Journal of Analytical PsychologyVolume 60, Issue 3 p. 413-418 Article A response to Robert Withers Susan McKenzie, Susan McKenzie Vermont, USASearch for more papers by this author Susan McKenzie, Susan McKenzie Vermont, USASearch for more papers by this author First published: 19 May 2015 https://doi.org/10.1111/1468-5922.12158Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References Bornstein, K. (1994). Gender Outlaw. New York: Vintage. Bromberg, P. (1998). Standing in the Spaces. Hillsdale, NJ: The Analytic Press. Brooten, B. (1996). Love between Women: Early Christian Responses to Female Homoeroticism. Chicago: The University of Chicago Press. Douglas, M. (1966). Purity and Danger: An Analysis of Concepts of Pollution and Taboo. New York: Praeger. Foucault, M. (1978). The History of Sexuality. New York: Vintage. Friedman, R. & Downey, J. (2002). Sexual Orientation and Psychoanalysis, Sexual Science and Clinical Practice. New York: Columbia University Press. Gozlan, O. (2015). Transsexuality and the Art of Transitioning. New York: Routledge. Harris, A. (2005). Gender as Soft Assembly. Hillsdale & London: The Analytic Press. Jung, C.G. (1959). The Archetypes and the Collective Unconscious. CW 9i. Jung, C.G. (1963). Mysterium Coniunctionis. CW14. McKenzie, S. (2006). ‘Queering gender: anima/animus and the paradigm of emergence’. Journal of Analytical Psychology, 51, 401– 21. Mckenzie, S. (2010). ‘Genders and sexualities in individuation: theoretical and clinical explorations’. Journal of Analytical Psychology, 55, 91– 111. Roscoe, W. (1998). Changing Ones: Third and Fourth Genders in Native North America. New York: St. Martin's Press. Sackville-West, V. (1991). Saint Joan of Arc. New York: Bantam Doubleday Dell. Schore, A. (1994). Affect Regulation and the Origin of the Self. Hillsdale, NJ: Lawrence Erlbaum. Williams, W.L. (1988). The Spirit and the Flesh: Sexual Diversity in American Indian Cultures. Boston: Beacon Press. Woolf, V. (1928). Orlando. San Diego: Harcourt Brace Jovanovich. Volume60, Issue3June 2015Pages 413-418 ReferencesRelatedInformation

Bolus manipulation is a primary treatment strategy in the management of oral-pharyngeal dysphagia. The use of thickening agents to alter bolus rheology is particularly commonplace; however, the precise effects of these alterations on swallowing remain uncertain. The purpose of our study, a prospective, double-blind clinical trial (Level 1b), was to investigate the effects of viscosity on aspiration. One hundred patients with dysphagia were prospectively evaluated with fluoroscopic swallow studies performed across three standardized and randomized conditions: thin liquid barium (THIN), liquid barium thickened with a starch-based agent (STARCH), and liquid barium thickened with a gum-based agent (GUM). Outcome measures included the prevalence of aspiration and score on the Penetration-Aspiration Scale. A total of 23 out of 100 patients exhibited 56 episodes of aspiration. Twenty patients aspirated on THIN, 15 on STARCH, and 11 on GUM bolus conditions (P<0.05, thin vs gum). There were 28 instances of aspiration on THIN, 16 on STARCH, and 12 on GUM. Mean Penetration-Aspiration Scale score ± standard deviation was 2.11 ± 2.22 for THIN, 1.76 ± 1.88 for STARCH, and 1.42 ± 1.47 for GUM conditions, respectively (P<0.001, THIN vs GUM). A clinically significant reduction in the incidence of penetration and aspiration was observed for gum-thickened barium compared with thin liquid barium.

Corbett's book, Boyhoods, Rethinking Masculinity, is a welcome addition to the growing body of psychoanalytic theory that examines gender from a post-modern viewpoint. He looks at boyhood development through the lenses of family, culture, body, and mind. In his deconstruction of traditional Freudian theory of masculine development, Corbett gives us new perspectives on masculinity that gesture toward the multiplicity inherent in gender's masculine realm. Corbett's beautifully articulated clinical stories engage readers in the experiences of boys who would be girls and then draw us back into contact with boys who would be boys. His work brings to our attention the powerful role culture plays in assumptions about normal gender and normal family and the ways in which this collective cultural unconscious limits the gender potential for those within the norm and harms those individuals and families living at the margins of the norm.

