Suicidal incised wound of a fistula for hemodialysis access in an elderly woman: case report.

A very rare case of suicide by stab wound of a fistula for hemodialysis access in an elderly woman is reported. The incidence of suicide attempts in people undergoing hemodialysis is well known. Nevertheless, suicide means do not usually include stab wounds of the arteriovenous access. Various pattern differences between homicidal and suicidal stab wounds, characteristics of suicide in the elderly, and approaches to the investigation of such cases are briefly discussed.

Sexual assault under benzodiazepine submission in a Paris suburb.

Sexual assaults under benzodiazepine submission have been described, since use of benzodiazepine enables non consensual sexual activity but rarely fully reported. An accurate evaluation of the phenomenon has seemed interesting. Files of 23 adult males and females examined at the Emergency Forensic Unit of an University Teaching Hospital near Paris were reviewed. All the victims had complained from sexual assault under drug submission, in the years 1996 and 1997. A complete examination for sexual assault was realised linked to clinical examination of drug intoxication. Every victim of rape under drug submission was sampled for urine screening (mean delay of 17.5 h after sexual assault) and blood alcohol level quantification. Urine was screened for benzodiazepines, cocaine, opiates and cannabinoids with qualitative immunochromatographic test. Traumatic lesions of sexual penetration were retrieved in 10 victims and sperm in 5. Clinical signs of benzodiazepine intoxication were retrieved in 12 out of 23 victims. Urine benzodiazepine screening was positive, over the cut-off values (300 ng/mL)when sampled less than 20 h after the facts. In 6 out of 23 victims, drugs of abuse and alcohol were associated to benzodiazepines. A reinforced attention can be brought to the rape under drug submission including the need of a proper examination and samplings shortly after the alleged facts to ascertain the diagnosis and to help the victim facing the Justice inquiry.

Suicide by electrocution with low-voltage current.

Three cases of suicide by electrocution with low-voltage current were observed in five years (1994-1998) by medical clinical forensic examiners of an Emergency Forensic Unit of the Paris suburb among 2,000 external death examinations. The cases involved one woman, aged 72 and two men, aged 38 and 41. In the last two cases, electric burns were retrieved under bared electric wires, placed on the arms or fingers in order to realize a hand-to-hand electric circuit involving the heart muscle. In the other case, the electric circuit between mouth and foot also involved the heart muscle. Household low-voltage current delivered (220 V in France) had a sufficient strength to induce local muscular paralysis and heart fibrillation. In the three cases, blood samples taken have retrieved very high levels of muscular enzymes (CPK, LDH) correlated to the mechanism of electric death. The rareness of suicide by electrocution and its forensic characteristics are detailed in order to help the clinical forensic examiners, prosecutors, and police officers concerned by such death examinations.

Kohut and Glover. The role of subjectivity in psychoanalytic theory and controversy.

The role of conflictual elements in the genesis of a new theory and in relation to the use of theory in a psychoanalytic controversy will be explored in two "case" studies. In the first, a close reading of Kohut's "The Two Analyses of Mr. Z" and in the second, a detailed examination of Glover's shifting allegiances toward Kleinian theory will reflect the role of transference and of idealization as powerful motivating elements.

The logic of controversy: Susan Isaacs and Anna Freud on F(PH)antasy.

Controversy leaves its mark on the subsequent development of psychoanalytic concepts in the form of ambiguous language and faulty reasoning. Examination of the form of an historical controversy suggests that enduring inconsistencies and a less than comprehensive appreciation of the strengths and weaknesses of the competing theories resulted from the emotional and political climate. The authors recommend that disputes over new theoretical proposals begin with (1) an identification of the clinical problems that are said to require the innovation and (2) an assessment of whether the identified problems actually require theoretical revision. The new model should then be examined (3) as to whether it is self-sufficient or depends on unrecognized aspects of the previous theory. In the latter case, (4) it is important, in order to avoid the emergence of a self-contradictory theoretical hybrid, to ascertain whether the new formulation contradicts the previous one on which it silently depends.

Revisiting the Freud-Klein controversies fifty years later.

This paper examines the contribution to the study of psychoanalytic controversy made possible by the publication of the Freud-Klein Controversies. The availability of the complete minutes allows us as never before to dissect a historical, scientific controversy immersed in passion and intertwined with issues of power, economics and educational control. For the first time in the analytic literature we are able to follow closely how each side conceptualised the nature of preverbal development, and how and where and with what consequences polemics and artificial polarisation contaminated the dialogue. The problematic relation between theory and data is illustrated very sharply and many of the methodological issues encountered are highly relevant to current disagreements within our field. A careful reading shows at which points opportunities for bridging gaps were scuttled, and how ensuing developments in our field were coloured by the failure of a true resolution. Particularly remarkable are the 'Memoranda on Technique' written by a number of participants. These very moving, brief essays document the process of acquiring a personal approach to analytic work. The section by Brierley deserves a special mention for its excellence, clarity and modesty.

The personal dimension and management of the supervisory situation with a special note on the parallel process.

This paper focuses on the vicissitudes of the supervisor/supervisee relationship and on the personal impact of supervision on the candidate. Conflicts within the supervisory situation and their potential intrusion into the learning process are discussed. The supervisee's character as a limiting factor and some of the dynamics of the parallel process are considered as well. A number of vignettes illustrate the problems involved and some possible remedies.

Faulkner's As I Lay Dying: issues of method in applied analysis.

This paper seeks to illustrate several possible approaches in the application of psychoanalysis to Faulkner's novel, As I Lay Dying. In applied analysis, the specific form and content of the work in question must be considered in order to determine which aspect of psychoanalysis will be most relevant in creating a meaningful context and in increasing our understanding.

The relevance of the analyst's character and attitudes to his work.

This paper is intended to sensitize analysts to the role of their character in analytic technique. The relation of character to countertransference, its role in analytic style, in the introduction of parameters, and in transference neurosis, will be elaborated. The problem of matching and of accounting for our failures will illustrate the complex meshing of character with more traditional factors.

Character in fiction and fiction in character.

This paper examines the concept of fictional character from a psychoanalytic point of view, including its synthesis and the role of reader response. A second section takes up the role of fiction in the development of character.

Character, character type, and character organization.

This paper explores the relevance of the concept of character organization for psychoanalysis and argues for its usefulness in preserving what is specific to character. Character organization is viewed as a bridge concept between the observable and the structural, the role of fantasy and object relations in development, and as a convenient way of describing certain global phenomena not easily encompassed by the structural theory or compromise formation.

A dream, a sonnet, and a ballad: the path to Keats's "La Belle Dame sans Merci".

This paper explores the relationship between Keats's ballad, "La Belle Dame sans Merci," and some of its precursors, including one of the poet's dreams and a sonnet titled "On a Dream." The process of creativity is examined.

An essay on method in applied psychoanalysis.

The author attempts to evaluate critically the application of psychoanalysis to literature by examining problems of method and the assumptions psychoanalysts unwittingly make about texts they are about to interpret. The special advantages of psychoanalysis over other interpretive systems are discussed, and several examples of the possible use of psychoanalysis in the study of literary texts are presented.

Character: a concept in search of an identity.

I have attempted to clarify the clinical usage of the concept of character. I have examined such terms as character trait, character, and character disorder. I have described various schemes of classification, and have proposed key definitions for the above terms. I have described the unique aspect of character, that is, its capacity to establish a relation between a superficial attribute and a deep structure. Finally, I have suggested that character represents the core of the individual from a particular point of view--a precipitate of a person's relations to the outside world.