bluuebunny/crossref_metadata_2025 huggingface dataset:
Central Nervous System Tuberculosis
Authors: Cruz Andrea T. , Starke Jeffrey R.
Published: March 2017

Mycobacterium tuberculosis is a common cause of bacterial meningitis in areas with high HIV prevalence and its diagnosis often is delayed in industrialized nations. Children (particularly infants) and immunocompromised persons are at higher risk of developing TB meningitis. Lymphocytic meningitis, high CSF protein, and (in children) frequently an abnormal chest radiograph should raise clinician index of suspicion for TB meningitis. Neuroimaging may show hydrocephalus, basilar leptomeningeal enhancement, ischemia, and/or tuberculomas. Prompt recognition and initiation of antituberculous antibiotics and corticosteroids can decrease morbidity and mortality.
Rabies
Authors: Jackson Alan C.
Published: March 2017

Rabies is an acute viral infection involving the central nervous system with distinctive clinical features reflecting early brainstem involvement, including hydrophobia. This infection is usually transmitted by animal bites, typically from dogs or wildlife, including bats. There is a progressive clinical course to coma and the disease is virtually always fatal. When rabies is treated aggressively there are usually multiple medical complications, including multiple organ failure. Therapeutic attempts have been disappointing and new approaches need to be taken in the future. An improved understanding of rabies pathogenesis might lead to important insights into the development of new therapeutic approaches.
Disorders Caused by Botulinum Toxin and Tetanus Toxin
Authors: Stafstrom Carl E.
Published: March 2017

Anaerobic organisms of the genus Clostridia (C) can cause significant human disease. Exotoxins secreted by C botulinum and C tetani cause botulism and tetanus, respectively (summarized in Table 156.1). Botulinum neurotoxin causes neuromuscular blockade by interfering with vesicular acetylcholine release, leading to cholinergic blockade at the neuromuscular junctions of skeletal muscle, and consequently, symmetric flaccid paralysis. Tetanus toxin prevents release of inhibitory neurotransmitters at central synapses, leading to overactivity of motor neurons and muscle rigidity and spasms. This chapter reviews clinical features of botulism and tetanus and discusses their pathophysiological basis.
Rickettsial Diseases
Authors: Sun Lisa , Johnston Michael V.
Published: March 2017

Tick-borne rickettsioses are emerging as more important health problems throughout the world. The spotted fever group including Rickettsia rickettsia can cause encephalopathy, meningitis and brain damage by selectively targeting capillary endothelial cells in the brain, and stimulating inflammation, capillary leakage, hemorrhage, and intravascular coagulation. Rickettsia are are arthropod-borne gram-negative coccobacilli bacteria and are obligate intracellular organisms that do not survive in artificial medium. In North and South America, the most common rickettsial disorder is rocky mountain spotted fever (RMSF) transmitted by the dog tick Dermacentor variabilis or the wood tick Dermacentor andersoni. A characteristic “starry sky” pattern can be seen on MRI imaging of the brain in some patients with RMSF encephalopathy and is thought to reflect the organisms targeting of brain endothelial cells in capillaries the white matter. Early treatment with doxycycline is curative and reverses signs of encephalopathy if given within a few day of onset, but delayed treatment can be associated with permanent neurological disability. The typhus group of rickettsia bacteria include R. prowazekii, which causes epidemic typhus and R. typhi, which causes murine typhus (endemic) typhus in tropical and subtropical parts of the world. Flying squirrels and humans carry R prowazekii and rats are carry R. typhi. Q fever caused by the rickettsia organism Coxiella burnetti is transmitted from farm animals including sheep and is seen throughout the world including the United States.
Ehrlichiosis
Authors: Havens Nicholas S. , Roland William E.
Published: March 2017

Human infections with Ehrlichia species have been found worldwide. It appears that at least six different species infect humans, and clinical and epidemiological data are highly suggestive of sole transmission by ticks. The clinical illness is a nonspecific febrile syndrome, often accompanied by cytopenias, abnormal liver enzymes, and “aseptic” meningitis. When diagnosis is delayed, it is occasionally fatal. Currently, the polymerase chain reaction (PCR) technique is the most rapid technique to confirm the clinical diagnosis. The infection is responsive to tetracyclines and chloramphenicol. Increased physician awareness, readily available rapid diagnostic techniques, and tick-bite preventive measures will help lessen the impact of this infection.
Neurological Manifestations of the Human T-lymphotropic Virus Type 1
Authors: Araujo Abelardo Q-C
Published: March 2017

The human T cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that infects about 20 million individuals worldwide. Its typical neurological presentation is of a chronic, slowly progressive myelopathy named “HTLV-1-associated myelopathy/tropical spastic paraparesis” (HAM/TSP). HAM/TSP emerges as the tip of the iceberg among numerous other neurological clinical syndromes caused by this virus, such as inflammatory myopathies, polyneuropathies, ALS-like syndromes, dysautonomia, etc. HAM/TSP designates a spastic paraparesis with neurogenic bladder, and minor sensory signs. Pathologically, HAM/TSP is characterized initially by perivascular lymphocytic cuffing and mild parenchymal mononuclear infiltrates affecting mainly the thoracic spinal cord. This is followed by gliosis and scarring in later stages. The neuropathogenesis of HTLV-1 is still poorly understood but is apparently immune mediated. The therapy of TSP/HAM remains basically symptomatic.
Central Nervous System Whipple Disease
Authors: Venkatesan Arun
Published: March 2017

