Clinical Psychology

This research paper explores the experiential life meanings of a group of middleclass South African women that identify with having been diagnosed with Bipolar Disorder. Having a mental illness contains the pejorative of madness and often results in silence of those diagnosed. This Survivor Research includes first person descriptions in an attempt to reflect these often marginalized voices responding to and their understandings of the diagnosis and experience thereof. It can be read as a journey embarked upon by the researcher into exploring what does a Bipolar diagnosis mean for herself, the group and in relation to cultural assumptions, practices and beliefs of the common public consciousness. It is an exegesis of a mental illness that goes beyond the boundaries of the medical paradigm of popular understandings, probing the significance and relevance of the diagnosis. In approaching a search for new possibilities of interpreting the lives of those regarded as mentally ill and challenging the marginalizing power of discrimination leads the researcher to argue and question if the manifestation of mental illness should rather be interpreted as an expression of sentiral diversity in society. It also leads the researcher in exploring the agency for change.

Key words: Bipolar Disorder, mental illness, psychiatry, Post-psychiatry, psychiatric discourse, anti psychiatry, users and survivors of psychiatry, psychosocial disability

The role of consultant is different from that of being a supervisor or a thera- pist, even though the relational consultant uses similar skills. Experienced psychotherapists have the privilege of consulting with teams of profession- als. This brief article offers a stage model to organize a collaborative, par- ticipatory, and transparent form of consultation in complex organizational settings, like child protective services and community health care agencies. Staging is not a normative process to the consultation process. However, offering a clear sense of the stages that occur in a collaborative consulta- tion may make facilitators more accountable to the consultation practice and thus start construing evidence about these activities. The stages described in this brief attempt at systematizing the consultation practice with teams working with families are: Introductions → Meaning-Making → Resonances → Alternatives Meaning → Planning and Implementation → Evaluating.

Public confidence in policing has received much attention in recent years, but few studies outside of the US have examined the sociological and social-psychological processes that underpin trust and support. This study, conducted in a rural English location, finds that trust and confidence in the police is shaped not by sentiments about risk and crime, but by evaluations of the values and morals that underpin community life. Furthermore, to garner public confidence the police must be seen first to typify group morals and values and second to treat the public with dignity and fairness. All these findings are consistent with the perspective that people are Durkheimian in their attitudes towards crime, policing and punishment – a perspective developed here in this paper.

"The role that the involvement of parents may play in the treatment outcome of their
children with anxiety disorders is still under debate. Some studies dealing with other
disorders have examined the role that the expressed emotion (EE) construct (parental
overinvolvement, criticism and hostility) may play in treatment outcome and relapse.
Given that some of these aspects have been associated with social anxiety for a long time,
it was hypothesized that EE may be associated with lower treatment outcome. The sample
was composed of 16 adolescents who benefited from a school-based, cognitive-behavioural
intervention aimed at overcoming social anxiety. Then, parents were classified with
high or low EE. The results revealed that the adolescents whose parents had low EE
showed a statistically significant reduction of their social anxiety scores at posttest, as
opposed to adolescents of parents with high expressed emotion. These findings suggest
that parental psychopathology (parents with high EE) should be taken into consideration
to prevent poor adolescent treatment outcome."

Eylül 2006’da, İstanbul’da çoğunluğu Batılı olmak üzere 55 ülkeden 500 ana akım gazetecinin bir araya geldiği bir toplantı yapılmıştı. News Xchange adı verilen bu toplantı aslında her yıl dünyanın bir başka şehrinde gerçekleştiriliyor ve  ana akım gazeteciler yaşadıkları çeşitli sorunlar hakkında görüş alış verişi yapıyorlar. Bu arada hazır bir araya gelmişken bir tür sahne performansı babında o ülkenin yöneticilerini çağırıp çarpraz ateşe de tutuyorlar. Bahsi geçen İstanbul’daki toplantıya da Başbakan olarak Tayyip Erdoğan davetliydi. Yaptığı konuşmayı salondaki çok az kişi simultane tercüme kulaklıkları olmaksızın dinleyebiliyordu, zira Erdoğan Türkçe konuşuyordu. Derken soru-cevap faslı başladı ve salonun kapıya yakın bir yerinde ayakta durur haldeki Elif Şafak mikrofonu alıp konuşmaya başladı. 301. Madde’den, yani Türklüğe hakaretten yargılanması söz konusuydu ve bu maddenin kaldırılması gerektiğini söyledi. Son derece haklıydı. Ama nedense, salonda bulunanlar arasında Elif Şafak’ı kulaklıkla dinlemek durumunda kalan tek kişi, Şafak’ın direkt olarak seslendiği Tayyip Erdoğan’dı. Onun dışında, salondaki herkes Şafak’ı kendi sesinden ve kelimeleriyle dinleme fırsatı bulmuştu.

