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PubMed2004

Nursing staff and nursing students' emotions towards homosexual patients and their wish to refrain from nursing, if the option existed.

Studies have reported that homosexual patients fear they will not receive adequate care if they openly show their sexual orientation, for example, when introducing their partner. The aims of this study were to investigate the emotions of nursing staff and nursing students, and possible relations to cultural background and gender, towards homosexual patients; whether nursing staff and nursing students would choose to refrain from nursing homosexual patients, if the option existed; and, if so, how they express their wish to refrain from nursing this group of patients. All participants received verbal and written information before the study started. Returning a completed questionnaire indicated a participant's tacit consent. Approval was obtained from the heads of departments and persons in charge of nursing and nursing assistant programmes. The study had a descriptive, comparative design, and an Affect Adjective Checklist (AAC) and specially designed Nursing Behaviour Questionnaire (NBQ) were used. The participants included nurses and assistant nurses from an infectious disease clinic, and students enrolled in a university nursing programme and upper secondary assistant nurses' training, all in central Sweden. The findings showed that both professional nursing staff (response rate 67%, n = 57), and students (response rate 62%, n = 165), expressed emotions of homophobic anger, homophobic guilt and delight. Groups with a cultural background other than Swedish expressed more homophobia. No gender differences were indicated for homophobic emotions. In the professional group, 36% would refrain from nursing for homosexual patients if given the option. The corresponding figure for the students was 9%. The limitations were that the sample was small and not randomly selected, and as participation was anonymous no follow-up could be done. It was concluded that the emotional factors of homosexual anger and homosexual guilt might be of value in helping to explain and predict attitudes towards homosexuals.

Adult↗

PubMed1996

Euthanasia on trial: examining public attitudes toward non-physician-assisted death.

This study investigated the influence of various contextual effects on the decisions of subjects evaluating a case of nonphysician-assisted suicide. Subjects viewed a videotaped deposition of an individual emotionally or nonemotionally describing how he assisted in the death of his terminally ill wife by disconnecting her respirator or shooting her in the head. The deposition was followed by jury instructions that outlined the duties of the subject and, in some cases, was followed by a nullification instruction that informed the subjects of their right to ignore the law in this case if they felt it would culminate in an unfair verdict. After viewing the videotape, subjects were asked to rate the guilt of the individual as well as their confidence in this rating. Results indicate that the means of death and the type of instruction significantly affect guilt ratings. The implications of these findings are discussed.

Adult↗

PubMed1979

The effects of sibling death on the surviving child: a family perspective.

The death of a child invariably affects the family, who in effect become survivors. Adaptations are made in order to secure a new family equilibrium attendant upon such a loss. Surviving siblings not infrequently become the focus of maneuvers unconsciously designed to alleviate guilt and control fate through silence and efforts to maintain silence, through substitution for the lost child, and through endowing the survivor-child with qualities of the deceased. Three types of clinically identifiable types of survivor-children are described. Families that emphasize silence and focus on guilt, families in which the child becomes incomparably precious, and families in which substitution and replacement provide the major theme lead respectively to the "haunted," "bound," and "resurrected" child. These children share many features, as do their families, but there appears to be a connection between the family defensive maneuver and the specific consequences for a child of the bereaved family.

Adaptation, Psychological↗

PubMed2001

Attributions and emotional reactions to the identity disclosure ("coming out") of a homosexual child.

This study examined factors that contribute to parental rejection of gay and lesbian youth. College students (N = 356) were asked to imagine being the parent of an adolescent son who recently disclosed that he was gay. Consistent with study hypotheses and based on attribution and moral affect theory, results of regression analyses indicated that greater perceptions of control over homosexuality, higher proneness to experience shame, and lower proneness to experience guilt were associated with increasing negative reactions toward an imagined homosexual child. Also in line with study hypotheses, greater willingness to offer help to the hypothetical child was predicted by lower perceptions of control over homosexuality, less intensely unfavorable emotional reactions, less proneness to experience guilt, and greater reported likelihood of experiencing affection toward him. Theoretical and clinical implications of this research are discussed.

Adolescent↗

PubMed1988

A multivariate predictor analysis of course and outcome in delusional psychosis.

