| 1. |
- Andræ, Margareta, 1943-
(författare)
-
Facing death : physicians' difficulties and coping strategies in cancer care
- 1994
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Even if the treatment of cancer has developed over the last decades 50% of the patients still die of their cancer. The doctor's way of dealing with his and his patient's anxiety must surely be of significance for the treatment the patient receives.In the first part of the thesis earlier studies of physicians' stress and ways of coping are reported. There is a lack of systematic studies which show how doctors working with cancer patients adjust to this work. The aim of this investigation is to study cancer doctors' difficulties and coping strategies. The theoretical frame of the study embraces parts of psychoanalytical theory and coping models, emphasizing that both unconscious and conscious psychological processes play their part in the coping process.The second, empirical part of the study includes 23 physicians strategically selected out of a population of physicians who work with institutional care and who have daily contact with adult cancer patients. The main method of data collection has been a series of recorded interviews. The focus of the interview was the physician's perception of how he reacts, thinks, talks and acts in different phases of the cancer disease. To illustrate the defence strategies of the interviewers, the projective percept-genetic test, the "Defence Mechanism Test" (DMT) is used. The "Structural Analysis of Social Behaviour" (SASB) has been used to study the doctors' self image.The results indicate that the stated difficulties deeply affect the doctor as a human being. The statements reflect conflicting feelings and wishes in relation to authority, conflicting feelings and wishes in relation to frightening and injuring, conflicting feelings and wishes in relation to intimacy/distance. Thirty themes of coping strategies frequently recur and they have been grouped into seven categories. Most of the doctors "seek knowledge" and support from scientific literature. The majority of them state that attempting to "solve a problem" is their main strategy. Most of the doctors "seek support " as a part of their coping strategy. An interesting observation is that the doctors to a higher extent "seek a relation" to their patients rather than to their colleagues. Almost one third use "denial of the severity of a situation" as their main strategy. All the doctors consciously or unconsciously use "diverting strategies", i.e. undertake tasks which are devoid of contact with patients, such as research and administration or other activities which allow them to avoid the patient. One third use "projective manoeuvres" but this is never a main strategy.In the third part of the study the credibility of the results and their pedagogical and practical implications are discussed.
|
|
| 2. |
- Wikman, Marianne, 1941-
(författare)
-
To desire and to choose : aspects of women's and men's urge to have children
- 1994
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to increase available knowledge about women's and men’s desire for pregnancy and for a child/children to serve as a basis for further studies of problems and inconsistencies in the reproductive sphere. The motivation to become a parent was hypothesized as being not only of an existential, social, interpersonal and intrapsychic character but also a biologically anchored personality trait.The first part of the study deals with the development of a method for collecting valid information concerning this intimate and personal sphere of life and to categorize this information into measurable dimensions. A questionnaire was constructed and factor analysis was used as a statistical tool. There are two versions of the final instrument, one for women and one for men. Interviews were used as a means of testing the validity of the instrument. Experiences from the methodological development process revealed that it was meaningful to deal with the issue though suitable wording was not easily found.In the main part of the study, two large populations, one reference group of 416 women and 329 men of fertile ages and one group of expecting parents, 369 women and 345 men, were investigated by means of the questionnaire. Attitudes were dominated by two opposing views of children: 'Children mean existential satisfaction' and 'Children mean restriction of freedom'. This confirmed the findings of earlier studies and clinical experience that ambivalence is a natural phenomenon, that may be associated with feelings of guilt. The view of one's own parents as models in parenthood was a third important dimension. The view of the child's sex was a fourth important and complex dimension.The similarities between women and men were striking. There were only subtle differences between reference women and pregnant women. Reference men and child-expecting men had different response patterns, child-expecting men emphasizing more the advantages of having children.In the last part of the study 48 women were followed during pregnancy and after childbirth using the questionnaire and determination of levels of the intestinal peptide gastrin. Gastrin may be a marker of energy-storing characteristics, thus influencing reproductive capacity. There were some attitudinal differences between 0-parous women and parous women, the latter agreeing less with the view of 'children as restriction of freedom'. The view of 'children as existential satisfaction' was agreed with more after childbirth than during pregnancy. The view of one’s own parents as models in parenthood correlated with the levels of gastrin during this period.
