Suicide--the other side. The factor of reality among suicidal motivations.

A prevalent feature of many investigations of suicide is a degree of recoil from true empathic closeness to a suicidal person. The motives for this lie within the investigator's own dynamics--they are anxiety over one's own suicide proneness, together with guilt, shame, contempt, and the avoidance of medicolegal involvement. These motives are not altogether unrelated to the suicidal motives themselves, and they hamper the capacity of objective, neutral assessment. With a recognition of these resistances, the seldomly mentioned realistic determinant of suicide becomes discernible, the act sometimes being a clever, courageous choice of death, and not, as usually diagnosed, a pathologically generated escape from life. All suicidal motives should be evaluated according to several concomitant ratings simultaneously, while emphasizing the realistic rating. A neutral, unbiased approach to suicide should reduce the dangerous false glory sometimes attributed to the act, thus contributing to the discrimination of sickness, therapy, and health.

Stress, anxiety and the dental patient: the missing specification.

The importance of stress and anxiety as contributing to the complex aetiology of dental disease is becoming more widely recognized. Clinical examples of organic dental disease which were relieved when their psychological causes had been uncovered are described. It suggested that specialized psychiatric skills are not always necessary in dealing with such cases. The dentist's own personal life experience, his human understanding and his interest his patients' well-being are usually sufficient. Equal attention must be given to all data in both physical and psychological spheres if the patient's best interests are to be served.

Autodestruction and nonexistence: two distinct aspects of the death drive.

The concept of the death drive is more frequently employed by European than by American psychoanalysts, although it is not unanimously accepted even by the former. In recent years there have been attempts to disconnect the longstanding theoretical link between the drive and aggression, in keeping with the observations of various nondestructive components of the death drive. A hitherto unmentioned aspect of this drive is the yearning for nonexistence, a shadow-like counterpoise to life, expressed by two analysands. Both had childhood histories of life-threatening disease without sufficient compensatory maternal presence at the time. Both displayed massive dissociation from their own body and its vital functions, as well as from objects and their representations. The death drive could be viewed as a continuum with the autodestructive aspect, or the striving for death, at one end, and the component of nonbeing, or the yearning for nonexistence, at the other end.

Defense and resistance in the psychoanalytic process.

"Defense" and "resistance" are usually regarded as two separate and distinct concepts, the first belonging to psychic functioning in general and the second to therapy, yet this distinction is far from constant. Clinical observations indicate a frequent overlapping of these two mental functions or positions. A patient's behavior may convey the meaning of either or both concepts, and a position or response that one assumes to bespeak resistance may reveal defense instead. This state of affairs may be seen in the analysis of patients with a relatively well-integrated neurotic identity, but its main import is in the analysis of psychosomatic patients and those with severe personality disorders. Insufficient holding experiences during the infancy of these patients do not enable them to develop functional structuralization. Deficient mothering in the first stages of life also prevents the stable differentiation between defense against threats from within and resistance against influence from outside.

The death instinct.

The death instinct has always been a controversial concept, insufficient to account for actual dying, and usually taken to be fused with aggression. After dislodging it from the shadow of aggression in order to evaluate its function, the instinct turns out to be one of the components that form the death motivation. Human beings develop a complex motivation for death, one that is more than biology (instincts) or physics (entropy). It includes (a) the death instinct, the primary analogue; (b) sequellae of the universal experience of object-loss, with identification and fantasies of a restorative reunion; (c) guilt over hostile attitudes toward the lost object, with depression, longings for atonement , and self-punishment; (d) compliance with reality, like that of old age or grave sickness. Examined in light of the complementary series of Freud's aetiological equation, the death instinct turns into a precondition of the composition motivation. Death motivation is a comprehensive concept, since patients express various of its aspects during their psychoanalyses , and it facilitates a metapsychological understanding and refines the accuracy of interpretation.

Euthanasia: a serene voyage to death?

Modern Western Culture regards death as a threatening enemy, whereas the ancients, as is the case in eastern philosophy, recognized both the fight with, and the releasing surrender to death. Dying is quite often a serene voyage, be it through old age, sickness, was or even suicide. Attentive listening to those who face the termination of incurable disease reveals the voice of enlightenment: 'euthanasia' also means 'clarified dying'. An attitude like this alleviates our recoil and assists in a supportive approach to the dying human.

Schizophrenia therapy: the trigger effect. An exceptional response to a short intervention.

A rapid abatement of symptoms during schizophrenia therapy may be called a 'trigger response'. These are combined effects of autonomous positive, constructively healthy potentials preserved within the pathological constellation, and of a therapist's active acceptance, care, and frankly direct communications; the technique includes partaking of certain risks as well as directiveness and drug prescription. Autonomous trigger effects are ingredients of many ameliorations in schizophrenia, both spontaneous and therapeutically initiated. The proceedings of one exceptional treatment are reported in order to illustrate the concept with an outstanding example.