The Biblical Job Against Zeno the Stoic: Living Purposively Versus Dying for Meaning.

Zeno the Stoic and the biblical Job react very differently to stressors in their lives. While Zeno succumbs to a relatively minor accident and takes his life, Job withstands cataclysmic losses, survives, and ultimately is restored. While Zeno's search for meaning ends in his suicide, Job's sense of purpose enables him to survive and ultimately thrive. The essential difference is that while Zeno greatly catastrophizes a relatively minor stressor in a desperate search for meaning, Job lives a life of purpose which gives his life intrinsic meaning. This distinction may be most relevant in today's chaotic world, with so many young people striving to "find themselves" in often the most destructive ways. While Job is resilient, Zeno is not. Job's biblical faith provides the grounding for his self-knowledge. Zeno the Stoic does not seem to have this foundational self-knowledge and is searching for signs that he is not adrift in an indifferent world. For some people, at least, biblical religion seems to provide a healthy foundational view which gives life essential purpose.

Eating and Drinking Narratives in Biblical-Rabbinic Versus Graeco-Roman Writings.

The writings of ancient Greece and Rome and of biblical Israel are filled with descriptions of food. The narratives in Greek and Roman mythology and poetry often describe violent and repulsive behavior associated with food. The biblical narratives, in contrast, tend to view food in a respectful and purposeful manner. We compare and contrast some of these stories with regard to the specific themes: restraint, respect, purpose, and order. In each comparison, patterns of eating described in biblical laws and narratives will be contrasted with those emerging from Graeco-Roman stories and customs.

Social Status and Suicidal Activity Among Psychiatric Patients: Moderating Effects of Gender, Race and Psychiatric Diagnosis.

The relationship between suicide and social class has proved to be complex. Durkheim predicted suicide rates would increase with social status, while others thought the opposite. Results have been mixed. In some studies, suicidality has increased with increasing social status, and in other studies, the two variables have had an inverse relationship. These studies have been primarily conducted on general non-psychiatric populations The present study, in contrast, examines this relationship on a 20-year prospective longitudinal sample of 400 psychiatric patients (differentiated by psychiatric diagnosis) after index hospitalization. Of these, 160 patients show some sign of suicide risk (87 cases of suicidal ideation, 41 of suicide attempts, and 32 suicide completions). A complicated pattern emerges across psychiatric diagnosis, gender, and race. The great majority of patients show no statistically significant relationship between social status and suicide risk. At the maximally different extremes, however, a dramatic difference does emerge. White women diagnosed with nonpsychotic depression show a positive relationship between social status and suicide risk (p < .01) while black men diagnosed with schizophrenia show a negative relationship between these 2 variables (p < .02). The relationship between social status and suicidality among psychiatric patients varies across race, gender, and psychiatric diagnosis. More research needs to be done on this complex and important topic, especially with regard to samples of psychiatric patients. The role of anomie should be studied.

The Twenty-Year Trajectory of Suicidal Activity Among Post-Hospital Psychiatric Men and Women with Mood Disorders and Schizophrenia.

The Chicago Follow-up Study has followed the course of severe mental illness among psychiatric patients for more than 20 years after their index hospitalization. Among these patients are 97 schizophrenia patients, 45 patients with schizoaffective disorders, 102 patients with unipolar nonpsychotic depression, and 53 patients with a bipolar disorder. Maximum suicidal activity (suicidal ideation, suicidal attempts and suicide completions) generally declines over the 3 time periods (early, middle, and late follow-ups) following discharge from the acute psychiatric hospitalization for both males and females across diagnostic categories with two exceptions: female schizophrenia patients and female bipolar patients. A weighted mean suicidal activity score tended to decrease across follow-ups for male patients in the schizophrenia, schizoaffective, and depressive diagnostic groups with an uneven trend in this direction for the male bipolars. No such pattern emerges for our female patients except for female depressives. Males' suicidal activity seems more triggered by psychotic symptoms and potential chronic disability while females' suicidal activity seems more triggered by affective symptoms.