|
|
| 3. |
- Bodlund, Owe, 1949-
(författare)
-
Transsexualism and personality : methodological and clinical studies on gender identity disorders
- 1994
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients suffering from transsexualism (TS) who apply for sex reassignment surgery (SRS) go through a complex evaluation process before being accepted for treatment. In general, the results from SRS are satisfying. However, further knowledge is needed to clearly delineate transsexualism from other related gender identity disorders (GID) and to improve the selection of candidates for SRS. Personality has for a long time been considered as the key concept for that purpose but systematic studies using reliable instruments are lacking. The present study aims at improving the assessment procedure, validating the concept of transsexualism and studying the outcome of SRS and important prognostic factors.Two methodological studies deal with the development and validation of two self-report instruments based on DSM-III-R: SCID screen covering Axis II personality disorders/traits and Global Assessment of Functioning (GAF-scale, Axis V). SCID screen diagnoses of personality disorders (PD) were compared with diagnoses from independent structured interviews by means of the SCID-II. The overall kappa in identifying a PD was 0.78 varying from 0.34 to 0.81 for the specific PDs when cut-off was adjusted. When applied to a group of GID-patients SCID screen diagnoses agreed well with clinical diagnoses (kappa 0.77). Self-report of the GAF also proved to be a reliable (overall Pearson r=0.62) and useful method and the study lends further support to the validity of Axis V.In three papers a group of 19 transsexuals was studied by means of a) SCID screen to examine their personality in a dimensional and traditional categorical way, b) the GAF-scale to study psychosocial functioning, c) Structural Analysis of Social Behavior (SASB) to examine self-image and d) Defense Mechanism Test (DMT) to analyze psychological defense structures from a psychodynamic perspective. Patients with atypical gender identity disorders (GIDAANT) and patients with borderline personality disorders as well as healthy subjects were used as contrast groups. Among the transsexuals 10 out of 19 had an additional axis I disorder and 37% had at least one PD, predominantly within cluster B. When analyzed dimensionally according to SCID screen, frequent subthreshold personality pathology was found and biological women fulfilled more axis II criteria than men. TS had less axis I and II pathology compared with GIDAANT and psychiatric patients. According to SASB, TS had a positive self-image with both self-control and spontaneous self and predominating self-love. They appeared significantly more healthy on self-image measures than GIDAANT patients. The DMT revealed a different pattern; TS patients were more disturbed in several areas than patients with borderline personality disorder. TS showed no ”emotional investment” and poorer reality orientation in contrast to both healthy controls and the borderline group but shared a similar pregenital pathology with the borderline patients.Finally, five-year outcome was studied among the transsexuals from a multidimensional approach (e.g. work, interpersonal relations, partnership, subjective opinion) and related to index- measurements on DSM-III-R, SCID screen, GAF, SASB and DMT. Based on combined outcome variables, 68% of the subjects were judged to have improved and 16% had an unsatisfactory outcome. One single case regretted the sex change. SCID screen pathology and SASB disturbances emerged as significant predictors for negative outcome, as well as male biological sex and lack of partnership. It was concluded, that although outcome is in general very favorable, the instruments under investigation, in particular SCID screen and SASB, revealed valuable prognostic information and they are suggested to become part of the future routine assessment of candidates for SRS.
|
|
| 4. |
|
|
| 5. |
- Chotai, Jayanti, 1948-
(författare)
-
Season of birth in suicidology : neurobiological and epidemiological studies
- 1999
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Several neuropsychiatrie disorders have shown season of birth associations. Low cerebrospinal fluid (CSF) levels of the serotonin metabolite 5-HIAA and the dopamine metabolite HVA have been associated with suicidal behaviour, impulsivity, and aggression. This thesis investigated associations between the season of birth, the CSF levels of three monoamine metabolites (including MHPG of norepinephrine), the scales of the diagnostic interview for borderline patients (DIB), and psychiatric diagnoses. Also, the methods of suicide were investigated in relation to the season of birth.Methods: We studied a clinical sample of 241 patients in Stockholm with mood, anxiety and adjustment disorders with respect to the CSF levels of monoamine metabolites in relation to the season of birth, and in relation to the DIB in an overlapping sample. We also analysed all completed suicides during the 42 years 1952- 1993inVästerbottenin northern Sweden (1466 cases) by multiple logistic regressions to relate suicide methods with season of birth, gender, age, urban-rural residence, marital status, year of suicide, and season of suicide. For the 20 years 1961- 1980 (693cases), psychiatric in-patient and out-patient records were also examined for any history of psychiatric contacts and psychiatric diagnoses. In two mutually independent samples, we investigated the DIB in relation to the season of birth.Results: In the Stockholm sample, those born during February to April had significantly lower CSF levels of 5-HIAA, and those born during October to January had significantly higher CSF levels of HVA, HVA/5-HIAA, and HVA/MHPG, as well as (non-significantly) higher levels of 5-HIAA. Those with an intermediate score of section II (impulse action patterns) of the DIB had significantly higher CSF levels of 5-HIAA and HVA, and they were significantly more likely to have been born during October to January. In the Västerbotten register, those born during February to April were significantly more likely to have preferred hanging rather than poisoning or petrol gases, and conversely for those born during October to January. These associations with suicide methods were found for the total sample and for those without any history of psychiatric contacts, but not for those with psychiatric contacts.Conclusions: Suicidal behaviour shows statistically significant variation according to the season of birth, most probably mediated by a variation in an independent trait of vulnerability to suicide based on neurodevelopmental parameters, particularly the serotonergic system. The suicidal process differs between those who seek psychiatric care compared to those who do not, reflecting differences in the diagnostic spectra and in the extent of mental illness.
