Kay Jamison

Psychosocial Aspects of Mastectomy: II. The Man's Perspective

In order to assess factors related to mens adjustment to mastectomy and its aftermath the authors administered a questionnaire to 31 men whose wives or partners had had mastectomies. Most men reported a good overall adjustment, but a subgroup remained distressed and reported adverse effects on their relationships with wives or lovers. The data indicate that the nodal points in the process are the involvement of partners in the decision-making process, the frequency of hospital visits, resumption of the sexual relationship, and the man looking at his partners body after surgery. These findings have implications for counseling couples who face this emotionally stressful procedure.

Suicide and bipolar disorders

Suicide represents the ultimate, final and most terrible consequence of manicdepressive illness. Those having the disease are at exceptionally high risk for committing suicide, constituting by far (with unipolar depressed patients) the single highest risk group for suicide. It is difficult to overemphasize that, in manic-depressive illness, suicide is a particularly real and dangerous possibility. Despite this, little is written about the unique pharmacological and psychological issues raised by this diagnostic group. The lack of research in this area is particularly surprising given the welldocumented and extensive overlap between suicide, suicide attempts, and affective disorders. The basic premises of this paper are several. First, suicide in untreated, inadequately treated, or treatment-resistant bipolar patients is not an uncommon outcome. Second, suicide in bipolar patients is usually, but by no means always, avoidable. Finally, although relatively little scientific literature deals specifically with this problem, there is enough known from the combination of recent biological studies, a formidable psychopharmacology literature, and an extensive clinical knowledge of manic-depressive illness to justify making specific suggestions for clinical management of suicidal bipolar patients.

A Comprehensive Program of Psychosocial Care for Mastectomy Patients

The traumatic experience of the discovery of a lump in the breast, the diagnosis of cancer and eventual mastectomy have focused medical attention on the importance of providing adequate psychosocial care for mastectomy patients. This paper outlines a comprehensive program now underway. The program includes the premastectomy (preventive), postoperative (interventive) and recovery (postventive) periods. To secure more information for this program, an initial project examining the psychological effects of mastectomy on women and their spouses has been undertaken. It is anticipated that these findings will be helpful in identifying some of the problems encountered and aid in the success of the program in attaining the desired results.

Integration Of Two Personality Factor Systems

Six major personality factors in inventory items have been developed through previous investigations in this series. These factors have been defined by analyzing total scores over groups of homogeneous items. An inventory containing items t o measure these factors, the Comrey inventory, and the Guilford Zimmerman Temperament Survey, or GZTS, were administered to 262 volunteers. The GZTS was divided up into groups of relatively homogeneous items. Total scores over 80 item groups from the two inventories were intercorrelated and factor analyzed. Of the 10 major factors obtained, three were represented only by item groups from the GZTS, namely, General Activity, Thoughtfulness, and Masculinity. Empathy and Compulsion were defined al- most exclusively by item groups from the Comrey inventory. The remaining major factors, Shyness, Dependence, Neuroticism, Hostility, and Socialization, were defined by item groups from both inventories.

Verification of Six Personality Factors

ous items, rather than to analyze single items (Comrey, 1961, 1962, 1964, 1965, 1966; Comrey and Schlesinger, 1962). Items have been developed to fit a certain homogeneous item pool, but have been required to exhibit a statistical as well as a logical belonging before being actually assigned to that item group. On the basis of these previous findings, six major personality factors were selected for further study. Six factored homogeneous item dimensions (FHIDs) were chosen to represent each hypothesized factor. Each FHID, in turn, consisted of six items intended to be relatively homogeneous in content. Most of the FHIDs selected for a given factor had been good marker variables for that factor in previous analyses; some were newly developed for this study. The major purpose of the present investigation was to determine whether the postulated six-factor personality structure would

Drug Usage, Personality, Attitudinal, and Behavioral Correlates of Driving Behavior

Summary Subjects (N = 164) were divided into four groups on the basis of their driving records: no accidents or moving violations, two or more violations, one or more accidents, and no accidents. They were compared on various personality, attitudinal, drug usage, and biographical variables. The less safe drivers scored significantly higher on a sensation-seeking scale; were more likely to have experimented with such drugs as marijuana, hashish, amphetamines, LSD, etc.; attended religious services less often; and were less likely to own their residences. There were also differences in political attitudes and life-style preferences among the groups.

Further study of dependence as a personality factor.

A 216-item inventory was administered to 252 Ss in an attempt further to clarify the personality factor of Dependence. 42 groups of homogeneous items were used to measure previously identified factors of Shyness, Empathy, Neuroticism, Compulsion, and Hostility, in addition to Dependence. Total scores were obtained for each item group and the matrix of intercorrelations was factor analyzed. 7 major factors were obtained. Dependence emerged as 2 factors, named Socialization and Dependence; each was well-defined by 5 item groups with loadings greater than .48. The other 5 personality factors under investigation appeared as predicted.

Atypical Cycloid Psychoses

Atypical cycloid psychoses are fascinating to clinical scientists for a number of reasons: They reflect the extremes in human moods, they tend to recur, and they almost always remit. As we shall see in discussing the nature and treatment of these atypical psychotic mood disorders, recent advances in psychobiological research make difficult the notion of “typical” or “atypical.” Are syndromes atypical because their clinical presentations are unusual, because their response to treatment varies significantly from the normal, or because their patterns of recurrence are either abnormally predictable or singularly unpredictable? In any event, most of the phenomena classified by earlier clinicians as atypical cycloid psychoses now would be regarded as variants of bipolar manic-depressive illness. Thus, rapid progression in the study of affective disorders has profoundly altered earlier conceptions of the extreme mood disorders. Important among these advances, and particularly relevant here, are (1) increasingly sophisticated diagnostic systems (Akiskal and Webb, eds., 1978; Spitzer et al., m1978); (2) natural history studies that overwhelmingly support the recurrent nature of the affective disorders (Angst and Grof, 1976; Zis and Goodwin, 1979); (3) the use of lithium for diagnostic and taxonomic purposes, and as a therapeutic agent (Dunner and Fieve, 1978); and (4) studies of the relationship between biological rhythms and affective illness (Wehr and Goodwin, 1978).

ASSESSMENT OF A PROPOSED EXPANSION OF THE COMREY PERSONALITY FACTOR SYSTEM

Six major factors of personality have been identified repeatedly in factor analytic studies by Comrey and his coworkers: Shyness, Dependence, Em- paths, Neuroticism, Compulsion, and Hostility. Analysis of the Guilford-Zimmerman test suggested that this system of six factors could be enlarged to include three additional factors : General Activity, Thoughtfulness, and Mas- culinity. An inventory designed to measure all these factors was administered to 259 volunteers, mostly from the general population. Analysis of the results by factor analytic methods showed that General Activity was well enough defined and confirmed to warrant adding it to the Comrey factor system. The other two additional factors failed to achieve this level of confirmation.