Michael von Rad

GRIEF AND DEPRESSION AFTER MISCARRIAGE : THEIR SEPARATION, ANTECEDENTS, AND COURSE

Bereavement is a major risk factor for physical illness, grief, depression, and anxiety.In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later.Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale [Munich Grief Scale] that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.

Alexithymia and symptom formation.

In regard to its clinical descriptive aspects the concept of alexithymia is based on a broad consensus of the investigators. However, with respect to its etiopathogenesis (hereditary, neurophysiologic

Affective Content of Speech as a Predictor of Psychotherapy Outcome

Affective content of speech has been used as an aid in the psychological evaluation of patients undergoing psychopharmacological or psychotherapeutic treatment [4, 12]. One assessment procedure, the Gottschalk-Gleser method [5], has proved valuable in studying both transient changes in mood and enduring psychological characteristics. This eclectic method relies on the grammatical clause as a coding unit and can be applied by technicians working on written materials for scoring up to 16 psychological “dimensions.” Most of the scales developed so far (particularly those measuring anxiety and hostility) have been externally validated and show some degree of stability over time and across situations [8].

Some Remarks about the College and Its Future

Some Remarks about the College and Its Future We are now 13 years old. Proverbally, we have reached our manhood and womanhood. But more likely we have only been thrown into the maelstrom of adolescence. This is our 7th congress and it seems we are in an appropriate identity crisis – who we are, where do we wish to go? We have lost our founding father. We have a membership of 400. We have wandered from Kyoto to Jerusalem. Our attendance has been as high as 1,300 and as low as the current conference. It gives us an opportunity to ask if smaller more focussed congresses are better? Will they get us beyond the platitudes and reiterations of the past toward more mature formulations of integration and synthesis? Perhaps we are establishing an identity. However, there are whole continents in which our presence and our effect is either limited or nonexistent. There is a second and a third world that we have failed to align. We have prestigious vice presidents and councillors, as well as a body of delegates whose use the Administration has tapped limitedly. We are a body without a head in the sense that we have failed in our efforts to establish a journal. The quality of our meetings has been increasingly good, as I am confident this congress will demonstrate. However, the work in their formation has been that of a few. We need to inquire of ourselves of the forwardness of our theories and of the originality of our research. How often do we confuse statistical correlations ofendless variables as proof and substantiation, independent of critical reasoning? Future administrations will need to develop communicative and directive skills in order to tap its officers, as well as its younger members at large to do the job that they have been expected to do. I believe that under the auspices of the Program Committee, with frequent communication, the officers and commitee chairpersons should be responsible for the organization of symposia in the area they share, drawing on their knowledge of the new and seminal work that is under investigation, often outside of our purview. The delegation and tendering of this responsibility will insure the quality ouf our presentations and discussions, allowing our congresses to be more scientific, more communicative, and more conceptual. Several of us believe that our congresses should return to the campus where there is a natural environment for the membership to interact and participate as scholars in a setting conducive for the intimacy of scholarship outside of, as well as within, our more formal sessions. Would this not be a more facile environment in which to bring in our students and associates from other disciplines? Within these settings, there Some Remarks about the College and Its Future 11

Opening Remarks to the 7th World Congress of the International College of Psychosomatic Medicine

Opening Remarks to the 7th World Congress of the International College of Psychosomatic Medicine Standing here, opening our 7th World Congress I am at the same time breaking a very solemn promise – practically an oath -given or sworn 24 years ago. Then – in the spring of 1959 – having been at the Hamburg Clinic for only a year, I watched Jores and Freyberger hosting and organizing the European Congress of Psychosomatic Medicine. What I perceived from my lowly position were hurt vanities of speakers or chairpersons for not having been attributed an adequate position, fights for more speaking time, and delays in the delivery of manuscripts. In my eyes – and this made the whole process simply agonizing – all these troubles seemed fully uncompensated by clear success experiences. As a consequence I gave myself the solemn promise to do anything and everything humanly possible to evade ever hosting an international congress. Having broken my oath with qualms and apprehensions, I can tell you now that the latter were completely unfounded. However, this may be a stroke of luck due to two external but mutually interacting factors. One is the cooperative dedication and zeal of the whole staff of our Psychosomatic Department. It is a very small team, but we managed with only two outside cooperations: Bernd Dahme from the Department of Medical Psychology, and – and this is the second factorthe expert help of the professionals of the Congress Center Hamburg. I am thanking them all for their work and for their dedication. Their cooperation achieved that computer outprints of plenary and symposium speakers were correct, the layout of programs attained expectations, the budget was updated regularly, and the timetable was kept throughout. Thus we have already had our success experiences and our narcissistic support, and therefore we can invite you to feel free of moral obligations and just give vent to your feelings. However, if we are quite honest, we would prefer you to enjoy the V∏th ICPM World Congress and we believe there is an objective albeit predictive reason for this. You certainly never have heard of the Meyer/Freyberger PPWC theorem, because we have only discovered it – independently but convergently – ad hoc of this world congress. PPWC stands for Progressive Pauperization of World Congresses. Its mechanism is an exceedingly simple and easy to understand economic process, one could call it the leverage depression acceleration for certain taxo-nomic subgroups of society (here scientists Opening Remarks 9