Whipple disease (WD) is a multisystemic infection caused by the bacillus Tropheryma whipplei. Although the organism is ubiquitous in the environment, WD is rare. In affected individuals, the organism resides intracellularly within macrophages and can manipulate host immune responses to avoid clearance. Central nervous system (CNS) involvement can occur as a manifestation of classic WD, in the setting of a relapse of previously treated WD, or rarely as isolated nervous system infection. Diagnosis of CNS WD rests on polymerase chain reaction (PCR) and demonstration of periodic acid-Schiff (PAS) positive macrophages in tissue, and ef
REM Sleep Behavior Disorder
Authors: Sullivan Shannon S.
Published: March 2017

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia featuring often violent dream enactment behavior, which may lead to injury. Its polysomnographic hallmark is loss of physiological REM muscle atonia. Prevalence is unknown but estimated to be less than 1% of the general adult population, and as high as 6% in the elderly. It is an important risk factor for development of alpha-synucleinopathy, with a conversion rate of approximately 80% after 15 years. Treatments include safeguarding the sleep environment, and clonazepam and/or melatonin to reduce injury. In the future, RBD diagnosis may provide an opportunity for new neuroprotective therapies.
Restless Legs Syndrome and Periodic Limb Movement Disorder
Authors: Accardo Jennifer
Published: March 2017

Restless legs syndrome (RLS), also known as Willis Ekbom disease (WED), is a sensory disorder with a circadian component. An irresistible urge to move the legs disrupts sleep onset and maintenance. Periodic limb movements in sleep, semirhythmic in nature, often overlap with RLS, though periodic limb movement disorder can be diagnosed in the absence of RLS’s distinctive sensory symptoms. Disruptions in dopaminergic pathways, iron metabolism, and the opioid system have all been implicated in pathogenesis, and there is a strong genetic component. RLS is common, affecting 5% to 10% of adults. Its best-known treatments are dopamine agonists; however, other treatments are effective.
The Neurobiology of Insomnia
Authors: Pigeon Wilfred R. , Orff Henry J.
Published: March 2017

The neurobiology of insomnia is intertwined with that of sleep and wakefulness. Conceptual models of insomnia are being refined to accommodate sleep-wake research and insomnia-specific research, including animal models. Neurobiological abnormalities associated with insomnia include homeostatic dysregulation; circadian abnormalities; and somatic, cognitive, and cortical hyperarousal. The role of hyperarousal in particular has been supported by evidence generated from a variety of psychophysiological measures and neuroimaging techniques. Insomnia is also associated with alterations in neuroendocrine and neuroimmune function. For the treatment of insomnia, both pharmacological and nonpharmacological approaches are efficacious with cognitive-behavioral therapy for insomnia considered the first-line treatment and with development of novel agents ongoing.
Neurologic Manifestations of Organic Chemicals
Authors: O’Donoghue John L.
Published: March 2017

Organic chemicals can produce many different effects on the nervous system. The nervous system functions are affected by a variety of different organic chemicals. Organic chemicals that induce neurotoxicity may be naturally occurring or synthetic. Those that are naturally occurring products of plants or animals are referred to as “toxins,” whereas those that are synthetic are referred to as “toxicants”; however, publications and regulations sometimes use these terms interchangeably. Underlying these functional changes are cellular and subcellular changes that mediate the clinical and pathological appearance of the neurotoxicity. The ability to make a diagnosis of organic-chemical-induced neurotoxicity is dependent on being able to link a clinical situation with an exposure in a dose-related manner. Treatment and management of organic-chemical-induced neurotoxicity in affected individuals is dependent upon the specific chemical involved and the underlying mechanism by which toxicity occurs.
Neural Mechanisms of Addiction
Authors: Whitaker Leslie R. , Hope Bruce T.
Published: March 2017

Addiction is a behavior characterized by compulsive seeking and taking of drugs despite severe negative consequences. Goal-directed behaviors and the motivation to perform these behaviors are altered in human addicts so that obtaining and using addictive drugs becomes the primary and overwhelming focus of their behavior. These altered behaviors result from maladaptive reward learning in which associations between drugs and drug-associated stimuli become powerful and enduring factors guiding behavior. Neural mechanisms specific to learning are likely to underlie addiction. This chapter provides an overview of both types of neural mechanisms and how they may interact to produce addiction.
Neurological Effects of Marine Toxins
Authors: Nakagawa Kazuma
Published: March 2017