This paper evaluates the effectiveness of group cognitive behaviour therapy (GCBT) as an intervention for unipolar depressive disorders. PsychINFO and PubMed databases were selected to generate the 34 papers used for this review. Our results showed that effect sizes for GCBT over the control conditions range from small (0.1) to large (2.87) with the mean effect size of 1.10. The prepost treatment effect sizes for GCBT range from 0.30 to 3.72 with a mean of 1.30. Convergent evidence was demonstrated across different outcome measures of GCBT. Our findings indicated that GCBT yielded outcomes better than no-treatment controls and was comparable with other treatments (including both bona fide and non-bona fide comparison treatments). It was concluded that GCBT was effective for the treatment of unipolar depression and thus can be used with confidence. There is now an urgent need to develop and evaluate a coherent GCBT theory, in particular the roles of group processes in GCBT, before further major advancement in this area can be made.

Anhedonia, the loss of pleasure or interest in previously rewarding stimuli, is a core feature of major depression. While theorists have argued that anhedonia reflects a reduced capacity to experience pleasure, evidence is mixed as to whether anhedonia is caused by a reduction in hedonic capacity. An alternative explanation is that anhedonia is due to the inability to sustain positive affect across time. Using positive images, we used an emotion regulation task to test whether individuals with depression are unable to sustain activation in neural circuits underlying positive affect and reward. While upregulating positive affect, depressed individuals failed to sustain nucleus accumbens activity over time compared with controls. This decreased capacity was related to individual differences in self-reported positive affect. Connectivity analyses further implicated the fronto-striatal network in anhedonia. These findings support the hypothesis that anhedonia in depressed patients reflects the inability to sustain engagement of structures involved in positive affect and reward.

This paper examines Kant's moral theory and compares it with certain key aspects of oriental (especially Buddhist) moral philosophy. In both cases, we focus on the suggestion that there may be a connection between a person's physical health and moral state. Special attention is paid to the nature of pain, illness, and personal happiness and to their mutual interrelationships.
A frequently ignored feature of Kant's approach to morality is his preoccupation with health, and his attempt to interpret it in terms of the moral law. An obvious antithesis of the health-moral imperative would be an illness-pathological imperative; we will regard both as forms imposed on our experience by the human mind. We demonstrate that the Kantian path to understanding the “moral metaphysics of medicine” can be supported by Tibetan medicine and Buddhist ethics.
What Buddhism understands as moral law, or “Sila”, corresponds directly to Kant's theory. In both cases, health is the supreme judge that demonstrates whether or not our moral state is justifiable. Our principal intention is to show that, through the power of mind, a person’s moral state can--and in fact does--influence the body, having as its expression either health or illness. By considering the relevance of the Kantian interpretation of morality to medicine, we regard proper attention to the former as the surest path to the goal of maintaining personal health.

El dolor es un problema multidimensional que requiere ser enfocado por encima de las divisiones disciplinares tradicionales. En este artículo abogaremos por un punto de vista que considera que la dimensión so-cial y subjetiva del dolor no es únicamente una dimensión complementa-ria al resto, sino que debe ser tenida en cuenta al enfocar cada una de las dimensiones que se consideren. Por poner un ejemplo, la fisiológica como una dimensión necesaria del dolor (aunque no suficiente), merece también atención en tanto que construida mediante las prácticas científi-cas y médicas de una sociedad dada. De lo que se desprende que nin-guna comprensión de lo fisiológico puede ser completa sin una reflexión sobre las prácticas que lo constituyen como cuerpo de conocimiento legítimo sobre el que contrastar las versiones de los enfermos y de su entorno. De la misma manera se opta por considerar que ni lo psicológi-co, ni la práctica clínica, ni la investigadora, pueden ser comprendidos por separado de lo social.

