John D. Rainer

X-linkage in bipolar affective illness ☆: Perspectives on genetic heterogeneity, pedigree analysis and the X-chromosome map

The search for genetic markers is a powerful strategy in psychiatric genetics. The present article examines four areas relevant to discrepancies among X-linkage studies in bipolar affective disorder. These are questions of ascertainment, analytic methods, the X-chromosome map and genetic heterogeneity. The following conclusions are reached: (a) Positive linkage findings cannot be attributed to ascertainment bias or association between affective illness and colorblindness. (b) The possibility that falsely positive linkage results were obtained by using inappropriate analytic methods is ruled out. (c) Reported linkages of bipolar illness to colorblind and G6PD loci are compatible with known map distances between X-chromosome loci. Linkage to the Xg antigen remains uncertain. (d) The discrepancy among the various data sets on affective illness and colorblindness is best explained by significant linkage heterogeneity among pedigrees informative for the two traits.

Reflections on the application of group methods to the use of dreams in stress reduction

Dr. Sarlin has written a fascinating report on the application of group dream work to the problems of medical students. Although the method was designed specifically for relief of stress, the author states also that, in the presence of a supportive group atmosphere, unconscious beliefs and conflicts can be uncovered, explored, and in some cases alleviated and resolved. Certainly the description of the stresses of medical school is an accurate one: information overload leading to anxiety, depression, or both; hypochondriasis in the clinical years; fearful, unconscious transference feelings developing with the onset of hands-on examination and patient care; development of professional identity and oedipal battles with teachers and attendings; separation from dependency and assumption of responsibility with fears of both success and failure. Coupled with these unique stresses, and aggravated by them, are the age-specific conflicts and anxieties over family relationships, sexual involvements, financial concerns what the author terms the near universal feelings and conflicts inherent in our society. As a psychoanalyst, I have developed ways of using dreams in treatment; as a biologist and evolutionist, I have speculated on the meaning and function of dreams on various levels of biological organization. I believe that considerations relating to both the therapeutic use of dreams and the biological function of dreaming are pertinent to understanding and evaluating the goals and achievements of Sarlins work with medical student groups. In his paper, Sarlin describes in detail the method of the dream workshops. As I went through the material on two students in the group, I was led to consider the specific contributions of the group method to the therapeutic use of dreams. First, in individual treatment, the therapist knows more about the patient than the group knows about the dreamer and so can associate to the place the dream has in the patients psychic economy; in the dream group, the length of the discussion allows for detailed examination of the dream determinants and may be equivalent to many weeks or months of individual work. Second, dreams in individual therapy typically include transference feelings toward the therapist; in the group, there is certainly a transference