys with developmental delay without autism from birth to age 36 months. Only children who had more than 3 occipitofrontal circumference measurements available during this age period were included. All data were converted to z scores based on the Centers for Disease Control and Prevention norms. Rate of growth from birth to age 36 months was statistically significantly higher for the autism spectrum disorder group than the developmental delay group, with children with autism spectrum disorder showing a statistically significant increase in occipitofrontal circumference relative to norms between 7 and 10 months; this group difference in rate of growth was more robust when height was used as a covariate. Rate of growth was not found to be different for children with autism spectrum disorder whose parents reported a history of loss of skills (regression) vs those whose parents reported early onset of autism symptoms. Findings from this study suggest that the aberrant growth is present in the first year of life and precedes the onset and diagnosis in children with autism spectrum disorder with and without a history of autistic regression.

The current work explored the properties of groups that lead them to be persuasive and the processes through which such persuasion occurs. Because more entitative groups induce greater levels of information processing, their arguments should receive greater elaboration, leading to persuasion when members of groups present strong (vs. weak) counter attitudinal arguments. Experiment 1 explored these hypotheses by examining if idiosyncratic perceptions of group entitativity and manipulations of argument strength affect attitude change and argument elaboration. Experiment 2 experimentally manipulated group entitativity and argument strength independently to examine the causal relationship between entitativity, attitude change, and argument elaboration. In both experiments, it was found that groups greater in entitativity were more persuasive when presenting strong (vs. weak) arguments and induced greater argument elaboration. Implications for our understanding of entitativity, persuasion, and information processing about social groups are discussed.

Using a large real-life corporate database initially consisting of 3,990 heads of households stratified on the basis of various demographic and geographic variables, and whose communication activities (long distance telephone calls, letters, cards, and visits) were surveyed and monitored, this study investigated the direction as well as magnitude of estimation errors in survey responses and diary entries. Supporting the 1994 Fiedler and Armbruster psychometric formulation and conjecture, we show that estimation errors in reports of the frequency and duration of people's own communication activities exhibit a consistent tendency to regress toward the mean. This regressive estimation is greater for those who are further away from the mean in actual behavior and is proportional to the actual deviation from the mean. Furthermore, this regressive estimation is inversely related to the average frequency across behavioral categories. An important implication of our findings is that the distribution of estimated behavioral frequencies and durations appear more concentrated in surveys than they actually are in the general population, although the general shape of the distribution is unaffected.

In most cases symptoms of autism begin in early infancy. However, a subset of children appears to develop normally until a clear deterioration is observed. Many parents of children with "regressive"-onset autism have noted antecedent antibiotic exposure followed by chronic diarrhea. We speculated that, in a subgroup of children, disruption of indigenous gut flora might promote colonization by one or more neurotoxin-producing bacteria, contributing, at least in part, to their autistic symptomatology. To help test this hypothesis, 11 children with regressive-onset autism were recruited for an intervention trial using a minimally absorbed oral antibiotic. Entry criteria included antecedent broad-spectrum antimicrobial exposure followed by chronic persistent diarrhea, deterioration of previously acquired skills, and then autistic features. Short-term improvement was noted using multiple pre- and post-therapy evaluations. These included coded, paired videotapes scored by a clinical psychologist blinded to treatment status; these noted improvement in 8 of 10 children studied. Unfortunately, these gains had largely waned at follow-up. Although the protocol used is not suggested as useful therapy, these results indicate that a possible gut flora-brain connection warrants further investigation, as it might lead to greater pathophysiologic insight and meaningful prevention or treatment in a subset of children with autism. (J Child Neurol 2000;15:429-435).

The analyst's wish to regress is used as a paradigm of the “forbidden” topic of what analysts want from their analysands. The aim is to expand the subjective domain of analysts' awareness so that they can analyze better by grasping more of their temptations with patients before enactment can occur. Clinical examples illustrate how the author temporarily joined patients in wish-fulfilling mutual regression. Analytic process is disrupted when the analyst wishes to relinquish the more differentiated role of the containing and interpreting analyst in favor of more childlike relatedness both with the patient and with the analyst's internal objects. The author, expecting a more typical countertransference, had not anticipated that he might temporarily join these nonpsychotic patients in mutual regression. It is suggested that in the face of analytic impasse analysts should consider whether they might temporarily have joined the patient in mutually regressive wishes that have taken them away from more responsible analytic functioning.