Human ingestion of marine toxins can produce various neurological effects, often involving the voltage-gated Na+ channels that are critical for action potential generation and propagation. Diagnosis for most marine neurotoxin is made clinically, and thus recognizing the signs and symptoms of each toxin, and obtaining the appropriate history, is essential. Major marine neurotoxins-tetrodotoxin, saxitoxin, ciguatoxin, brevetoxin, and domoic acid, have a distinct mechanism and clinical manifestation.
Fetal Exposure to Tobacco and Cannabis
Authors: Onigu-Otite Edore C.
Published: March 2017

Tobacco and cannabis are the most commonly used legal and illegal substances among pregnant women in the United States, respectively. About 12% to 25% of women smoke tobacco during pregnancy. Smoking tobacco during pregnancy and maternal exposure to environmental tobacco smoke during pregnancy is associated with a variety of adverse fetal outcomes. About 11% of women of childbearing age reported using cannabis in the preceding month. Fetal exposure to tobacco or cannabis is associated with dysregulation in development and may indicate a higher risk for neurodevelopmental and other psychiatric problems. As research has become more sophisticated, findings suggest that some of the associations between fetal exposure to cannabis and tobacco and adverse outcomes may be due to familial genetic risk factors. Separating environmental, familial, and genetic factors while disentangling their interactive effects on fetal and offspring development and neurobehavioral regulation remains a challenge in this field of study.
Neurobiology of Child Maltreatment and Psychological Trauma
Authors: Copeland-Linder Nikeea , Onigu-Otite Edore , Serico Jennifer , Jamora Mariflor , Belcher Harolyn M.E.
Published: March 2017

Trauma is defined as exposure to an event or situation that overwhelms one’s capacity to cope, and threatens or causes harm to mental and physical well-being. This may include direct exposure, witnessing events, or learning about distressing experiences that happened to a loved one. Trauma can have deleterious consequences for children including increased risk for psychopathology, physical health problems, and impairment in several domains of functioning including emotion regulation, academic abilities, and social relationships. Examples of acute or short-lived traumatic experiences include natural disasters, sudden death of a loved one, a terrorist attack, or a number of other one-time occurring distressing events. Children also may experience trauma that is chronic in nature, such as witnessing frequent community violence or exposure to daily war-related violence.
Alcohol Abuse
Authors: Welch Killian A
Published: March 2017

Unqualified, “alcohol” refers to ethyl alcohol (C2H5OH), the favored drug of much of the world’s population. It was probably discovered following experimental fermentation, and archaeological investigations suggest that beer was being habitually consumed earlier than 6000 BCE. Although often considered a “moral failing,” the neurobiological changes that underpin addiction to alcohol are increasingly understood. This has been accompanied by development of an increasing variety of interventions for alcoholism with demonstrated efficacy, these spanning the social, psychological, and pharmacological. Despite these advances, an estimated 3.8% of all global deaths and 4.6% of global disability-adjusted life-years is now attributable to alcohol. The detrimental consequences of alcohol are multifarious, but the nervous system is particularly vulnerable.
Thyroid Disease
Authors: Ishii Makoto
Published: March 2017

Thyroid diseases including hypothyroidism and thyrotoxicosis are common endocrine disorders that have widespread systemic and neurologic manifestations. The neurologic complications of thyroid diseases range from subtle muscle loss in chronic thyrotoxicosis to severely depressed consciousness in myxedema coma. Because many patients may not have overt systemic manifestations of thyroid disease, accurately identifying the thyroid disease as the underlying etiology and treating the underlying thyroid disease is critical, as restoring the patient to a euthyroid state can rapidly reverse the neurologic symptoms.
Neurological Manifestations of Renal Disease
Authors: Hundert Joshua S. , Verma Rashmi , Suri Ritika , Singh Anika T. , Singh Ajay
Published: March 2017

In the United Syates, chronic kidney disease (CKD) affects approximately 5% to 10% of the general population. It is estimated that about 20 million Americans have some degree of CKD. Central nervous system (CNS) abnormalities are common in patients with CKD, especially in those individuals with end stage renal disease (ESRD) who require renal replacement therapy, such as dialysis or transplant. Neurological symptoms in patients with CKD may range from mild altered sensorium and cognitive dysfunction to tremors and coma. By the time patients require renal replacement therapy, some patients may have uremia, a clinical syndrome with protean manifestations.
Neurologic Manifestations of Hematological Disease
Authors: Elham Bayat
Published: March 2017

A wide sprectum of hematologic disorders affect the central and peripheral nervous system. These disorders include porphyria, thrombotic thrombocytopenic purpura-hemolytic uremic syndromes, sickle cell disease, plasma cell dyscrasias, monoclonal gammopathy, primary systemic amyloidosis, primary systemic amyloidosis, Waldonstrom’s macroglobulinemia, myeloproliferative syndromes, cryoglobulinemia, and polycythemia vera. Some, like porphyria, cause both central and peripheral nervous system manifestations including sensory/motor peripheral neuropathy, dysautonomia, pain, seizures, and abdominal pain. Others such as sickle cell disease primarily affect the brain and cause both clinically apparent strokes associated with a vasculopathy of large intracranial blood vessels, as well as less obvious microstrokes that cause progressive cognitive decline if not treated.
Letter to Merton J. Kahne
Authors: Winnicott Donald W.
Published: March 2017

