EMBRACING DISAPPOINTMENT AS PSYCHOANALYTIC PRAXIS.

Psychoanalysis involves studying how people maintain not knowing what they "know." As a result, how psychoanalytic psychotherapists orient toward what their patients may be experiencing but cannot say is at the core of psychoanalytic praxis. Jeremy Safran's unique psychoanalytic sensibilities were a model for how to yield to feeling states and relational dynamics that are at the heart of therapeutic action, but which all too frequently get bypassed. This brief recollection highlights how Safran's commitment to open inquiry and mutuality-not just with his patients but also with his students-continues to impact the field.

Relieved or disappointed? Children's understanding of how others feel at the cessation of events.

People's emotional states are influenced not just by events occurring in the present but also by how events have unfolded in the past and how they are likely to unfold in the future. To what extent do young children understand the ways in which past events can affect current emotions even if they are no longer ongoing? In the current study, we explored children's ability to understand how others feel at the cessation of events-as events change from being present to being past. We asked 97 4- to 6-year-olds (40.2% female) and 35 adults (54.3% female) to judge how characters felt once particular types of events had ended relative to how they felt during these events. We found that from age 4, children judged (as adults do) that the character would feel positive at the cessation of negative events-what we refer to as temporal relief. This understanding of relief occurs earlier than has been shown in previous research. However, children were less likely than adults to judge others as feeling sad at the cessation of positive events-what we refer to as temporal disappointment. Overall, our findings suggest that children not only understand that the cessation of events can affect others' emotions but also recognize that people feel differently following the cessation of positive, negative, and neutral events.

The affective gap: a call for a comprehensive examination of the discrete emotions underlying affective polarization.

Bakker and Lelkes (2024) point at a critical gap in research on affective polarisation: the limited understanding of its affective components, mainly due to the reliance on a unidimensional operationalisation of affect in affective polarisation. They advocate for a broader approach to study affect, integrating explicit and implicit measures, and call on emotion specialists to address this gap. Acknowledging the complexity of affect in the ideological divide, we argue that the lack of a thorough examination of the distinct role of discrete emotions constitutes the primary "affective gap". Drawing from studies on the relationship between ideological groups and utilising a discrete emotions approach, we contest the prevailing assumption that hatred predominantly underlies affective polarisation. Instead, we propose that disappointment, better captures the intricate dynamics between ideological groups. We argue that such nuanced approach, regarding the affective component of affective polarisation enhances our understanding of the phenomenon and shed light on its implications for societies.

Post-Traumatic Stress Disappointment: Disappointment and Its Role in PTSD.

Disappointment is an under-studied concept in the field of PTSD; it is nevertheless apparent in testimonies of individuals diagnosed with PTSD. Self-disappointment, disappointment with others, and disappointment with the Sublime are mentioned in the literature yet were not studied and described in the context of PTSD and spiritual recovery. This study aims to fill this gap; 50 individuals of varying backgrounds who recovered from PTSD and attributed their recovery to spirituality were interviewed. Participants underwent a variety of traumas, had different piety levels, and used different recovery methods. Findings revealed a mechanism where individuals diagnosed with PTSD experience three-dimensional disappointment (TDD) with self, others, and the Sublime, and that this disappointment breeds a sense of disconnection and helplessness. Findings suggest also that disappointment plays a significant role in both creating PTSD and intensifying the suffering from it. Implications for caregivers, therapists, and individuals with PTSD are discussed.

"The biggest disappointment": women's expectations from sex are ignored, from the perspective of infertile women.

OBJECTIVE: The aim of this study is to determine the attitudes, behaviours and experiences of infertile women towards sexuality. METHODS: This study was carried out in the infertility outpatient clinic of a state hospital in Istanbul of Turkey. Fifteen infertile women who had been receiving primary infertility treatment for at least two years and were actively continuing infertility treatment were included in the study. Data were collected by means of an detailed information form and a semi-structured interview. Content analysis was applied to the data obtained from semi-structured interviews. Consistency percentage calculation was made between the codes and themes determined by 4 researchers who are experts in their fields. RESULTS: Results based on the interviews with the participants, 2 main themes, 6 sub-themes and 27 codes related to sub-themes were determined as 'Factors Affecting Sexual Life' and 'Overview of Sexual Health and Sexuality'. 'Disappointment' was determined as the most commonly defined code in the determined main theme and sub-themes. CONCLUSION: It was determined that the majority of infertile women base their sexual lives on reproductive functions, experience serious sexual health problems, feel worthless, and describe their sexual life as a great disappointment.

Social disappointment and partner presence affect long-tailed macaque refusal behaviour in an 'inequity aversion' experiment.

