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Aesthetic experience involves the resolution of contradiction, accomplished in part through the viewer's mental oscillations between antithetical constructs. These oscillatory phenomena evoke enjoyable associations with infancy's earliest pleasurable experiences, which are themselves characterized by rhythmic oscillations that lay the groundwork for the developing sense of psychological separateness. A work of art, functioning as a special kind of transitional object, affords the viewer an opportunity to experience a pleasurable sense of achievement by accomplishing additional increments in the work of psychological separation. These two mechanisms account for some of the pleasure inherent in aesthetic experience.

Bulimia is an eating disorder characterized by episodic, uncontrollable overeating and frequently by purging after binges. It appears to afflict approximately 5 percent of female college students in the United States. Most sufferers are high-achieving but passive and unassertive young women from similarly high-achieving but disorganized families. Confusion over social roles for women is common in bulimic patients. Bulimia shows a strong association with affective disorders; depression is common in both bulimic patients and their close family members. Bulimic patients seem to have a pronounced affective vulnerability to rejection, loss, and failure. Bulimia presents a special diagnostic challenge to the primary care physician because of the paucity of clues provided by a typical review of systems and a physical examination, even a very thorough one. Making the diagnosis requires persistent and thorough history-gathering and is best accomplished through special attention to the psychosocial history (particularly history of depression and substance abuse, family dynamics, and recent stressors) as well as pointed questioning regarding eating behavior. Because of the severe, potentially lethal complications that may attend bulimia (including fluid and electrolyte imbalance, cardiac conduction abnormalities, gastric rupture, pneumonia), diagnosis and appropriate referral by the primary care physician may have a critical impact on the patient's life and health.

A well-documented association exists between the phenothiazines and the tricyclic antidepressants and such alarming side effects as cardiac arrhythmias, ECG changes, and even sudden death. Most disturbing is the fact that major and possibly fatal arrhythmias can occur in young adults without antecedent heart disease who are receiving therapeutic dosages of these psychotropic drugs (especially thioridazine). Further study of the cardiovascular side effects of psychotropic drugs is needed to clarify the association. In the meantime, it is mandatory that physicians individualize treatment programs that include these drugs and carefully monitor patient response.