bluuebunny/crossref_metadata_2025 huggingface dataset:
Endothelin-1 Is a Key Mediator of Coronary Vasoconstriction in Patients With Transplant Coronary Arteriosclerosis
Authors: Larose Eric , Behrendt Dominik , Kinlay Scott , Selwyn Andrew P. , Ganz Peter , Fang James C.
Published: June 2009

Background—

Transplant coronary arteriosclerosis (TCA) is the principal long-term complication in cardiac transplant recipients. The mediators responsible for vascular proliferation and vasoconstriction typical of TCA remain largely unknown. We tested whether endothelin-1 (ET-1), a potent vasoconstrictor and mitogen, contributes to the pathogenesis and manifestations of TCA.

Methods and Results—

BQ-123, an ET-1 receptor-A antagonist, was infused into a coronary artery (40 nmol/min for 60 minutes) of 18 subjects, 6�4 years after transplantation. Vasomotor responses were measured in the infused artery and in a noninfused control artery in patients with (n=10) and without (n=8) advanced TCA (108 total coronary segments). Changes in diameters were compared at 15-minute intervals up to 60 minutes. Contribution of ET-1 to coronary constrictor tone was assessed by comparing vasodilation from BQ-123 with that of the maximal vasodilator nitroglycerin (200-μg intracoronary bolus).

BQ-123 dilated coronary arteries of transplanted patients (8.4% at 60 minutes versus −0.4% in noninfused arteries,
P
<0.001). Dilation was greater for arteries with advanced TCA defined as diameter stenosis ≥15% (dilation 15.2% with versus 0.6% without advanced TCA,
P
=0.004). Judged against the response to nitroglycerin, ET-1 accounted for 53.2% of coronary tone in advanced TCA but only 12.9% without advanced TCA.

Conclusions—

This study shows for the first time in humans that ET-1 is an important mediator of coronary vasoconstriction in TCA and accounts for >50% of the increased vasomotor tone. Therapeutic targeting of ET-1 may retard the development of TCA.
Loss of Angiotensin-Converting Enzyme 2 Accelerates Maladaptive Left Ventricular Remodeling in Response to Myocardial Infarction
Authors: Kassiri Zamaneh , Zhong Jiuchang , Guo Danny , Basu Ratnadeep , Wang Xiuhua , Liu Peter P. , Scholey James W. , Penninger Josef M. , Oudit Gavin Y.
Published: June 2009

Background—

Angiotensin-converting enzyme 2 (ACE2) is a monocarboxypeptidase that metabolizes Ang II into Ang 1-7, thereby functioning as a negative regulator of the renin-angiotensin system. We hypothesized that ACE2 deficiency may compromise the cardiac response to myocardial infarction (MI).

Methods and Results—

In response to MI (induced by left anterior descending artery ligation), there was a persistent increase in ACE2 protein in the infarct zone in wild-type mice, whereas loss of ACE2 enhanced the susceptibility to MI, with increased mortality, infarct expansion, and adverse ventricular remodeling characterized by ventricular dilation and systolic dysfunction. In ACE2-deficient hearts, elevated myocardial levels of Ang II and decreased levels of Ang 1-7 in the infarct-related zone was associated with increased production of reactive oxygen species. ACE2 deficiency leads to increased matrix metalloproteinase (MMP) 2 and MMP9 levels with MMP2 activation in the infarct and peri-infarct regions, as well as increased gelatinase activity leading to a disrupted extracellular matrix structure after MI. Loss of ACE2 also leads to increased neutrophilic infiltration in the infarct and peri-infarct regions, resulting in upregulation of inflammatory cytokines, interferon-γ, interleukin-6, and the chemokine, monocyte chemoattractant protein-1, as well as increased phosphorylation of ERK1/2 and JNK1/2 signaling pathways. Treatment of
Ace2

−

/y

-MI mice with irbesartan, an AT1 receptor blocker, reduced nicotinamide-adenine dinucleotide phosphate oxidase activity, infarct size, MMP activation, and myocardial inflammation, ultimately resulting in improved post-MI ventricular function.

Conclusions—

We conclude that loss of ACE2 facilitates adverse post-MI ventricular remodeling by potentiation of Ang II effects by means of the AT1 receptors, and supplementing ACE2 can be a potential therapy for ischemic heart disease.
Soluble CXCL16 Predicts Long-Term Mortality in Acute Coronary Syndromes
Authors: Jansson Anna M. , Aukrust Pål , Ueland Thor , Smith Camilla , Omland Torbjørn , Hartford Marianne , Caidahl Kenneth
Published: June 2009

Background—

CXCL16/SR-PSOX is an interferon-γ–regulated chemokine and scavenger receptor for oxidized low-density lipoprotein that is expressed in atherosclerotic lesions. Proteolytic cleavage of membrane-bound CXCL16 releases soluble CXCL16, which may promote migration of effector T cells and augment a proatherogenic inflammatory response. We hypothesized that soluble CXCL16 concentrations are associated with long-term outcome in patients with acute coronary syndromes.

