The palimpsest phenomenon.
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Biomedical subjects
Publications and source records attributed to M Ostow.
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The classical pattern of apocalypse, comprising in its active form, an initial phase of savage destruction followed by a phase of messianic rebirth, can be recognized in individual psychosis and in the Nazi type of destruction, persecution and virtual suicide. It can be clearly discerned also in Hitler's thinking and in the thinking of Eickhoff's Nazi-minded patient. The apocalyptic mood of Nazi society attracted this patient, for by identifying with it, she was able to overcome the isolation that her psychosis imposed upon her. The Holocaust, the other side of the Nazi apocalypse, evoked classical methods of mutual identification among the victims, but apocalyptic and messianic views became evident only after the immediate crisis had passed. The attempt to solve urgent problems by resort to apocalyptic campaigns has resulted in the murder of large numbers of Jews throughout history, and of others where there were no Jews. The international psychoanalytic community can take upon itself the task of detecting and unmasking such tendencies when and where they appear, in an effort to arrest the evolution of yet another apocalypse.
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This paper presents an assessment of The Robert Wood Johnson Foundation's Municipal Health Services Program, a demonstration in five major cities of neighborhood-based health care delivery for inner-city residents, started in 1978 and supported until 1984. The program was successful in achieving higher levels of clinic utilization, as well as in integrating preventive and therapeutic services; it was less successful in reducing the dependence of inner-city residents on hospital-based ambulatory services. Although the neighborhood centers provided care at substantially lower cost than that of other public facilities, they remained dependent on outside financial support. The viability of the community health care centers at the end of the grant period is discussed, in terms of the changes that have affected the health delivery system in the seven years since the program was started, and in terms of expected changes over the next few years that will affect their future usefulness and stability. A series of alternatives that might provide for the health care needs of the indigent are also discussed.
In following the course of any patient who is being treated with psychiatric medication, the treating physician must at all times focus on the course of the primary symptom complex for which the treatment was undertaken; the therapeutic changes induced by the medication, following an appropriate latency; toxic side-effects and other effects of the medication, and their influence upon the patient's resistance to drug therapy and psychotherapy; the effect of the movement on the manic-depressive spectrum induced by the drug on the patient's affect, attitude, and behavior; and the psychodynamic responses to all these inputs.
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