Reducing risk for cardiovascular disease in uninsured women: combined results from two WISEWOMAN projects.

OBJECTIVE: to evaluate the effectiveness of a cardiovascular disease (CVD) risk factor reduction program for financially disadvantaged women. The program included cholesterol and blood pressure assessments and tailored physical activity and nutrition interventions. METHODS: Women who attended selected National Breast and Cervical Cancer Early Detection Program sites in North Carolina and Massachusetts received either enhanced physical activity and nutrition interventions (EI) or minimum interventions (MI). The effectiveness of EI was assessed by pooling data from the North Carolina and Massachusetts projects after 1 year, and a mixed models analysis of covariance was used to compare changes in CVD risk factors across groups. RESULTS: The blood pressure, total cholesterol, and high-density lipoprotein cholesterol profiles of both groups improved, body weight was maintained, and smoking declined. The 10-year estimated coronary heart disease death rate (per 1,000 women) at baseline was 64.8 for the El group and 61.9 for the MI group. The rate declined by 3.5 deaths per 1,000 for the EI and 0.7 per 1,000 for the MI. Although the decline was statistically significant for the EI group, the difference between groups was not significant. CONCLUSION: Further lifestyle intervention research targeting financially disadvantaged women is needed.

The prisoner's dilemma: game theory and the therapeutic alliance.

My aim in this paper is to describe how the therapeutic alliance evolves during psychoanalytic treatment. Lindgren has shown that a coevolutionary process can optimize the level of cooperation by the players in the game of prisoner's dilemma. This level is reached when strategies for recognizing reliable patterns in the sequence of moves by the other player have evolved. These are multiple memory strategies. Lindgren's work suggests that the analytic process must have sufficient time for multiple memory strategies to emerge if it is to achieve the necessary level of trust for an effective therapeutic alliance to develop.

Oedipus and the sphinx: triumph and catastrophe.

The downfall of Oedipus in Sophocles' most famous play, Oedipus Tyrannus, is the reversal of his triumphant entry into the city of Thebes 17 years earlier. The oracle at Delphi has told the Thebans that the plague will end only when the murderer of Laius is identified and punished. The unconscious collusion between Oedipus and the Thebans to ignore the unsolved murder breaks down. Told by Teiresias that he is the culprit, Oedipus begins a desperate effort to find evidence to refute this accusation. When other witnesses come forward, his cause is lost. The effect of Oedipus's collusive interaction with the Thebans is balanced in Sophocles' account by the story of the riddle of the Sphinx. The Sphinx is a goddess of discontinuity. She represents the unconscious forces at work both in Oedipus's personal fantasies and in the collective fantasies of the Thebans. The tragedy results from the interaction of these fantasies in the government of the polis. Sophocles' play thus exemplifies the intricate intertwining of the child's innate wishes and the reaction they evoke from the environment during the oedipal period. The neurotic patient's illusion of sexual triumph over his or her father or mother as a child can be best understood through the interaction of these factors.

The Eros of dreaming.

This paper examines the aspects of dreaming derived from the principle of Eros, the life instinct as described by Freud in Beyond the Pleasure Principle. The life instinct is interpreted in information-processing terms, as the inverse of entropy. The paper emphasizes the role of condensation as a mechanism that binds together the representations of present and past events in the imagery of the dream. This distinguishes it from displacement, which appears to be a mechanism whose function is solely defensive. The role of the dream in finding a common ground between current and past experience (Galton's method of comparison by superimposition) is discussed in detail. It is suggested that condensation is a primitive cognitive mechanism at work in many kinds of mental activity. The implications of this idea for psychoanalysis and for the creative process in general are explored in brief.

Connectivity and condensation in dreaming.

Converging developments in the cognitive- and neurosciences have brought Freud's hope of a bridge between psychoanalysis and psychophysiology nearer to hand. This paper concerns the relation between dream construction and memory in terms of these new developments. The neural network architecture of memory structures in the brain is described and illustrated with simple examples. We see how a network is connected and how connection weights vary with experience. The distributed representation stored by the network and its crucial properties for mental functioning are discussed. These concepts are used to explain how particular memories of past events are selected for inclusion in the dream. The properties of the neural network suggest that images of distinct past events are conflated at times during the selection process. The appearance of these conflated images may complicate the matching of day residues with representations of past events in the dream itself. Some likely implications for psychoanalytic theory are explored.