Gender assignment, as a key aspect of identity and cultural position, has existed throughout recorded time and across all cultures. An individual's biological sex and particular cultural milieu has a profound effect on their sense of themselves as a gendered being. Sexuality is a more recent marker in identity formation. In the last few decades there has emerged a great deal of interest in the psychology of gender formation, in the interplay of biological sex, culture, brain development, and attachment experiences in the formation of gender identities. Queer theory in its post-modern deconstructionist thinking has suggested that gender is a socially 'constructed' concept having no biological or psychological precursors or realities. Contemporary developmental psychoanalysis is bridging the gap between concepts of gender as purely biological and gender as non-existent. In this paper I explore the emergence of same-sex desire at mid-life, presenting two case histories with extensive dream material. The impact of sexual desire on gender identities is examined through the lenses of culture, dynamic systems theory, neuroscience, and depth psychology. The use of dream analysis as a window into the body/mind movement of gender emergence reflects my sense of gender as a fluidly shifting reality of mind, neither hardwired nor fictional.

Journal of Analytical PsychologyVolume 54, Issue 3 p. 425-427 Book reviews Gender as Soft Assembly by Harris, Adrienne Susan McKenzie, Susan McKenzie New England Society of Jungian AnalystsSearch for more papers by this author Susan McKenzie, Susan McKenzie New England Society of Jungian AnalystsSearch for more papers by this author First published: 01 June 2009 https://doi.org/10.1111/j.1468-5922.2009.01791_5.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume54, Issue3June 2009Pages 425-427 RelatedInformation

Background We have noticed a protrusion on the pharyngeal wall in patients with Zenker's diverticulum (ZD). The protrusion gives the appearance of a neo‐pharyngoesophageal segment (faux‐PES) and may represent an adaptation to protect the airway. Study Design A case‐control study. Methodology The fluoroscopic swallow studies of patients with ZD were compared with matched controls. Information regarding the presence and location of a faux‐PES, true PES opening, pharyngeal constriction, and laryngohyoid elevation was compared. Results The fluoroscopic swallow studies of 31 patients with ZD were compared with 31 controls. A faux‐PES was found in 100 percent of ZD patients and in 0 percent of controls. The mean maximum opening of the faux‐PES was 1.5 (±0.27) cm. The faux‐PES was located 1 cm above the true PES below the entrance to the supraglottic airway. This is the optimal location for airway defense. Conclusions The faux‐PES was identified in 100 percent of patients with ZD. The faux‐PES may represent a physiologic adaptation to protect the airway from regurgitation out of a ZD.

Pharyngeal swallow delay is frequently found in dysphagic patients and is thought to be a factor in a range of swallowing problems, including aspiration. Implicit in notions of swallow “delay” is a temporal interval between two events that is longer than normal. However, there appears to be little agreement about which referent events should be considered in determining delay. A number of pharyngeal bolus transit points and various pharyngeal gestures have been used in delays determined from fluoroscopic evidence, and other referents have been used in electromyographic and manometric studies of swallow. In this study latencies between the first movement of the hyoid and several pharyngeal bolus transit points were calculated from fluoroscopic swallow studies in normal nondysphagic adults. Means and standard deviations of these latencies are provided for a 3-cc and a 20-cc bolus and for both nonelderly and elderly adults. The data may be a useful resource for relating the specific latencies investigated to concepts of pharyngeal swallow delay, in particular, when assessing videofluoroscopic studies using a similar protocol.

BACKGROUND:The World Health Organization (WHO) recommends a 3-tier grading system (Grades 1-3) for follicular lymphomas (FLs) based on the absolute number of centroblasts per high-power microscopic field (HPF) in 10 neoplastic follicles. Grades 1 and 2 FL are still managed as indolent FLs, whereas Grade 3 FL is thought to behave more aggressively. In this study, the feasibility of grading FL using ThinPrep (TP) slides and flow cytometry (FC) was evaluated.METHODS:Fifty-three cases of lymph node fine-needle aspiration (FNA) from patients with histologically confirmed FL (20 Grade 1, 17 Grade 2, and 16 Grade 3) were included. The number of centroblasts present in 300 lymphoid cells and in 10 HPF in TP Papanicolaou-stained slides was evaluated. The percentage of CD10-positive small cells was calculated with FC results. Statistical analysis was performed with the Jonckheer-Terpstra nonparametric trend test and the Wilcoxon rank sum test.RESULTS:The statistical analysis demonstrated a significant upward trend in the number of centroblasts as the grades increased. Also, all 3 methods had statistically significant results to distinguish different grades of FL, except when FC was used to distinguish Grade 2 from Grade 3 FL.CONCLUSIONS:Counting centroblasts, either in 300 lymphoid cells or per 10 HPF in TP slides, represented a statistically significant method to separate different grades of FL in FNA samples. Analysis of cell size by FC was not as reliable to distinguish different grades of FL, especially Grade 2 from 3.