Objective: This is the first of two papers that aim to identify some of the institutional processes of 19th century European psychiatry, and some prevailing cultural themes of that era that played a role in shaping the development of schizophrenia as a disease concept. Method: Three areas of psychiatric history are examined: the first is concerned with the key figures who coined the concept of dementia praecox; the second with the rise of the asylum; and the third is to do with the ideology of 19th century psychiatric science and its relationship to a broader intellectual milieu. These three literatures are examined for common themes. Results: The theme of degeneration is evident in all three literatures, and denotes both a biological process (neuro-degeneration) and a moral state (degeneracy). Conclusions: The idea of degeneration, a pervasive cultural theme of the 19th century, dominated psychiatric thinking long before schizophrenia was developed as a diagnostic category. It contributed to the ideational form-work that gave foundation, structure and shape to the concept of schizophrenia.

Just as formerly recalled screen memories may be remembered again in the course of psychoanalysis, so new screen phenomena can arise during the treatment process. This paper attempts to relate the process of reconstruction and the occurrence of a type of screening. It is proposed that, under certain circumstances, psychoanalysis can result in a mutually determined screen construction that both patient and analyst consider convincing and valid but which may, for the most part, actually be untrue as a result of the screen function. Screen memories arising during the reconstructive process resemble the déjà vu and déjà raconté situation in that the experience is felt with certainty to have actually occurred previously, although a degree of doubt about its having happened can consciously or unconsciously coincide. Factors contributing to the formation of screen constructions include regressive aspects of the analytic situation; superego elements and the experience of an injunction to remember; the wish to witness what took place in the past; direct or indirect suggestive influence by the analyst; a defensive identification with the analyst; and the analyst's theoretical orientation to reconstruction. Like a screen memory having some veridical content yet serving a masking function, a screen construction can have elements of truth. At the same time such constructions may function as a strong resistance or compromise against intense erotic, sadomasochistic, or narcissistic themes in the transference/counter-transference that were painful or conflictual in the past. If screen constructions are assumed to be historically real or valid, they may not be analyzed for their transferential screening role. A previously published case involving a presumably repressed memory of sexual molestation is considered from the perspective of the possible development of a screen reconstruction. Clinical and scientific aspects of seeking extra-analytic confirmation or falsification of reconstructions are discussed.

This paper reports on one of fifteen subjects from the Mahler separation-individuation project who have participated in a twenty-five-year follow-up study. The focus is on the beginning transfer of interpersonal conflict to intrapsychic conflict and compromise formation early in the second year of life, and on the course and persistence of these into adulthood. Conflict and compromise, along with constitutional and environmental factors, were major determinants of the subject's personality and a major source of continuity in personality development from one-and-a-half to twenty-five years of age.

Hitherto available studies on the percept-genetic defensive organization of Schizophrenia have not distinguished between acute and chronic stages of the disorder. The present research with the Defense Mechanism Test included 30 chronic inpatients with several years of hospitalization and with acceptable perceptual thresholds. Compared with 30 sex- and age-matched nonschizophrenic psychiatric control patients, schizophrenics resorted significantly more often to (a) regression, (b) disappearance of the peripheral figure, (c) introjection (wrong sex attribution to the hero), and (d) significantly less often to the most mature variants of repression. In a further comparison of a subgroup of 16 women schizophrenic patients and a matched group of melancholic inpatients, the findings on regression, introjection, and repression were replicated.

L'etude d'episodes pedophiles cher l'adulte mur illustre la facon dont le passage a l'acte dans un contexte emotionnel particulier peut aider une personne a reorganiser sa vie. Apres l'examen de 36 cas confies a la clinique de psychiatrie medico-legale McGill entre 1980 et 1989, on a retrace dans douze cas des antecedents de victimisation chez le contrevenant. Une analyse minutieuse de tous les cas a revele une reactivation du conflit dans la famille de naissance dans 34 des cas. On suggere diverses hypotheses psychodynamiques selon l'histoire anterieure du contrevenant et la relation entre la victime et le contrevenant. L'analyse d'un suivi longitudinal dans 26 cas suggere que, par l'entremise de divers mecanismes d'organisation, de desorganisation et de reorganisation, l'episode pedophile represente une occasion pour ces pedophiles d'âge moyen et senescents de resoudre des problemes qui entretiennent leurs interets pedophiles et d'atteindre un niveau plus eleve de maturite, ce qui previent la recidive des episodes pedophiles

