Nonimmune hydrops fetalis in a 49,XXXXY fetus at 16 menstrual weeks.
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Biomedical subjects
Publications and source records attributed to E Kafka.
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The power of moral ideas, here equated with superego strength, has been explained in increasingly complex terms over the course of the development of psychoanalysis. At first regarded mainly as useful in opposing oedipal instinctual demands, morality came to be seen also as opposed to aggressive wishes while at the same time capable of gratifying aggressive and libidinal forces. In this paper, I discuss the contribution to the strength of morality that comes from the effects of painful ("traumatic") experiences and from the use of moral ideas for social, adaptational purposes. In addition I consider the possibility that unchanging moral ideas can have changes in function in clinical work. A case is presented to illustrate these points.
My experience of clinical work is consistent with the conclusion that both practice and theory are improved by applying the contributions of Heinz Hartmann. His work provides an important conceptual bridge to understanding the adaptive and pathologic changes that appear in the course of human development. The specific details of those changes are just as much an issue demanding the analyst's attention as is the tracing of patterns of childhood instinctual life. In this paper, I will point to some areas of controversy where renewed attention to Hartmann's ideas might be useful, and I will attempt to illustrate the clinical utility of his theoretical contributions.
The author rises a number of questions about cognitive difficulties in relation to psychoanalysis. He presents the case of an adult patient in whom previously unrecognized childhood cognitive difficulties were discovered during the course of analysis. Their relationship to the patient's problems in adulthood is discussed. Some suggestions and speculations about the questions raised are presented with the hope of stimulating further exploration of what the author considers to be an interesting and important subject for psychoanalysis.
The literature concerning examination dreams is reviewed, and the case of a patient who had a number of examination and examination-like dreams is described. Examination dreams are related to traumatic dreams, "idiosyncratic" dreams, and various behavioral expressions. In addition, constitutional factors involving impulse-defense imbalance, childhood experiences with physical difficulties and medical examinations, and ambivalent identifications and object relations seem to find representation in these dreams.
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