Methods and Results—

We assessed the association between circulating CXCL16 levels obtained within 24 hours after admission and time to death in 1351 patients (median age 67 years, 30% female) with a diagnosis of unstable angina, non–ST-segment–elevation myocardial infarction, or ST-segment–elevation myocardial infarction. During a median follow-up time of 81 months, 377 patients died. Increased levels of CXCL16 were prognostically unfavorable; the fourth versus first quartile was associated with higher risk of death (hazard ratio 2.1; 95% CI 1.6 to 2.8;
P
<0.0001), triple risk of developing heart failure (hazard ratio 3.0; 95% CI 1.8 to 5.1;
P
<0.0001), and a doubling of the risk of rehospitalization for myocardial infarction (hazard ratio 2.1; 95% CI 1.3 to 3.3;
P
=0.002). After adjustment for conventional risk markers, logarithmically transformed CXCL16 level remained a strong independent indicator of long-term mortality (hazard ratio 1.21; 95% CI 1.09 to 1.36 per 1 SD increase in CXCL16;
P
=0.0006) and congestive heart failure development (hazard ratio 1.25; 95% CI 1.05 to 1.48;
P
=0.01). In a subsample of 714 patients, after further adjustment for troponin T, high-sensitive C-reactive protein, pro–B-type natriuretic peptide, and left ventricular ejection fraction, CXCL16 still provided significant additional prognostic information on mortality (hazard ratio 1.21; 95% CI 1.02 to 1.42 per 1 SD increase in CXCL16;
P
=0.02).

Conclusions—

In patients with an acute coronary syndrome, CXCL16 levels obtained within 24 hours of admission are associated with long-term mortality after adjustment for other risk factors.
Safety and Efficacy of Drug-Eluting and Bare Metal Stents
Authors: Kirtane Ajay J. , Gupta Anuj , Iyengar Srinivas , Moses Jeffrey W. , Leon Martin B. , Applegate Robert , Brodie Bruce , Hannan Edward , Harjai Kishore , Jensen Lisette Okkels , Park Seung-Jung , Perry Raphael , Racz Michael , Saia Francesco , Tu Jack V. , Waksman Ron , Lansky Alexandra J. , Mehran Roxana , Stone Gregg W.
Published: June 2009

Background—

The safety and efficacy of drug-eluting stents (DES) among more generalized “real-world” patients than those enrolled in pivotal randomized controlled trials (RCTs) are controversial. We sought to perform a meta-analysis of DES studies to estimate the relative impact of DES versus bare metal stents (BMS) on safety and efficacy end points, particularly for non–Food and Drug Administration–labeled indications.

Methods and Results—

Comparative DES versus BMS studies published or presented through February 2008 with ≥100 total patients and reporting mortality data with cumulative follow-up of ≥1 year were identified. Data were abstracted from studies comparing DES with BMS; original source data were used when available. Data from 9470 patients in 22 RCTs and from 182 901 patients in 34 observational studies were included. RCT and observational data were analyzed separately. In RCTs, DES (compared with BMS) were associated with no detectable differences in overall mortality (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.81 to 1.15;
P
=0.72) or myocardial infarction (HR, 0.95; 95% CI, 0.79 to 1.13;
P
=0.54), with a significant 55% reduction in target vessel revascularization (HR, 0.45; 95% CI, 0.37 to 0.54;
P
<0.0001); point estimates were slightly lower in off-label compared with on-label analyses. In observational studies, DES were associated with significant reductions in mortality (HR, 0.78; 95% CI, 0.71 to 0.86), myocardial infarction (HR, 0.87; 95% CI, 0.78 to 0.97), and target vessel revascularization (HR, 0.54; 95% CI, 0.48 to 0.61) compared with BMS.

Conclusions—

In RCTs, no significant differences were observed in the long-term rates of death or myocardial infarction after DES or BMS use for either off-label or on-label indications. In real-world nonrandomized observational studies with greater numbers of patients but the admitted potential for selection bias and residual confounding, DES use was associated with reduced death and myocardial infarction. Both RCTs and observational studies demonstrated marked and comparable reductions in target vessel revascularization with DES compared with BMS. These data in aggregate suggest that DES are safe and efficacious in both on-label and off-label use but highlight differences between RCT and observational data comparing DES and BMS.
Importance of Treadmill Exercise Time as an Initial Prognostic Screening Tool in Patients With Systolic Left Ventricular Dysfunction
Authors: Hsich Eileen , Gorodeski Eiran Z. , Starling Randall C. , Blackstone Eugene H. , Ishwaran Hemant , Lauer Michael S.
Published: June 2009

Background—

We sought to determine whether treadmill exercise time may be of value as an initial prognostic screening tool in ambulatory patients with impaired systolic function who are referred for cardiopulmonary exercise testing.