The purpose of the study was to examine whether certain social variables of first-admitted patients with delusional psychosis were of predictive value of course and outcome as illuminated through the dimensions: psychiatric symptoms, impairment, remission, and relapse at 2-year follow-up. Furthermore, the aim was to perform a multivariate analysis of the most informative clinical and social predictors of course and outcome. Several predictors were significantly associated with at least one of the dimensions of poor outcome. In the multivariate logistic analysis an independent significant effect was assigned to male sex, no work, no evasiveness of delusions, perceptual disorder, preoccupation with delusions, dread, and few social contacts. The most informative clinical and social predictors yielded a maximal information of 27% to 47% for the different dimensions of course and outcome. One fifth of the patients had good outcome. This was significantly predicted by the following variables: married, living with others, frequent social contacts, high social group, full time work, clouding, delusions of guilt, and attempt at concealment of delusions and hallucinations, yielding a maximal information of 41%. Frequent social contacts and delusions of guilt had an independent statistical effect on good outcome. It is concluded that good prognosis is exceptional in patients with delusional psychosis and not combined to a single nosological unit. The findings stress the need for a specific investigation of the prognostic importance of social intervention and community care in patients with delusional psychosis.

Adolescent↗

PubMed1998

Suicidality and aggressive behaviour.

Psychiatrists have always maintained that there is a relationship between aggressive behaviour and suicide in depressed patients. However, this relationship is based on inconsistent and undocumented hypotheses, not on reliable clinical experimental data. The present study was designed to investigate the relationship between aggressive behaviour assessed by means of the Buss and Durkee Hostility Inventory (BDHI), and suicide in a sample of 134 depressed out-patients. The group with a higher level of suicidal behaviour was of younger age. The association between depressive subtypes (major depression, recurrent; major depression, single episode; bipolar disorder, depressive episode; dysthymia) and suicidality was found to be statistically significant. In contrast, there was no correlation between depressive subtypes and aggressive behaviour. The relationship between suicide and guilt as measured by the BDHI suggests that, in depression, suicidal behaviour becomes part of a symptom pattern in which aggression does not appear to be the main component. The suicide dimension arises when the cognitive sphere is involved. In fact, in depression, suicide is included among the cognitive disturbances, together with guilt, paranoid and obsessive-compulsive symptoms, depersonalization/derealization and agitation.

Adolescent↗

PubMed2007

Culpability and blame after pregnancy loss.

The problem of feeling guilty about a pregnancy loss is suggested to be primarily a moral matter and not a medical or psychological one. Two standard approaches to women who blame themselves for a loss are first introduced, characterised as either psychologistic or deterministic. Both these approaches are shown to underdetermine the autonomy of the mother by depending on the notion that the mother is not culpable for the loss if she "could not have acted otherwise". The inability to act otherwise is explained as not being as strong a determinant of culpability as it may seem at first. Instead, people's culpability for a bad turn of events implies strongly that they have acted for the wrong reasons, which is probably not true in the case of women who have experienced a loss of pregnancy. The practical conclusion of this paper is that women who feel a sense of guilt in the wake of their loss have a good reason to reject both the psychologistic and the deterministic approaches to their guilt-that they are justified in feeling upset about what has gone wrong, even responsible for the life of the child, but are not culpable for the unfortunate turn of events.

Abortion, Spontaneous↗

PubMed2000

Emotion, regulation, and moral development.

Research and theory on the role of emotion and regulation in morality have received considerable attention in the last decade. Much relevant work has concerned the role of moral emotions in moral behavior. Research on differences between embarrassment, guilt, and shame and their relations to moral behavior is reviewed, as is research on the association of these emotions with negative emotionality and regulation. Recent issues concerning the role of such empathy-related responses as sympathy and personal distress to prosocial and antisocial behavior are discussed, as is the relation of empathy-related responding to situational and dispositional emotionality and regulation. The development and socialization of guilt, shame, and empathy also are discussed briefly. In addition, the role of nonmoral emotions (e.g. anger and sadness), including moods and dispositional differences in negative emotionality and its regulation, in morally relevant behavior, is reviewed.

