1
|
Benjet C, Bromet E, Karam EG, Kessler RC, McLaughlin KA, Ruscio AM, Shahly V, Stein DJ, Petukhova M, Hill E, Alonso J, Atwoli L, Bunting B, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Huang Y, Lepine JP, Kawakami N, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott KM, Shalev A, Slade T, ten Have M, Torres Y, Viana MC, Zarkov Z, Koenen KC. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychol Med 2016; 46:327-343. [PMID: 26511595 PMCID: PMC4869975 DOI: 10.1017/s0033291715001981] [Citation(s) in RCA: 596] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. METHOD General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. RESULTS Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. CONCLUSIONS Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
Collapse
Affiliation(s)
- C. Benjet
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - E. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, New York, NY, USA
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - R. C. Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - A. M. Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - V. Shahly
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - M. Petukhova
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - E. Hill
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - L. Atwoli
- Moi University School of Medicine, Eldoret, Uasin Gishu, Kenya
| | - B. Bunting
- School of Psychology, University of Ulster, Northern Ireland, UK
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - J. M. Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre, Brescia, Italy
| | - S. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, People’s Republic of China
| | - J. P. Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot and Paris Descartes, Paris, France
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - M. E. Medina-Mora
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - F. Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - M. Piazza
- National Institute of Health, Lima, Peru
| | | | - K. M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - A. Shalev
- NYU School of Medicine, New York, NY, USA
| | - T. Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M. ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Z. Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - K. C. Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Kessler RC, Adler LA, Berglund P, Green JG, McLaughlin KA, Fayyad J, Russo LJ, Sampson NA, Shahly V, Zaslavsky AM. The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol Med 2014; 44:1779-1792. [PMID: 24103255 PMCID: PMC4124915 DOI: 10.1017/s0033291713002419] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although DSM-IV attention deficit hyperactivity disorder (ADHD) is known to be associated with numerous adverse outcomes, uncertainties exist about how much these associations are mediated temporally by secondary co-morbid disorders. METHOD The US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13-17 years (n = 6483 adolescent-parent pairs), assessed DSM-IV disorders with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Statistical decomposition was used to compare direct effects of ADHD with indirect effects of ADHD through temporally secondary mental disorders (anxiety, mood, disruptive behavior, substance disorders) in predicting poor educational performance (suspension, repeating a grade, below-average grades), suicidality (ideation, plans, attempts) and parent perceptions of adolescent functioning (physical and mental health, interference with role functioning and distress due to emotional problems). RESULTS ADHD had significant gross associations with all outcomes. Direct effects of ADHD explained most (51.9-67.6%) of these associations with repeating a grade in school, perceived physical and mental health (only girls), interference with role functioning and distress, and significant components (34.5-44.6%) of the associations with school suspension and perceived mental health (only boys). Indirect effects of ADHD on educational outcomes were predominantly through disruptive behavior disorders (26.9-52.5%) whereas indirect effects on suicidality were predominantly through mood disorders (42.8-59.1%). Indirect effects on most other outcomes were through both mood (19.8-31.2%) and disruptive behavior (20.1-24.5%) disorders, with anxiety and substance disorders less consistently important. Most associations were comparable for girls and boys. CONCLUSIONS Interventions aimed at reducing the adverse effects of ADHD might profitably target prevention or treatment of temporally secondary co-morbid disorders.
Collapse
Affiliation(s)
- R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - L. A. Adler
- Departments of Psychiatry and Child and Adolescent Psychiatry, NYU School of Medicine and Psychiatry, NY VA Harbor Healthcare Service, New York, NY, USA
| | - P. Berglund
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
| | - J. G. Green
- School of Education, Boston University, Boston, MA, USA
| | - K. A. McLaughlin
- Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - J. Fayyad
- Institute for Development Research, Advocacy, and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon
| | | | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - V. Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - A. M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Kessler R, Shahly V, Hudson J, Supina D, Berglund P, Chiu W, Gruber M, Aguilar-Gaxiola S, Alonso J, Andrade L, Benjet C, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Haro J, Murphy S, Posada-Villa J, Scott K, Xavier M. A comparative analysis of role attainment and impairment in binge-eating disorder and bulimia nervosa: results from the WHO World Mental Health Surveys. Epidemiol Psychiatr Sci 2014; 23:27-41. [PMID: 24054053 PMCID: PMC4100465 DOI: 10.1017/s2045796013000516] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 02/05/2023] Open
Abstract
Background. Cross-national population data from the WHO World Mental Health surveys are used to compare role attainments and role impairments associated with binge-eating disorder (BED) and bulimia nervosa (BN). Methods. Community surveys assessed 23 000 adults across 12 countries for BED, BN and ten other DSM-IV mental disorders using the WHO Composite International Diagnostic Interview. Age-of-onset was assessed retrospectively. Ten physical disorders were assessed using standard conditions checklists. Analyses examined reciprocal time-lagged associations of eating disorders (EDs) with education, associations of early-onset (i.e., prior to completing education) EDs with subsequent adult role attainments and cross-sectional associations of current EDs with days of role impairment. Results. BED and BN predicted significantly increased education (females). Student status predicted increased risk of subsequent BED and BN (females). Early-onset BED predicted reduced odds of current (at time of interview) marriage (females) and reduced odds of current employment (males). Early-onset BN predicted increased odds of current work disability (females and males). Current BED and BN were both associated with significantly increased days of role impairment (females and males). Significant BED and BN effects on adult role attainments and impairments were explained by controls for comorbid disorders. Conclusions. Effects of BED on role attainments and impairments are comparable with those of BN. The most plausible interpretation of the fact that these associations are explained by comorbid disorders is that causal effects of EDs are mediated through secondary disorders. Controlled treatment effectiveness studies are needed to trace out long-term effects of BED-BN on secondary disorders.