In this letter in response to M. J. Kahne’s communication concerning his analysis of a young woman, Winnicott offers some advice and suggestions concerning deprivation, regression and transitional objects.
The Effect of Psychosis on Family Life
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott argues that psychosis is an illness of a psychological nature, in some cases with a physical basis, which is concerned with the elements of human personality and existence. It is a term that includes schizophrenia, manic depression and melancholia with more or less paranoid complications. Winnicott argues that psychosis represents an organization of defences, and behind all organized defences is the threat of confusion, a breakdown of integration. Winnicott indicates there is acute need for preventive measures, especially in the provision of mental care for children, perhaps in a residential centre where children live indefinitely and could be taken for daily treatment by psycho-analysts. Winnicott proposes that psychosis proper indicates a disturbance of emotional development at an early stage. In some cases a hereditary tendency to psychosis is strong, whereas in others it is not a significant feature.
Review: The Concept of Love in Child Care
Authors: Winnicott Donald W.
Published: March 2017

In this review of Professor Simey’s book, The Concept of Love in Childcare, Winnicott questions whether a Christian view of love is sufficient and wants an understanding of psychoanalytic theories of the nature and growth of love to be included. He is particularly concerned for this in the case of deprived children—those in care.
Psychoanalysis and Science: Friends or Relations?
Authors: Winnicott Donald W.
Published: March 2017

Winnicott, in this talk to the Oxford University Scientific Society, summarizes what psychoanalysis is: a treatment for the psychiatrically ill by psychological methods, that it has a body of theory, and that it is an applied rather than pure science. Like science, it asks questions and has faith in its own aims to discover answers, although not necessarily to find them. Psychoanalysis moves on from physiological science to exploring human personality, feelings, and conflicts, especially through addressing the unconscious and dreams. Some examples from clinical experience are given.
Letter to Harry Guntrip
Authors: Winnicott Donald W.
Published: March 2017

In this letter, Winnicott thanks Guntrip for his book and says that his own earlier review of Fairbairn’s book did not do it justice.
The Paediatric Department of Psychology
Authors: Winnicott Donald W.
Published: March 2017

In this essay, Winnicott argues for the link between child psychiatry and paediatrics, rather than child psychiatry and adult psychiatry. He insists that training in child psychiatry demands physical paediatrics and psychoanalysis.
Envy: A Male Patient Near the End of His Analysis
Authors: Winnicott Donald W.
Published: March 2017

In this short piece of clinical documentation of a male patient close to the end of his analysis, Winnicott explores the experience of the patient needing to attack and destroy the potency (the ‘good breast’ in Kleinian theory) of Winnicott as his much needed analyst, and the patient’s dependence on him. He adds that Klein’s theory in her recent Geneva Congress paper does not, for him, sufficiently address early maternal failure and its effect on the infant.
The Aims of Psycho-Analytical Treatment
Authors: Winnicott Donald W.
Published: March 2017

In this short statement on the aims of psychoanalytic treatment presented to the British Society, Winnicott describes the surface aims of the analyst (keeping and behaving well, alive, and awake, and completing the work of analysis) and the deeper ones. He hopes the patient can use him as a transitional and subjective object; he makes interpretations to show the extent of his understanding and to create an intellectual connection with the patient; he acts to facilitate the pathology of early environmental difficulties and strengthen the ego of the patient. He recognises that nonstandard analyses need modifications of this method and that analysts differ in their abilities in this work. Even in cases of extreme difficulty, the aim is to meet the needs of the patient and verbalise the nascent unconscious where possible.
Review: Un Cas de Psychose Infantile
Authors: Winnicott Donald W.
Published: March 2017

In this review, Winnicott expresses his enthusiasm for this detailed account of 166 sessions of analysis of a child through infancy and early development done in France by J. McDougall.
The Tree
Authors: Winnicott Donald W.
Published: March 2017

A poem by Winnicott on the subject of the relationships between mothers and children and depression.
Fear of Breakdown
Authors: Winnicott Donald W.
Published: March 2017

In this account, Winnicott contends that a fear of breakdown expressed by some patients in sessions refers to an experience of a breakdown earlier in life which cannot be returned to without help. The experience is defended against because unthinkable anxieties or ‘primitive agonies’ prevail. There is no self to sustain facing this experience again, and even a psychotic illness may be preferable. This fear is characterized by feelings of falling forever, a loss of reality sense and a loss of the capacity to relate to objects. Often analysis feels unproductive or futile because this state has not yet been identified. Persistent fears of a death that has happened and not been faced as well as feelings of annihilation, emptiness and nonexistence all feature in this symptom. A clinical example is given of this ‘fear of breakdown’.
Review: Heal the Hurt Child
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s review of Heal the Hurt Child by Dr Riese, an account of her work at an educational therapy centre in Richmond, Virginia, USA.
Psycho-Somatic Illness in Its Positive and Negative Aspects
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott discusses psycho-somatic illness as the persistence of a split in the patient’s ego-organisation, or of multiple dissociations within it, that constitutes the true illness. Winnicott writes that in health there is a tendency towards psycho-somatic integration, which is a part of the forward movement in the developmental process. Psycho-somatic integration is an achievement of the ‘indwelling’ of the psyche in the soma, to be followed by the enjoyment of a psycho-somatic unity in experience. Winnicott concludes that psycho-somatic illness, like the antisocial tendency, has a hopeful aspect and that the patient may be in touch with the possibility of psychosomatic unity (or ‘personalisation’) and dependence, even though his or her clinical condition actively illustrates the opposite of this through splitting, dissociations, a persistent attempt to split medical provision and through omnipotent self-caretaking.
The Importance of the Setting in Meeting Regression in Psycho-Analysis
Authors: Winnicott Donald W.
Published: March 2017

