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There are very few books I would send to friends as holiday gifts. Amy Schaffer’s moving discussion of therapy with older patients qualifies, for its combination of fine scholarship and contagious ...

Has the concept of “character” gone out of fashion? Or is it due for a comeback, in part because of a newfound appreciation of its vital significance when we choose political leaders? Did we (psych...

Shakespeare’s great play King Lear traces the downfall of a man who retired without sufficient insight into the impact of his decision. The author uses the play to frame questions about the course ...

This paper explores the current relevance of Fromm’s concept of reactive violence for understanding particular patients and for generating hypotheses about the world we live in. In his discussion of reactive violence, Fromm gives us a nuanced approach to forms of aggression that can be employed in the service of life. According to Fromm, the aim of reactive violence is preservation, not destruction. It is rooted in fear and, he believes, is the most frequent form of violence. This paper traces the evolution of Fromm’s concept of reactive violence, and considers how it might apply to today’s social and political challenges.

This paper describes my struggle to retain my personal and professional identity while undergoing treatment for breast cancer. It would have been easy to slip into being “the tumor in the left breast.” A circumscribed writing project helped, since writing has always been part of my life. Some interactions with patients in treatment were also crucial to my sense of ongoing personhood.

Can clinicians hold passionate convictions about psychological health and still retain open minds about what health means to each person we treat? Erich Fromm’s writing challenges us to grapple with this issue. This commentary on Ilene Philipson’s paper suggests that we can gather strength from Fromm’s deeply heartfelt work but still have to struggle with integrating it with an open stance toward whom the patient wants to become.

This paper explores how Sullivan's interpersonal theory can be applied clinically and illustrates this with a clinical case. It considers the emotional impact, on the clinician, of a Sullivanian point of view. Each theoretical orientation equips the analyst differently. Sullivanian technique impacts the analyst's focus, feelings of competence, and hopefulness. Although each theory emphasizes different aspects of the clinical material, this paper suggests that there is a set of clinical values that inspire the work of all analysts, regardless of orientation.

This paper explores paranoid and depressive trends in a patient who was abused as a child. It discusses how each parent affected the patient's way of coping with life's challenges. In this context, paranoia is described as a set of defenses against the father's shocking intrusions, while the mother's impact shows itself in the patient's depressive tendencies.

This article explores some implications of Sullivan's (1953, p. 32) postulate that “everyone is much more simply human than otherwise....” Comparisons with seemingly similar statements by philosophers, poets, and emotion theorists may clarify what Sullivan meant. The author discusses her own theoretical and clinical applications of Sullivan's concept and focuses on the emotions of joy and sorrow, as quintessentially “simply human” experiences.

Sandra Buechler (SB): If someone new to the field reads your book, what do you hope they get from it?Steven Kuchuck (SK): I hope that readers at all levels of experience will find inspiration to ex...

This article describes ethnographic research involving street children and child labor in urban Honduras. It is set in a context of deteriorating social, political, and economic conditions that has created an increase in child labor. However, the research findings have delineated that a growing number of children are choosing to work and live on the street to escape extreme poverty and hunger in their familial households. Despite the multi-local spaces they inhabit, they have been able to create unique non-kin relations while often maintaining family based linkages. This study, undertaken in two centers for boys in Tegucigalpa and Comayagua, Honduras analyzes the contextual dynamics and decision-making processes of Honduran youth regarding work and living arrangements in urban spaces.

In this discussion I emphasize that the medium is the message in psychoanalytic supervision. But as supervisors, our approach often fails to communicate the clinical values we strive for in our work with patients. I speculate as to why this happens so frequently.

What can help the novice clinician navigate first encounters with patients without overwhelming anxiety? One-size-fits-all prescriptions about what to say in sessions are generally unhelpful, but inexperienced clinicians do need some guidance. Hazanov's openness about his thoughts and feelings during sessions gives us unusual access to the trial-and-error process of creating a particular treatment for each patient. Theory can provide some useful guideposts, but I believe that each clinician needs to develop conviction about what most facilitates the therapeutic action. From my point of view, much of the “action” is in the clinical values we embody in the way we relate to the patient.

This article, based on our research in eastern Germany, examines the manner in which farmers—including managers of the cooperatives that emerged out of former agricultural collectives, newly independent eastern German individual farmers, and newcomers from the West—define their roles and identities in the newly unified German state. We analyze this process within a framework that combines social‐interactional, social network, and cognitive models, taking into account fluidity and contradictions in behavior and in its symbolization. Identity formation unfolds in an arena characterized by competition for land based on differential access to various sources of power. Historical identities from the pre‐communist past, the recent communist past, and those developed in western Germany during the period of separation all provide the basis for emerging identities. The logic and reality of this redefinition are embedded in wider political and economic interests that are themselves inconsistent and in flux.

This article describes three attitudes toward psychic pain and suffering, and their clinical implications are explored and illustrated. When analyst and patient differ fundamentally in their understanding of the place of suffering in psychic life, treatment destructive clashes may result. The attitude that pain should be reduced as quickly as possible has a significant impact on the analyst's focus in treatment, most especially on the timing of interpretations of defense. A different orientation is that pain is an inevitable part of human experience and is best accepted rather than avoided. A third possibility embraces suffering as not only unavoidable, but as a primary source of wisdom and personal identity.

This case discussion explores what “healthy” mourning means, and how we can become better able to bear life's inevitable losses.

