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Medium 9781855759688

1. Infantile anxiety-situations reflected in a work of art and in the creative impulse

Donald Meltzer Karnac Books ePub

Melanie Klein

My first subject is the highly interesting psychological material underlying an opera of Ravel’s, now being revived in Vienna. My account of its content is taken almost word for word from a review by Eduard Jakob in the Berliner Tageblatt.

A child of six years old is sitting with his homework before him, but he is not doing any work. He bites his pen-holder and displays that final stage of laziness, in which ennui has passed into cafard. “Don’t want to do the stupid lessons”, he cries in a sweet soprano. “Want to go for a walk in the park! I’d like best of all to eat up all the cake in the world, or pull the cat’s tail or pull out all the parrot’s feathers! I’d like to scold everyone! Most of all I’d like to put mama in the corner!” The door now opens. Everything on the stage is shown very large—in order to emphasize the smallness of the child—so all that we see of his mother is a skirt, an apron and a hand. A finger points and a voice asks affectionately whether the child has done his work. He shuffles rebel-liously on his chair and puts out his tongue at his mother. She goes away. All that we hear is the rustle of her skirts and the words: “You shall have dry bread and no sugar in your tea!” The child flies into a rage. He jumps up, drums on the door, sweeps the tea-pot and cup from the table, so that they are broken into a thousand pieces. He climbs on to the window-seat, opens the cage and tries to stab the squirrel with his pen. The squirrel escapes through the open window. The child jumps down from the window and seizes the cat. He yells and swings the tongs, pokes the fire furiously in the open grate, and with his hands and feet hurls the kettle into the room. A cloud of ashes and steam escapes. He swings the tongs like a sword and begins to tear the wallpaper. Then he opens the case of the grandfather-clock and snatches out the copper pendulum. He pours the ink over the table. Exercise-books and other books fly through the air. Hurrah! …

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Medium 9781855759107

2. Two ways of seeing

Margaret Cohen Karnac Books ePub

Two ways of seeing

… the traces of the storyteller cling to the story the way the handprints of the potter cling to the clay vessel.

Walter Benjamin, The Storyteller, 1999

When I applied for the child psychotherapy post at the neonatal intensive care unit of a large inner-city hospital, the part of the job description that caught my attention was that the post-holder would be expected to articulate the babies’ experience. I understood that I would also be required to be available to mothers, to fathers, to extended families, and to staff, that my job would be to listen and to try to understand their feelings. Although these latter things were difficult, I had some ideas about how to do them, some experience to fall back on. I was not too surprised that I felt rather superfluous in a busy unit, that I often wished I were a doctor and could be clear about what I should be doing and could do something useful, without feeling so full of ignorance and impotence. These are states of mind that psychoanalytically trained therapists are familiar with and learn to tolerate. But articulating these babies’ experience—that was something different. I rather fancied myself as knowing about babies; after all, I had had three of my own, and I had also done a two-year baby observation as part of my training and had supervised others doing such observations here in London and for many years in Italy. But these babies on the NICU I found hard to watch. I wondered what they were feeling and, dare one say, thinking. One doctor said to me: “We do such dreadful things to them, I just hope that they forget.’ Whether or not the baby forgets the experience, I wondered if it was ever going to be possible to imagine what the babies’ experience might be. I decided I had to sit and observe the babies and to get to know them, to know which baby belonged to which mother, and so on.

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Medium 9781786390394

11 Synergy of Antimicrobial Peptides



Synergy of Antimicrobial Peptides

Mobaswar H. Chowdhury, Gill Diamond* and Lisa Kathleen Ryan

University of Florida Colleges of Dentistry and Medicine, Gainesville, Florida, USA


the microorganisms. Mechanisms of AMPenhanced antibiotic activity are not well studied, although it is postulated that the membrane altering effects allow for increased permeabilization of the membrane to the antibiotic, enhancing antimicrobial activity. Combinations of AMPs with conventional antibiotics serve the advantage of overcoming microbial resistance to the antibiotic as well as decreasing some of the toxicity of certain antibiotics in the patient. Creation of chemical compounds, termed AMP mimetics, that could replace AMPs known to combine with antibiotics to enhance activity would be

­ advantageous in solving the problem of economically feasible AMP production. The examination of synergy with this new class of antibiotics is needed, for the pharmacodynamics of synergy and antagonism between combinations of these agents is complex and varies with the specific combination of agents. So far, research results demonstrate that synergy between AMPs or their mimetics, between themselves or with existing antibiotics offers a solution to the antibiotic resistance problem.