Styles of adaptation to the Stroop task were studied with the Serial Color-Word Test among 50 schizophrenic patients and 50 sex- and age-matched clinical controls. Measures of linear (R) and nonlinear change (V) in reading times were derived for each of the five interference trials. Schizophrenia was significantly characterized by (1) a high sum of nonlinear change, (2) the Cumulative-Dissociative pattern (high R and high V), (3) concomitantly high secondary Vs (V of the 5 Rs and V of the 5 Vs), and (4) Cumulative-Dissociative secondary patterns (gradual increase of both linear and nonlinear change on both the 5 Rs and the 5 Vs).

The method of free association, rooted in the topographic model, has not been clearly defined in structural terms. Little changed since Freud; the method is geared toward overcoming rather than investigating resistances. Furthermore, it is designed to discourage rather than encourage self-analysis. This seems to be another example of a "developmental lag" in adapting the psychology of the ego to clinical technique.

Behavioral procedures have proven efficacious in the ward-wide treatment of psychiatric inpatients. These procedures are often recommended and administrated by behaviorally oriented staff who work as consultants. While numerous published reports show that behavioral consultation is effective for changing patients' targeted behavior, few data show whether it affects recidivism and other general indicators of patients' functioning. The present report describes group and case study data for 7 patients regarding the effects of behavioral consultation on frequency and duration of hospital admissions, distress upon readmission, proportion of time spent at regressive versus autonomous privilege levels, and other molar indices of patients' functioning.

The purpose of this study was to investigate the dispositional optimism—posttraumatic growth (PTG) relationship in postoperative breast cancer patients and to examine if perceived social support moderates this relationship. The study was conducted with 104 women undergoing postoperative chemotherapy treatment or coming to the hospital for their routine controls. Hierarchical multiple regression analyses indicated that breast cancer survivors high on dispositional optimism and perceived social support, are more likely to develop PTG. Among the different sources of social support, only social support perceived from a private person moderated the dispositional optimism—PTG relationship. Strengths, limitations and possible implications of the findings are discussed.

In this paper I challenge some prevalent psychoanalytic concepts of the etiology and pathogenesis of severe mental illness which I believe to be in need of revision. There is insufficient evidence to conclude that the etiology of the two major adult psychoses, schizophrenia and manic-depressive illness, can be attributed to failures in development or fixations during the earliest years of life. Furthermore, I believe it incorrect to ascribe these failures of development to deficiencies in the early maternal environment. I base my disagreements on three main considerations: the misinterpretation of the etiological significance of regression, the relevance of new biological data, and erroneous conclusions drawn from lack of diagnostic distinctions. I also challenge the generally held concept of etiologic phase specificity which proposes that failures during various early phases of development can be correlated with different kinds of adult psychopathology. In calling this concept into question, I argue that current psychoanalytic concepts of the etiology of the borderline group of disorders also need to be reevaluated.

The nature of therapeutic action varies not only with each patient's psychological predilection for utilizing opportunities for change, but also with the manner in which the analyst or therapist presents opportunity for change. Ideally, the therapist bases the latter on personally identifiable theoretical concepts and aims. This inquiry focuses on a relatively narrow field of clinical material in order to provide as close as possible an examination of therapeutic action. The technical approach provides opportunities for change, minimizing alterations resulting from internalizing processes or suggestion. The therapeutic actions arise from analyst and patient sharing observations of the patient's intrapsychic activities of resistance to drive derivatives the patient briefly allowed into consciousness, and represent processes of ego maturation set in motion by intellectually gained and experientially exercised insights.

The Regressive Coping Checklist has been used to measure the extent to which individuals cope with stress by denying, minimizing, or avoiding stressful situations. In this study, the checklist was modified to include the frequency of use of regressive coping strategies and was shown to be a moderately reliable instrument (α = .57) when used with a sample of 750 Australian postprimary teachers.

