Adjustment Disorders

A case of the Capras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.

Against the current climate of hospital closure programmes and community care, attitudes to caregiving were examined in three groups of carers, namely mothers caring for a mentally handicapped child, mothers caring for a mentally handicapped adult and daughters caring for a parent with dementia. An 'attitude questionnaire' was developed by the author and administered, postally, to the three groups. Daughters were found to be more likely than the mothers to see their caring role in a negative way and were more inclined to favour institutional care.

Out of a consideration of the relevance of interpersonal physical contact to mental health is developed the hypothesis that unsatisfactory physical contact experience predisposes to depression. This hypothesis is then systematically explored using self-ratings of depression and physical contact (and love) experience obtained on admission and at discharge from 254 unselected psychiatric in-patients.

The loss of one's partner is always a stressful event. If this loss cannot be adequately coped with, depression, psychosomatic disorders or addictive disorders may result. In the worst case scenario, the victim of such a loss may resort to suicide or even kill the partner insisting on a separation. An active life, new personal contacts, or the support of a self-help group may help suffers to cope with the crisis more readily. Severe disorders--in part determined by the personality structure of the grieving partner--may require treatment by pharmaceuticals or cognitive therapy.

Suffering is commonly seen as an unconscious effort to alleviate painful feelings of guilt. However, suffering also aims at averting loss of ego functions and hence loss of mental stability. This second function of suffering is discussed in the light of Freud's observations of characters wrecked by success and Weiss's ideas about mutual love as a threat to mental stability.

The usefulness of coping as an explanatory variable in parental adjustment to the death of a child is suggested in a study of 194 parents who responded to a survey shortly after their bereavement and again a year later. The most adaptive coping strategies were active and externally directed, including replacement of the child and altruism; least adaptive were escape and preoccupation with the child. Effects of participation in a self-help group are examined and discussed.

The relationship between hypnotizability and clinical improvement following brief psychotherapy was investigated. Prior to treatment 32 patients were assessed for hypnotizability utilizing an objective standardized measure of hypnotizability. Measures of psychopathology were obtained at the conclusion of ten sessions and six months post-treatment. A positive relationship was found between outcome and hypnotizability. This was most pronounced at the conclusion of ten sessions. Use of hypnotic techniques as a therapeutic adjunct did not necessarily lead to greater therapeutic effects.