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Medium 9781855752610

CHAPTER FOUR. The uncovering of a lack of identity

Jane Desmarais Karnac Books ePub

Roberta Mondadori

I have divided this chapter into two parts corresponding to two phases of psychotherapy with Lydia, a 17-year-old anorexic girl. As I shall describe, Lydia ended her therapy abruptly after one year but asked to resume eighteen months later. Fortunately I was able to accept.

This second phase continued for two years. In her first phased-type therapy Lydia mainly communicated through primitive early mechanisms such as splitting, projections, and particularly through the “no-entry system” of defences (Williams, 1997). I greatly relied on the transference–countertransference relationship with Lydia, as she seemed at the beginning to have very little space for thinking. In the first phase, Lydia used me mainly as a container of her anxieties, and it was essential for me to perform a holding function. In her second phase, Lydia began to develop sufficient trust in our relationship, and some exploratory analytic work gradually took place. The feeling of trust was furthered by the experience of reliability and the stability of our relationship, which had withstood Lydia’s mental rejection and deep anxieties about her own survival.

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Medium 9780433308829

CHAPTER SEVEN. Infantile autism: a disorder of the self

Michael Fordham Karnac Books ePub

An outline theory of the self and its relation to individuation has been developed and the ground has now been laid for considering theoretically a particular disorder of childhood.

Pioneering work has been done in defining the syndromes of infantile autism by Kanner, Bradley, Bender, Heller, De Sanctis, Weygandt, Despert, Creak and others, while the psychoanalysts Mahler, Klein, Isaacs, Rodrigu6, Bettelheim and Tustin have made significant contributions to its psychological structure and its origins.

It is apparent, when reviewing the literature, that die cases described, analysed, and treated by differing therapeutic methods, with varying results, are difficult to evaluate because diagnoses are mostly insufficiently specific and the prognosis consequently uncertain. Creak tried to resolve the problem by isolating nine characteristics and specifying that to make a diagnosis of autism a child must show a specified number of them. Her method aimed at defining objective criteria, but the way in which they were interpreted by clinicians showed that they were unreliable so, if the characteristics can be interpreted so differently, it is doubtful whether her own achievement can be assessed as objective either.

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Medium 9780253014863

11 Healing the Nation: Politics, Medicine, and Analogies of Health in Southeast Asia / Rachel Leow

Tim Harper Indiana University Press ePub

11 Healing the Nation

Politics, Medicine, and Analogies of Health in Southeast Asia

Rachel Leow

In colonial situations around the world, the relationship among modernity, health, and political power has frequently been invoked by both colonizer and colonized. In India, for example, David Arnold has argued that introduction and spread of Western medical discourses was intended in part to demonstrate the superiority of Western science over “Eastern prejudice” and scientific inertia, to persuade through concrete practices the legitimacy of colonial rule.1 Yet when invoked by nationalist resistance, leaders often did not dispute the scientific superiority of Western health, merely the colonial state’s monopoly over it. In Vietnam, medical self-reliance was one of the most widely available forms of resistance, and in the rallying cry “hygiene is the love of one’s nation” (ve sinh la yeu nuoc) is embedded a view of health inherited from colonial science.2 Ruth Rogaski has traced the shifts in Chinese perceptions of what health (weisheng) has meant over the course of the nineteenth and twentieth centuries in engaging with Western imperial domination, and shown that in this period, notions of Chinese health were dislocated from their deep association with Chinese cosmology, and reoriented towards what she calls “hygienic modernity,” comprising such concerns as bodily cleanliness, racial fitness, and national sovereignty. These new concerns, she argues, were articulated in the idiom of modern Western science, and were in fact precisely qualities that foreign observers criticized China for lacking.3