Day residue and screen memory in Freud's dream of the botanical monograph.

Freud's theory of dream construction allowed the censorship to intervene only when a repressed infantile wish emerged from the unconscious. In his (1899) paper on screen memories, however, he proposed a mechanism for the defensive displacement of current events as they are sorted for introduction into permanent memory. I suggest that Freud was actually describing the conflictual process through which the day residue of the dream is formed. Day residue and screen memory are closely related as elements of the dreamer's present and past experience displaced from his more central instinctual concerns. Freud's dream of the botanical monograph clearly illustrates this relation. Substituted day residues were matched in the dream with relatively innocuous memories of past events of similar cognitive and affective significance. By retracing the substitutions, one can see how a current conflict over Fliess's role in the writing of the dream book recapitulated a series of Freud's earlier conflicts concerning his father and the power of books.

Recovery of early memories associated with reported dream imagery.

In recent years dreaming has been characterized as an information-processing activity that functions adaptively to match new experience with representations of past events already stored in long-term memory. Nine patients who reported dreams in psychotherapy were asked expressly if the dream imagery recalled a specific event from early in their lives. Of 50 consecutively reported dreams, 46 were associated with early events whose imagery appeared in the dream. When questioning about the past was omitted in a later series of 34 dreams, the same patients spontaneously recalled early events represented in the dream imagery only 13 times.

Deconstructing the manifest dream.

A major part of the analyst's task is to discover the basis for the patient's misidentification of his present life situation with significant but threatening events of his earlier life, now repressed and inaccessible to conscious recall. Reconstructing the patient's history is a crucial step in this process of discovery, but the dynamic relation between the present and the past must be reconstructed as well. The structure of the manifest dream contains the key to this relation. The imagery of the dream is a composite of experimental materials drawn from important drive-related events of the present and the past. The complex formed by the manifest dream and the patient's associations provides the analyst with data about both of these distinct sets of drive-related experiences. As Freud's discussion of his M elusine dream illustrates, one associative thread can be traced to an experience that incorporates a conflicted current wish. Another thread will lead to an experience in which a repressed wish of childhood has been expressed. Where the two associative threads converge, in the composite imagery of the dream, the basis for the identification between the wishes of the present and the past will be exposed. An understanding of the structure of the manifest dream helps to clarify some of the important theoretical issues left unresolved in Freud's writings. These include: the function of the day residue and the mechanism through which it is formed, the relation of the screen memory to the associative process, and the differing roles of condensation and displacement in dream construction and free association. A simple procedure is described for enhancing the recovery of the significant childhood memories whose details have been incorporated into the composite imagery of the manifest dream.

The genius of the dream.

In Act V of A Midsummer Night's Dream, Theseus and Hippolyta exchange views on the dreamlike adventures reported by the young lovers. Theseus dismisses their stories as fantasies of wish fulfillment, but Hippolyta points out that despite their strangeness, the tales reflect an adaptive change in the psychic reality of the lovers. The dramatic action of the play supports Hippolyta's view. The release of Demetrius from his transferential infatuation with Hermia comes at the moment of awakening from a dream in which he has matched his current feelings for Hermia with a repressed libidinal fantasy of childhood. This example of a correction dream illustrates how condensation in dreams functions adaptively in matching a new experience with previously stored representations of related events in the past. It also illustrates the ability of the matching process to go beyond the narrow logical categories of waking thought to reach deeper levels of experience otherwise inaccessible to the dreamer. This ability accounts for the important role played by dreaming in the creative process generally and in the day-to-day working-through process of psychoanalytic therapy. The adaptive function of dreaming is subject at many points to interference from the censorship mechanisms discovered and emphasized by Freud. A theory of dreaming combining these antagonistic processes is more consistent with the data of the sleep laboratory than the traditional psychoanalytic theory alone. It also provides a better fit with the introspective date more familiar to the analyst as illustrated by Freud's well-documented analysis of his own dreams.