Protest in response to unequal reward distribution is thought to have played a central role in the evolution of human cooperation. Some animals refuse food and become demotivated when rewarded more poorly than a conspecific, and this has been taken as evidence that non-human animals, like humans, protest in the face of inequity. An alternative explanation-social disappointment-shifts the cause of this discontent away from the unequal reward, to the human experimenter who could-but elects not to-treat the subject well. This study investigates whether social disappointment could explain frustration behaviour in long-tailed macaques, Macaca fascicularis. We tested 12 monkeys in a novel 'inequity aversion' paradigm. Subjects had to pull a lever and were rewarded with low-value food; in half of the trials, a partner worked alongside the subjects receiving high-value food. Rewards were distributed either by a human or a machine. In line with the social disappointment hypothesis, monkeys rewarded by the human refused food more often than monkeys rewarded by the machine. Our study extends previous findings in chimpanzees and suggests that social disappointment plus social facilitation or food competition effects drive food refusal patterns.

Relationships Between Maternal Perinatal Mood, Sex of Infant, and Disappointment with Sex of Infant in a North American Sample.

OBJECTIVES: Little is known about the relationships between sex of infant, disappointment with sex of infant, and risk for perinatal depression, particularly in societies where the nature of parental sex preference is thought to be "balanced" between male and female offspring. We sought to explore relationships between these variables in a North American population. METHODS: In this exploratory study, we used data from a large Canadian prospective longitudinal study in which data were collected at up to four timepoints: during pregnancy, and at 1 week, 1 month and 3 months postpartum. Data about sex of infant, maternal preference for, and disappointment in sex of infant were recorded at the first possible timepoint; while at each postpartum timepoint infant fussiness and EPDS scores were recorded. We performed a mixed-effects linear regression to evaluate relationships between these variables. RESULTS: In our sample of N = 207 women, EPDS scores were higher for mothers of male versus female infants, and independently associated with infant fussiness. There was no interaction between sex of infant and maternal disappointment, or between maternal disappointment and EPDS scores. CONCLUSIONS: Mothers of male infants may have slightly more depressive symptoms than mothers of female infants regardless of maternal preference for, or disappointment in sex of infant; sex-specific biological risk factors for PPD should be explored.

Getting Over Past Mistakes: Prospective and Retrospective Regret in Older Adults.

OBJECTIVE: A considerable number of older people who hold powerful positions in governments and corporate are actively engaged in making decisions that have a far-reaching impact on the community. Some of them have to make decisions on behalf of others, and sometimes, the outcomes of their decisions for others are unfavorable. We experience retrospective regret when the obtained outcome turns out to be less attractive than the counterfactual one. We also actively make choices to avoid regretful outcomes if we prospectively anticipate the regret. In the current study, we investigated how older adults experience regret and how they make choices to avoid potential regret, in the context of making decisions for themselves and on behalf of others. METHOD: Sixty younger and 60 older participants performed a gambling task in which two types of regret were independently measured: prospective (planning to avoid regret during decision making) and retrospective (feeling of regret following the comparison of alternative outcomes). RESULTS: Our results showed that compared to younger adults, the older adults were less sensitive to regret-inducing outcomes, whereas they demonstrated comparable ability in using prospective regret to guide decisions, regardless of whether they made decisions for themselves or on behalf of others. DISCUSSION: Our findings indicate that although older adults experience blunted regret, their ability to avoid future regret to guide subsequent choices remains unimpaired. Our research has implications for understanding how older adults cope with regret.

Patients' response to moments of disappointment with their therapist: the roles of disappointment experience, emotional abilities, and perceived alliance negotiation.

OBJECTIVE: Disappointment has not received sufficient attention in psychotherapy research. I examined how patients experience and respond to disappointment events with their therapist, as a function of patients' emotional abilities and perceived alliance negotiation in their therapy. METHOD: A sample of 119 patients reported their emotional abilities (i.e., emotion dysregulation and alexithymia), perceived level of alliance negotiation, their experience during a specific disappointment event with their therapist and their responses to that event. Responses were conceptualized according to Rusbult's model as exit, voice, loyalty, and neglect, and by whether the therapy was ended following the event. RESULTS: Moments of disappointment were associated with premature termination. Patients' responses were related to the quality of their experience. Alexithymia and emotion dysregulation were positively correlated with passive and destructive responses to disappointment. Patients with high levels of emotion dysregulation or alexithymia perceived the therapeutic alliance as less negotiable and responded passively and destructively in moments of disappointment with their therapist. DISCUSSION: Patients' responses to disappointment moments depend on their emotional experience, emotional abilities, as well as on their perception of the therapist's willingness to discuss the different aspects of the therapeutic relationship. The theoretical and clinical implications of these results are discussed.