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Medium 9781855754195

14: Psychoanalytical access to children under extreme stress: squiggle interviews in research

Michael Gunter Karnac Books ePub

In the following chapter I am primarily presenting the results of research projects. In a large-scale, long-term project we used the squiggle interview to examine children who had to undergo bone marrow or stem cell transplants (SCT) because of an illness that would otherwise be fatal. The starting point for our research was the examination and treatment of several patients who had developed severe stress reactions after a bone marrow transplant. This raised the question of how other children managed to cope with the stress of treatment, conditioning and isolation. The aims, hypotheses and results of the whole investigation have been described in detail elsewhere (Günter et al, 1997, 1999; Günter, 2003). Here I want to concentrate essentially on describing the inner mechanisms for coping which came to light in the psychoanalytical squiggle interviews with the children.

Why did we use squiggle interviews in our research? There were several reasons, partly to do with methodology and partly determined by pragmatic considerations. First of all, we were anxious to create a space in which these extremely sick children might be able to talk about their problems. The squiggle technique therefore offered us an alternative way of making contact with these children (Winnicott, 1971a, p. 3) in a situation where they were willing to take part in and co-operate with the investigation, but would nevertheless not have been willing to talk about their own situation. For here, in this situation of extreme stress, the defences protecting the children from affects of great fear ensured not only that they were inclined to be very quiet and reserved in verbal communication, but also that in the brief initial greeting phase they were mostly quick to tell us that admission to hospital for the transplant was no great problem for them. It would all go well, most of the children indicated to us in one way or another, and anyway they didn ’t want to talk any further about it. By contrast, the children were easily won over to the idea of a squiggle interview, and then usually let themselves get deeply involved.

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Medium 9781605099798

Chapter 10: Dr. V’s Practice of Perfect Vision

Pavithra Mehta Berrett-Koehler Publishers ePub

Thresholds are important in India because the place where edges meet is seen as both vulnerable and powerful. The evil eye is warded off with masks tied above doorways. At dawn, and again at dusk, propitious forces are invited into the home by lighting brass lamps. The flame is a symbol of higher consciousness, and implicit in this ancient custom is a reminder to live a life governed by light. This relationship woven between truth, light, consciousness, and vision is common to many of the world’s cultures.

On a morning in 2005, wearing a crisp cotton sari, Chitra Ravilla heads up the front steps of Aravind-Madurai and makes her way past the bustle of the front desk to the hospital’s meditation room, where a lamp has already been lit. Chitra is Thulsi’s wife and Dr. V’s niece, and heads Aravind’s communications department. A few minutes later, she emerges from the meditation room with a small white line of freshly applied vibhuti (sacred ash) on her brow. It is 9 a.m., and this short stop is part of her workday routine.

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Medium 9781786394583

The Effects of a Nutritional Supplement (Solliquin) in Reducing Fear and Anxiety in a Laboratory Model of Thunder-induced Fear and Anxiety

Denenberg, S. CABI PDF

The Effects of a Nutritional

Supplement (Solliquin) in

Reducing Fear and Anxiety in a

Laboratory Model of Thunderinduced Fear and Anxiety

Gary Landsberg1*, Scott Huggins2, Julie Fish3 and

Norton W. Milgram1

CanCog Technologies, Toronto, Ontario, Canada; 2Nutramax Laboratories

Veterinary Science Inc, Lancaster, South Carolina, USA; 3Vivocore Inc.,

Fergus, Ontario, Canada


Funding: This project was funded as contract research by Nutramax Laboratories to

CanCog Technologies.

Conflict of interest: Scott Huggins is an employee of Nutramax Laboratories.

