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Medium 9781855753495

CHAPTER SEVEN He or she? Trying to think psychodynamically about a service for people with gender dysphoria

Karnac Books ePub

Bernard Ratigan

“The ego is first and foremost a bodily ego . . .”

Freud (1923b) p. 69


The subjective experience of gender dysphoria is one of a more-or-less profound sense of dis-ease with one’s body and, following Freud, with one’s core sense of self. I have come to think that the psychic trauma of growing up in the “wrong body” is acute, and is heightened at puberty. When the dysphoria emerges in infancy, or no later than latency, it may be possible for the child to keep a phantasy alive that what is seen and experienced is not real. Despite having the physical characteristics of a boy, for example, the child may imagine that he will grow to become a woman. The onset of puberty can cruelly challenge this with the emergence of adult physical and sexual features.

Much of the suffering experienced by gender dysphoric children and adolescents seems to go consciously unnoticed and usually unmodified by understanding and sympathy. Indeed, the gender dysphoric child or young person may sometimes collude in an attempt to “bury” their unease with their gender. Parents, usually mothers, report a sense of things not being quite right and sometimes a half-conscious knowledge of the meaning of “dressing up” in the case of male-to female (MTF) children and clinging to boys’ clothes in female-to-males (FTMs). The depths of the dis-ease are only really known to the child or young person. Following Freud’s dictum, one is left wondering about the corrosive impact of the confusion and increasingly widening gap between physical, somatic, reality, and phantasy on the developing child’s ego and sense of self-worth. The crisis of puberty, for the child suffering from gender dysphoria, is one where the physical evidence of sex and gender are made incarnate; mind and body are going in different directions (Di Ceglie, 1998).

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Medium 9781567262179

CHAPTER 17: “A Series of Unfortunate Events,” or Event Chain Methodology

Virine, Lev Berrett-Koehler Publishers ePub

Often, in hindsight, projects can seem like Lemony Snicket’s series of unfortunate events. It is the unexpected effect of a series of events that often derails even the most well managed projects. Event chain methodology is a schedule network analysis technique that focuses on identifying, modeling, and managing the events that can affect a project schedule. Event chain methodology helps determine project duration, cost, and other parameters while taking into account these events and event chains. It also identifies critical risks and crucial tasks, performs resource leveling, and resolves other complex project scheduling problems.

The story of Toyota’s hybrid car, the Prius, is unique (Figure 17.1). Toyota positions itself as risk-averse company and is seen as a “fast-follower,” a company that quickly integrates externally developed technologies into its own products when they have proven to have market acceptance (Taylor 2006). At the same time, Toyota is capable of breaking its own rules, as the Prius example illustrates. The Prius project was launched in 1995 when Toyota’s management wanted to present a hybrid concept at the Tokyo Motor Show, which was only 12 months away. To make things more exciting, management set a requirement that the designers and engineers make at least a 100% improvement in fuel consumption compared to its other models. Finally, management wanted to put the Prius into production within 24 months—about two-thirds the time required for conventional vehicles.

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Medium 9781605099750

Chapter 2 Picky: Why Today's Customers Are Finicky

Bell, Chip R. Berrett-Koehler Publishers ePub

Customers today want the very most and the very best for the very least amount of money, and on the best terms.

Brian Tracy
Now, Build a Great Business

Chip recently fired his insurance agent—and hired a new one! “The old insurance agent did absolutely nothing bad,” Chip said, “and the office clerk was always friendly when I called.”

It’s just that the agent never did anything other than write my insurance policies and send me annual bills. The agent never called to thank me for my business, opting instead for a form letter only at renewal time. And, this is a small insurance office in a small town, not some mega-business with a gazillion customers!

The straw that broke the camel’s back was when I called one Wednesday afternoon just minutes past noon to inquire about getting a new umbrella policy. I heard a recording stating that the agency office always closed at noon on Wednesday but would reopen at 9 o’clock on Thursday morning. There was no answering service to channel my call should this have been an insurance emergency. So, I considered sending an email. I Googled the agency name only to find they had no website; there was no email address on any of their correspondence. If this were 1950, such practices might have made more sense.

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Medium 9781574411737

I. Background Factors: The Source, the Laredo Archives

Robert D. Wood University of North Texas Press PDF


n singing “The Cowboy’s Lament” (“As I walked out on the streets of Laredo . . .”) one could easily forget that this intriguing city was once a part of Spain. In a way this was fortunate because the preservation of papers and records dealing with national, municipal, legal, commercial, religious and social affairs was one of the ongoing and important requirements of Spain from her colonies. Each town was expected to report regularly to the higher echelons of authority. It was likewise expected to preserve copies of all of the decrees, ordinances, and legislation from the Crown and the viceregal, regional, and local governments, as well as the active and passive correspondence, copies of reports, and such things as the census. The accumulation of all of this material is what constitutes an archives. The preservation of all of these documents is another matter and depends very much on how succeeding generations appreciate their historical value. All too often they are relegated to some out-of-the-way spot with an agglomeration of boxes and bundles considered too important to throw away but never really referred to. And then, for some, there comes a time when they seem to be an encumbrance, when they are no longer a vital link to the past but a present nuisance, and they face the fate of all unwanted things.

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Medium 9781855756014

Ward Observation

Karnac Books ePub

Ward observation

Upon entering the ward, I went to the nurses' office. The nurses were very busy with something and did not seem to notice my presence. After waiting for a short while, I said that I had come for the community meeting. One nurse then told me to go to the nearby large common room, where the community meeting group was about to start.

In the group room, five patients and one nurse were seated, in two circles. There was an inner circle composed of several chairs and one sofa, and an outer circle formed by several chairs scattered further away and one sofa near the wall of the room. After a short while, a second nurse entered and then a third nurse popped in just to ask for the TV to be switched off; she then went out, although she returned a little later. One patient said he did not want the TV to be switched off, and it remained switched on for a little while (I did not notice when it was switched off later on). One patient left the room, and then another patient also left and shouted very loudly just outside. One nurse then left, and the nurse remaining in the room at that time asked me if I wanted to introduce myself; I did so.

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