Search PubMed⌕ Search

Biomedical subjects

P L Giovacchini

Publications and source records attributed to P L Giovacchini.

At least 19 recordsLinked to original sources
PubMed2001

Dangerous transitions and the traumatized adolescent.

One of the developmental tasks for the adolescent is to construct a new transitional space that leads to internal changes and adapts to the external world. When a nurturing matrix is unavailable, adolescents experience the entrance into the adult world as a dangerous transition. The author bases his arguments on psychoanalytic theories, mostly Winnicott's, and illustrates these with clinical material. He suggests that, even though these traumatized adolescents experienced nonfunctional transitional spaces, it is proven that they could be treated psychoanalytically. Here, the main task of the analyst is to establish a holding environment as a type of transference, resulting in less emphasis on interpretation of inner conflicts.

Adolescent↗
PubMed1995

Schizophrenia and oxymorons.

From the viewpoint of character structure, patients with schizophrenia can be seen as the diametric opposite of persons with a nonpsychotic organization. They construct adaptations and defenses to deal with an externalized primitive mental orientation, whereas nonpsychotic persons tend to develop defensive mechanisms to render these primitive parts inactive. Patients with schizophrenia do not have a continuum between primary process id levels and secondary process reality operations. Thus polarities are not differentiated, leading to a series of paradoxes and oxymorons. These patients may view themselves as omnipotent and grandiose, yet at the same time lead a miserable, drab existence. Primitive parts of the personality may feel alive and powerful, whereas the ego is viewed as dead--the fundamental oxymoron of the living dead. The author presents several illustrative case vignettes of these features.

Adult↗
PubMed1993

Treatment issues with borderline patients and the psychosomatic focus.

I have discussed a group of borderline patients who can be conceptualized as having defects in character structure. There is no smooth, hierarchically arranged continuum from lower id-oriented to higher ego, secondary-process organized psychic levels. They suffer from psychic discontinuity, characterized by psychic lacunae, empty spaces devoid of psychological content. These lacunae are often the locus of somatic disruptions, a psychosomatic focus, which are manifested as psychosomatic symptoms. Though the treatment of these patients can be stormy, and, in some instances impossible, providing a setting in which these patients can comfortably regress and eventually get in touch with split-off parts of the self can lead to a manageable therapeutic interaction. On occasion, this might be life-saving.

Adult↗
PubMed1991

The creative person as maverick.

The innate talents that are the essence of creativity are associated with a particular type of character structure. The child's creative potential has to be supported by the infantile milieu, which also happens to have a characteristic stamp. Within this context of personality configurations and developmental antecedents associated with creative ability, there can be considerable variation. I am not postulating a specific or stereotypic creative character. There are, however, certain qualities that can be found in various character types (and can even exist alongside psychopathology) that are often found in creative scientists and perhaps artists as well. I believe the maverick often possesses these character traits and many of the scientists I have had the opportunity of treating proudly considered themselves mavericks. The creative personality is characterized by paradoxes; these cast it in the maverick mold. Possessors of this personality belong and do not belong. They do not break the rules but bend them a little. They are nonconformists but not rebels. They display many features that do not seem to belong together. The paradoxical qualities that dominate the creator's personality and behavior are the outcome of a certain fluidity of character and ego boundaries. The creative process involves a broad range of functioning and traverses various levels of the psyche, frequently reaching down to the very earliest, primary-process-oriented parts of the self. Ego boundaries, in turn, can become quite fluid and permeable, even though they are ordinarily firmly established and well structured. It is this broad spectrum, a prominent feature of the creative process (Giovacchini, 1965, 1971, 1981), that has been often confused with psychopathology. These paradoxical elements are the outcome of an infantile environment that has provided considerable gratification. Again the early milieu of creative personalities may be extremely varied, but there has always been some person or persons who have had a considerable emotional investment in the child. As the developing psyche incorporates and introjects these gratifying and security-establishing experiences, they become amalgamated into the self-representation. In the face of adversity, they provide confidence and reassurance and allow the creator to soothe him- or herself when upset by inner tension. Consequently, creative scientists do not depend so much on the outer world as they do on inner resources. One scientist told me that he could not understand how anyone could ever be bored. Even if he were denied access to his work, he could always find something interesting to do or explore.(ABSTRACT TRUNCATED AT 400 WORDS)

Aptitude↗
PubMed1990

Erotism and chaos.