Keywords: dog, l-theanine, Magnolia officinalis, Phellodendron amurense, noise-induced anxiety


The objective of this study was to evaluate the effectiveness of a nutritional supplement in reducing the anxiety response of Beagle dogs in a thunderstorm test model of noise-induced anxiety after one day of test article administration and after a double dose of the product following 7 days of administration. The supplement (Solliquin) is a nutraceutical intended for relief of clinical signs associated with fear, anxiety and stress, which contains a proprietary blend of l-theanine, extracts of Magnolia officinalis and Phellodendron amurense, as well as a whey protein concentrate previously found to have anti-anxiety effects. (Araujo et al., 2010;

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Medium 9781782201632

CHAPTER TWO Mapping the unknown world: a narrative approach to risk assessment

Alan Corbett Karnac Books PDF


Mapping the unknown world: a narrative approach to risk assessment


isk assessment is an attempt to formulate risk, profile the alleged perpetrator and examine ways in which risk factors can be managed. It is a process made more complex when the patient is acutely disturbed, presenting some form of mental disturbance (Duggan, 1997), and requires a particularly sophisticated formulation when the patient has an intellectual disability. In this chapter

I will examine ways in which the risk presented by forensic patients with intellectual disabilities can be analysed and responded to using a narrative approach. A risk assessment represents an opportunity to create a coherent account, one of the defining features of the narrative form (Linde, 1993), and should, I argue, be regarded primarily as a co-authored story, with the assessor, the patient and his support network being seen as “joint authors”. I will use anonymised clinical vignettes to explore the notion of risk assessment as an intersubjective process, the result of a clinical interaction between not only assessor and assessed, but also members of what I call the “triangular square”.

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Medium 9781780647463

Appendix B: Formulary

Scott, D.E. CABI PDF

Appendix B: Formulary

Drug dosages were derived from several sources, including those listed in the Bibliography. Many have been used by the author at the Carolina Raptor Center.



Acid citrate dextrose


0.15 ml/ml blood for transfusions

Activated charcoal

10–20 ml/kg PO


5 mg/kg IM q7d × 4, then monthly as needed


(sulfadimethoxine 12.5%)

25–50 mg/kg PO SID × 3–5d


For hyperuricemia/gout: 10 mg/kg PO BID

Toxic in RTHAs at 50 mg/kg


4 mg/kg PO BID/QID. Prepare suspension with a compounding syrup

10 mg/kg IV/IM TID

May have diuretic effects but may not be an effective bronchodilator in birds


150 mg/kg IM QID


150 mg/kg PO BID

Amoxicillin with clavulinic acid

125–150 mg/kg PO BID

Not metabolized by liver. Good for anaerobes and penetrates lungs well

Amphotericin B

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Medium 9781605099798

Chapter 5: Get Less, Do More

Pavithra Mehta Berrett-Koehler Publishers ePub

In 2005, a man from Turkey arrived in Madurai and announced plans to set up 20 facilities like Aravind in Egypt—now could someone please tell him how much it would cost, so that he could start buying the equipment and materials needed? If only setting up a system with Aravind’s reach and impact were that simple. “Every day I meet some people who want to change the world in two days—or two weeks,” Dr. V once wrote in an e-mail.

Most explanations of the Aravind model start at the middle of the story. They treat the founding of the Aravind Eye Clinic as the beginning and plunge from there into a fast-paced account in which a series of eye hospitals burgeon into existence, thanks to the financial viability of a revolutionary approach. But the truth is that Aravind was built on Dr. V’s track record of more than two decades of pioneering work at the village, state, and national levels. By the time he was 58, India’s mandatory retirement age from government service, Dr. V had served as an ophthalmologist, an educator, and a national public health figure. He had already personally performed over 100,000 surgeries, pioneered a hugely successful outreach model, trained hundreds of young doctors as vice principal and dean of the Madurai Medical College, and been awarded a Padma Shri (one of India’s highest honors).