Drawing on John Ellis's comparison between the screen - viewer relationship in Television and Cinema, this paper develops a reading of how players tend to relate to console games. Where the relationship to the screen of cinema is famously the gaze, Ellis argues television is the glance.
The player of console games is different again: not glance nor gaze, but glaze. The glaze is immersive (eyes glaze over), sticky (holding power); and self-reflective (identification with avatar).

Some therapists, as well as other commentators, have suggested that memories of horrific trauma are buried in the subconscious by some special process, such as repression, and are later reliably recovered. We find that the evidence provided to support this claim is flawed. Where, then, might these memory reports come from? We discuss several research paradigms that have shown that various manipulations can be used to implant false memories—including false memories for traumatic events. These false memories can be quite compelling for those who develop them and can include details that make them seem credible to others. The fact that a memory report describes a traumatic event does not ensure that the memory is authentic.

""Few studies have reported long-term follow-up data in adults and even fewer in adolescents. The purpose of this work is to report on the longest follow-up assessment in the literature on treatments for adolescents with social phobia. A 5-year follow-up assessment was conducted with subjects who originally received either Cognitive Behavioral Group Therapy forAdolescents(CBGT-A), Social EffectivenessTherapy forAdolescents—Spanish version (SET-Asv), or Intervencio´n en Adolescentes con Fobia Social—Treatment for
Adolescents with Social Phobia (IAFS) in a controlled clinical trial. Twenty-three subjects completing the treatment conditions were available for the 5-year follow-up. Results demonstrate that subjects treated either with CBGT-A, SET-Asv and IAFS continued to maintain their gains after treatments were terminated. Either the CBGT-A, SET-Asv and IAFS can provide lasting effects to themajority of adolescentswith social anxiety. Issues that may contribute to future research and clinical implications are discussed.""

"The reviews of recent literature in the field reveal a significant growth in
the number of research studies on social anxiety disorder (SAD) in children and
adolescents. However, there is a lack of information and on-going debates on
different issues related to this disorder. This paper presents a look ahead toward
critical steps to extend our knowledge and improve the understanding of this
disorder. In particular, this paper reviews the nature of social anxiety symptoms
as well as etiological explanations for the disorder. Additionally, the issue of
evidence-based assessment and treatment of SAD is discussed, with a particular
focus on cognitive-behavioral interventions. We conclude with a discussion of
future directions for the field."

Although social phobia is one of the most common mental disorders in adolescents, information on the need for normative data is missing. For this reason, this cross-sectional study aims at determining if there is a need to have normative data according to age and gender in socially anxious adolescents. Furthermore, this study analyzes if boys and girls differ in the nature of their social fears. The study population comprised 2,543 Spanish-speaking adolescents randomly recruited from 10 schools. The results point out that there is no need for different normative data based on age and gender. Moreover, our data indicate that even though there are quantitative differences between boys and girls, i.e. the girls reporting a higher percentage, a qualitative analysis reveals that boys and girls experience the same social fears and, therefore, the nature of the social anxiety-provoking situations is the same across gender. Implications for developmental theories and assessment are discussed.

Although social phobia is one of the most common mental disorders in adolescents, there are few reliable and valid assessment instruments for this age group. This study examined the factor structure and psychometric properties of a brief version of the Social Phobia and Anxiety Inventory (SPAI; Turner, Beidel, Dancu, & Stanley, 1989) in a sample of adolescents. Although the original 45-item SPAI has excellent psychometric properties, its utility is limited by its length. We developed and piloted a brief, 16-item version of the SPAI that has good psychometric properties, assesses cognitive, behavioral, and somatic symptoms, consistent with the original scale, which may be particularly useful as a screening measure. Limitations and suggestions for future research are discussed.