In this seminar, Winnicott describes his personal views in relation to meeting the condition of clinical regression in psychoanalysis. Winnicott reminds his students that he accepts the basic principles of psychoanalysis as laid down by Freud but adds that, in some cases, the psychoanalytic setting and the careful maintenance of that setting (reliability and management) are as important as the way the analyst deals verbally with the material. He suggests that in this kind of work with regressed patients it is as if the patient gradually seduces the analyst into collusion with the infant within the patient, the infant who received inadequate attention at the earliest stages. The patient is not there to work in a productive way with the analyst, except when the analyst provides these necessary conditions.
Letter to Mrs B. J. Knopf
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s letter in response to a mother who had taken umbrage at his previous letters to The Observer on autism. Winnicott regrets the confusion and points her in the direction of Benjamin Spock’s book, Baby and Child Care.
The Price of Disregarding Psychoanalytic Research
Authors: Winnicott Donald W.
Published: March 2017

Winnicott proposes that to assess the price we pay for neglecting psychoanalytic research findings, we must first inquire into the nature of such psychoanalytic research. Winnicott points out that research that concerns itself with the unconscious is largely unacceptable to society. For Winnicott psychoanalytic research is not to be forced into the pattern that suits research in the physical sciences. The material for psychoanalytic research is essentially the human being: being, feeling, acting, relating and contemplating. For Winnicott, analytic research is the collective experience of analysts. The price here has to be measured in terms of human waste and suffering. Research along these lines gets Winnicott’s full support, though he recognises that much psychoanalytic research is held up because of mutual suspicion between psychiatrist and psychoanalyst.
Further Comments on Obsessional Neurosis and ‘Frankie’
Authors: Winnicott Donald W.
Published: March 2017

The transcription of Winnicott’s contributions to the discussion of the case of ‘Frankie’, a paper by Bertha Bornstein given at the Amsterdam IPA congress. Winnicott discusses obsessional tendencies, noting that obsessional neuroses can be very closely linked to an extreme degree of dissociation of the intellectual processes from the rest of the child’s psyche. This ‘flight to the intellectual’ he considers is a defence against the mental breakdown that has already taken place in the child.
A Child Psychiatry Case Illustrating Delayed Reaction to Loss
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott gives a detailed child psychiatry case study. Patrick, at age 11, suffered the loss of his father by drowning. Patrick had always been devoted to his mother, who knew he had not properly reacted to the tragedy. In all the consultations, and using the squiggle drawing technique, Winnicott indicates that Patrick was describing the illness which antedated the tragedy in which the father died. Patrick is enabled to become psychiatrically ill, to regress and break down, and to then recover slowly. He begins to process his long-standing depression, his guilt, and the sense of the loss of his father whose relationship with Patrick’s mother the boy felt to be indescribably tense. Patrick eventually recovers and resumes his education. The therapeutic work is described by Winnicott in great detail.
Letter to The Times
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s letter to The Times on King George III’s mental illness and Robert Graves’s views on poetry and psychoanalysis.
The Ordinary Devoted Mother
Authors: Winnicott Donald W.
Published: March 2017

In this lecture, Winnicott recounts the origins of the idea and phrase ‘the ordinary devoted mother’, which he describes as a ‘well-worn subject’. He sees it as a logical step in mothering that if ‘devotion’ is important, a lack of devotion is also. He goes on to stress the ordinariness and naturalness of the mothering state in which, to a large extent, the mother ‘is’ the baby and the baby ‘is’ her. Winnicott holds that when a mother has a capacity quite simply to be a mother, we must never interfere.
Review: The Psychoanalytic Study of the Child, Volume 20
Authors: Winnicott Donald W.
Published: March 2017