Emotions↗

PubMed2005

Association between hostility and plasma total homocysteine concentrations in a general population sample.

OBJECTIVE: The present study focuses on testing the association of hostility with plasma homocysteine levels in a general population sample. METHOD: Four hundred and ten healthy adults (200 men and 210 women), participating in a health survey in Greece, had blood samples taken for homocysteine concentrations and also completed a multidimensional hostility questionnaire, assessing direction of hostility ('extra- and intropunitive') as well as total hostility and its ingredients, i.e. urge to act out hostility, criticism of others, delusional hostility, self-criticism and delusional guilt. Multivariate relationship was tested between hostility components and homocysteine, after statistically controlling for potential confounders such as age, gender, educational status, smoking and body mass index. RESULTS: Total hostility, delusional guilt as well as extrapunitive direction of hostility were positively related to homocysteine levels. Self-criticism was negatively related to homocysteine. CONCLUSION: The study provides further evidence that particular dimensions of hostility are associated with increased plasma homocysteine levels, thus deserving a place within the spectrum of the coronary heart disease risk factors.

Adult↗

PubMed1988

Suicide attempts correlate with delusional content in major depression.

A retrospective analysis of all medically serious suicide attempts made by 45 patients hospitalized consecutively at the Payne Whitney Clinic with the Diagnostic and Statistical Manual III discharge diagnosis of unipolar major depression recurrent with psychotic features was undertaken. Patients with delusions of persecution in combination with delusions of guilt were significantly more likely to make medically serious suicide attempts than patients with single categories of delusions or combinations other than guilt and persecution.

Adult↗

PubMed1991

Depressive delusion.

In this study of 160 consecutively admitted inpatients who met ICD-9 criteria of endogenous depression, mood-congruent depressive delusions were ascertained in 14.4% (n = 23). The total HRSD score was significantly higher in the delusional than in the nondelusional group. Delusions of guilt were recorded by far the most frequently. There was a correlation between delusions of guilt in the current depressive episode and suicide attempts in the past. In the delusional patients the individual courses of the illness were characterized by marked symptomatological differences from one depressive episode to another. In all but one of the patients, depressive delusions coincided with a thematically identical experience of anxiety. How often anxiety occurs in delusional form depends substantially on the respective theme of anxiety. In accordance with earlier psychopathological literature the findings confirm that depressive delusion is closely linked to the experience of anxiety.

Adult↗

PubMed1999

A psychoanalysis of love: the patient with deadly longing.

Freud made some seriously mistaken assumptions about mature love based on his notion about the role unconscious guilt plays in human affairs. Clinical data are presented here about a young man, who implicated in the suicides of two of his colleagues, was more concerned with the failure of his love affair in college than with guilt for his involvement in the suicides. By tracing the functions of shame--a concept the author contends that Freud failed to understand properly--in the patient's relationship with his parents, the author formulates a proactive and optimistic theory of mature love to replace Freud's pessimistic and reductionistic explanation.

Adult↗

PubMed2001

Schizoid anxiety: a reappraisal of the manic defense and the depressive position.

The author views the manic defense as a combined attempt to control persecutory objects and to save them from the aggressive forces within the ego. Rather than strictly a manifestation of depressive guilt, it is also a defense against the fear of destroying the object and subsequently the self. Therefore, Melanie Klein's depressive position is a hierarchical outgrowth of more primitive schizoid anxieties about killing off the ideal part object. This is contrasted with the depressive guilt of harming the whole and reliable object. The depressive position is a psychic state of worry about loss of the object's love resulting from temporary harm done to the object that can be fixed. The paranoid-schizoid position is a much more hopeless internal situation involving a complete loss of the object and, by extension, the self. A case study is used for illustration.

Adult↗

PubMed1984

An example of self-analysis.