Are there gender-specific risk factors for suicidal activity among patients with schizophrenia and depression?

Are there gender-specific risk factors for suicidal activity among patients with schizophrenia and depression? A total of 74 schizophrenia patients (51 men, 23 women) and 77 unipolar nonpsychotic depressed patients (26 men, 51 women) from the Chicago Follow-up Study were studied prospectively at 2 years posthospitalization and again at 7.5 years. Poor early posthospital global functioning is significantly associated with later suicidal activity only for men in both our schizophrenia and depressive samples. Early display of psychotic symptoms is associated with later suicidal activity among male schizophrenia patients. Early cognitive impairment is not significantly associated with later suicidal activity for any of the four groups of patients. The study results must be seen as exploratory and will hopefully spur future research on this important topic.

Hopelessness, temperament, anger and interpersonal relationships in Holocaust (Shoah) survivors' grandchildren.

The psychiatric literature is divided with regard to the long-term psychological effects associated with Holocaust (Shoah) experiences because the findings of clinical and empirical studies often contradict each other. Despite case reports of emotional sequelae related to intergenerational transmission of trauma, recent empirical research has suggested that offspring of survivors of the Shoah did not differ from other children and found no evidence that traumatic experiences of survivors of the Shoah affected their children's and grandchildren's adjustment. To shed light on some of the differences between the empirical and clinical observations, the present study set out to compare the grandchildren of survivors of the Shoah and persons of the same age whose families had not been through the Shoah experience. This study compared the two groups on some psychological dimensions relevant to traumatic sequelae: hopelessness, temperament, personality, attitudes, and interpersonal expectations. Subjects were 124 equally divided among the Shoah survivors' grandchildren and comparison groups; we administered to all subjects TEMPS-A Rome, Beck Hopelessness Scale, State-Trait Anger Expression Inventory, and 9AP (9 Attachment Profile). We found no differences between two groups in Hopelessness, Dysthimic/Cyclotimic/Anxious, Hyperthimic temperament, and self-perception; instead the Shoah survivors' grandchildren have a view of the other as rejecting, hostile, submissive, insecure, unreliable, and competitive in the interpersonal relationships. The Shoah survivors' grandchildren are similar to controls in affective temperament, hopelessness and self-perception, but they are more irritable and angry than controls, and their perception about others is deeply negative. Attribution theory was used to elucidate these findings.

Suicide risk in schizophrenia: learning from the past to change the future.

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.

Why does zeno the stoic hold his breath? "Zenoism" as a new variable for studying suicide.

A single misfortune may be seen as just that, or may be interpreted as Zeno the Stoic did, as a "sign" of cosmic proportion (zenoizing), which paradoxically provides a missing meaning structure. This article presents two studies testing out this new variable (zenoism): in Study One (n = 233), we explore the moderating effects of religiosity and gender on zenoism, depression, demoralization, and suicidality. In Study Two (n = 137), we explore these same moderating effects on zenoism, fear of dependency, value of life, and favorability toward physician-assisted suicide (PAS). Results indicate: 1) men and non-religious respondents (especially men) zenoize more than women and religious respondents; 2) non-religious respondents, (especially men) are more generally favorable to PAS and more suicidal; 3) Zenoism is negatively related to depression, demoralization, and value of life for non-religious respondents, and for men; 4) Zenoism is positively related to favorability toward PAS toward one's self and overall suicidality; and finally 5) general and self-specific favorability toward PAS are distinct, but both relate to overall suicidality.

Followup of psychotic outpatients: dimensions of delusions and work functioning in schizophrenia.