Methods and Results—

We studied 2231 adult systolic heart failure patients (27% of whom were women) who underwent cardiopulmonary stress testing using a modified Naughton protocol. We assessed the value of treadmill exercise time for prediction of all-cause death and a composite of death or United Network for Organ Sharing status 1 heart transplantation. During a mean follow-up of 5 years, 742 patients (33%) died. There were 249 United Network for Organ Sharing status 1 heart transplants (11%). Treadmill exercise time was predictive of death and the composite outcome in both women and men, even after accounting for peak oxygen consumption and other clinical covariates (adjusted hazard ratio of lowest versus high sex-specific quartile for prediction of death 1.70, 95% confidence interval 1.05 to 2.75,
P
=0.03; for prediction of the composite outcome, 1.75, 95% confidence interval 1.15 to 2.66,
P
=0.009). For a 1-minute change in exercise time, there was a 7% increased hazard of death (eg, comparing 480 to 540 seconds, hazard ratio =1.07, 95% confidence interval 1.02 to 1.12,
P
=0.004).

Conclusions—

Because cardiopulmonary stress testing is not available in every hospital, treadmill exercise time with a modified Naughton protocol may be of value as an initial prognostic screening tool.
Direct Chronic Effect of Steroid Hormones in Attenuating Uterine Arterial Myogenic Tone
Authors: Xiao Daliao , Huang Xiaohui , Yang Shumei , Zhang Lubo
Published: June 2009

Pregnancy is associated with a significant decrease in uterine vascular tone and an increase in uterine blood flow. The present study tested the hypothesis that estrogen and progesterone differentially regulate the extracellular signal–regulated kinase (ERK)1/2 and protein kinase C (PKC) signaling pathways in vascular smooth muscle, resulting in a decrease in uterine vascular myogenic tone in pregnancy. Uterine arteries were isolated from nonpregnant and near-term pregnant sheep. Chronic treatment (48 hours) of nonpregnant uterine arteries with 17β-estradiol and progesterone caused a significant decrease in PKC-mediated contractions and pressure-induced myogenic tone. In accordance, treatment of near-term pregnant uterine arteries for 48 hours with ICI 182780 and RU 486 significantly increased PKC-induced contractions and myogenic tone. In contrast, acute treatment for 30 minutes had no effect on uterine artery contractility. An ERK1/2 inhibitor, PD098059, restored the chronic effect of steroids on PKC-mediated contractions in nonpregnant sheep. ERK1/2 protein and mRNA levels were greater in near-term pregnant as compared with nonpregnant uterine arteries. 17β-Estradiol and progesterone increased ERK1/2 protein in nonpregnant sheep. In agreement, ICI 182780 and RU 486 caused significant decreases in ERK1/2 protein in near-term pregnant sheep. Western blot showed 6 PKC isozymes, α, β
I
, β
II
, δ, ε, and ζ, in the uterine arteries. 17β-Estradiol and progesterone decreased the particulate:cytosolic ratios of PKCα, ε, and ζ, respectively, in nonpregnant sheep. ICI 182780 and RU 486 increased the ratios in near-term pregnant sheep. The results indicate a direct chronic effect of the steroid hormones in the upregulation of ERK1/2 expression and downregulation of the PKC signaling pathway, resulting in attenuated myogenic tone of the uterine artery in pregnancy.
Differential Effects of Antihypertensive Treatment on the Retinal Microcirculation
Authors: Thom Simon , Stettler Christoph , Stanton Alice , Witt Nicholas , Tapp Robyn , Chaturvedi Nish , Allemann Sabin , Mayet Jamil , Sever Peter , Poulter Neil , O'Brien Eoin , Hughes Alun
Published: June 2009

Changes in the retinal microcirculation are associated with hypertension and predict cardiovascular mortality. There are few data describing the impact of antihypertensive therapy on retinal vascular changes. This substudy of the Anglo-Scandinavian Cardiac Outcomes Trial compared the effects of an amlodipine-based regimen (373 patients) with an atenolol-based regimen (347 patients) on retinal microvascular measurements made from fundus photographs. The retinal photographs were taken at a stage in the trial when treatments were stable and blood pressure was well controlled. Amlodipine-based treatment was associated with a smaller arteriolar length:diameter ratio than atenolol-based treatment (13.32 [10.75 to 16.04] versus 14.12 [11.27 to 17.81], median [interquartile range];
P
<0.01). The association remained significant after adjustment for age, sex, cholesterol, systolic and diastolic blood pressures, body mass index, smoking, and statin treatment. This effect appeared to be largely attributable to shorter retinal arteriolar segment lengths in the amlodipine-treated group and is best explained by the vasodilator effects of amlodipine causing the visible emergence of branching side vessels. Photographic assessment of the retinal vascular network may be a useful approach to evaluating microvascular structural responses in clinical trials of antihypertensive therapy.
Gilgamesh the Giant: The Qumran Book of Giants' Appropriation of Gilgamesh Motifs
Authors: Goff Matthew
Published: June 2009

