The place of annihilation anxieties in psychoanalytic theory

What Makes the Time Tradeoff Tick? A Sociopsychological Explanation

BACKGROUND

A theoretical interpretation of factors influencing time tradeoff (TTO) scores is lacking. In this conceptual study, we use a sociopsychological theory, terror management theory (TMT), to explain how death thoughts may play a role in the TTO method. TMT describes how respondents suppress death thoughts by invoking psychological defenses, such as self-esteem, and by bolstering cultural values.

RESEARCH QUESTION

What is the relation between TMT and TTO scores?

METHODS

A framework is developed to link TMT to TTO scores. Predictions of the framework pertain to the directionality of relations between characteristics (e.g., being religious) affecting TTO scores. These predictions are then tested against the findings in the literature.

RESULTS

The value "prolonging life" can be used as a linking pin between TTO and TMT as it is relevant for both TMT and TTO. It is argued that the value "prolonging life" is related to TTO scores but also to TMT defense strengths. Thus, TMT defense strengths become associated with trading. Directionality predictions of the framework were confirmed in 34 out of 39 retrospective tests (P < 0.001).

CONCLUSION

Directionalities of relations between TTO scores and socioeconomic characteristics, euthanasia, subjective life expectancy, and religion were explained in terms of TMT defense strengths. Our framework offers a theory-based and parsimonious framework to think about characteristics influencing TTO scores.

HIGHLIGHTS

Terror management theory (TMT) is a sociopsychological theory about death thoughts.Several factors are known to influence TTO scores.A new framework applies TMT to TTO scores to interpret such factors.Our framework is mostly of importance to health economists studying the TTO.

"Existential Catastrophe Anxiety": Phenomenology of Fearful Emotions in a Subset of Service Users With Severe Mental Health Conditions

A subset of people with severe mental health conditions feels they are on the verge of losing control, even in the absence of external threats or triggers. Some go to extreme ends to avoid affective arousal and associated expectations of a possible, impending catastrophe. We have learned about such phenomenological, emotional challenges in a group of individuals with severe, composite mental health problems and psychosocial disabilities. These individuals have had long treatment histories in the mental health care system. They have been encountered at a specialized inpatient ward offering exposure-based therapy that aims at restoring self-regulation and recovery. We describe the phenomenology of anxiety and fear presented by these service users, a fear we have coined existential catastrophe anxiety (ECa). We also suggest a set of underlying, interacting, psychological mechanisms that may give rise to ECa, before comparing ECa with three other constructs previously described in the literature—annihilation anxiety, ontological insecurity, and affect phobia. These comparisons show several similarities, but also unique qualities with ECa and its suggested underlying mechanisms. The conceptualization of ECa may aid clinicians in addressing extreme experiential turmoil and engage service users in empowering therapeutic projects.

War, immigration and COVID-19: The experience of Afghan immigrants to Iran Amid the pandemic

INTRODUCTION

Afghanistan's domestic upheaval following the Taliban's invasion leads to massive displacement of its population. The number of Afghan refugees in Iran has dramatically increased since the Taliban's takeover of Afghanistan in August 2021. Multiple pre-and post-migratory traumatic experiences affect immigrants' physical, psychological, social, and economic wellbeing. The coronavirus outbreak, considered a traumatic experience in human life in the 21st century, added to their problems in Iran and exposed them to new challenges. This qualitative study aimed to investigate their experiences early before, during, and after immigration and the pandemic's challenges to their lives in Iran.

METHODS

In the present qualitative study, ten Afghan residents living in Iran who immigrated to Iran legally or illegally since the summer of 2021 and the last year after the second Taliban invasion were selected via purposive sampling. A semi-structured interview was applied to gather the data, and the data were analyzed through Braun and Clarke's thematic analysis method.

RESULTS

Ten male participants with a mean age of 26 y/o were interviewed. Their residence in Iran was between 20 days and 8 months. Four main themes were extracted. The first theme, the Tsunami of suffering, represents a disruption of the normal flow of life. Six subthemes, including loss, being near death, insecurity, sudden hopelessness, leaving the country involuntarily, and reluctance to explore underlying emotions, are included in this category. The second one, Lost in space, describes the participant's attempt to leave Afghanistan following the extensive losses and violent death threats. Their experiences are categorized into four subthemes: the miserable trip, encountering death, life-threatening experiences, and being physically and verbally abused. The third theme, with its five subthemes, try to demonstrate the participants' experiences after getting to their destination in Iran. The last one, Challenges of the COVID-19 explained the experience of Taliban return, war trauma, running away, and living as a refugee or immigrant coincided with the COVID pandemic.

DISCUSSION

Our interviewees explained multiple and successive traumatic experiences of war, migration, and the pandemic. The central clinical features of survivors are fears of losing control, being overwhelmed, and inability to cope. They felt abandoned because not only lost their family support in their homeland but could not also receive support in Iran due to the pandemic-related social distancing and isolation. They were dissociated and emotionally numb when describing their experience, which is a hallmark of experiencing severe, unprocessed traumas.

CONCLUSION

Gaining a better understanding of Afghan refugees lived experiences may help provide them with better social and health care support. Proper mental and physical healthcare support and de-stigmatization programs may reduce the impact of multiple traumas on their wellbeing.

Creativity and Perversion: Waiting for the Muse

Although there is an extensive psychoanalytic literature on perversion, and numerous articles about creativity, few authors have explored relations between creativity and perversion. In particular, the role of childhood trauma and its impact on object relations has not been examined in patients with perversions whose creativity is blocked. In association with preoedipal anxieties and fantasies, childhood trauma can not only contribute to the development of perversion, but can also inhibit or distort the creative process by establishing an inner world characterized by the presence of a threatening internal bad object and the elusiveness of an internal good object. Though it is essential to help these patients establish an identification with the phallic father, an internal good maternal object, in the form of a muse, needs to be retrieved to bring inspiration and reduce the anxieties generated by an internal bad object, thereby facilitating the pursuit of authentic creative work. A detailed case report illustrates how this theoretical perspective guided the treatment approach to a male patient with macrophilia who was struggling to realize his creative potential.