In Winnicott’s review of The Psychoanalytic Study of the Child, Volume 20, he notes that the works in this series are consistent due to their familiarity with the development of psychoanalytic theory associated with Anna Freud and that an important part of this volume consists of diagnostic assessments at the Hampstead Child-Therapy Clinic. Winnicott gives particular attention to three papers on the effect of blindness on the emotional development of children.
On Cardiac Neurosis in Children
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott revisits his early work on cardiac neurosis in children based on his experience of running the London Rheumatic Clinic between the wars. He states that the key to good clinical sense in the diagnosis of rheumatism was to take a full history and give a physical examination. In positive diagnoses, the child’s activity would be restricted, but in around half of the cases the child could be diagnosed as non-choreic and therefore not liable to heart disease, thus allowing the doctor to manage child’s difficulties without restricting his or her activity. Winnicott states that this is where psychiatry gives a definite and positive diagnostic contribution, when the symptomatology can be accounted for in terms of the child’s normal variables due to his personality and emotional development.
Letter to Donald Meltzer
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s letter to the psychoanalyst Donald Meltzer on the Kleinian group’s attendance at British Psychoanalytic Society Scientific Meetings only for Kleinians’ papers. In Meltzer’s paper, Winnicott challenges and discusses at length Meltzer’s use of the terms ‘dependence on the internal mother’ and ‘envy’.
Review: Your Child Is a Person
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s Review of Your Child Is a Person, in which he regrets the need to confirm that a child is a person. For Winnicott, it is sad that the authors tend to offer ‘more sensible’ advice in the form of a complete statement of all possibilities, rather than to stop advising and provide a workable theory of childhood development.
Letter to Renata Gaddini
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s letter to Renata Gaddini discussing the merits of his two prefaces for the book The Family and Individual Development in relation to her translation of it into Italian.
The Absence of a Sense of Guilt
Authors: Winnicott Donald W.
Published: March 2017

In this undated text, Winnicott describes a patient creating, in the analytic setting, the need to experience an extreme sense of guilt and self-punishment due to an occasion of Winnicott’s failure in his work with her. This patient believes everything to be under her control; Winnicott asserts that such a patient would feel no guilt or compunction at killing her analyst. He discusses another patient who experiences extreme guilt at any kind of self-betrayal of her own uncompromising self. The violence of these feelings evoked in these analytic experiences is powerfully demonstrated.
Foreword to The Hands of the Living God
Authors: Winnicott Donald W. , Milner Marion
Published: March 2017

Winnicott’s Foreword to Marion Milner’s long case study with a schizophrenic patient.
Review: Absent: School Refusal as an Expression of Disturbed Family Relationships
Authors: Winnicott Donald W. , Clyne Max B.
Published: March 2017

Winnicott’s favourable review of a general practitioner’s study of the specific childhood phenomenon of school refusal.
Winnicott’s Wisdom
Authors: Winnicott Donald W.
Published: March 2017

A magazine article composed of extracts from Winnicott’s series ‘The ordinary devoted mother’.
Review: How to Survive Parenthood
Authors: Winnicott Donald W. , LeShan Eda J.
Published: March 2017

Winnicott’s review of ‘How to Survive Parenthood’ by Edna LeShan. Winnicott finds the author lively and with a good common-sense attitude, but regrets that her exposition of various kinds of therapeutic treatment is out of date. Rather than claim parenthood to be universal, Winnicott feels the book has value as a picture of contemporary family life in America.
Letter to Arthur Miller
Authors: Winnicott Donald W.
Published: March 2017

Letter from Winnicott to Arthur Miller linking Miller’s book and the cartoon series Peanuts by Schulz to his own work on transitional objects. He is also curious whether Miller and Monroe had heard of him.
Mirror-Role of Mother and Family in Child Development
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott takes the subject of the mother’s face for the baby as the precursor of the mirror in the child’s emotional development. He explores the normal and pathological aspect of this idea, also referring to the work of Lacan on ‘Le Stade du Miroir’. Winnicott writes that, if all goes well, the baby gets a reflection of himself and his state by looking at the mother’s face, and if he does not, the baby withdraws from exploring himself in the mother. Clinical cases are described.
Physical and Emotional Disturbances in an Adolescent Girl
Authors: Winnicott Donald W.
Published: March 2017

Winnicott reports the case of an adolescent girl and her general health despite physical and emotional disturbances in development, together with that of the same girl once she becomes a mother and then her own daughter’s difficulties. Sexuality and gender issues are discussed.
A Link Between Paediatrics and Child Psychology
Authors: Winnicott Donald W.
Published: March 2017

Winnicott, in a lecture to trainee doctors, argues by means of several clinical examples for a link being made between physical health and emotional or psychological health of the child within the family. He chooses to eschew giving a précis of psychoanalytic theory in favour of interesting the doctors directly by means of his clinical cases, linking them to what they would come across in their daily medical experiences.
Roots of Aggression
Authors: Winnicott Donald W.
Published: March 2017

In this unfinished paper, never given, Winnicott debates the sources of aggression from a psychoanalytic perspective. He advocates discarding the contributions of Freud on the Death Instinct and Klein on envy as laid out in her 1955 paper, and unlinking these concepts from their authors in order to asses their value free of loyalty or cliché.
Letter to Adam Limentani
Authors: Winnicott Donald W.
Published: March 2017

Letter from Winnicott to Adam Limentani on Winnicott’s contribution to the training of analytic candidates at the British Society.
Letter to Joyce Coles
Authors: Winnicott Donald W.
Published: March 2017

Winnicott writes from Lenox Hill Hospital in New York to his long-standing secretary Joyce Coles about his serious heart condition and slow recovery and comments on the cold ‘machinery’ of hospital care.
Letter to Joyce Coles
Authors: Winnicott Donald W.
Published: March 2017

