J.L. Moreno,M.D.

You could call Moreno a composer of religion. He drew his religious and spiritual ideas from different sources and self-confidently created his world-view and an individual notion of God. In this article important stations of his religious biography are told and integrated. The abiding benchmark of Moreno’s religious thoughts is the message of Friedrich Nietzsche that god is dead. Moreno sees what a high price society pays for disposing of its gods too quickly and not in a consequent way: the price for an imperfect secularization. He does not accept that important issues like existential questions, sense and death or the position of man in the cosmos cannot be debated anymore. That is the reason why he claims a new theory of God. That is also the reason why he provides the axiodramatic scene to deal with those themes.     

Norsk Psykiatrisk Forening: Årsberetning for tiden 18. 6. 60.-3. 6. 61

Haver B. Longitudinal study of female alcoholics. Clinical implications.

The article reviews findings from follow-up studies of treated female alcoholics. At a group level, women seem to have an equal or even somewhat better treatment outcome compared with male alcoholics. The presence of psychiatric disorders like anxiety and depression is correlated to a better treatment outcome in women, but not in men. In the individual cases, a complicated interaction between factors related to life events, maturation and living conditions might precipitate turning points in the women's drinking careers. Treatment can possibly instigate turning points as well as reinforce the effects of naturally occurring turning points, by inducing cognitive, behavioural and psychodynamic changes inherent in the process of change. The reported results are mostly based on studies of women alcoholics coming to treatment late in their drinking careers. The treatment programs rarely address the special treatment needs of female alcoholics and their families. Therefore, better results might be obtained by developing special treatment programs for women alcoholics, attracting women to come to treatment earlier in their drinking careers.     

Sex reassignment. Follow-up.

Although medical interest in individuals adopting the dress and life-style of the opposite sex goes back to antiquity, surgical intervention is a product of the last 50 years. In the last 15 years, evaluation procedures and surgical techniques have been worked out. Extended evaluation, with a one- to two-year trial period prior to formal consideration of surgery, is accepted practice at reputable centers. Cosmetically satisfactory, and often functional, genitalia can be constructed. Less clear-cut however, are the characteristics of the applicants for sex reassignment, the natural history of the compulsion toward surgery, and surgery's long-term effects. The characteristics of 50 applicants for sex reassignment, both operated and unoperated, are reported in terms of such indices as job, education, marital, and domiciliary stability. Outcome are reviewed. The results of long-term follow up data are discussed in terms of the adjustments of operated and unoperated patients.     

Tumor immunology. A neurosurgical perspective. I. General concepts of tumor immunology.

In the quest for the elusive cure of human neoplasms, considerable effort has been expended over the course of the past 10 years to define the immune system as it relates to the development and evolution of cancer in man. At this time thera is ample evidence for, but incomplete of, the existence of a multifactorial immunosurveillance system that is important in the production and control of neoplasms. The framework for this system has been defined and its modification, with the development and progression of various neoplasms, has been studied with great detail. These studies have been undertaken with the hope of harnessing immune mechanisms and altering their response in favor of the host's defenses related to the evolving tumor. This paper will review the major principles and concepts that have evolved.     

Lithium discontinuers. II. Therapeutic outcome.

Eleven patients from a lithium-treated cohort of 64 patients with major affective disorder (DSM-III) were investigated after a mean of 6.7 years on lithium prophylaxis and reinvestigated 7 years later, at which point they had discontinued lithium for a mean of 2.3 years. Therapeutic outcome was compared in the 11 discontinuers and 20 continuers on lithium from the same cohort, matched for sex, age, and mental status on admission to the study. Ratings of psychopathology (CPRS) at the end of the 7-year follow-up period showed that the only significant difference between the patient categories was a higher frequency of reported autonomic disturbances and worry over trifles in the discontinuers. Daily doses of neuroleptic drugs were significantly higher in discontinuers than in controls by the end of the study. Alternative concomitant treatment outside conventional medicine was sought by 45% of the discontinuers, whereas no lithium-treated control reported the need for such additional therapeutic measures.     

Pathogenesis of visna. IV. Spinal fluid studies.

Visna is a persistent retrovirus infection of sheep which produces a chronic progressive paralytic disease after an incubation period lasting from months to years. The cerebrospinal fluid (CSF) was repeatedly sampled in a group of Icelandic sheep which were infected intracerebrally and followed up to 42 months. Minimal levels of infectious virus were isolated from the cerebrospinal fluid (CSF) up to 4 months after infection after which CSF neutralizing antibodies appeared in many sheep. These antibodies varied in titer and in some animals exceeded serum antibody levels which were moderate to high. CSF antibody is apparently produced within the CNS by local proliferation of B cell clones, and is accompanied by the appearance of considerable numbers of plasma cells in the neural parenchyma. Some sheep raised serum antibody to a second serotype of visna virus and in a number of these animals heterotypic antibody was also found in the CSF. An increase in CSF leukocytes often occurs within 1 to 3 months following infection and may then persist or wane. A persistent high level of CSF cells is an indicator of progressive CNS disease and such animals are more likely to yield virus, have higher CSF antibody levels, more severe CNS lesions, and an enhanced risk of clinical illness (progressive paralysis). CSF cells are predominantly macrophages and lymphocytes, with a consistent minority of plasma cells.     