The Traumatogenic Dynamics of Internalized Stigma of Mental Illness Among Arab American, Muslim, and Refugee Clients

Understanding the dynamics of mental health stigma through existing frameworks, especially in minorities with higher stigma, is problematic. There is a need to reconceptualize stigma, particularly in highly traumatized groups. The current study examines the validity of a new development-based trauma framework that conceptualizes stigma as a type III chronic trauma that contributes to negative mental health effects. This framework proposes that public stigma is a unique chronic traumatic stress that mediates the effects of similar trauma types in mental health patients. To test this proposition, this study explores the relationships between internalized stigma of mental illness (ISMI), different trauma types, and posttrauma spectrum disorders. ISMI, posttraumatic stress disorder, other posttrauma spectrum disorders, and cumulative trauma measures were administered to a sample of 399 mental health patients that included Arab (82%), Muslim (84%), and refugee (31%), as well as American patients (18%). Age in the sample ranged from 18 to 76 years (M = 39.66, SD = 11.45), with 53.5% males. Hierarchical multiple regression, t tests, and path analyses were conducted. Results indicated that ISMI predicted posttraumatic stress disorder and other posttrauma spectrum disorders after controlling for cumulative trauma. ISMI was associated with other chronic collective identity traumas. While Arab Americans, Muslims, and refugees had higher ISMI scores than other Americans, the elevated chronic trauma levels of these groups were significant predictors of these differences. The results provide evidence to support ISMI traumatology model. Implications of the results for treating victims of ISMI, especially Arab Americans, Muslims and refugees are discussed.

"Oh, that I might be parted from my body": mirror perplexity and the nonrelational self

Psychoanalytic models have a commonly held view of necessary and accurate mirroring in the dialectic of emergent and already formed aspects of the self. Mirroring-perplexity, however, is a cognitive and affective state found in a group of patients for whom reflective mirroring results in a dissociative rather than a unifying experience of body and mind. A review of the myth of Narcissus reveals that mirroring requires a relational mediation of self and mirror image through another. This ontological organization affectively links the simultaneous sense of being in the body and in the reflected image after experiencing a state of dyadic union. Clinical vignettes illustrate the effects of missing maternal relational response initially made evident in unmirrored self-representations in the transference.

Suicide-nearness assessed with PORT, the Percept-genetic Object-Relation Test: A replication and a reliability study

To determine the reliability and validity of a previously identified "suicide cluster" in the Percept-genetic Object-Relation Test (PORT), which test documents subliminal perception of object-relation pictures, 20 suicide attempters and 70 controls were investigated. The correspondence between scores assigned by two judges was 95%-100%. The suicide-cluster signs in PORT, notably "lack of attachment relationships" and "Motor activity," were significant. Differences between the results of this and the previous study are discussed as is the role of psychiatric disorder in suicide.

Traumatic subjective experiences invite suicide

The overwhelming events that lead to posttraumatic stress disorders and similar states are commonly understood to arise from noxious external events. It is however the unmasterable subjective experiences such events provoke that injure the mind and ultimately the brain. Further, traumatic over-arousal may arise from inner affective deluge with minimal external stimulation. Affects that promote suicide when sufficiently intense are reviewed; we propose that suicidal crises are often marked by repetitions (flashbacks) of these affects as they were originally endured in past traumatic experiences. Further, recurrent overwhelming suicidal states may retraumatize patients (patients who survive suicide attempts survive attempted murders, albeit at their own hands). We propose that repeated affective traumatization by unendurable crises corrodes the capacity for hope and erodes the ability to make and maintain loving attachments.

Prospective investigations of the prodromal state of schizophrenia: review of studies

OBJECTIVE

The paper presents a comprehensive overview of prospective studies monitoring or intervening in the pre-onset phase of first episode psychosis.

METHOD

A systematic literature search was conducted and supplemented by a manual search. All relevant studies were ordered and intensively reviewed according to specified criteria. Methodological and conceptual issues are discussed.

RESULTS

Reports of 23 prospective studies were found, some describing subsamples of larger samples. Major methodological and conceptual divergences exist.

CONCLUSION

Applied criteria detect individuals with a significantly increased risk of psychosis within the schizophrenia spectrum, but these criteria are only validated on clinical populations. The significance of differences in sample-characteristics is unclear. Most study samples are small. Results are preliminary and in need of further research before they constitute a realistic knowledge base. Methodological and conceptual issues should not be underestimated.

Analyzing the traumatic impact of childhood visual impairment

Material is presented from three analyses involving the impact on adult functioning of childhood trauma to the visual system. The clinical process by which unrecognized but ongoing traumatic reactions are identified for subsequent analysis is described. It is of particular importance, with these patients, to recognize their lifelong experience of visual confusion resulting from problems in their visual anatomy. Only then can fantasies and affects related to these physically induced states of confusion be worked through. Working through these reactions promotes the neutralization of related primitive narcissistic affects, mourning, and realistic accommodation, and leads to a more intact and integrated sense of self, and a marked increase in self-esteem. With this newly integrated sense of self, the complex interaction between physically induced confusion states and more typical developmental conflicts with objects can be worked through, resulting in more realistic and intense cathexes of the external world. The trauma suffered by these patients had been greatly compounded by its having gone unrecognized. To miss this yet again in an analysis is to repeat the past and retraumatize the patient. These findings have clear implications for patients with other biologically related symptoms (e.g., ADD, ADHD, and dyslexia).