Collapse
Affiliation(s)
- R.C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - V. Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - J.I. Hudson
- Psychiatric Epidemiology Research Program, McLean Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - D. Supina
- Health Economics, Outcomes Research and Epidemiology, Shire Pharmaceuticals, Wayne, Pennsylvania
| | - P.A. Berglund
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan, USA
| | - W.T. Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - M. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - S. Aguilar-Gaxiola
- University of California, Davis, Center for Reducing Health Disparities, School of Medicine, CTSC Building, Sacramento, California, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L.H. Andrade
- Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), campus Gasthuisberg, Leuven, Belgium
| | - G. de Girolamo
- IRCCS Centro S. Giovanni di Dio Fatebenefratelli Brescia, Bologna, Italy
| | - R. de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S.E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - J.M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - S.D. Murphy
- School of Psychology, University of Ulster, Londonderry, Northern Ireland
| | | | - K. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - M. Xavier
- Department of Mental Health – CEDOC and Faculdade Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
4
|
Shahly V, Chatterji S, Gruber MJ, Al-Hamzawi A, Alonso J, Andrade LH, Angermeyer MC, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, de Girolamo G, de Jonge P, Florescu S, Gureje O, Haro JM, Hinkov HR, Hu C, Karam EG, Lépine JP, Levinson D, Medina-Mora ME, Posada-Villa J, Sampson NA, Trivedi J, Viana MC, Kessler RC. Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys. Psychol Med 2013; 43:865-879. [PMID: 22877824 PMCID: PMC4045502 DOI: 10.1017/s0033291712001468] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. RESULTS Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. CONCLUSIONS Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.
Collapse
Affiliation(s)
- V. Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | | | - M. J. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - A. Al-Hamzawi
- Al-Qadisia University College of Medicine, Diwania Teaching Hospital, Diwania, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L. H. Andrade
- Section of Psychiatric Epidemiology, Sãu Paulo, Brazil
| | | | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
| | - B. Bunting
- University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - J. M. Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisbon, Portugal
| | - G. de Girolamo
- IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - P. de Jonge
- University Medical Center Groningen, Groningen, Netherlands
| | - S. Florescu
- National School of Public Health Management and Professional Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, University of Ibadan, College of Medicine, Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - H. R. Hinkov
- National Center for Public Health Protection, Sofia, Bulgaria
| | - C. Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China
| | - E. G. Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
| | - J.-P. Lépine
- Hôpital Lariboisiére Fernand Widal, Paris, France
| | - D. Levinson
- Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - M. E. Medina-Mora
- Instituto Nacional de Psiquiatria Ramon de La Fuente Muñiz, Mexico City, Mexico
| | | | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - J.K. Trivedi
- Department of Psychiatry, C.S.M. Medical University, Lucknow, India
| | - M. C. Viana
- Department of Social Medicine, Center for Health Sciences, Vitória, Spain
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Kessler RC, Shahly V, Stang PE, Lane MC. The associations of migraines and other headaches with work performance: results from the National Comorbidity Survey Replication (NCS-R). Cephalalgia 2010; 30:722-34. [PMID: 20511212 PMCID: PMC3486691 DOI: 10.1177/0333102410363766] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is unknown if comorbid conditions account for the association between migraines and work performance. This issue was investigated in the National Comorbidity Survey Replication (n = 9282). Twelve-month severe or persistent migraines and other headaches were assessed with comorbid 12-month mental and physical disorders using the WHO Composite International Diagnostic Interview. Work performance was assessed using the WHO Health and Work Performance Questionnaire. Significant associations of these conditions with work disability disappeared with controls for comorbid disorders, but severe or persistent migraines continued to predict work loss days even with controls. Individual-level and societal-level annual human capital values were $1165 and $9.3 billion for this subset of migraines. Roughly 20% of these associations were due to comorbidity, 60% to direct effects and 20% to indirect effects through temporally secondary comorbidities. These strong associations suggest that workplace interventions for severe or persistent migraines might have a positive return-on-investment for employers.
Collapse
Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
6
|
Abstract
BACKGROUND Although depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life. METHOD We studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0. RESULTS Lifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged 65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly. CONCLUSIONS Given that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.
Collapse
Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
7
|
Shahly V. Boundaries of self and subject. The aesthetic consequences of engulfment and separation anxiety in two artists. Psychoanal Study Child 1999; 53:325-59. [PMID: 9990838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The paper considers the efforts of two artist patients--one productive and the other not--to manage engulfment and separation anxiety through manipulations of virtual and literal spaces. The patients assumed characteristic emotional distances from their objects, subjects, products, audiences, and culture. More concretely, they developed artistic styles that, through formal structure and narrative content, signified a compromise between isolation and merger. Further investigation revealed that the productive patient's mother suffered a protracted postpartum depression that estranged her emotionally and physically from the patient in infancy. The tension between early maternal deprivation and later reaction-formed intrusiveness promoted the patient's aesthetic compromise between communication and concealment, permitting successful delivery of fantasy material. Although the unproductive patient portrayed repellent scenes which alienated her audience, she curiously never attempted stylistic corrections. Her press for merger was countered by a dread of contact conditioned by paternal abuse. Further exploration suggested that her artworks were not selfobjects, but rather close relations competing with her for audience attention.
Collapse
Affiliation(s)
- V Shahly
- Cambridge Hospital, Department of Psychiatry, Harvard Medical School, USA
| |
Collapse
|