Despite stem cell transplant and new therapies, nearly all patients with AL and MM die of disease or complications of treatment. Novel approaches that selectively kill clonal plasma cells are needed. CD32B, the inhibitory Fcγ receptor IIB, is a member of the Fc receptor (FcR) family on chromosome 1q. B-cells and some monocytes and dendritic cell subtypes express cell-surface CD32B, which has a cytoplasmic inhibitory motif important in regulating immune responses. Unlike the CD32B2 isoform on myeloid cells, CD32B1 on B-cells is not internalized, making it a suitable target for monoclonal antibody (MAb) therapy (Blood 2006Jun6 Epub). CD32B has not previously been found on AL and MM plasma cells. We used purified CD138+ marrow and blood cells from AL, MM and plasma cell leukemia (PCL) patients, and 5 human MM cell lines, to evaluate CD32B gene and cell-surface expression with gene expression profiles (GEP) (Affymetrix U133 PLUS 2.0), RT-PCR for CD32B1 and B2, and flow-cytometry with the 2B6 MAb for CD32B. In AL, GEP showed that CD32B expression was significantly higher than other FcR genes (p<0.01), RT-PCR showed that CD32B1 was prominently expressed on CD138+ cells from both newly diagnosed and relapsed AL patients, and flow cytometry showed intense cell-surface staining for CD32B on >98% of all AL plasma cells. In MM, public GEP data (http://lambertlab.uams) showed that CD32B expression was significantly higher than other FcR genes while RT-PCR showed CD32B1 message in CD138+ MM and PCL specimens but not in the RPMI 8226 cell line. Cytogenetic analysis then showed that 8226 cells lack t(4;14) but have 4 copies of 1q, implicating segmental uniparental tetrasomy of a mutant allele in the lack of CD32B message. Flow cytometry showed median 96% CD32B expression on CD138+ marrow cells from patients with normal or hyperdiploid cytogenetics, but significantly lower expression (median 69%, p=0.01) in patients with unfavorable cytogenetics (del 13, t(4;14)). CD32B expression was lower still on PCL specimens (median 10%) and nil on MM cell lines. We then investigated the GEP of sorted CD138+/CD32B+ and CD32B− fractions from MM patients. In CD138+/CD32B+ cells, CD45C and CXCR4 were overexpressed. In CD138+/CD32B− cells, genes on chromosome 1q were overexpressed, including those for cancer testis antigens and others possibly associated with biologic aggressivity (Cancer Cell 2006; 9:313). Notably, the CD32B-specific MAb 2B6 directs human mononuclear cell cytotoxicity against CD32B+ cell lines, reduces tumor growth and improves tumor-free survival in a mouse xenograft model. Moreover, an Fc-engineered humanized variant of 2B6 elicits ADCC-mediated specific cytotoxicity against a low-level CD32B+ MM cell line in vitro. In sum, these data show that CD32B is important in AL and MM; that CD32B on AL and the majority of MM plasma cells provides a target for MAb therapy; and that, given the results in MM, PCL and MM cell lines, CD32B expression is inversely related to biologic aggressivity. Genetic instability of chromosome 1q may provide a direct basis for this relationship thereby mechanistically linking CD32B expression in MM to prognosis. These data support further evaluation of CD32B and clinical studies of anti-CD32B MAb therapy in AL and MM.