Polyneuropathy. Facts and fancies.

Some conclusions are drawn from findings in 167 consecutive patients with the ordinary "garden variety" of polyneuropathy; the aetiology was unknown in 15%. Histological findings in sural nerves were related to clinical and electrophysiological abnormalities. In some patients with discrete clinical abnormalities, sensory and motor conduction and amplitudes of evoked sensory and muscle action potentials were normal, whereas the nerve biopsy showed slight but definite abnormalities. The reverse, abnormal nerve conduction and normal histological findings, did not occur. Histological findings were rarely, and electrophysiological findings were not, specific for the aetiology or type of a neuropathy. Thus, neither conduction studies nor conventional or single fibre electromyography can identify the underlying pathology: loss of large myelinated fibres (greater than 7 micrometers) was equally prominent in nerves with de- and re-myelination as in those without them. Paranodal and segmental demyelination in less than 20% of the teased fibres occurred as often in nerves with as in those without disproportionate slowing in conduction. When the recorded conduction velocity was equal to that to be expected from the fibres with the largest diameter, slowing in conduction could be explained by axonal degeneration ("proportionate" slowing, 79% of the nerves). When the recorded velocity was disproportionately slower than that expected from fibre diameter (21% of the nerves), causes other than loss of the largest fibres must be assumed to explain the slowing in conduction. Myelin abnormalities in more than 50% of the teased fibres were found only in nerves from patients with the hypertrophic type of peroneal muscular atrophy and in postgastrectomy neuropathy and can probably explain the marked disproportionate slowing in conduction. The material contained, however, only one patient with acute idiopathic polyradiculoneuropahy. In diabetic neuropathy, segmental demyelination was present in only 8 of 502 teased fibres (9 nerves), remyelination was present in 135 fibres, and could not explain the disproportionate slowing in conduction. The mechanism of disproportionate slowing, when it is not due to demyelination, is still obscure.     

Kumho Tire Co., Ltd. v. Carmichael.

The U.S. Supreme Court considered an appeal by the defendant, Kumho Tire, in a products liability action. The appeal resulted from a ruling by the Court of Appeals in the Eleventh Circuit that overturned the district court's exclusion of expert testimony. The plaintiff's expert had sought to testify regarding the reasons for a tire failure and blowout. The subsequent accident resulted in personal injury and the death of a passenger in the plaintiff's vehicle. The Supreme Court held that expert testimony, whether based on professional studies or on personal experience, is subject to the same standard of scrutiny for relevancy and reliability. This decision resolved a conflict that had arisen among the circuit courts of appeal with respect to this issue. The article first outlines the Court's decision, then considers the implication the decision has for the admissibility of expert opinion testimony in future cases.     

Chlordecone intoxication in man. I. Clinical observations.

Industrial overexposure to chlordecone, an organochlorine insecticide, caused tremor in 76 of 148 exposed workers. Chlordecone was absorbed through oral, respiratory, and dermal routes, the last possibly the most significant. Epidemiology of this incident disclosed low-level, widespread environmental exposure of man to chlordecone. In 23 workers with chronic chlordecone intoxication, tremor was associated with opsoclonus, pleuritic pain and arthralgia. No seizures were reported. The site of action of chlordecone on the central nervous system is unknown. It concentrates in human adipose and hepatic tissue but is not biodegradable, either in humans or elsewhere in nature.     

Polygraphy revisited: U.S. v. Scheffer

U.S. v. Scheffer is a case that poses two questions. First, must a defendant who wishes to place polygraphic evidence before the court be allowed to do so for fear that refusal will create a Constitutional issue by depriving him of due process? Second, is polygraphic evidence admissible evidence at all, as defined by the Military Rule of Evidence or the Federal Rules of Evidence? The case, originally tried in Court-Martial, was reviewed by two military courts of appeal, with resulting judicial dissention leading to the granting of certiorari by the U.S. Supreme Court. In its decision, the Supreme Court affirmed the refusal of the Court-Martial to admit the requested polygraphic evidence.     