This is the back copy from Duke:

What happens when a baby is born with “ambiguous” genitalia or a combination of “male” and “female” body parts? Clinicians and parents in these situations are confronted with complicated questions such as whether a girl can have XY chromosomes, or whether some penises are “too small” for a male sex assignment. Since the 1950s, standard treatment has involved determining a sex for these infants and performing surgery to normalize the infant’s genitalia. Over the past decade intersex advocates have mounted unprecedented challenges to treatment, offering alternative perspectives about the meaning and appropriate medical response to intersexuality and driving the field of those who treat intersex conditions into a deep crisis. Katrina Karkazis offers a nuanced, compassionate picture of these charged issues in Fixing Sex, the first book to examine contemporary controversies over the medical management of intersexuality in the United States from the multiple perspectives of those most intimately involved.

Drawing extensively on interviews with adults with intersex conditions, parents, and physicians, Karkazis moves beyond the heated rhetoric to reveal the complex reality of how intersexuality is understood, treated, and experienced today. As she unravels the historical, technological, social, and political forces that have culminated in debates surrounding intersexuality, Karkazis exposes the contentious disagreements among theorists, physicians, intersex adults, activists, and parents—and all that those debates imply about gender and the changing landscape of intersex management. She argues that by viewing intersexuality exclusively through a narrow medical lens we avoid much more difficult questions. Do gender atypical bodies require treatment? Should physicians intervene to control the “sex” of the body? As this illuminating book reveals, debates over treatment for intersexuality force reassessment of the seemingly natural connections between gender, biology, and the body.

Modern digital games are a highly successful commercial form of entertainment, however it is only relatively recently that they have started to be taken seriously as a modern art form. A central aspect of game form is the active role held by the player, whose actions and behaviour create the gaming experience. The argument presented in this paper is that the playing of videogames is a performance act and that our understanding of this precocious dramatic form is enhanced by applying the lens offered by performance theory to more closely understand the dynamics that thrive in the dance between player and game.

This paper offers a position statement that outlines some starting points for exploring the unique aspects of digital game performance.

"Reviews of The Making of Psychotherapists:

“An insightful study of the training of psychoanalytic psychotherapists from an anthropological perspective…[and] a valuable contribution to ethnographies of professional socialization.”
- Journal of the Royal Anthropological Institute.

“A remarkable anthropological study via participant observation of the world of psychoanalysis and psychoanalytic psychotherapy. Davies has produced a tour de force of critical yet compassionate engagement covering all aspects of our institutional life, including the institution of the clinic itself…. Anyone involved with training or other work of any kind in psychoanalytic organisations who cares about the degree of self-knowledge and social awareness they bring to their jobs should read this work.”
- Professor Andrew Samuels (Analytical Psychology), University of Essex


"According to James Davies's fascinating book, the medicalized mental health landscape in which English psychoanalytic institutes currently operate...further discourages analysts from critically assessing their institutional systems, theoretical assumptions, and professional practices....This thought-provoking book, which is suitable for teaching at both the graduate and undergraduate level, should make even the most unreflexive analyst question traditional institutional practices. If such questioning ultimately leads to better patient care, then we all stand to benefit"
- Medical Anthropology Quarterly

“James Davies has produced an unprecedented book that is stimulating, challenging and unequivocal in its claims.”
- The United Kingdom Association for Psychotherapy Integration.