There is a continuum from primitive, undifferentiated feelings that are simply the manifestations of homeostatic balance and imbalance to highly differentiated, pleasurable erotic feelings that characterize mature, intimate love relationships. Sensory reactions are elevated from simple reflex levels to highly complex, sophisticated affects that involve wide areas of the psyche. Thus, affects are associated with integration and organized psychic structure. Consequently they may function in various ways. Freud developed a continuum for anxiety as initially functioning as a conversion reaction enabling sexual feelings that cannot reach mentational levels or be consummated in erotic activity to be discharged. It reaches a final level of organization where it serves as a signal calling various defenses into play as emerging instinctual impulses threaten to upset psychodynamic equilibrium. I have focused on how affects, erotic feelings in particular, have an organizing function that binds a primitive inner agitation that occurs during what is called a prementational stage of the neonatal period. This is a stage that precedes psychological processes. Sexual feelings are generated as an attempt to bind inner chaos that stems from an amorphous, inchoate psychic state. Erotic feelings are experienced in order to smoothe inner tension. The patient tries but seldom achieves calm because the affective binding and structuralizing process, in itself, becomes painful and disruptive. I present several clinical incidents and also refer to so-called treatment relationships where the therapist absorbs the patient's chaos and then acts out sexually which leads to a total breakdown of the therapeutic setting.

Anxiety Disorders↗
PubMed1984

The psychoanalytic paradox: the self as a transitional object.

I have focused upon a group of patients whose biological needs for nurture and comfort were adequately met but whose mothers never related to them beyond simple caretaking. They never smiled at their children inasmuch as they derived no pleasure from playing with them or in their emerging sense of aliveness. From both the analyses of mothers and these patients, it appears that the mothers used their children as transitional objects. In turn, the children's emotional development became fixated in the in-between transition space. This fixation led to specific types of character structure and ego defects. Early development levels did not form a smooth continuum with higher later acquired adaptive ego states. There seem to be extensive lacunae in the middle layers of the psychic apparatus which manifested themselves as defective modulating elements. These patients showed extremes of behavior, marked polarities of sane, sensitive rationality to psychoticlike irrational episodes. There were no transitional gray areas between black and white. They exhibited a peculiar kind of fragmentation or splitting in which connecting bridges between higher and lower levels were missing. There are many such patients who seek treatment. However, they present special problems in therapy which can be explained in terms of the psychoanalytic paradox. The psychoanalytic paradox refers to a treatment impasse caused by an imbrication of psychopathology and various attributes of the psychoanalytic method. The mother's attitude toward her infant child has some similarity to the low-keyed objective analytic attitude, what has been sometimes referred to as analytic neutrality. These patients require different modes of relating which indicate that the therapist is, unlike the mother, very much concerned with their patient's developing autonomy and their entering and exploring the external world. These variations of analysis are not modifications or deviations of analysis. They are elements of the analytic process necessary for the treatment of specific types of psychopathology. Just as each patient is unique and the transference manifests itself in a particular fashion which then causes the analyst to make certain interpretations, the variations of technique discussed in this article address themselves to the construction of a holding environment appropriate for this group of patients.

Adolescent↗
PubMed1977

Alienation: character neuroses and narcissistic disorders.

Various defensive adaptations are described that patients with structural defects involving the self-representation (character neurotics) use to adapt to the external world, often achieving an organization sufficiently stable to lead to considerable success. Externalization rather than projection is used. The differences between these two psychic processes are important for our understanding of character neurotics. Projection signifies placing impulses or parts of the self into external objects whereas externalization involves creating or finding a reality to support the defences, including projecting. The patient externalizes his infantile traumatic environment to construct a current world after his early environment which he finds both threatening and familar. Clinical material illustrates how the process of externalization operating within the transference context may lead to special technical problems. One type of character neurotic demonstrates a special type of externalization which supports overcompensatory feelings of self-aggrandizement, which are in effect, narcissistic defenses. To varying degrees, all character neurotics have some narcissistic defenses. Countertransference problems are also discussed.

Adaptation, Psychological↗
PubMed1976

Symbiosis and intimacy.

The symbiotic phase of development is crucially involved in determing the nature of psychopathology as well as promoting psychic processes that are involved in creative activity and intimate object relationships. In a well-established object relationship, the partners relate to each other in a symbiotic fashion. From the analysis of married persons (and some clinical material is presented in this paper), the author concludes that the fundamental character structure, psychopathological or otherwise, of each spouse is identical. Exceptions to this conclusion exist, but here one is dealing with an object relationship that is superficial and transitory. Symbiotic fusion regularly occurs in creative activity and empathic intimate relationships.

Character↗