B. F. Skinner and the cognitive revolution.

The behaviorism that cognitive scientists attack is a caricature, drawn primarily from the more polemical writings of J. B. Watson and B. F. Skinner. In this brief commentary, I discuss the fact that these writings, and especially Skinner's, offered the neocognitivists such a polar difference from their own position, that it was easier to ignore the distinction between behaviorism and neobehaviorism than to recognize it. I point out that there are factors in Skinner's intellectual history that may account for the emergence of his more radical behaviorism out of what was essentially his own theoretical, neobehavioristic approach to the study of conditioning and learning.     

Assessing treatment outcome. I. Adjustment in the community.

In recent years, the re-examination of treatment outcome has substantially advanced the sophistication with which the issues involved have been conceptualized. This study is directed toward the empirical elaboration of four of these issues as they relate to adjustment in the community. They may be stated briefly as the extent to which a) a common outcome pattern exists across different dimensions of adjustment; b) the vantage point of the observer influences adjustment ratings; c) judgments of overall improvement encompass the major dimensions of adjustment; and d) judgments of overall improvement represent changes in adjustment levels. With regard to the first issue, the data indicate that each major dimension of adjustment has a somewhat different pattern over time. Secondly, a substantial consensus exists between patients and their significant others concerning patients' adjustment relative to the adjustment of other patients as described by them and their significant others, although not in terms of the actual magnitude of their adjustment. Third, global improvement ratings are related to two dimensions of adjustment primarily (symptomatology and social involvement), and they are virtually unrelated to other major dimensions. Finally, global improvement ratings are highly reflective of the current level of adjustment. The relevance of these findings to outcome assessment is discussed and some suggestions are offered.     

Peripheral nerve ischemia. Part 1. Experimental model.

Following simultaneous ligation of the abdominal aorta and the femoral artery, extensive lesions were consistently produced in the nerves of the hind limb in the absence of gangrene in the ischemic leg. Total necrosis of all elements of nerve bundles was seen to involve most of the segment of tibial and peroneal nerves between the knee and the ankle. Distal portions of these nerves in the first days after vascular ligation appeared either morphologically normal or showed only minor changes. Later they underwent Wallerian degeneration. The morphologic features and dynamics of changes in the necrotic portion differed from the axonal degeneration seen in the more distal portions of the affected nerves. This model of peripheral nerve ischemia has two advantages in comparison to models used before, namely that: marked changes are produced in every cat, and there is no compression or stretching, or any manipulation of investigated nerves and thus there is no doubt that the changes are related to ischemia.     

Ontogenetic development of somatosensory thalamus. I. Morphogenesis.

Structural maturation of the somatosensory thalamus in several laboratory mammals has been studied with the use of the Golgi methods. The period covered extends from approximately 1 week before term to 90 days after birth with emphasis on the immediate postnatal period. Although all systems appear immature at birth, the data indicate that those ascending and descending axon systems playing upon the ventrobasal complex tend to mature more quickly than certain significant elements in the neuropil of the receptive field. Those elements are particularly the small dendritic structures (for example, excrescences, tufts, etc.) which enter into the formation of synaptic glomeruli and are probably involved in the dendrodendritic linkages which abound in this part of the thalamus. The possible significance of the earlier maturation of thalamopetal afferents compared to the intrinsic thalamic neuropil whose processing operations they modulate, is discussed.     

Memorial: John L. Schimel,M.D.

This essay proposes that the formative years of psychoanalytic theory and praxis were affected by the fascism, war, and genocide in their midst. That this impact was largely absent from analytic discourse throughout most of the 20th century may be attributed to a number of factors. Analysts at the time had hopes for a positivist psychoanalysis—a “new science”—both universal and independent of context. Subjective experiences of the trials and expulsion of mostly Jewish professionals were thus viewed as a threat to the status of both the theory and its practitioners. Some analysts may have also been reluctant to dwell on their ordeal because they felt lucky to be alive and to start anew, unlike those left behind. Finally, the relative silence on the topic may represent a response to trauma, to experiences so overwhelmingly conflictual as to be only partially appreciated, or at times adaptively dissociated. Focusing as much on what has been omitted as on what is included in writings and interviews of analysts from the period, this discussion attempts to discern a presence in absence, noting the style and tenor of the work that theorists and clinicians left behind, all in an effort to find traces of a personal and collective catastrophe that altered theoretical and clinical ideas.     

The human amygdala. I. Electrophysiological responses to odorants.