The Qumran Book of Giants shows familiarity with lore from the classic Mesopotamian Epic of Gilgamesh. It has been proposed that the author of the Book of Giants drew from the epic in order to polemicize against it. There is much to commend this view. The name of the hero of the tale is given to one of the murderous, wicked giants of the primordial age. Examination of fragments of the Book of Giants, in particular 4Q530 2 ii and 4Q531 22, however, suggests that key aspects of its portrayal of Gilgamesh the giant cannot be explained as polemic against Mesopotamian literary traditions. The Book of Giants creatively appropriates motifs from the epic and makes Gilgamesh a character in his own right in ways that often have little to do with Gilgamesh.
Qumran Pesharim and the Pentateuch: Explicit Citation, Overt Typologies, and Implicit Interpretive Traditions
Authors: Tzoref Shani
Published: June 2009

Qumran pesher is characterized as contemporizing exegesis of poetic/prophetic biblical texts. Previous research has focused upon pesher exegesis of works which later canonical tradition designates as "Latter Prophets" and of the book of Psalms, the dominant base-texts in pesharim. The current study surveys the use of the Pentateuch in Qumran pesher, examining instances of explicit citation, overt Pentateuchal typology, and implicit interpretive traditions. The most noteworthy attributes that emerge are the prominence of Deuteronomy and a strong reliance upon pre-existing exegetical traditions.
On the Content of Banking in Contemporary Capitalism
Authors: dos Santos Paulo
Published: June 2009

This paper considers the character and social content of banking in contemporary capitalism. Based on a survey of the operations of nine leading international banks, it documents the marked differences between contemporary banking and the traditional business of taking, making loans to enterprises, and making profits from the difference in interest-rates between them. Notably, the operations of the world's top banking organisations are shown to centre on various forms of credit to individual wage-earners and on mediating access to financial markets by corporations and, increasingly, individuals. In order to characterise the social content of such activities, the paper seeks to apply, and where necessary extend, existing Marxist analyses of banking, capital-markets, and their relationship to capitalist accumulation. This includes advancing a number of elements of a distinctive Marxist interpretation of capital-market operations to theorise financial-market mediation-relations between banks, corporations, and the mass of retail-savers. The analysis pursued helps identify the distinctive and exploitative content of the relations banks maintain with ordinary wage-earners through consumer- and mortgage-lending, as well as through the provision of pension-related saving services.
The Ambivalence of Gewalt in Marx and Engels: On Balibar's Interpretation
Authors: Basso Luca
Published: June 2009

This article is a reflection on Balibar's account of the concept of Gewalt in Marx, Engels and Marxism. The German term contains both the meanings of power and violence. At the centre of the analysis is the structural link between the notion of Gewalt and the capitalist mode of production and state-form. The problem is whether Gewalt can be understood in relation to the actions of the working class. Balibar rightly refuses any sort of counter-politics of power set against the power of the state which would retain the same overall logic as the latter. However, the question is how such a critique of the ahistorical ontology of violence can interact with Marx's idea of capital as a constitutively violent entity which threatens to subordinate to itself any stance of non-violence.
Homo Juridicus: On the Anthropological Function of the Law
Authors: Knox Robert
Published: June 2009

In Homo Juridicus, Alain Supiot argues that law has an 'anthropological' function – constituting people as rational beings by linking together their biological and symbolic dimensions. The law also serves a 'dogmatic function', embodying Western values and serving as a bar to totalitarian scientism and tempering the excesses of technology in the workplace. However, the anthropological function of the law has been undermined by the advance of science and economics and widespread privatisation, contractualisation and deregulation. This article contests Supiot's claims, especially as regards Marxism, counterposing his position to that of Bolshevik legal theorist Evgeny Pashukanis. Pashukanis's insights into the relationship between law and capitalism are used to re-frame Supiot's argument and to undermine his contention that globalisation is inimical to law. Pashukanis is also invoked to contest the claims that the anthropological function of the law is the only alternative to totalitarianism and that law serves to 'humanise' technology.
Editorial Introduction to the Symposium on the Global Financial Crisis
Authors: Ashman Sam
Published: June 2009

The current global economic crisis is historically unprecedented in that it began when poor groups in the United States defaulted on their mortgage-payments and spread fear of 'toxic debt' through an internationalised financial system, bringing the banking system close to collapse and highlighting the very individualised nature of contemporary financial relations. The symposium explores contemporary finance and banking practices in the context of Marxist political economy seeking to develop the notion of financialisation and arguing that banks' increasing reliance on individual households as a source of profits amounts to a form of financial expropriation or additional profit generated in the sphere of circulation.
Fetishistic Behavior: A Contribution to Its Complex Development and Significance
Authors: Dickes Robert
Published: June 2009

…ideas are not the foundations of science, upon which everything rests; that foundation is observation alone-Freud (12)
Psychoanalytic Studies on Joseph Conrad: I. The Family Romance
Authors: MEYER BERNARD C.
Published: June 2009

Fair Portia's counterfeit!

What demi-god hath come so near creation?