|
|
| 6. |
|
|
| 7. |
- Edenius, Bo, 1944-
(författare)
-
Gud eller Svensson : om en teori för psykos och utveckling av en behandlingsmetod
- 1999
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The two principal elements comprising this thesis are 1) a description of the development of a theory concerning schizophrenic psychosis and 2) an attempt to develop a treatment strategy based on this theory. The theory was developed by Palle Villemoes on the basis of the French psychoanalyst Lacan's work and may be described as an ego-structuring psychotherapy with its foundation in the castration complex. The psychosis is seen as a consequence of the child's inability, for various reasons, to a apt itself to symbolic castration - i e disappointment and frustration over not constantly having its own way, and over being required to subordinate itself to universal principles and authorities. The psychotic person has not subordinated under symbolic is castration but continues to exist in the original symbiotic relation with the imagined pre-oedipal mother, When the pressures of the teenage and early adult years make themselves felt, such an ego-weak person is unable to withstand and deal with them and develops a psychotic relation to her/his surroundings,The- treatment strategy described in this thesis, was developed by the author and colleagues at the treatment centre Norrgården in Härnösand. It is a milieu therapyoriented treatment during which the patient optimally passes through three phases. During the first - narcissistic - phase the aim is that the patient's contact person develop such a relationship with her/him that "idolization" of the contact person occurs. This idolization is achieved by means of interest on the part of the contactperson, and a non-polarized attitude. The contact person shows interest in the patient and in her/his situation, life-story and interests. The non-polarized attitude means that little or no importance is attached to differences, particularly those due to gender and power position. The contact person avoids provoking the patient in areas about which she/he is sensitive. When a balanced, conflict-free relationship with the patient bas been achieved, treatment moves into a so- called working phase. Now the establishing of her/ his own history in the patient takes over from the idolization built up in the course of the close relationship. The patient is to become the subject of her/his own life-story, to achieve which patient and contact person go through the story together. If all goes well the patient passes through the castration complex and is able to find a realistic place for her himself in the story, the culture, and the society that has to be lived in with all its relations towards other people. The patient now begins to view her/himself, with both possibilities and limitations, more and more realistically. She/he also begins to show interest in the future and in plans for a life after treatment.In the final phase, progressively more responsibility for decisions is left to the patient. The aim of this phase of the treatment is to consolidate the narcissism of the patient's own ego. She/he must be released from the symbiotic dyad with the contact person who now leaves it to the patient to make choices and decisions and to be aware of the passage of time.The thesis discusses the development of the theory in a dialectic relation to the practical experiences of treatment work during the earliest years at Norrgården. A central place in the thesis is occupied by 11 case descriptions of the first patients who completed the treatment at Norrgården.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Hansson, Jan-Håkan
(författare)
-
Organizing normality : Essays on organizing day activities for people with severe mental disturbances
- 1993
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on the organizing of day activities, outside hospital care, for people with severe mental disturbances in Sweden. The purpose of the study is threefold: to describe the material and structural conditions of day activity settings on a national scale; to analyse some of the ideological claims made in the field; and to discuss problems and possibilities arising when more than one organizational sector is involved in the work.The thesis is divided into two parts. Part A presents the empirical material, derived from a national survey, as well as some historical and theoretical points of departure and concludes with a summarizing analysis of results. Part B contains four empirically based papers.The results show a considerable growth in the 1980s of day activity units specifically arranged for this group of people with severe mental disturbances. The average economic resource-input is considerably larger in psychiatry-run units than in units run by the social services. The collaborative efforts between the social services and psychiatry are discussed in the light of the fact that joint venture units develop distinctively different features, when it comes to, for example, recruitment routes of users and collaborative work with other organizations, as compared to units run by the social services or psychiatry alone. Thestructural and discursive power in this new field is largely in the hands of psychiatry. Ideological claims as to the definition of the work adhers to a "therapeutic paradigm".Results from an analysis of self-presentation documents reveals five distinct content categories: the dimension of ambition to change, the dimension of time-structuring, the dimension of profession/expertise, the dimension of intimacy of relation, and the dimension of autonomy. This is discussed in view of tendencies towards professionalization from different occupational groups as well as in view of issues of social control in modem society.Finally some prospects for the development in the future are discussed.
|
|