It is possible that Jack the Ripper can be understood in terms of doctor-identification borne of one or more terrifying experiences he may have had with doctors during his childhood. The fantasies acted out by this primitive murderer are similar to the fantasies experienced by people who have been surgically traumatized as children. The evidence suggests that the activities of Jack the Ripper resemble the acting-out of a horror story in which he, as the main character, played to the population of London as an actor plays to his audience, through the need to discharge anxiety and regain some kind of emotional balance. When his depredations failed to achieve the desired results for him, the Ripper probably committed suicide.

Clinical study of three schizophrenic men without known seizure disorders has heuristic implications, pointing to neurophysiological factors in their somesthetic hallucinations: (a) In two instances the body areas involved in such hallucinations (the abdominal cavity and the top of one foot) also happen to be represented side by side on the “map” of the receptive somesthetic areas at the postcentral gyrus. (b) In all three schizophrenic men the occurrence of their somesthetic hallucinations can be conceptualized along the lines of MacKay's (1970) information flow model for perception in general, with some specific modifications, which center around the key roles of sufficient change occurring in two specific aspects of this model. (c) Further conceptualization is suggested within Grey Walter's (1973) testable model of triple association among Conditional, Imperative and Operant Response—albeit mostly in reverse sequence with respect to somesthetic hallucinations under discussion. These schizophrenic men reveal in their past and present experiences a pattern in which the sequence of events is initiated through changes at the efferent side (restriction of voluntary motility), which trigger afferent experiences, albeit hallucinated ones. Practical implications center around the probably salutary role of voluntary motility performed purposefully and at the person's own pace.

POSITIVE mental health is used as a bio-adaptive concept, operationally defined in terms of four components : emotional capital (EC), autonomy (A), self-regula tion (SR) and competence (C). It is argued that the current adaptive crisis of Western man is due, amongst other factors, to the failure of key social institutions in Western Society, including the family, to provide conditions conducive to the development and/or exercise of these components of mental health. Western man's solutions to this adaptive crisis are shown to fall into two categories—one, representing destructive (anarchist) and the other, a constructive approach. The position is taken that the latter approach needs to be applied more extensively in the functional rehabilitation of the family.

The purpose of this case report is to describe the evolution of a psychosocial plan of management for an “uncooperative” patient on the inpatient nephrology unit at The New York Hospital. The edited transcript of the weekly multidisciplinary Psychosocial Conference on this unit is presented in order to detail this evolution. The conference was attended by nurses, social workers, psychiatrists, a psychology intern and the patient's primary physician, who all had input into formulating the plan and joint responsibility in effecting it. A brief discussion follows the transcript.

A patient, during the course of a lengthy analysis, experienced several panic attacks. These regressive episodes, occurring only in the analytic setting, provided her with her special means for recalling and eventually mastering repressed elements of her life. This facilitating aspect of her disorganization, when identified and analyzed as such, helped deepen the patient' analytic experience. It was necessary for the analyst to define verbally and clarify her reconstructed past as it emerged as part of her panic state, transferentially, so that the patient could finally recognize, acknowledge, and understand hitherto hidden aspects of her life. The psychiatric literature in regard to panic states is briefly noted, as is the relevance of comparing the present almost exclusively organic, pharmacological orientation, with Freud' discussion of the “actual” or current neuroses of his day, almost a century ago. On the basis of this case report, the importance of understanding the content and meaning of the panic attack, by analytic means, is once again emphasized.

Psychological state measures were obtained on over two thousand junior high school students. Half of the students were tested relatively early in the day and the other half late in the day. Results indicated that self-reported measures of anxiety, stress, regression and depression tended to be higher for the group tested near the end of the school day than for those tested early in the day. A major methodological implication is that we should have separate norms for ‘time of day’ when we are dealing with state measures.

The multiple sources of psychological stress to the hospitalized child are reviewed with references to the literature. The Hahnemann Pediatric Ward and patient population are described as are the functions of a weekly group meeting for school aged hospitalized children led by a child psychiatrist. Efforts are made to use knowledge gained from the children for therapeutic purposes within the group as well as for teaching the inpatient pediatric staff how the hospitalized child's behavior reflects his inner thoughts and feelings. Aspects of the children's behavior and verbal productions in the group are discussed from a psychodynamic viewpoint. Conflict, ambivalence, fantasy distortion, denial and displacement are exemplified, as is the children's ever-present need to simultaneously express, defend against and master anxiety. Questions are raised about outcome and future avenues of investigation.