“His careful and well-written examination of the training process and the insights that he brings from anthropology offer us a timely and valuable contribution to meeting the many challenges now threatening the vitality and even very existence of our profession…. This groundbreaking new book dissects the way that the profession is taught and asks whether its very vitality is at stake.”
- The Foundation for Psychotherapy

“A wise, thoughtful, careful examination of a world often shrouded in secrecy. Davies is both a trained psychotherapist and a trained anthropological observer. As a result, his observations have a quite different feel than most of the literature in either field. Not only psychotherapists, but their clients (not to mention anthropologists) can look to this book to understand how this profession learns to see and respond to human pain.”
- Professor Tanya Luhrmann, (Anthropology and Psychology),
Stanford University

“Combining narrative and analytical skills, Davies provides a gripping story of life among trainee and professional psychoanalytic therapists and their patients. The clinic is the participant anthropologist's village and the dramatis personae are the individuals he studies, whose ambitions and problems punctuate their learning and experiences of psychotherapy.... While laying bare the sometimes unpalatable essence of such training, Davies conveys warmth and empathy for his fellow participants. The value of the study goes beyond the particular instance of psychoanalysis and tells us how small groups meet all kinds of unanticipated consequences as they transmit the knowledge on which their profession depends”.
- Professor David Parkin (Social Anthropology),
University of Oxford.

“I highly recommend this book to anyone interested in the field of psychoanalysis, in
the culture of institutions, and in how institutions foster change in their constituent members.”
- Contemporary Psychology (American Psychological Association).

“James Davies’ ‘The Making of Psychotherapists: An Anthropological Analysis’ is a thorough and thought provoking anthropological study of the culture of psychoanalytic training…. On his impressive juxtaposition of mastery of both anthropological and psychoanalytic theory, Davies points out that in a parallel development psychoanalysis developed the notion of countertransference and anthropology that of self-reflexivity….Davies’ book is well written, thoroughly and academically resourced and describes with acute detail the striving for the establishment of the doctrine of psychoanalysis…. It is essential reading for anyone involved in the therapy world who is interested in the understanding of the philosophical, historical, social and political implications of the construction of psychoanalysis in the twentieth century.”
- The European Journal of Psychotherapy and Counselling."

This paper was given at a College Art Association conference in 2000, in a session on the state and future of social art history chaired by Marc Gotlieb. The session was one of the big ones that year--maybe 300 people in attendance--and it was, by several standards, a total disaster. The respondent, Tom Crow, was annoyed by most of the papers; the conversation afterward was more about the history of social art history, and who owned it, than about Marc's questions; and the speakers addressed Marc's concerns in such different ways that I think few people could have gotten much out of the session as a whole.

This paper asks perhaps the most annoying question that can be asked about an historian's work. There is no doubt that historical writing is specific to the time and place of the historian, and informed by the historian's way of conceptualizing the world: that has been described beautifully, and repeatedly, by writers from Walter Benjamin to Dominic LaCapra. But strangely, writing on the subject of historians' subjectivity has not helped historians think about their own writing.

One assertion in this paper has had an afterlife: it's the idea that art history, in particular, has a shelf life of about thirty years. After that, the texts are likely to be consulted mainly for stray facts, and otherwise to be considered as products of their age. No one reads Dvorak or Friedlaender any more for information about the seventeenth century; they are read (when they are read) as writers who exemplify cultural currents in the first half of the twentieth century. In other words, historical accounts gradually become accounts of the time in which the historian lived. I proposed that thirty years is the cutoff point, and that we should try to do better.

Objective: The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). Method: The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder symptoms, general psychopathology, and CSA history at admission to hospital. Results: Thirty-seven patients (48%) reported a history of CSA before the onset of the eating disorder. Individuals with a history of CSA reported significantly greater psychiatric comorbidity, including higher levels of depression and anxiety, lower self-esteem, more interpersonal problems, and more severe obsessive-compulsive symptoms. Patients with the binge-purge subtype of AN (AN-BP) were significantly more likely to report a history of CSA prior to the onset of the eating disorder as compared with patients with the restricting subtype (AN-R) of the illness (65% of the AN-BP patients vs. 37% of the AN-R patients; p < .02). Contrary to our predictions, abused patients were not significantly more likely to dropout of treatment overall. However, patients of the binge-purge subtype (AN-BP) with a history of CSA were significantly more likely to terminate treatment prematurely as compared with the other patients. ଝ Conclusions: Consistent with previous findings, the present results indicate that the prevalence of CSA is high among individuals seeking inpatient treatment for AN. A history of CSA was associated with greater psychiatric disturbance overall and a higher rate of dropout for patients of the binge-purge subtype.

