Internalization and Opposition to Stigmatized Social Discourse among Incest Survivors.

Despite the high prevalence of incest, survivors are reluctant to disclose its existence for reasons such as shame, guilt and the presence of an accusatory and stigmatizing social discourse. The current mixed methods study examined the internal discourses of 13 incest survivors in Israel, reflected in self-reported internal dialogs which emerged during interviews. The qualitative analysis revealed a dialectical tension between two themes - one reflecting an internalization of the social discourse (manifested as quotes taken from social discourse and uttered by the survivors) and the other an agentic discourse (manifested in utterances either resisting the social discourse or showing an empowering advertence to one's own fulcrum). The quantitative analysis showed that for seven participants the internalized social discourse expressions were most frequent, for five the agentic expressions were most frequent, and that for one the discourses were at equilibrium. The ubiquitous sub-themes manifested in the internalized social discourse were: victimhood (feelings of vulnerability and helplessness), survivorship (meaningless existence, despair and hopelessness), negative self-esteem and self-pathology (perception of the self as having pathological psychological problems), and denial/repression of the abuse. The ubiquitous sub-themes manifested in the agentic discourse were: positive self-image and sense of potency, hope, optimism and positive perception of life, and uprising against the parents and institutions that did not give support. The discussion is based on Butler's concept of vulnerability, which suggests how to address the harms inflicted by incest without erasing aspects of the survivors' agency and growth.

The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study.

OBJECTIVE: Previous reports on the prognosis of white coat hypertension are ambiguous. We aimed to determine the prognostic implications of the white coat phenomenon in treated patients. METHODS: Our 14-year hospital-based ambulatory blood pressure (BP) monitoring prospective database was analyzed for all-cause mortality. The relationships of the white coat and masking effects with mortality were assessed both categorically (controlled awake versus clinic BP) and in a continuous mode (clinic-awake BP difference). RESULTS: During the follow-up period, 2285 treated patients (aged 61 +/- 13 years, 57% women) were monitored (17621 patient-years, 286 deaths). Mean BMI was 27.8 +/- 4.5 kg/m2 and 13% were treated for diabetes. Controlled hypertension (normal clinic and awake BP) was found in 15.8%, high clinic BP (with controlled awake BP; namely, white coat uncontrolled hypertension) in 12.1%, awake hypertension (with controlled clinic BP; namely, masked uncontrolled hypertension) in 11.8%, and sustained hypertension (both clinic and awake) in 60.3%. Compared with white coat uncontrolled hypertension, age-adjusted Cox-proportional all-cause mortality hazard ratios were 1.42 (0.81-2.51) for controlled hypertension, 1.88 (1.08-3.27) for masked uncontrolled hypertension, and 2.02 (1.30-3.13) for sustained hypertension. Hazards ratios per 1% increase in the clinic-awake BP difference were 0.992 (0.983-1.002) for systolic BP and 0.981 (0.971-0.991) for diastolic BP, adjusted for age, sex, diabetes, and either systolic or diastolic awake BP, respectively. CONCLUSION: In treated hypertensive patients referred for ambulatory BP monitoring, the white coat effect is benign compared with the reverse (masking) phenomenon, which has a poorer prognosis.