-Merchant of Venice
Mankind at its Best
Authors: Eissler K. R.
Published: June 2009

I am already looking fonvard to seeing [my biographers] go astray.-FREUD, 1885
Historical Notes Concerning Psychoanalysis and Early Language Development
Authors: Ekstein Rudolf
Published: June 2009

In the agreement between that peculiarity of the dream-work mentioned at the beginning of this paper and this which philologists have discovered to be habitual in the oldest languages, we may see a confirmation of our supposition in regard to the regressive, archaic character of thought-expressions in dreams. And we cannot dismiss the conjecture, which forces itself on us psychiatrists, that we should understand the language of dreams better and translate it more easily if we knew more about the development of language.
When Interpretation Masquerades as Explanation
Authors: Spence Donald P.
Published: June 2009

The principal goal of the clinical interpretation (and of the larger clinical narrative) is to bring about insight and change in the patient, and not to present a reasoned argument that relies on public data and shared rules of evidence and logic. When the clinical account is transposed to the public domain and presented as a form of explanation, it is no longer designed for the benefit of one individual but must now be accessible to all. We are still under the shadow of Freud's five famous cases which are literary landmarks of exposition and persuasion. As a result, we are less sensitive to what happens when interpretations are substituted for explanations. The time has come to develop a new genre and a new mode of clinical reporting that would allow the reader to participate in the argument, allow him to evaluate the proposed links between evidence and conclusion (instead of relying on the authority of the analyst-author), and open up the clinical report to the possibilities of refutation, disconfirmation, and falsification.
On The Nature of the Oceanic Experience
Authors: Werman David S.
Published: June 2009

It is postulated that consciousness is not simply an organ of perception, but that it possesses a structure, or organization, despite its enormous fluidity. In support of these views, the oceanic experience is explored. It demonstrates the impact, on this state of consciousness, of the subject's values and culture. Like the oceanic experience, every state of consciousness–what is in awareness at any given time–is a complex phenomenon that derives from all aspects of the psyche, including the subject's value system and the influences of his culture.
Female Psychology: A Review
Authors: Chehrazi Shahla
Published: June 2009

This paper examines the differences between early psychoanalytic views of female development and current views, illustrating that recent suggested revisions offer an updated preliminary theoretical framework. The clinical implications of the differing views are discussed, and examples (two from the psychotherapy of children and a third from the psychoanalysis of a young woman) are offered to demonstrate particular clinical issues, such as penis envy and genital anxiety. It is postulated that the outcome of psychoanalytic treatment of women is markedly affected by the different clinical formulations and conceptualizations that result from different views. Further, the psychoanalytic terminology can contribute in subtle ways to ambiguity, distortion, and lack of clarity regarding female psychology.
Countertransference Evolution in Theory and Practice
Authors: Tyson Robert L.
Published: June 2009

A framework tS suggested for conceptualizing countertransference, based on expansion of the concept emerging subsequent to Freud's original view of the phenomenon: (1) from Ucs to Cs, (2) from reactions to transference to all reactions, (3) from the analyst's neurosis to the anabst's functioning, (4) from self-analysis to self-scrutiny, (5) from obstacle to contribution. Particular attention is called to the advantages of maintaining the distinction between the patient' transference and the analyst's countertransference; the importance for successful psyhoanalytic work of being aware of the subtleties of countertransference in work with neurotic patients, especially in contrast to the blalant countertranrsference experiences more disturbed patients thrust upon the analyst; the need for furlher investigation of the relations between the analyst's empothy, regression, and countertransference; the lack of understanding of and information about the homosexual countertransference, based on insufficient knowledge of the mechanisms if resistance to self-analjsis, among other reasons; and the need for more reliable information about the limits of and indications for using countertransference responses in particular kinds of clinical situations, whether for informing the patient as to the analyst's responses to him, for informing the analyst in the interpretive process, or in formulating reconstructions. A clinical example provides an illustration of the complexity of countertransference-transference interaction and of the impact of countertransference on the transference.
On Countertransference Enactments
Authors: Jacobs Theodore J.
Published: June 2009

This communication focuses on the relation of countertransference to psychoanalytic technique, calling attention not to the more obvious forms of countertransference that have been commented on by previous writers on the subject, but to its subtler ones. Often well camouflaged within the framework of traditional, time-tested techniques this aspect of countertransference may attach itself to our way of listening and thinking about patients, to our efforts at interpretation, to the process of working through, or to the complex issue of termination. Less recognizable than its more boisterous counter-part und in some respects less tangible, this side of the problem of countertransference is no less important. For it is precisely those subtle, often scarcely visible countertransference reactions, so easily rationalized as parts of our standard operating procedures and so easily overlooked, that may in the end have the greatest impact on our analytic work.
Psychoanalytic Observations on the Pathology of Depressive Illness: Selected Spheres of Ambiguity or Disagreement
Authors: Stone Leo
Published: June 2009