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Medium 9781855753723

CHAPTER FOUR: Contact issues

Roger Kennedy Karnac Books ePub

General points

Contact between children and the parent who is not their primary carer is desirable in principle but often fraught with complex issues that may have to be addressed before such contact can take place. The decisions that have to be made about such contact include its frequency and whether or not it is direct, that is face to face, or indirect, through letter or telephone contact; whether or not it is supervised or unsupervised, and where it should take place. Such decisions can usually be taken by social services in consultation with the parents. However, there are occasionally times when an expert is called in to give advice, particularly when there is some dispute between the various parties about aspects of the contact, whether or not it should be direct or indirect, supervised or unsupervised, or whether or not is should take place at all.

In principle, any decisions about contact should be flexible, as situations involving contact disputes change over time. A parent who is initially intransigent about contact arrangements, particularly soon after a decision affecting their care of their child has been taken, may be full of anger and bitterness about the decision, making it difficult for them to see what is in the child’s best interest rather than their own. However, their attitude may change once the dust has settled. A parent who is mentally ill and unable to care for their child may be able to keep up contact when they are well, but not when they are ill again. Another parent who may be unstable and unreliable over keeping up regular contact may eventually settle down. From the child’s point of view, they may wish to change any contact arrangements as they grow up and can decide for themselves whether or not they wish to see an absent parent and for how long. Setting up contact arrangements in stone is to be done only as a last resort, when all possibility of negotiation has broken down. In addition, there is the basic principle that must also be taken into account: that any contact should not jeopardize the child’s new placement, should not cause the placement undue disruption. Making a decision about whether or not there should be contact and what kind and at what level must also take into account the effect on the child’s new home. How much weight one attaches to this factor will depend on the age of the child and the reasons for their removal from the parent’s care. While the absent parent should in principle be able to see their child reasonably frequently, this may not be in the child’s best interests, at least in the early stages of a new placement.

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Medium 9781786391599

3: Semiochemicals: Pheromones, Signature Mixtures and Behaviour

Nielsen, B.L. CABI PDF


Semiochemicals: Pheromones,

Signature Mixtures and Behaviour

Tristram D. Wyatt

Department of Zoology, University of Oxford, UK

Since prehistoric times we have known that smell is important for interactions between animals. For example, a bull sniffing a cow, just as we might observe it now, is featured among the 30,000-yearold prehistoric cave paintings in the Dordogne of southern France. Smell signals between members of the same species, chemical signals that we call pheromones, are especially important in sexual interactions, here between the bull and cow at oestrus. Charles Darwin (1871) wrote about the powerful smells given off by male goats in the breeding season and he speculated that these signals could have evolved by females choosing the smelliest (‘most odoriferous’) males. These would be the smelly equivalent of the spectacular tail display of the male peacock. Animals also use smell to distinguish different individuals of their own species. For example, a mother sheep learns the individual ‘signature mixture’ odour of her lamb. She uses this smell memory to recognize her own offspring, rejecting any other lamb that tries to suckle (see Chapter 8).

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Medium 9781855754195

9: How do sea monsters help against bed-wetting?

Michael Gunter Karnac Books ePub

With occasional interruptions, Jonathan was increasingly wetting his bed several times a week. After wetting his bed, he came over to his parents ’ bed and snuggled up to his father, wanting to be very close to him. According to the parents, even as a very small child he ’d always been a “great one for snuggling ”, he came into their bed almost every night and snuggled up to his father. Jonathan was a bright boy, attending Gymnasium (academic secondary school) and performing well. Both parents were in academic professions. When Jonathan was two years old, there had been a change of childminder due to the family moving house; he seemed to have taken this in his stride.

Jonathan seemed fairly shy in the first two interviews, mentioning as problems only that if he got angry he liked to withdraw. He would read or not go out with family on trips at the weekend. He was sure that he would be able to cope with this bed-wetting and was motivated to do something about it. My impression was that he was putting himself under considerable pressure, and also wanted to do very well at school. He followed instructions like a good boy, particularly the one about not going to his parents ’ bed. The frequency of bed-wetting dropped considerably, but it didn ’t disappear altogether.

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