The impact of teacher attitude and teaching approaches on student demotivation: Disappointment as a mediator.

Student demotivation with English as a medium of instruction has attracted increased attention of scholars, particularly in those countries where it is taught as a second or foreign language. While there is a consensus that proficiency in English brings several benefits, it is found that students are demotivated to learn in English. As a result, many studies have tried to investigate the factors that reduce the motivation to learn in English. Drawing on disappointment theory, this study aims to investigate why and how the discouraging attitude of a teacher and discouraging teaching approaches create negative emotions (i.e., disappointment with English as a medium of instruction), which in turn demotivates Chinese students with English as a medium of instruction. This study has adopted a cross-sectional research design. The data were collected through a self-administered questionnaire survey from Chinese students (n = 428) studying in different universities in China. The hypothesized relationships were tested through PLS-based SEM by using Warp-PLS 7.0 software. The findings show that teachers' discouraging attitudes and discouraging teaching approaches are important determinants of student demotivation with English as a medium of instruction. The results also confirm that student disappointment is an important underlying mechanism in the relationship between exogenous and endogenous variables. This study contributes to the literature on student demotivation with English as a medium of instruction by superficially identifying teacher-related factors in China, which were previously overlooked. The implications of this study are that the university administration should monitor the attitude of the teachers toward English, as well as their teaching approaches, in order to curb any potential threat to student motivation. The administration should train the teachers on how to show a positive attitude and follow encouraging teaching approaches. In this way, students' disappointment with the English language and teaching methodology can also be overcome, which will ultimately increase their motivation with English as a medium of instruction in universities.

[Feelings of cancer patients in exclusive palliative care: Towards a general practitioner, oncologist pairing?] / Ressenti des patients atteints de cancer en soins palliatifs exclusifs: vers un binôme médecin généraliste, cancérologue?

INTRODUCTION: In palliative care, cancer patients' thoughts about support given by their general practitioner are poorly described in the literature. General practitioners are involved in the management of cancer patients in palliative care, but when contact with the oncologist become less frequent, the place of the patient's different doctors becomes difficult to define. The objective of our work is to analyze the patient's perception of the place and role of the general practitioner. METHODS: Qualitative study by individual semi-directed interviews, with voluntary patients with solid cancer in palliative care. Patients were selected by palliative care physicians. A thematic analysis was performed on the basis of the patients' verbatim transcripts. RESULTS: Seventeen patients were interviewed and four main themes were highlighted: a perception of abandonment, a resignation to call the general practitioner, an omnipresence of the oncologist who seems not to leave the place to the general practitioner and a search for global support. The general practitioner did not appear to be empathetic nor supportive enough and was not available enough. DISCUSSION: Patients are looking for empathy and for their doctors to listen. Our work shows a certain disappointment of the patients regarding the place and role of their general practitioner. This disappointment reflects the insufficient coordination between hospital and community care setting. While the early integration of palliative care is becoming a standard of care, the patients' testimony commits us to improve the articulation between the oncologist and the general practitioner.

ESSM Position Statement on Surgical Treatment of Peyronie's Disease.

INTRODUCTION: Patients with Peyronie's disease may experience significat distress. The choice of treatment depends on a variety of factors, including the stage of the disease, the presence of pain, severity and direction of the curvature, penile length and the quality of erectile function. AIM: To review the evidence associated with surgical treatment of Peyronie`s Disease and provide clinical recommendations on behalf of the European Society for Sexual Medicine. 131 peer-reviewed studies and systematic reviews, which were published from 2009 to 2019 in the English language, were included. METHODS: MEDLINE, Google Scholar and EMBASE were searched for randomized clinical trials, meta-analyses, open-label prospective and retrospective studies. MAIN OUTCOME MEASURE: The panel provided statements on clinically relevant questions including patient involvement in the decision process, indications for surgery, choice of the approach, and the management of patient expectations. A comparison of the different grafts used in patients who have undergone plaque incision/excision and grafting in order to identify an ideal graft, has been carried out. The prevalence of postoperative complications has been summarized. Levels of evidence were provided according to the Oxford 2011 criteria and Oxford Centre for Evidence-Based Medicine recommendations. RESULTS: In order to allow shared decision making, a patient preoperative counselling regarding the pros and cons of each intervention is recommended. In particular, adverse effects of surgical treatments should be discussed to set realistic understanding and expectations of surgical outcomes and ultimately improve postoperative satisfaction rates. Surgical treatment should be only offered in the chronic phase of the condition, when the deformity and/or degree of erectile dysfunction, prevent patients from engaging in satisfying sexual interaction, or if the deformity is the cause of severe bother. CONCLUSIONS: Current European Society for Sexual Medicine recommendations cover several aspects of Peyronie's disease treatment. These recommendations aim both to ensure patients and partners have accurate and realistic expectations of their treatment options, as well as to formulate algorithms to guide clinician management pathways. Osmonov D, Ragheb A, Ward S et al, ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med 2022;10:100459.