This paper has two general sources: (1) ins own clinical psychoanalytic work extending over about four and one half decades; and (2) consideration of certain outstandingly influential ideas in our literature: first, those of the pioneer contributors, arid then those of certain more recent writers, whose views have sometimes exhibited important differences from those widley held in the post. I try to evaluate the two groups—in their occasional overlapping and important divergences, in relation to my own clinical experience. A certain general position of my own emerges from such process inevitably; but it is far from “revolutionary.” Indeed the contrary is more largely ture. In extreme anticipatory condensation—what I de propose, from my own reflections, is the preeminent importance of an archaic characterological core in depressive illness.
Can Psychoanalysis Find its Self?
Authors: Meissner W. W.
Published: June 2009

There is a place for the theory of the self in psychoanalysis. To justify that claim, I return to an era in the development of psychoanalytic thinking about the self that preceded Kohut's formulations and that has set itself on a course of evoluing a concept of the serf more congruent with extant structural theory: I try to articulate the potential role of such a self-concept in connection with the issues of personal agency and subjectivity, complex personal qualities, areas of the complex interaction and integration of intrapsychic structures, object relations, narcissism, and internalization. The intent of this discussion is to facilitate the further development and articulation of the psychoanalytic theory of the self, particularly in terms of its integration with structural theory, to promote clearer thinking and more effective clinical efforts.
Jung's Lost Contribution to the Dilemma of Narcissism
Authors: Satinover Jeffrey
Published: June 2009

This paper proposes a partial answer to the hypothetical question, “What might Jung's contribution to a theory of narcissism have been had he remained a psychoanalytic writer?” An attempt is made to demonstrate that, long before it became the vogue, Jung began to explore narcissistic terrain. In the course of this exploration, he formulated many insights, in idiosyncratic language, some of which have since been reformulated in psychoanalytic terms. It is posited that, in addition to narcissism, Jung formulated some ideas that go beyond it. Whether or not they prove accurate, these ideas are an untapped psychoanalytic resource.
Freud, Dora, and The Maid: A Study of Countertransferenge
Authors: Glenn Jules
Published: June 2009

Early advances in psychoanalytic knowledge, profound though they were, were incomplete structures to be built upon, modified, and partially discarded. In addition to errors due to insufficient knowledge, Freud's difficulties with Dora stemmed from countertransference. Dora's transference included an identification with a governess/maid. Important oedipal role played by a nursemaid in Freud's life made him vulnerable to being left by Dora. The maid, Monika, “the prime originator” of Freud's neurosis, seduced him, chastised him, and taught him of hell. In his self-analysis she was associated with Freud's mother who left him when she gave birth to his sister. When he was two and a half years old, Monika was discharged and jailed for stealing. I suggest that Freud's attraction to Dora revealed itself in his libidinal imagery of the treatment and his premature sexual interpretations, the effects of which he misjudged. Defending against his attraction, he pushed her away from him, did not act to keep her in analysis or allow her to reenter analysis later. In addition, since Dora had left him as he must have felt his childhood nursemaid had, he reacted as if she were that maid. Hurl, saddened, and angered, he used reversal and deserted her, thus damping his feelings.
The Revival Of “Dora”: Advances in Psychoanalytic Theory and Technique
Authors: Jennings Jerry L.
Published: June 2009

For nearly six decades after its publication in 1905, Freud's remarkable case of Dora remained untouched by critical comment. However, beginning in the early 1970's, an abundance of articles began to appear, which focused exclusively on the Dora case. The present paper reviews the literature of this so-called “Dora revival” in order to explain the historical and theoretical reasons leading to this extraordinary burst of research. Above all, two vital developments in the psychoanalytic discipline created the climate that fostered the Dora revival. First, there was a revolutionary change in attitude toward the phenomenon of countertransference: in contrast to the classical view of countertransference as a disruptive interference in treatment, analysts increasingly regarded countertransference as a pervasive and natural process, which could be potentially utilized to enhance understanding of the patient's unconscious conflicts and defenses. Second, there was enormous and rapid growth of a comprehensive psychoanalytic theory of adolescence and its treatment. Thus, based on a more favorable attitude toward countertransference, and a much improved understanding of the unique problems of adolescence, psychoanalysts could reexamine and better understand the decisive events that contributed to Freud's abortive analytic treatment of Dora.
The Princess in the Tower: Zelda Fitzgerald's Creative Impasse
Authors: Waites Elizabeth A.
Published: June 2009

Gifted women often find it difficult to integrate an acceptable social image with an autonomous artistic identity. This paper explores the ambitions and conflicts of Zelda Fitzgerald, who aspired to be an artist in several fields, but whose fame is largely contingent on the role she played in the life of her husband, F. Scott Fitzgerald. Zelda's flamboyant public pose, which served as a model for many of her husband's literary characters, is interpreted as an attempt to organize a consistent identity configuration by means of constant appeals for applause from an admiring audience. But although this configuration provided some stability and cohesion for her during her twenties, it was a superficial and vulnerable structure which failed to support her serious artistic aspirations. An examination of the separation conflicts and difficulties in internalization which contributed to Zelda's dilemma leads to a consideration of the role of the father in the organization of differentiated female achievements. Although Zelda Fitzgerald's pathology was extreme, her struggles suggest useful insights into the intrapsychic and social barriers commonly confronting creative women.
Childhood Amnesia: A Conceptualization in Cognitive-Psychological Terms
Authors: Wetzler Scott E. , Sweeney John A.
Published: June 2009