The philosopher Seneca once said that we spend our whole lives preparing to die. Far from a morbid statement, I see this as expressing the truth that all human beings spend their whole lives overcoming their narcissism. We have to make a significant enough investment in the lives of others, and in ongoing life, so that the loss of our own, personal lives is bearable to us. How can we help our patients overcome their excessive narcissism? The analyst must be a person who has, to some degree, overcome some part of his or her own narcissistic issues. This means that he or she values human life more than pride. Our ability to make the meaning of the patient's life a priority is a key part of the treatment. In how he or she behaves, the analyst must embody the principle that the quality of a life is more important than the appearance of success or failure.

Since an analytic hour presents infinite choices, it also provides infinite possibilities for retrospective regret. The analyst's work furnishes opportunities to regret acts of commission and omission. Missteps that seem like consequences of our personal character issues are likely to evoke shame and/or guilt, which can further complicate our feelings of regret. But genuine compassion and curiosity about ourselves can facilitate finding ways to atone. Atonement can be understood as a movement toward integration of all parts of oneself, or, more globally, a movement toward the inclusion of all human beings into the human community. For the analyst, atonement can mean becoming “at one” by finding a positive expression for what we have learned from our regrets. The challenge atonement poses is to face our shortcomings, yet retain self-respect and self love.

Twenty-five years later, the author examines the impact of her first analytic supervisor on her growth as an analyst and as a human being.

Metadata only record This article concentrates on the viability of gendered agricultural production in Sonora, Mexico in the framework of climate change. Sonora, Mexico was selected as the study area because fruit and vegetable family production still persists even though several types of fruit cannot be grown in the area due to increasing temperatures throughout the region. Feminist research methodologies were employed while conducting interviews to collect data. The results indicated that female farmer incomes are threatened by climate change and the exhaustion of water supplies. The results also showed that men and women depend differently on agricultural activities. The loss of income due to the effects of climate change on agricultural production of fruits and vegetables leave women vulnerable because other forms of employment demand higher education and do not pay an adequate wage. In the face of dramatic loss of income, the author suggests a combination of adaption and mitigation policies. These policies should include: job-creation and training programs, agricultural projects with erosion mitigation, water harvesting/retention, reforestation, natural fertilizer and local seeds.

Sudden health crises can change a life forever, including the life of the analyst. How do the analyst's physical and emotional crises affect the patient? This discussion of Stuart Pizer's paper first considers how the analyst's experience of illness can vary, depending, in part, on aspects of the patient. The discussion goes on to describe Pizer's case as an encounter between two human beings with differing values and histories of emotional experience. In analysis, our core values about life inevitably shape what we focus on, fight for, and fail to notice. This commentary concludes with a description of the active empathy central to Pizer's therapeutic action. More generally, each analysis requires us to grapple with shifts in the balance of our own emotions, as we discover who we need to be, to participate in a particular treatment process.

An earlier version of this paper was presented at Symposium, 2006, March 5, 2006, and is in press, Contemporary Psychoanalysis.

The peptide hormones guanylin and uroguanylin and their receptor, guanylate cyclase C (GC-C), are expressed in pancreatic duct cells. In colon cancer, guanylin peptides are shown to exert strong anti-tumor activity through the GC-C pathway. The objective of this study was to analyze the role of guanylin and uroguanylin in human pancreatic cancer.Quantitative real-time polymerase chain reaction (QRT-PCR) was used to show the expression of guanylin, uroguanylin and GC-C in specimens of human pancreatic cancer, chronic pancreatitis donor and in pancreatic tumor cell lines. The presence of guanylins and GC-C in tumor cell lines and in pancreatic cancer tissues was shown by immunofluorescence and immunohistochemistry. The effect of guanylin and uroguanylin on cell cycle and cell death of pancreatic cancer cells was investigated by fluorescence activated cell sorter (FACS) analysis using annexin and propidium iodide. In addition, the growth inhibitory effect of guanylins on pancreatic cancer cells was assessed using the MTT assay.Guanylin, uroguanylin and GC-C were expressed at mRNA and protein levels in pancreatic cancer and cancer cell lines. As shown by QRT-PCR, GC-C expression was significantly up-regulated in pancreatic cancer compared with that in healthy pancreatic tissues (p0.00001) and chronic pancreatitis (p0.05). Guanylin and uroguanylin were not up-regulated in pancreatic cancer. The MTT assay revealed significant inhibition of pancreatic cancer cell proliferation by uroguanylin in a dose-dependent fashion, whereas Panc1 and Capan1 cell lines were significantly inhibited already at the lowest uroguanylin concentration (2 nM, p0.05).Our data suggest therapeutic properties of uroguanylin in pancreatic cancer via GC-C-dependent mechanisms. In addition, determination of GC-C expression might be a useful marker for differentiation between pancreatic cancer and chronic pancreatitis.

Given that analytic training involves profound self-examination, self-exposure, and personal and professional assessment, it should come as no surprise that candidates often suffer from anxious shame. To what extent should we consider shame inevitable, and perhaps even a necessary aspect of the training process? What constructive uses might it have? What are the sources of shame in analytic training, and how might unnecessary, deleterious shame be avoided? The long-term consequences of inducing shame in candidates are considered. Shame in training can have a tremendous impact on the analyst's professional identity, ambition, and personal sense of worth.