Resting state activity in the ventral cingulate may be an important neural marker of symptomatic improvement in depression. The number of task related functional magnetic resonance imaging (fMRI) studies correlating blood oxygenation level dependent (BOLD) response with symptomatic improvement is limited and methodologies are still evolving. We measured BOLD responses to sad and happy facial stimuli in 12 severely depressed individuals in the early stages of antidepressant treatment (Time 1) and 12 weeks later (Time 2) using event-related fMRI. We calculated correlations between temporal changes in BOLD response and changes in symptom scores. Most subjects improved markedly by Time 2. At Time 1, depression severity correlated positively with responses to sad stimuli in the right visual cortex, subgenual cingulate, anterior temporal pole and hippocampus and correlated negatively with responses to happy stimuli in left visual cortex and right caudate. Decreases in individual effect sizes of right subgenual cingulate and right visual cortical responses to sad, but not happy, facial stimuli were correlated with decreases in symptom scores. There are contrasting cortical and subcortical responses to sad and happy stimuli in severe depression. Responses to sad stimuli show the strongest correlates of clinical improvement, particularly in the subgenual cingulate.

En este trabajo pretendo corregir algunos de los “excesos” y simplificaciones de las teorías posmodernistas sobre la identidad. Trato de restituir al sujeto una ontología que no lo reduzca a meras determinaciones sociales, recuperar su carácter corpóreo-orgánico (embodiment) para su comprensión/construcción y, de este modo, retomar la cuestión de la unidad del sujeto (y de la unidad de/en su identidad) frente a la manida exaltación de su fragmentación (pluralidad de su identidad --en oposición a lo cual sostengo la idea de una ‘pluralidad de/en su identidad’).

Sample chapter available for download!

CONTENTS
Introduction - Psychiatry as Cognitive Neuroscience: An Overview (M.R. Broome and L. Bortolotti)

Psychiatry as Science
Chapter 1. Is Psychiatric Research Scientific? (R. Cooper)
Chapter 2. A Secret History of ICD and the Hidden Future of DSM. (K.W.M. Fulford and N. Sartorius)
Chapter 3. Delusion as a Natural Kind. (R. Samuels)

The Nature of Mental Illness
Chapter 4. Mental Illness is Indeed a Myth. (H. Pickard)
Chapter 5. Psychiatry and the Concept of Disease as Pathology. (D. Murphy)

Reconciling Paradigms
Chapter 6. On the Interface Problem in Philosophy and Psychiatry. (T. Thornton)
Chapter 7. What does Rationality Have to Do with Psychological Causation? Propositional attitudes as Mechanisms and as Control Variables. (J. Campbell)
Chapter 8. Mad Scientists or Unreliable Autobiographers? Dopamine Dysregulation and Delusion. (P. Gerrans)

Psychiatry and the Neurosciences
Chapter 9. When Time is Out of Joint: Schizophrenia and Functional Neuroimaging. (D. Lloyd)
Chapter 10. Philosophy and Cognitive-Affective Neurogenetics. (D. Stein)
Chapter 11. An Addictive Lesson: A Case Study in Psychiatry as Cognitive Neuroscience. (L. Stephens and G. Graham)

Phenomenology and Scientific Explanation
Chapter 12. Understanding Existential Changes in Psychiatric Illness: The Indispensability of Phenomenology. (M. Ratcliffe)
Chapter 13. Delusional realities. (S. Gallagher)

Delusions and Cognition
Chapter 14. Delusions: a Two-Level Framework. (K. Frankish)
Chapter 15. Explaining Pathologies of Belief. (A.M. Aimola Davies and M. Davies)

Moral Psychology and Psychopathology
Chapter 16. Mental Time Travel, Agency and Responsibility. (J. Kennett and S. Matthews)
Chapter 17. Motivation, Depression and Character. (I. Law)

Conclusion: The Future of Scientific Psychiatry. (L. Bortolotti and M.R. Broome)


One of the best books of 2009 for the Guardian, according to Mary Warnock:
http://www.guardian.co.uk/books/2009/nov/22/books-of-the-year-2009.