Childhood amnesia is defined operationally as the forgetting of early life events to a significantly greater degree than is accounted for by “normal” forgetting, which is an increasing recall decrement as time since occurrence increases. Three cognitive processes and their developmental changes are discussed which, when considered with psychodynamic factors, may broaden the understanding of childhood amnesia. It is argued that psychoanalytic theory and technique can benefit from the research and methods of cognitive psychology.
The Microstructure of Free Association
Authors: Teller Virginia , Dahl Hartvig , Teller Virginia , Dahl Hartvig
Published: June 2009

The author's purpose is threefold: first, to demonstrate the redundancy in the events of the complex life of a patient as told to a psychoanalyst; second, to show two novel ways to represent those events simply; and third, to suggest that the field of psychoanalysis, under assault from philosophers of science and hermeneuticists alike for either not being or for trying to be a science, can in principle be reclaimed for science. It can be done by abandoning a widely held belief that human behavior is simply too complex, too malleable, too rooted in ineffable experience to permit of systematic scientific capture.
Institutional Problems of Psychoanalytic Education
Authors: Kernberg Otto F.
Published: June 2009

I believe that psychoanalytic education is suffering from serious disturbances, which, by analogy, might be examined as an illness affecting the educational structures of psychoanalytic institutes and societies. After describing the symptoms of this illness, I shall explore its causes and suggest a possible course of treatment. My objective is not to present “ideal solutionsy” to problems, but to provide a theoretical frame that might facilitate such solutions.
A Preliminary Report on Defenses and Conflicts Associated with Borderline Personality Disorder
Authors: Perry J. Christopher , Cooper Steven H.
Published: June 2009

The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped, from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts.

A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value.

Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.
Recontact with the Analyst Following Termination: A Survey of Seventy-One Cases
Authors: Hartlaub George H. , Martin Gary C. , Rhine Mark W.
Published: June 2009

A questionnaire was sent to graduate members of the Denver Psychoanalytic Society asking for their experience with patients making contact with them after the analysis. They reported that within three years after termination two thirds of “successfully analyzed” patients had recontacted them. Seventy-one cases were surveyed. Most contacts were brief and did not seem to be the result of incomplete analysis. Rather, they aimed to satisfy ongoing needs for: (1) the continuing deidealization of the analyst, (2) the reactivation of the self-analytic function, and (3) the restructuring of self- and object representations by reporting developmentally significant accomplishments to the former analyst. The analyst's acknowledgement appears to be an integral part of the restructuring. This is work which either cannot be done before termination or the need for which has not been recognized during the analysis.
The Consciousness of Being Conscious
Authors: Joseph Edward D.
Published: June 2009

Starting with the therapeutic advantage gained when insight acquires consciousness, an investigation of the nature and function of consciousness is undertaken. Consciousness is a state of awareness, having a range of higher mental functions saving a regulator, controlling, and integrating role in mental activity. There are high levels of thinking, reality testing, experiencing, judging, anticipating; self-awareness and self-reflection enter into these controlling activities. Psychoanalysis has rightly been a science that studies the workings and contents of the unconscious portions of the mind. It has perhaps overlooked the important role that consciousness plays in ordinary life and in providing the levels of control and self-awareness individuals both experience and require. That pathology and disturbances of function may accompany normal stales of consciousness as well as altered states of consciousness is a common clinical phenomenon. Psychoanalysis as a therapy widens the scope of the conscious control systems.
The Fundamental Rule: A Study of Current Usage
Authors: Lichtenberg Joseph D. , Galler Floyd B.
Published: June 2009

Members of the editorial boards of the Journal of the American Psychoanalytic Association, Psychoanalytic Quarterly, and Psychoanalytic Inquiry, plus selected analysts from Canada, France, and England, were asked how they presented the fundamental rule to their analysands and what considerations led to their choice of initial guidelines. Forty-nine of eighty-three analysts responded to the survey.