Winnicott writes from Lenox Hill Hospital in New York to his long-standing secretary Joyce Coles, on his gradually increasing confidence and the high cost of his hospital care.
Letter to Joyce Coles
Authors: Winnicott Donald W.
Published: March 2017

Winnicott writes from Lenox Hill Hospital in New York to his long-standing secretary Joyce Coles on their preparations to leave hospital and eventually return to London.
Foreword to Therapy in Child Care
Authors: Winnicott Donald W. , Dockar-Drysdale Barbara
Published: March 2017

Winnicott’s supportive preface to Barbara Dockar-Drysdale’s book Therapy in Child Care, in which Winnicott recounts the contribution of helpful clinical vocabulary for child therapy.
Review: The Psychology of Childhood and Adolescence
Authors: Winnicott Donald W. , Sandström C. I.
Published: March 2017

A Review by Winnicott of the textbook of academic psychology The Psychology of Childhood and Adolescence, by Sandström. Winnicott’s assessment is that Sandström misses the joys and difficulties of real family life and focuses on ‘scientific’ measurement, advice and value judgments.
Thinking and Symbol-Formation
Authors: Winnicott Donald W.
Published: March 2017

Winnicott discusses the development of thinking in the growing psyche as a natural result of graduated maternal failure. He also points out how thinking can become a defensive substitute for maternal inadequacy and then split-off from the integrated whole self of the child. Clinical material is used to illustrate his points. He concludes that psycho-analysis does not cure, although a patient may make use of psycho-analysis and achieve a degree of integration, socialisation and self-discovery which he would not or could not have achieved without it.
Letter to F. Robert Rodman
Authors: Winnicott Donald W.
Published: March 2017

Letter to F. Robert Rodman regarding his paper.
Letter to Renata Gaddini
Authors: Winnicott Donald W.
Published: March 2017

Letter to Dr Gaddini on his recovery from his illness.
Letter to Michael P. Collinson
Authors: Winnicott Donald W.
Published: March 2017

Letter to Michael P. Collinson on social anthropology and babyhood.
Development of the Theme of the Mother’s Unconscious as Discovered in Psycho-Analytic Practice
Authors: Winnicott Donald W.
Published: March 2017

In this follow up to Winnicott’s two earlier papers on the depressive position (1954), and the mother’s defence against depression (1948), Winnicott makes a further comment on analysis of patients in whom the mother’s unconscious can be seen.
The Threat to Freedom
Authors: Winnicott Donald W.
Published: March 2017

In this paper, following up on the previous paper on freedom, Winnicott examines the threat to freedom with reference to those whose inner freedom is curtailed by their mental ill health, noting that the right moment for investigating this is before freedom is lost. He posits that a prolonged threat can undermine the mental health of anyone, and the essence of cruelty is to destroy that degree of hope which makes sense of the creative impulse and of creative thinking and living.
Berlin Walls
Authors: Winnicott Donald W.
Published: March 2017

In this essay, Winnicott uses the Berlin Wall and the ‘peace line’ in Belfast as metaphors to describe how, even for the healthiest individual, inner psychic reality will always contain a division and conflict: a line along which there is always war. He compares these discrete borders where play cannot occur—where if there was no wall there would be war—to the gradual sense of change of place when travelling, for example, between England, Scotland and Wales, which can be done without knowing where the border has been crossed.
Answers to Comments on ‘The Split-Off Male and Female Elements’
Authors: Winnicott Donald W.
Published: March 2017

In this response to a discussion of his paper, Winnicott responds directly to the comments of Masud Khan, Margaret Mead, Dr Rosenfeld, Dr Sterba and Prof de Souza. This paper also includes the original comments as well as a version published in 1972. Winnicott uses Rosenfeld’s notion that ‘where the delusional female self does not experience envy, it is “certainly not a primary” structure’, to re-examine his own opinion that it is a primary condition.
Commentary on Play Therapy
Authors: Winnicott Donald W.
Published: March 2017

This is Winnicott’s spoken commentary on Virginia Axline’s book Play Therapy. He praises the book in that its method and Axline’s attitude can be communicated to suitable people in a relatively short period of time and without a psychoanalytic or medical training. He also makes note of the book’s limitations as regards the complication of psycho-analytic interpretation.
Cure
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott describes how, in medical practice, there is a gap between two extremes that he calls care and remedy. Medical practitioners, he holds, are in a battle to prevent the meanings of the two words losing touch with each other. He relates this to reliability and dependence, gratitude, holding and growth. He asks whether care-cure makes too many demands on the practitioner, but rather feels that this kind of professional work is the application of principles learnt at the beginning of our lives.
Letter to John Davis
Authors: Winnicott Donald W.
Published: March 2017

Letter to John Davis in which he expresses his sadness over the loss of his friends in the First World War.
Letter to Jeannine Kalmanovitch
Authors: Winnicott Donald W.
Published: March 2017