An exploration into the world of the queer others of gender and sexuality moves us beyond the binary opposition of male/masculinity and female/femininity in our understanding of gender and expands the meaning of gender and sexuality for all humans. A revision of Jungian gender theory that embraces all genders and sexualities is needed not only to inform our clinical work but also to allow us to bring Jungian thought to contemporary gender theory and to cultural struggles such as gay marriage. The cognitive and developmental neurosciences are increasingly focused on the importance of body biology and embodied experience to the emergence of mind. In my exploration of gender I ask how gender comes to be experienced in a developing body and how those embodied gender feelings elaborate into a conscious category in the mind, a gender position. My understanding of emergent mind theory suggests that one's sense of gender, like other aspects of the mind, emerges very early in development from a self-organizing process involving an individual's particular body biology, the brain, and cultural environment. Gendered feeling, from this perspective, would be an emergent aspect of mind and not an archetypal inheritance, and the experiencing body would be key to gender emergence. A revised Jungian gender theory would transcend some of the limitations of Jung's anima/animus (A/A) gender thinking allowing us to contribute to contemporary gender theory in the spirit of another Jung; the Jung of the symbolic, the mythic, and the subtle body. This is the Jung who invites us to the medial place of the soul, bridging the realm of the physical body and the realm of the spirit.

The intent of the study was to investigate upper esophageal sphincter (UES) opening and cricopharyngeal bar, and their relationship to other swallowing variables, in elderly, nondysphagic subjects. Extent and duration of UES opening, hypopharyngeal transit time, hyoid displacement, hyoid-to-larynx approximation, and incomplete pharyngeal clearing were determined from fluoroscopic swallow studies in 84 nonelderly control subjects and 88 elderly subjects. No differences in these measures were found between elderly subjects with and without medical conditions, and data were subsequently pooled. Mild, moderate, or marked cricopharyngeal bars were identified in more than 30% of elderly subjects, and subsequent analyses were performed on the control group, the elderly group without bars, and the elderly group with bars. Maximum opening of the UES in the elderly bar group was significantly reduced compared with that of the elderly group without bars and the nonelderly control group. However, timing measures did not differentiate elderly subjects with bars from other elderly subjects and they suggest that prolonged transit times in the elderly cannot be explained by the presence of a cricopharyngeal bar. With the exception of hyoid displacement, all variables investigated differed significantly between the nonelderly and one or both of the elderly groups. With the exception of UES opening, variables examined generally did not differentiate the two elderly groups.

Deglutition in the elderly may be impacted by the sequelae of medical diseases. It is unknown if the long-term presence of common medical diseases, such as arthritis and hypertension, leads to changes in neurologic and muscular function and thus swallowing ability. The aim of this project was to determine if the duration of bolus pharyngeal transit in nondysphagic elderly individuals with chronic medical problems is longer than that measured in nondysphagic elderly individuals without medical problems. Videofluoroscopic swallowing studies were performed on 63 elderly subjects with a variety of well-controlled medical problems and on 23 elderly subjects with no medical problems. The mean timing of pharyngeal bolus transit was compared between the two groups. The relationship between the presence of medical problems and the likelihood of transit times prolonged beyond two standard deviations of the mean transit time found in 60 younger normal controls was also analyzed. Findings included significantly prolonged pharyngeal transit time in the group of subjects with medical problems compared with those subjects without medical problems for a small bolus size. Those individuals with hypertension demonstrated the most significant delays in bolus transit. The presence of medical problems did correlate with an increased likelihood of prolonged transit times. This preliminary study indicates that medical problems common in elderly populations are associated with a deterioration of swallowing function and that changes identified in elderly individuals may not be due to aging alone.

During videofluoroscopic swallowing studies performed in the lateral view, the arytenoid cartilages are seen to elevate and approximate the down-folding epiglottis, effectively closing the supraglottic larynx and protecting the airway. This mechanism may be incomplete or delayed in patients complaining of dysphagia and may lead to “penetration” of bolus material into the airway. This study evaluates the timing of supraglottic closure relative to the arrival of the bolus at the upper esophageal sphincter in 60 young control subjects and in 63 elderly control subjects without dysphagia. Event timing was measured in 0.01-s intervals from videofluoroscopic studies for two liquid bolus size categories. Results of the analysis revealed that, in most individuals, the arytenoid cartilages approximate the epiglottis prior to the arrival of the bolus at the upper esophageal sphincter. However, in both bolus size categories, there were individuals who achieved complete supraglottic closure after the bolus had arrived at the sphincter, but never greater than 0.1 s later. No delay in the timing of supraglottic closure relative to bolus arrival at the sphincter was found in the elderly subject group compared with the young subject group. The information from this study has allowed us to objectively determine if supraglottic closure timing is delayed in patients with dysphagia and to address any delay with strategies and exercises designed specifically to correct the delay. A case study is presented to illustrate the clinical significance of this study.