We studied three characteristics or dimensions of delusions in schizophrenia patients living in the community, including their influence on work and community functioning. The 149-patient sample included 57 delusional schizophrenia and nonschizophrenia outpatients, 50 nondelusional outpatient controls, and 42 delusional inpatient controls. The data indicated the strength and prominence of acute-phase psychopathology on characteristics of delusions, with large significant differences in intensity of delusions between the acute inpatient phase and the postacute inpatient and outpatient phases. Contrary to some views, the data indicate that the overall presence of any delusions in general, and the various dimensions of delusions, both influence work performance and community functioning, with the greater part of the variance due to the presence of delusions in general. Despite their outpatient status, delusional outpatients showed surprisingly poor self-monitoring about whether others would regard their delusional ideation as unrealistic. Schizophrenia and affectively disordered patients with high emotional commitment to their delusions showed significantly poorer work functioning and were significantly more likely to be rehospitalized (p < 0.05), indicating the important impact on functioning of patients' feelings of immediacy and urgency about their unrealistic beliefs.

Thought disorder in schizophrenia: working memory and impaired context.

This research was designed to provide data on whether thought disorder in schizophrenia patients is due to difficulty in holding external stimuli or the external context online in working memory. We assessed 231 early phase acute inpatients, including 68 schizophrenic patients and 38 bipolar manic patients. Patients were administered a thought disorder test that requires holding stimuli online in working memory as they respond and another in which the stimuli is in direct view of the patients throughout the test procedure. The results indicated that patients who were thought disordered on the test requiring holding the external stimuli online in memory also were more thought disordered on the test that provides full vision of the stimuli throughout the testing (p < 0.001). Thus, schizophrenia patients vulnerable to thought disorder show thought disorder regardless of whether or not they are required to hold the stimuli online in memory. Overall, the data did not support the formulation that thought disorder is primarily a consequence of failure to hold external stimuli or contextual material online in working memory. An alternate view of thought disorder is presented.

Disordered verbalizations in schizophrenia: a speech disturbance or thought disorder?

This research provides empirical data relevant to the long-standing theoretical issue of whether disordered speech in schizophrenia should be viewed as a speech disturbance or a thought disorder. The study analyzed whether schizophrenia patients with disordered speech on one test also show strange nonverbal behavior and unrealistic ideas on other assessments. One hundred eighty-four patients, including 55 schizophrenia patients, were assessed at the acute phase and followed up twice, over 4.5 years. Patients were assessed (1) with a standardized measure that can elicit disordered speech, (2) with a different measure that can elicit an atypical sorting of objects and an intermingling of personal ideas, and (3) for delusions (unrealistic thinking). Schizophrenia patients with disordered speech on the Proverbs Test also (1) sorted objects strangely on the Object Sorting Test (P <.05), (2) showed an intermingling of personal ideas into their thinking (P <.01), and (3) had delusional ideas when assessed at two successive follow-ups over a multiyear period (P <.001). The data suggest that most schizophrenia patients and other psychotic patients with disordered speech also show strange nonverbal behavior and unrealistic ideas/beliefs. These data support a theoretical framework in which disordered speech in schizophrenia and other types of psychotic patients is viewed as not just due to a speech disorder, but is often part of a broader constellation that includes gross reality distortions, strange behavior and ideas, and disordered thinking.

Isaac versus Oedipus: an alternative view.

Max Sugar (2002) argues for the essential similarity of the legends of Oedipus and Isaac with regard to the common themes of filicide, patricide, guilt, punishment, and expiation. Sugar does point out, however, that while the outcome in the Oedipus myth is tragic, it is hopeful in the narrative of Isaac. This article, in contrast, argues that this distinction between tragedy and hopefulness is not incidental and indeed stems out of the essential differences between the legends of Oedipus and Isaac, which themselves reflect the opposing life views emerging from Athens and Jerusalem. Indeed, we will argue for viewing the Akedah (the binding of Isaac) as a Biblical alternative to the Oedipus Complex, rather than simply an extension of it, and as the basis for a Biblical psychology and psychotherapy.