Nine patients had an amygdalotomy for attempted relief of intractable seizures and, as an aid for localization, recordings were made from the amygdala and later computer analyzed. The background activity is 3-18 c/sec; in response to odorants sinusoidal bursts are seen, synchronous with inspiration at 12-24 c/sec, but mainly 40-70 c/sec. Each odorant is associated with a given group of frequency components. However, for many different odorants the number of these components is restricted and the hypothesis is presented that odor discrimination in man's amygdala is not determined by which components are present, but the patterning of the components according to their amplitude. Odorants within the same odor class produced similar patterns of response. Epileptiform activity was recorded in two different forms, one in response to odors, similar in frequency to the slower bursts, except for sharper configurations, at times progressing to clinical seizures and the second as an insertion discharge from an advancing electrode, similar in frequency to the faster bursts. These latter data suggest that the repertoire of a given neural system or structure may be limited to specific frequencies but the configuration or patterning of these frequencies define the different states of the structure.     

Immediate Retrospects on the I.P.C.

This study examines the long-term psychiatric consequences, pain interference in daily activities, work loss, and functional impairment associated with 9/11-related loss among low-income, minority primary care patients in New York City. A systematic sample of 929 adult patients completed a survey that included a sociodemographic questionnaire, the PTSD Checklist, the PRIME-MD Patient Health Questionnaire, and the Medical Outcomes Study Short Form-12 (SF-12).

Approximately one-quarter of the sample reported knowing someone who was killed in the attacks of 9/11, and these patients were sociodemographically similar to the rest of the sample. Compared to patients who had not experienced 9/11-related loss, patients who experienced loss were roughly twice as likely (OR = 1.97, 95%; CI = 1.40, 2.77) to screen positive for at least one mental disorder, including major depressive disorder (MDD; 29.2%), generalized anxiety disorder (GAD; 19.4%), and posttraumatic stress disorder (PTSD; 17.1%). After controlling for pre-9/11 trauma, 9/11-related loss was significantly related to extreme pain interference, work loss, and functional impairment. The results suggest that disaster-related mental health care in this clinical population should emphasize evidence-based treatments for mood and anxiety disorders.     

Age,clinical features and prognosis in S.D.A.T.

Two groups of patients suffering from Senile Dementia of the Alzheimer Type (S.D.A.T.) have been studied from first referral till death in hospital. The point of separation between the two groups was age — the younger group were aged 65–74 at the time of terminal admission and the older over 85. The variables studied were history of illness prior to referral, assessment on the Crichton Royal Behavioural Rating Scale at the time of terminal admission, duration of illness and duration of hospital stay. The last two factors were measured both in absolute terms and as features relative to life expectancy. The history proved unhelpful in identifying features capable of separating the two groups. Although in absolute terms the younger group survived longer, both from onset of illness and admission, in relative terms these patients fared considerably worse. The possibility that S.D.A.T. in the very elderly runs a more benign course is discussed.     

Survey of cases of familial mental illness. L. S. Penrose, July 1945.

An investigation was made of all known cases of mental illness where more than one member of the family entered one of the Ontario Mental Hospitals. The materials is fairly complete for a period of 18 years. Analysis of the resulting data, on pairs of relatives, gave rise to the following conclusions of particular interest. (i) Schizophrenia, affective psychosis, senile psychosis, Huntington's chorea and mental defect are shown to be conditions which remain significantly true to type when mental disease occurs in different members of a family. As a rider to this, however, it is found that schizophrenia and affective psychosis are not very distinct entities and groups of closely related familial cases frequently include both diagnoses. (ii) Schizophrenia is a rare diagnosis in the fathers of patients and occurs in only 8.7% of fathers, as opposed to the 30.7% in the whole sample of relatives: it is not so rare in mothers (24.5%). (iii) The most frequent type of relationship in pairs of patients is sister and sister: next in frequency is the type brother and brother, then brother and sister. Mother and son, mother and daughter, father and daughter and then father and sone come next in order. Less frequent are uncle and nephew or uncle and niece and, again less frequent, aunt and nephew or niece; grandparents and grandchildren were rarely found. (iv) Fathers, diagnosed schizophrenic or first admitted below the age of 35, have more psychotic sons than psychotic daughters, but the reverse is true for mothers in the same categories. (v) Fathers diagnosed as having affective illness or first admitted at the age of 35 or over have more psychotic daughters than psychotic sons, but the reverse is true for mothers in the same categories. (vi) Male subjects with either schizophrenic or affective diagnosis and in early- or late-onset age groups, have more psychotic brothers than psychotic sisters. Similarly, female subjects have more psychotic sisters than psychotic brothers. (vii) Each main diagnosis group has its characteristic first admission age. (viii) The first admission age is earlier in males than in females for schizophrenics, and later in males than in females for affective disorders. (ix) Study of first admission ages in families indicates that parents and, particularly, grandparents are much older than children and, particularly, grandchildren at first admission. This effect is not attributed to progressive degeneration. (x) Male subjects show a significantly wider scatter of first admission ages than do female subjects.(ABSTRACT TRUNCATED AT 400 WORDS)