Roger F. Spencer

Adaptation in Hemophiliac Adolescents

U Mattsson and Gross have discussed the “coping mechanisms” which are used in successful adjustment to hemophilia in boys and young men2. In their study of 35 hemophiliac boys and young adults, 27 were considered to have adapted well at school, in the home, and with their peers, with few limitations except for those realistically imposed by the disease. In those instances of failure, difficulties seem to fall into the category of behavioral disturbance with either excessive risk-taking behavior or inappropriate passivity. However, an investigation of the social and psychological adjustment of 26 hemophiliacs at this center3 revealed a high incidence (46%) of gross sexual and marital maladjustment, in spite of a low frequency (23%) of frank psychiatric problems. The ten adolescent patients in this group were studied more closely to identify precursors of the sexual and marital maladaptations, and a variety of problems were found which make us consider the adaptation of virtually all these adolescents to be sub-optimal. Although the overall educational achievement was impressively high in the younger group, several instances were found of inhibition of school performance going beyond the interference of bleeding episodes. In some cases adjustment at school, in the family, and with peers was superficially good, but closer examination revealed areas of considerable conflict and impairment. These difficulties can be loosely categorized into the following areas: 1. Problems in vocational and scholastic achievement, involving the child’s refusal or reluctance to attend school, learning difficulties, or a seeming lack of goals and ambitions.

Psychiatric impairment versus adjustment in hemophilia: review and five case studies.

The literature on psychiatric impairment and adjustment in hemophiliacs is reviewed with particular regard to types of psychiatric disorder and social maladjustment which have been found in adolescents and adults. A set of hypotheses is developed from the literature regarding factors which may interact with hemophilia to produce psychiatric impairment. The hypothetical factors relate to the age of onset and frequency of bleeding episodes; degree of gratification and restriction consequent to them; rejection by the father; and death of a sibling. Five cases are presented which are representative of the spectrum of psychiatric impairment in hemophilia. Some of the hypothesized factors are found to be significantly operative in the individual cases, and others are not.

Ambiguity of Gender Identity Fantasies and Aspects of Normality and Pathology in Hypopituitary Dwarfism and Turner's Syndrome: Three Cases

Three cases of short stature females are presented, two with, gonadal dysgenesis and one with hypopituitarism, all about the same age, social class, and intelligence. One of the subjects with gonadal dysgenesis was normally functional; the other depressed, but she became functional after psychotherapy. The patient with hypopituitarism was poorly adapted and failed to change on brief effort at psychotherapy, discontinuing treatment. Evidence is drawn from transference and observational material that disturbances in the mother‐child relationship may lead to persistence of unreasonable wishes to grow physically. This leads to a split in the ego which prevents adaptation to small stature because it is not acceptable to the patient. In the case which was successfully treated, it is shown that the acceptance of the defective self led to restoration of ego functions adaptive to small stature.

Changing characteristics of psychiatric consultation in a university hospital. A study of outcome.

Fifty-seven patients were referred for psychiatric consultation during a two-month period. One year later adequate follow-up data were obtained on 46 persons. The study evaluated the outcome of the original psychiatric disturbance in these patients, the accuracy of prediction by the psychiatric consultants and the factors influencing outcome. The recommendations most frequently followed are noted and the implications of the study for the future psychiatric care of general medical patients are discussed.

Some problems in the evaluation of women for therapeutic abortion.

Large numbers of patients with unwanted pregnancies are now being seen in areas where the abortion laws have been liberalized. A few frequently occurring psychologic mechanisms noted in these patients are described, and their significance for the consultant is noted.