The respondents described diversity in phrasing of the fundamental rule, the time in analysis when the guidelines are given, and the reasons for the practice they follow. The method each appears to reflect the differing conceptions analysts have analytic process. Two major trends emerged: either our respondents emphasized delineating a work or functional framework or contract, or they emphasized establishing an altitude or spirit of cooperation, mutuality and work sharing. In each group respondents differed as to whether they favored minimal or more lengthy instructions. They also differed as to whether they followed a consistent approach or one tailored to the needs of the individual analysand. A source of tension lay in an inclination either to remain in the tradition set by Freud or to experiment with different phrasings and timings. The authors give their reasons for choosing to give explicit instructions, requesting associational material beyond thoughts and feelings, and describing resistance as inevitable and a potential source of insight.
Changes In Psychoanalytic Ideas: Transference Interpretation
Authors: Cooper Arnold M.
Published: June 2009

Interpretation of the transference is central to all psychoanalytic models. Definitions of transference and transference interpretation have changed greatly daring the past half-century, influenced by major movements in philosophy, advances in psychoanalytic research and theory, and changes in our understanding of Freud. This paper suggests that historical, relatively simple, concepts of the transference as the reproduction in the present of significant relationships from the past do not adequately meet current clinical and theoretical demands. Modernist view of the transference emphasize as additional sources of transference responses, the role of the analytic background of safely, the constant modification of unconscious fantasy and internal representations, and the interactive nature of transference responses, with important interpersonal and intersubjective components. It is suggested that the evolving modernist views of transference and transference interpretation permit a fuller accounting for transference phenomena and open the way for better informed interventions. A brief discussion of the issue of psychological “truth” and “distortion” as applied to transference phenomena is presented. The themes are illustrated with clinical vignettes.
The Case Of Anna O.: A Neuropsychiatry Perspective
Authors: Orr-Andrawes Alison
Published: June 2009

Previous interpretations have not adequately explained the presence of focal neurological signs, delirium, and a variety of highly specific disturbances of perception, language, and sensorium in the case of Anna O. Examination of the neurological details suggests that Anna suffered from complex partial seizures exacerbated by drug dependence, and that she developed conversion symptoms patterned after the preexisting organic pathology. Hysterical conversion symptoms that mimic ictal events are not uncommon in psychomotor epilepsy. Recent neuropsychiatric models of hysteria are remarkably similar to the hypnoid states theory Breuer formulated, based on his observation of Anna O. The hypothesis presented here does not conflict with previous psychodynamic interpretations. I submit that it was the development of a conversion disorder patterned on actual organic phenomena, which highlighted for Breuer and Freud the “psychical mechanism” of somatic symptoms, thus paving the way for the important psychodynamic discoveries for which the case is remembered.
Rules of Clinical Understanding in Classical Psychoanalysis and in Self Psychology: A Comparison
Authors: Reed Gail S.
Published: June 2009

This paper compares the rules that govern clinical understanding in classical psychoanalysis and in self psychology. The rules of understanding in the two systems are fundamentally different. Self psychology interprets causes and relies on interpretive rules similar to those used in allegory. Classical psychoanalysis investigates reasons and seeks to uncover the patient's own interpretive system. Self psychology refinds its own theory in the relation between elements disguised in the manifest content of patients; productions. Classical psychoanalysis seeks to open up manifest content. Where self psychology reiterates theory in its interpretations, classical interpretations move away from theoretical generalizations toward specific fantasy-memory constellations. Theory, in self psychology, organizes directly the content of interpretations; theory in classical psychoanalysis organizes a technique of exploration and furnishes general sequences according to which data can be understood. This paper also suggests that the differences in the rules of clinical understanding have potential consequences for psychoanalysis which manifest themselves in psychoanalytic training and in the capacity for self-analysis.
Objects and Attitudes
Authors: Compton Allan
Published: June 2009

The concept of an attitudinal object has long been present in psychoanalysis bat almost entirely neglected. This omission is integral in the confusion and controversy about the object concept in general. It has left a theoretical gap which the so-called object relations theories have attempted to fill. This paper offers some preliminary suggestions for a psychoanalytic understanding of attitudes as a first level of inference in the study of relationships and their psychological basis.
Countertransference During an Analyst's Brief Illness
Authors: Dam Heiman van
Published: June 2009

This paper describes an example of acting out of countertransference during a brief but unexpected serious illness. My emphasis is on the regression that occurred with hospitalization and how it dovetailed with a particular patients transference. A confluence of my residual neurosis, the patient's neurosis, her transference state, her other characteristics (that she was female, for example), plus the fact that she was the last patient contacted, all conspired with the regression from the trauma of being hospitalized to produce the countertransference reaction.

This presentation is also intended to add to the very sparse literature on a distasteful subject of supreme importance.
Projection and Projective Identification: Developmental and Clinical Aspects
Authors: Kernberg Otto F.
Published: June 2009

Projective identification and projection are defined, described, and contrasted. Projective identification is seen as an early or primitive defensive operation, and projection as later or more advanced and derivative in nature. The developmental origins and adaptive functions of projective identification are examined with an emphasis on the cognitive preconditions for the operation of this defense. The varying functions of both defensive operations are described within the context of psychotic, borderline, and neurotic personality organization. Case material is presented to illustrate the diagnostic approach to and the clinical functions of projective identification, particularly its importance in contributing to complementary identification in the countertransference. Also illustrated is the technical management of severe transference regression under the impact of projective identification. Finally, alternative approaches to the diagnosis and interpretation of projective identification are discussed.