The literature on self-analysis indicates that it is a desirable process to cultivate postanalytically for continued self-growth, analyzing countertransference problems, and dealing with symptoms or problems of living that might arise after formal analysis is completed. A number of techniques are described, the choice of which is probably dependent on the personality of the individual who wishes to pursue self-analysis. I describe an episode of self-analysis occurring near the end of the analysis of a woman who aroused in me an unusual degree of positive feeling, at least part of which can be considered countertransference. After she had aroused negative feelings in me, she was able to deal in an affectful way with strongly repressed impulses, actually acted out in early childhood, to steal from her mother. This stimulated dreams in me that allowed me to work out guilt for hostility to my mother. A dream representing stealing her purse altered long-standing compulsive thoughts I had known meant guilt to my mother. The self-analysis was not undertaken to deal with a countertransference problem, but arose out of it to deal with a symptom, or old conflict, 25 years after the completion of formal analysis.

Adult↗

PubMed1990

Helping patients by analyzing self-criticism.

This paper is addressed to patients' need for help with punitive self-critical attitudes. Such help has not always been sufficiently provided by psychoanalysts, owing to an unrecognized failure of neutrality. Historically, a gradual overemphasis on the concept of an unconscious sense of guilt has acted as a barrier to the appreciation of shame. An alternative concept, punitive unconscious self-criticism, which stands in contrast to constructive self-criticism and is common to the painful affects of guilt, shame, humiliation, and depression, can facilitate helpful analytic treatment. Heinz Kohut's contributions are examined. His analytic stance is differentiated from his theories of development. In the former, characterized by an affirmative attitude, he takes a position of functional neutrality toward shame and pays consistent though unstated attention to the effects of punitive unconscious self-criticism. The affirmative attitude can be employed without adoption of Kohut's self psychology, i.e., without abandoning the basic psychoanalytic approach to mental conflict and development. The concept of punitive unconscious self-criticism and the concept of divergent conflict, provide sufficient explanatory power. Clinical examples are used to illustrate these ideas.

Adolescent↗

PubMedDate not supplied

Intimacy and women with type 2 diabetes: an exploratory study using focus group interviews.

PURPOSE: This study explored if and how women perceived diabetes as affecting their social and sexual intimacy and if they wished to receive professional attention for any sexual disturbances that they experience. METHODS: A series of five focus group interviews were conducted with 33 women with type 2 diabetes, ages 44 to 80 years, who also completed a questionnaire on sexual functioning: Two thirds were married and one third were sexually active. RESULTS: Categories resulting from the qualitative analysis were guilt and embarrassment in diabetes; female intimacy and shame; sexual dysfunction, an invisible problem; and the female patient. Asking women about intimacy revealed self-blame and embarrassment regarding their diabetes and sexual functioning. Several women who had experienced sexual dysfunction described barriers that made it difficult to obtain optimal care and/or self-care measures to cope with vaginal dryness, pain during intercourse, and decreased desire. Many of the women had the social and emotional resources to cope with their disease. Nonetheless, they experienced guilt, shame, and embarrassment, which are potentially oppressive features of having type 2 diabetes. CONCLUSIONS: Asking women with type 2 diabetes about intimacy in a contextually adequate way at routine follow-up visits could give them a chance to discuss both sexual and social intimacy concerns related to their diabetes.

Adaptation, Psychological↗

PubMed2006

Group morality and intergroup relations: cross-cultural and experimental evidence.

An observational, cross-cultural study and an experimental study assessed behaviors indicative of a moral code that condones, and even values, hostility toward outgroups. The cross-cultural study, which used data from the Standard Cross-Cultural Sample (Murdock & White, 1969), found that for preindustrial societies, as loyalty to the ingroup increased the tendency to value outgroup violence more than ingroup violence increased, as did the tendencies to engage in more external than internal warfare, and enjoy war. The experimental study found that relative to guilt-prone group members who were instructed to remain objective, guilt-prone group members who were instructed to be empathic with their ingroup were more competitive in an intergroup interaction. The findings from these studies suggest that group morality is associated with intergroup conflict.

Adult↗

PubMed1975

A factor-analytical study of depression across cultures (African and European).

In a factor-analytical study of depression across two cultures, African and European, certain similarities and important differences were found. Depression in African cultures presented principally as depressed mood, somatic symptoms and motor retardation. In European cultures depression presented with depressed mood, guilt, suicidal ideas, motor retardation or anxiety. Both groups lost interest in work and the environment. Guilt and suicidal ideas and acts are uncommon in African sample, and appear to be culturally determined.

Anxiety↗