Winnicott writes to Jeannine Kalmanovitch asking if she had received his last three letters.
Interrelating Apart from Instinctual Drive and in Terms of Cross-Identifications
Authors: Winnicott Donald W.
Published: March 2017

In this chapter, Winnicott uses clinical material to juxtaposes two contrasting statements, each illustrating intercommunication. The first case, a therapeutic consultation with a girl at an early stage of adolescence, illustrates how the psychotherapist can act as a mirror. In the second case, cross-communication is illustrated in terms of the capacity for introjective and projective identifying mechanisms. Winnicott argues that there are mechanisms for object relating, such as elements of playing, that are not drive-determined.
Tailpiece to Playing and Reality
Authors: Winnicott Donald W.
Published: March 2017

This is Winnicott’s epilogue to Playing and Reality. He recounts that there is a stage in the development of human beings that comes before objectivity and perceptibility and that this conception–perception gap provides rich material for study. He postulates an essential paradox that must be accepted and is not to be resolved.
Note on Infant Observation
Authors: Winnicott Donald W.
Published: March 2017

In this note, Winnicott explains that a discussion of infant observation properly belongs to the scientific meetings of psychoanalytic research workers because a better view of infancy can be obtained through the psychoanalytic study of the child and adults than by direct observation. This is especially true if the patient does in fact need in the transference a degree of dependence that belongs properly to earliest and early infancy.
Case I: ‘Iiro’ aet 9 Years 9 Months
Authors: Winnicott Donald W.
Published: March 2017

This is case I in part 1 of Winnicott’s book Therapeutic Consultations in Child Psychiatry: the case of ‘Iiro’, aet 9 years 9 months.
Case III: ‘Eliza’ aet 7½ Years
Authors: Winnicott Donald W.
Published: March 2017

This is case III in part 1 of Winnicott’s book Therapeutic Consultations in Child Psychiatry: the case of ‘Eliza’, aet 7½ years.
Case V: ‘Robert’ aet 9 Years
Authors: Winnicott Donald W.
Published: March 2017

This is case V in part 1 of Winnicott’s book Therapeutic Consultations in Child Psychiatry: the case of ‘Robert’, aet 9 years.
Inter-Relationship of Body Disease and Psychological Disorder
Authors: Winnicott Donald W.
Published: March 2017

In this chapter, Winnicott summarises diseases of the soma (body), which are in origin hereditary, congenital, intake deficiency, accident, infestation and infection, and the effect on the body tissues of psychological states. He then summarises illness of the psyche, which for Winnicott is clinically a disorder of emotional development. He summarises again the neuroses, psychoses, and schizophrenia, and adds that these distinctions between psyche and soma then enable him to make interconnections between the two, leaving out for the moment the impact of the environment on each.
Introduction: Primitive Emotional Development
Authors: Winnicott Donald W.
Published: March 2017

In the Introduction to Part IV, Winnicott states that he will describe primitive (early) emotional development in terms of the establishment of a relationship between the self and external reality, then the integration of the unit self out of a previously unintegrated state, and, finally, the proper lodging of the psyche within the body.
The Birth Experience
Authors: Winnicott Donald W.
Published: March 2017

In this chapter, Winnicott describes what the stage of being unborn to becoming born might be like for the infant. He suggests that if birth is healthily accomplished, the infant may be able to have the illusion that all was brought about and achieved by himself. He proposes that a caesarean section birth has losses for the baby in terms of normal delivery and that time delays that effect delivery can become sufficiently impinging, creating for that infant a sense of formlessness in time and space which cannot be managed. Winnicott addresses the changeover from not-breathing states in the womb to the newborn’s learning to breathe and also to the newborn’s connecting with the mother’s breathing and then feeling held in a quiet way after birth. He proposes that some patients in analysis have very early body experience memories related to birth trauma and that the study of very early birth-related experience in analysis helps with understanding more severe mental illness, such as the psychoses.
The Patient
Authors: Winnicott Donald W.
Published: March 2017

The first chapter of The Piggle consists of extracts from two letters from the parents indicating a need for help for their daughter. The chapter briefly describes some of her difficulties following the birth of a younger sister.
Fifth Consultation
Authors: Winnicott Donald W.
Published: March 2017

The sixth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the fifth consultation with Gabrielle, 9 June, 1964, along with a letter from her mother and a reply by Winnicott, followed by two further communications from her mother.
Tenth Consultation
Authors: Winnicott Donald W.
Published: March 2017

The eleventh chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the tenth consultation with Gabrielle, 23 March, 1965, along with two letters from her mother.
Eleventh Consultation
Authors: Winnicott Donald W.
Published: March 2017

The twelfth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the eleventh consultation with Gabrielle, 16 June, 1965, along with letters from her mother, from Gabrielle, and one from Winnicott to her parents.
Fourteenth Consultation
Authors: Winnicott Donald W.
Published: March 2017

The fifteenth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the fourteenth consultation with Gabrielle, 18 March, 1966.
Chronological Bibliography of Letters by D. W. Winnicott
Authors: Pearn Clay , Adès Robert
Published: March 2017

Winnicott’s correspondence published in the Collected Works presented in chronological order.