Neither an Optimist Nor a Pessimist Be: Mistaken Expectations Lower Well-Being.

This article speaks to the classic view that mental health requires accurate self-perception. Using a representative British sample (N = 1,601) it finds that, as measured by two established well-being indicators, those with mistaken expectations, whether optimistic or pessimistic, do worse than realists. We index unrealistic optimism as the difference between financial expectations and financial realizations measured annually over 18 years. The effects are not small, with those holding the most pessimistic (optimistic) expectations experiencing a 21.8% (13.5%) reduction in long-run well-being. These findings may result from the decision errors and counteracting emotions associated with holding biased beliefs. For optimists, disappointment may eventually dominate the anticipatory feelings of expecting the best while for pessimists the depressing effect of expecting doom may eventually dominate the elation when the worst is avoided. Also, plans based on inaccurate beliefs are bound to deliver worse outcomes than would rational expectations.

'If there were doctors who could understand our problems, I would already be better': dissatisfactory health care and marginalisation in superdiverse neighbourhoods.

How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.

Clinical Recommendations From the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances.

INTRODUCTION: To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied. AIM: The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and systematic reviews, which were published from 2007-2018 in the English language, were included. METHODS: MEDLINE and EMBASE were searched for randomized clinical trials, meta-analyses, and open-label prospective and retrospective studies. MAIN OUTCOME MEASURE: The panel provided statements exploring patients and partner expectations, satisfaction in male and phalloplasty cohorts, the impact of penile length, girth and implant type, reservoir placement, the influence of comorbidities, and social circumstances. Levels of evidence were provided according to the Oxford 2011 criteria and graded as for the Oxford Centre for Evidence-Based Medicine recommendations. RESULTS: In the preoperative setting, it is fundamental to identify and interact with difficult patients with the intention of enhancing the surgeon's ability to establish the surgeon-patient relationship, reduce physical and legal risk, as well as enhancing patient satisfaction. To address this need, the mnemonic Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric ("CURSED") has been suggested to identify patients who are at high risk of dissatisfaction. The current recommendations suggest improving glycemic control in patients with diabetes. Available evidence suggests evaluating transplant recipients with the criteria of Barry, consisting of stable graft function for >6 months, avoidance of intra-abdominal reservoir placement, and low-dose immunosuppression. HIV status does not represent a contraindication for surgery. Smoking, peripheral vascular disease, and hypertension may be associated with an increased risk of revision surgery. Patients with spinal cord injury may receive IPP. Patients aged ≥70 years, as well as obese patients, can be offered IPP. The IPP implantation can be performed in patients with stable Peyronie's disease. Ectopic high submuscular reservoir placement can be considered as an alternative method. CLINICAL IMPLICATIONS: There is a relevant lack of high-level data and definite conclusions in certain areas remain difficult to draw. STRENGTH & LIMITATIONS: All studies have been evaluated by a panel of experts providing recommendations for clinical practice. Because of lack of sufficient prospective data, some of the included studies are retrospective and this could be stated as a limitation. CONCLUSION: This ESSM position statement provides recommendations on optimization of patient outcome by patient selection, and individualized peri- and intra-operative management. ESSM encourages centers to collaborate and to create prospective, multicenter registries in order to address this topic of increasing importance. Osmonov D, Christopher AN, Blecher GA, et al. Clinical Recommendations from the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020;17:210-237.

Is 'gender disappointment' a unique mental illness?

'Gender disappointment' is the feeling of sadness when a parent's strong desire for a child of a certain sex is not realised. It is frequently mentioned as a reason behind parents' pursuit of sex selection for social reasons. It also tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection. Our aim in this paper is to investigate whether 'gender disappointment' represents a unique diagnosis. We argue that 'gender disappointment' does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy. That said, we recognise that parents' distress is real and requires psychological treatment. We observe that this distress is rooted in gender essentialism, which can be addressed at both the individual and societal level.

"It's Not About You": Disappointment as Queer Pedagogy in Community-Engaged Service-Learning.