This study investigated spatial displacement variables important to pharyngeal constriction and clearing in nondysphagic elderly subjects and a control group of nondysphagic younger adults. Height, weight, and body mass index (BMI) characteristics were determined for all subjects, who then underwent videofluoroscopic swallow studies. Measures obtained during swallow of a 20-cc bolus included hyoid and laryngeal displacement, unobliterated pharyngeal space at the point of maximum pharyngeal constriction, and pharyngeal width when maximally expanded during the swallow. Data were first examined to determine if elderly subjects with medical conditions common to an aged population differed from elderly subjects with no medical condition. No differences were identified and data for all elderly subjects were subsequently pooled for comparison to data for the nonelderly control group. Findings revealed no differences in maximum hyoid displacement between the groups. Significant differences were identified for larynx-to-hyoid approximation and for the measure representing unobliterated pharyngeal space at the point of maximum pharyngeal constriction. Elderly subjects did not elevate the larynx to the same extent, or clear the pharynx, as well as the younger control subjects. In addition, data suggested that the larynx was positioned lower and that the width of the pharynx maximally expanded was greater in elderly subjects. Implications of the data for swallowing function in the elderly are discussed.

The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. Individual variability has not been studied, however. The purpose of this study was to determine the amount of sequence variability that normally occurs during the hypopharyngeal phase of deglutition. Dynamic swallow studies from 60 normal volunteers were evaluated and event sequence variability was determined for 12 two-event sequences during swallowing of three bolus sizes. There was found to be some variability in event sequences for almost all events evaluated except for the following : (1) arytenoid cartilage elevation always began prior to opening of the upper esophageal sphincter, (2) the sphincter always opened prior to the arrival of the bolus at the sphincter, (3) larynx-to-hyoid approximation always occurred after the onset of upper esophageal sphincter opening, and (4) maximum pharyngeal constriction always occurred after maximal distension of the upper esophageal sphincter. Variability was more common during swallowing of the smallest bolus size. This information may be helpful in evaluating event coordination in patients with dysphagia.

Measurement of kinematic pharyngeal transit times, a new videofluoroscopy technique, provides useful quantitative data to supplement the qualitative data previously available from videofluoroscopy swallowing studies. Kinematic pharyngeal transit times have not previously been reported for subjects with myopathy. This study demonstrates the use of quantitative kinematic pharyngeal transit times for dysphagia evaluation in 15 patients with myopathy. The successful treatment of dysphagia by cricopharyngeal myotomy is reported in two patients with limb-girdle syndrome.

4′-Demethoxydaunorubicin (idarubicin [IDR]) is a new anthracycline that differs from its parent compound by the deletion of a methoxy group at position 4 of the chromophore ring. This minor structural modification results in a more lipophilic compound with a unique metabolite that has a prolonged plasma half-life as well as in vitro and in vivo antileukemia activity. To determine its activity in acute myelogenous leukemia (AML), 130 consecutive adult patients between the ages of 16 and 60 with newly diagnosed disease were randomized in a single institution study to receive either IDR in combination with cytosine arabinoside (Ara-C) or standard therapy with daunorubicin (DNR) and Ara- C. The trial was analyzed using the O′Brien-Fleming multiple testing design that allowed for periodic inspection of the data at specific patient accession points. After accrual of 60 patients per arm, analysis showed that patients who received IDR/Ara-C had a superior response compared with those who received standard therapy: 48 of 60 patients (80%) achieved complete remission on the former arm compared with 35 of 60 patients on the latter (58%, P = .005). Logistic regression analysis of factors associated with complete response indicated that treatment with IDR/Ara-C offered a significant advantage to patients who presented with a high initial white blood cell count compared with treatment with DNR/Ara-C. The degree of marrow aplasia was approximately the same on each arm as was nonhematologic toxicity. Overall survival for patients on the IDR/Ara-C arm was 19.5 months compared with 13.5 months on the DNR/Ara-C arm (P = .025) at a median follow-up of 2.5 years. We conclude that IDR/Ara-C can effectively replace standard therapy with DNR/Ara-C in adult patients less than age 60 with newly diagnosed AML.

The statement in Table 2 (p 1018) of the article by Gaynor et al published in the June 1988 issue (6:1014–1030), "among factors associated with a shorter remission duration" should have read, "among factors associated with remission duration." The association listed directly below that statement, "high log (WBC) with Null or B cell ALL" should have read, "high log (WBC) with T cell ALL."