For reviews and other information about the book, go to: http://sites.google.com/site/lisabortolottiphilosophy/books/psychiatry

The importance of the interpersonal circle in organizing the interpersonal domain is complemented by its empirical relations with broader personality taxonomies and with more specific personality variables. Yet circumplex structure in interpersonal measures has often been investigated using the "eyeball test" rather than using circumplex criteria of known effectiveness. Simulations showed the effectiveness of 5 exploratory criteria (3 entirely new) that assess the properties of equal spacing, constant radius, and no preferred rotation. Along with Browne's (1992) criterion, these were applied to the Interpersonal

In two longitudinal studies, the authors examined the direction of the relationships between trait gratitude, perceived social support, stress, and depression during a life transition. Both studies used a full cross-lagged panel design, with participants completing all measures at the start and end of their first semester at college. Structural equation modeling was used to compare models of direct, reverse, and reciprocal models of directionality. Both studies supported a direct model whereby gratitude led to higher levels of perceived social support, and lower levels of stress and depression. In contrast, no variable led to gratitude, and most models of mediation were discounted. Study 2 additionally showed that gratitude leads to the other variables independently of the Big Five factors of personality. Overall gratitude seems to directly foster social support, and to protect people from stress and depression, which has implications for clinical interventions.

Erectile dysfunction (ED) affects approximately one in ten men at some point in their lives. ED can have profound effects on interpersonal relationships.This article describes its causes and the treatments available, and examines the effect it can have on those who experience the condition.

Attentional and perceptual differences between women with high and low levels of bulimic symptoms were studied with techniques adapted from cognitive science. Stimuli were pictures of young women varying in body size and facial affect. A multidimensional scaling analysis showed that the highsymptom women were significantly more attentive to information about body size and significantly less attentive to information about affect. In prototype classification tasks, the high-symptom women used significantly more information about body size and significantly less information about affect. There were strong associations between individual differences in attention in the similarity task and decision making in the classification tasks. The study shows the potential utility of cognitive science methods for the study of cognitive factors in psychopathology.

The author uses an anthropological perspective to consider how certain social conditions of training institutes, through the stresses they evoke, render trainees susceptible to the instruction of seniors. And depending on that which seniors advocate -'inclusive' or 'closed' therapeutic adherence -trainees will be influenced in that direction as practitioners. In this sense the internalization of clinical perspectives is facilitated by certain exacting conditions of psychotherapeutic training which generate this anxiety. This argument exposes for those desiring clinical reform two sites at which it might be profitably directed: at the social conditions of the training institute which arouse susceptibilities, or else at the instruction, which, by capitalizing on such susceptibilities, inculcates particular clinical values and perspectives. He concludes that if changes are to be brought to such perspectives then it is the social conditions of the training institute that need to be altered.

The article discusses a topical issue in contemporary Bulgaria: the crime among the underage offenders aged 14–17. National Statistical Institute data for a 17 year period is reconfigured, analyzed and then interpreted from the standpoints of sociology of delinquency and criminology. As a result a quantitative generalized profile of the juvenile offender is constructed and presented both in short and in detail.
The article also traces the structure and dynamics of the convicted underage offenders throughout the period. Using the correlation method of statistical analysis, the author offers a periodization of the transitional period. The periodization emerges on the basis of changing dynamics explained by the finding that the convicted criminal activity of underage and full age offenders is determined by different factors during the sub-periods. A number of hypothetical explanations, pending verification, are offered in relation to the changes in convicted criminal activity in Bulgaria. The periodization is exclusively based on data and statistical coefficients provided and estimated by the National Statistical Institute.
Furthermore, the article discusses the structure and dynamics of convicted underage offenders by a number of demographic and social attributes, e.g. sex, age, education, ethnicity, type of crime, family type, situation in the family, physical and mental health, and all types of inflicted punishments. As a result of all analyses and interpretations based on the available data it is generalized that there are approximately 190 underage (aged 14–17) offenders per year whom can be referred to as dangerous offenders active in Bulgaria.