Increasingly popular in the neoliberal university, community-engaged service-learning (CESL) courses offer rich yet contradictory opportunities for LGBTQ studies students to synthesize queer critiques of community and identity with experiences in LGBTQ communities. Much CESL scholarship has focused on the tensions between benefits to community and to students, prioritizing either radical social change or student satisfaction. Beside such debates, I propose the queer ethical, pedagogical, and political value of disappointment in the tedium and contradictions of community itself. Such queer disappointment, I contend, might enable students to cultivate the emotional and critical capacities to engage in community work on sustainable, dedramatized, and unentitled terms.

Efficacy of Acceptance and Commitment Therapy in Reducing Disappointment, Psychological Distress, and Psychasthenia among Systemic Lupus Erythematosus (SLE) Patients.

Objective: The aim of this study was to evaluate the efficacy of acceptance and commitment therapy (ACT) in the reduction of disappointment, psychological distress, and psychasthenia among patients with systemic lupus erythematosus (SLE). Method : This quasi-experimental study was conducted on 24 females with lupus who referred to the Rheumatoid Disease Research Center (RDRC) of Ghaem hospital in Mashhad, Iran. This study had a pretest-posttest control group design. The participants were randomly assigned into 2 groups of experimental and control. The experimental group was treated with ACT. Data were collected using the Beck's Hopelessness Scale, Kessler's Psychological Distress Inventory, and Krupp's Psychasthenia Inventory. Results: Mean age and mean duration of illness were 37.25±4.61 and 5.12±2.33 years, respectively. The mean disappointment score and psychological distress in the experimental group were lower compared to those in control group at the post experimental stage (P<0.001). Moreover, there was a significant difference between the experimental and control groups in the mean scores of psychasthenia in the posttest stage (P<0.001). Conclusion: According to the obtained results of this study, the enhancement of psychological flexibility based on ACT positively affected disappointment, psychological distress, and psychasthenia among the lupus patients. Therefore, it can be concluded that this therapeutic approach could reduce psychasthenia in patients through clarification of the values.

Patient violence and health professionals' occupational outcomes in China: A time-lagged survey study.

OBJECTIVE: To examine the prevalence of patient violence in China and the association between patient violence and Chinese health professionals' felt disappointment with their occupations, occupational turnover intention, and word-of-mouth communication. METHODS: Data were collected from a convenience sample of 199 Chinese doctors and nurses in the summer of 2016 using two surveys. First, participants reported their experience of patient violence (i.e., physical and non-physical violence). Two weeks later, participants rated their disappointment, occupational turnover intention, and negative occupational word-of-mouth communication. Using path analysis, we examined the mediating role of disappointment in explaining the association between patient violence and health professionals' occupational turnover intention and word-of-mouth communication. RESULTS: On average, health professionals in the present sample experienced non-physical violence once or twice per month. Non-physical violence was positively related to feeling disappointed with one's occupation, which was in turn positively related to occupational turnover intention and negative word-of-mouth communication. Physical violence was experienced at a much lower rate, and was not correlated with either occupational outcome. CONCLUSIONS: Patient violence found in this study was prevalent, especially in terms of non-physical violence. The rates of patient violence were lower than those in previous studies conducted in China, reflecting potential differences between the present study and earlier studies in study sites, sample composition, measurements, and timing of studies. Nonetheless, our findings show that patient violence can be related to health professionals' intention to leave their occupation and negative word-of-mouth communication regarding their occupation. These findings call for interventions to reduce health professionals' turnover, improve their work conditions and quality-of-life, and subsequently improve the patient-provider relationship and the quality of patients' care.

Gender disappointment in India: SEM modeling approach.

Despite people emphasizing their luck of having healthy baby, many secretly mourn for not having a baby which they preferred leading to gender disappointment. Hence, it is critical to explore factors contributing to gender disappointment particularly girl child which is pervasive in Asian countries. The study analyzes the variation in gender disappointment among different genders and age groups using percentage analysis and also employs structural equation modeling (SEM) to determine the direct factors and moderators contributing to gender disappointment. The findings reveal that societal pressure, cultural factors, economic expectancy, and safety expectancy significantly explain the gender disappointment with girl child. Neuroticism, conscientiousness, extraversion, and intellect were found to be the most significant personality bias moderators. The findings of the study give an insight for the government in designing awareness programs and free counseling programs to persuade people with different personalities to suppress gender disappointment, thereby enhancing women's mental health. Focusing on exploring the factors causing gender disappointment with girl babies, the role of personality in explaining gender disappointment and variation in gender disappointment between different genders and age groups makes the study unique from other research contributions. It also gives an insight for the government to create awareness programs and free counseling programs among people to eradicate these issues for the well-being of the society.