OBJECT RELATIONS AND THE FAMILY SYSTEM IN BULIMIA: A THEORETICAL INTEGRATION

This paper presents an integration of object relations theory and family systems theory in the conceptualization of bulimia. It is based primarily on Winnicott's construct of the maternal "holding environment," and Klein's formulation of ego deficits at the level of part-object relations, as they apply to the family as a whole. We propose that in bulimic families there are transgenerational developmental deficits and adaptations which determine the level and quality of intrapsychic experience within individuals, as well as the interpersonal relationships and dynamic functioning of the larger family system.     

Legal Disposition of Inter-Group and Intra-Group Homicides

A study of the legal treatment of inter-group and intra-group homicides reveals that dispositional decisions are made on the basis of the sex and occupational prestige combinations of offender-victim pairs. Discriminant analysis of data concerning 444 defendants and 432 victims indicates that males accused of slaying females receive the most severe dispositions, while females held in the death of males are noticeably underpenalized. Final convictions are most severe for low status defendants alleged to have murdered high status victims. Contrary to earlier studies, there are no significant differences in legal treatment in terms of the racial combinations of the offender-victim pair. An interpretive approach to the legal process may explain these results: differential processing of homicides depends on the extent to which defendants and victims conform to the popular conception of violent criminality.     

The Simple Bind and Discontinuous Change

The author argues that families usually respond to internal and external demands for change in terms of leaps or transformations to new and different adaptive structural arrangements. Such transformations unavoidably have stress and disruption as a prelude. Transformations are precipitated by paradoxical injunctions called “simple binds”. The presence of “double binds” lead to the disqualification of, and failure of transformations. Symptomatic behaviour of family members can be seen as a product of failed transformations.     

The association between mood states and physical activity in postmenopausal, obese, sedentary women

Mood states influence evaluative judgments that can affect the decision to exercise or to continue to exercise. This study examined how mood associated with graded exercise testing (GXT) in sedentary, obese, postmenopausal women (N = 25) was associated with physical activity and predicted VO2max during and after a behavioral weight-loss program (BWLP). Measures of physical activity included planned exercise, calories from physical activity, leisure-time physical activity, and predicted VO2max. Mood before and after pre-BWLP GXT was assessed using the Profile of Mood States. Mood before and after the GXT was more strongly associated with planned exercise than other forms of physical activity, and this effect became stronger over time. Mood enhancement in response to exercise was not related to physical activity. Mood before and after exercise might yield important clinical information that can be used to promote physical activity in sedentary adults.     

THE CARING DILEMMA IN MIDWIFERY

The caring dilemma, first described by Reverby in 1987, denotes the tension caused by being obliged to provide care without the right to determine how that care is to be provided. Such a dilemma is salient in the practice of midwifery based on a continuity of care model that has recently emerged or been implemented in various jurisdictions. Briefly, this model involves the provision of care by a single midwife or pair of midwives to a woman throughout her pregnancy, birth and post-natal period. Continuity of care necessitates that midwives be on call for significant lengths of time to ensure attendance at the woman's birth. It is the on-call nature of this form of midwifery work that most significantly poses a caring dilemma for midwives. In this paper, we trace both the structural and experiential aspects of the caring dilemma through an examination of midwifery in the Canadian province of Ontario. Our analysis reveals that despite being a salient feature of midwifery practice, some work structures can be created to mediate the caring dilemma experienced by midwives.

Le dilemme de la prise en charge, que Reverby a évoqué la première fois en 1987, dénote la tension que cause le fait d’être tenu d'offrir une prise en charge sans avoir le droit d’établir de quelle manière l'offrir. L'exemple des sages-femmes, dont la pratique repose sur un type de soin continu qui est récemment apparu ou qu'on vient de mettre sur pied dans diverses administrations, illustre très clairement ce dilemme. Pour résumer, ce modèle veut qu'une femme enceinte soit prise en charge pendant sa grossesse, à son accouchement et durant sa période postnatale par une ou deux sages-femmes. La continuité de la prise en charge oblige les sages-femmes à être sur appel durant des périodes prolongées pour que la femme qui accouche bénéficie de leur présence. Pour les sages-femmes, c'est la nature même de leur travail effectué sur appel qui engendre, de façon cruciale, le dilemme de la prise en charge. Dans cet article, nous abordons les aspects structurels et expérimentaux que représente le dilemme de la prise en charge par le biais d'une étude sur la pratique du métier de sage-femme dans la province canadienne de l'Ontario. Notre analyse révèle que, si le dilemme de la prise en charge est inhérent à la profession de sage-femme, il n'empêche que des structures professionnelles peuvent être mises en place pour en atténuer les aspects négatifs.     

能挽救生命的医学突破

新生代治疗方法已加入到与中风、癌症和心脏病作斗争的行列。除了小时侯摘除过扁桃体之外,63岁的霍华德·库比兹从未进过医院。因此,1998年6月8日,当他中风、身体右半边麻痹时,他唯一的恐惧就是,正如他所了解的,生活就此结束了。他已经想象自己被束缚在轮椅上或是在疗养院里度过余生。     

THE PARENTING EXPERIENCES OF MOTHERS WITH DISSOCIATIVE DISORDERS

This article presents a qualitative analysis of the experience of parenting of mothers with dissociative disorders. This analysis was performed to complement the quantitative analysis of problems of mothers with dissociative disorders that Benjamin, Benjamin, and Rind (1996) presented previously. They found that the functioning of these mothers, as well as their subjective experience of mothering, was poorer that that of either clinical or nonclinical control mothers. Our goal was to provide a clearer, richer picture of their problems in parenting. Using the mothers' own words, we describe how the five symptom areas of dissociation (amnesia, depersonalization, derealization, identity confusion, and identity alteration) impeded their parenting efforts. We conclude with a discussion of the necessity of addressing parenting in the treatment of client-mothers with dissociative disorders.     

THE INTERACTION BETWEEN MARITAL STANDARDS AND COMMUNICATION PATTERNS: HOW DOES IT CONTRIBUTE TO MARITAL ADJUSTMENT?

Couples' cognitions about marriage and their communication patterns have both been found to be highly associated with marital distress. To examine the relationships among marital cognitions, communication, and marital adjustment, we had a sample of 387 community couples complete three self-report measures: the Dyadic Adjustment Scale, the Inventory of Specific Relationship Standards, and the Communication Patterns Questionnaire. Results indicated that the correlation of communication with marital adjustment is higher for women with more relationship-focused standards than for women with less relationship-focused standards; this interaction does not occur for men. The implications of the interaction and the gender difference as well as the importance of teaching communication skills, and working with associated cognitions are discussed.     

The American Stop Smoking Intervention Study. Conceptual framework and evaluation design.

Reducing tobacco use, especially cigarette smoking, is a public health priority. The American Stop Smoking Intervention Study (ASSIST) was initiated in 1991 to prevent and reduce tobacco use primarily through policy-based approaches to alter the social-political environment. This article describes the conceptual design, research framework, evaluation components, and analytic strategies that are guiding the evaluation of this demonstration research endeavor. The ASSIST evaluation is a unique analysis of the complex relationships between the social context, public health activity at the state level, tobacco use, and individual behavior. The measures of tobacco control activity developed for this evaluation may be useful in ongoing national cancer control surveillance efforts, and the lessons learned will enhance the development of tobacco control programs.