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Biomedical subjects

R D Chessick

Publications and source records attributed to R D Chessick.

At least 19 recordsLinked to original sources
PubMed1995

Psychosis after open heart surgery: a phenomenological study.

This brief self-reflective phenomenological study attempts to throw light on the inner mental processes that go on immediately following open heart surgery. The combination of organic assault, medication, post-traumatic stress, and psychological injury involved produces an abnormal mental state that can better be treated if it is understood from the point of view of the patient.

Atrial Fibrillation↗
PubMed1994

On corruption.

This paper begins with the premise that in most individuals and in most cultures there is an inevitable force that presses toward the production of corruption as time passes, a force that requires vigilant resistance. Corruption is here defined as a falling away from the ego ideal of the individual or the ideals of the culture, which results in certain unfortunate and maladaptive changes in attitude and behavior of both the group and the individual. Support is given to the premise by a brief review of the work of Robert Hutchins and of Oswald Spengler, both of whom were eloquent and learned advocates of the premise, although, perhaps for personal reasons, they were too pessimistic. There follows a discussion of the metapsychology of corruption both in individuals and in cultures, both from an ego psychology point of view and from a self psychology point of view. Freud's paper on narcissism and Kohut's "psychology of the self in the narrow sense" are taken as starting points. Using the terms of the former, a divestment of the ego ideal of narcissistic libido is described, along the lines of, and somewhat parallel to, Freud's concept of secondary narcissism. Using Kohut's early concept of a separate line of development for narcissism, it is suggested that a similar separate line of development can exist for "corruption" in both individuals and cultures. At the root of this development are the repeated narcissistic wounds inevitable in the course of individual life and in the life of a culture as it tries to live up to its ideals. Resistance to the demoralizing effects of the vicissitudes of life is an important function of the ego, and depends on the strength of the ego, of the cohesiveness of the sense of self, and of a conscious awareness of the dangerous pressures toward corruption that pervade our civilization and resolve not to be swept up by these pressures. This leads to the main point of the paper, focus on the status of the ego ideal of the psychoanalyst or, conversely, his or her level of "corruption," whether conscious or unconscious. It is maintained that this level and the particular value system of the analyst, as well as the level of energy invested in living up to his or her value system, is communicated subtly to both one's students and patients, and has a vital role in the treatment process.(ABSTRACT TRUNCATED AT 250 WORDS)

Cultural Characteristics↗
PubMed1994

What brings about change in psychoanalytic treatment?

The development of two general points of view regarding what brings about change in psychoanalytic treatment is traced in this article. One set of conceptions emphasizes interpretation, especially of the transference, and historical or narrative reconstruction. The other set emphasizes the experiential and transactional aspects of a new and better human relationship. Various current versions of this difference in emphasis are discussed. Future investigation is needed to distinguish the role of correction of expectations generated out of actual infantile experiences through the new relationship to the analyst, from the role of interpretation of early fantasy activity and reconstruction of how this was generated and congealed in the patient's childhood. The danger of avoiding the analysis of core infantile fantasy activity and its effect on the patient's current perception, thinking, and behavior, by a premature termination of the treatment when the relationships of the patient seem to be more successful, mature, and realistic, is stressed. One must be careful not to utilize self psychology or object relations theory beyond foundational repair in psychoanalytic therapy without considering the consequences. One must ask oneself always if one is utilizing such theories and practices and the interpretations based on them defensively, in a collusion to avoid facing the patient's core unique childhood oedipal and preoedipal fantasy activity and the reverberations of it in the analyst's core fantasy activity. Continuing self-analysis is required in each and every treatment process, which is why the analyst also learns and matures from every case. The openness of the analyst permits insight through interpretation, meliorative noninterpretive aspects of the new object relationship or experience, regression due to the analyst's reliability which gives the opportunity to undo developmental arrests through the analysis of core fantasies, a symbolic holding environment, and the collaborative creation of a narrative, all of which are known to have therapeutic effects and work together to produce change in psychoanalytic treatment.

Fantasy↗
PubMed1992

On falling in love and creativity.

This paper discusses the ego functioning and self psychological aspects of falling in love and passionate love. These universal and extraordinary phenomena are conceptualized as representing the activity of the creative imagination in solving problems related to coping with intense narcissistic and libidinal pressures. The work of other authors is reviewed and recast into a metapsychological framework involving ego and superego contributions to the experience, and focused on self cohesion. An illustrative clinical psychotherapy case is presented in an effort to understand what has traditionally appeared to be a mysterious and disjunctive life experience, and to explore the creative surge that can be generated by falling in love both in and out of the transference.

Adult↗
PubMed1991

The unbearable obscurity of being.

This cross-disciplinary study attempts to investigate the Being-question: what is the ultimate ground of everything there is? Psychotic solutions to this problem are compared with Kundera's literary approach (On the Unbearable Lightness of Being), and with famous metaphysical solutions. Special attention is given to Heidegger's attempt to grapple with this question, as exemplified in his four- (in the English translation) volume study of Nietzsche--who regarded Being as "a vapor and a fallacy." Psychoanalytic conceptions of the origin of the sense of Being in the mother-infant interaction, and in the ego's ongoing awareness of itself are examined, especially since in psychoses, borderline disorders, and other narcissistic disorders the sense of Being and the ego's experience of itself often are defective. Genetic and dynamic psychoanalytic considerations also clarify the historical preoccupation with the Being-question. It is concluded that only through consensual validation can psychotic solutions be distinguished form solutions having a general sense of validity. The methodology for exploring the validity of answers to the Being-question is contrasted with scientific method, and the necessity for clear exposition--limited by the inevitable boundaries of one's culture and language--is emphasized; for only through a historical process of dialectic can there be hope of eventual consensual validation on solutions to the problem.

Humans↗
PubMed1990

Hermeneutics for psychotherapists.

Hermeneutics as a method of approach has been used differently by many different authors, and in this paper I have reviewed the history and evolving employment of the hermeneutic approach. For the purposes of psychotherapists, the point of hermeneutics is that, in contrast to the natural sciences, it focusses away from the classical notion of the neutral independent observer (or subject or psychotherapist) as detached from the object of his or her study, the patient. All understanding in the human sciences is viewed by hermeneutics as arising out of a fusion of horizons between the investigator and the humans being investigated. The "knowledge" which arises from such an investigation is not some sort of immutable truth or essence, but is context dependent and a function of the "prejudices" which the investigator brings to the investigation. Diagnoses and formulations in the practice of psychotherapy, if the hermeneutic approach is employed, cannot be viewed as disease entities and natural science "facts," but rather as temporary formations that change with changing times, historical eras, cultures, and prevailing prejudices and practices. The problem of a hermeneutic psychiatry would be to steer between the Scylla of naive realism ignoring the major participation of the psychotherapist on the one hand, and the Charybdis of relativism, nihilism, and hopeless skepticism on the other. Much work remains to be done in order to clarify the role and limitations of hermeneutics, and to incorporate it into the clinical practice of psychotherapy, and this work must be done against the prevailing ideology of scientific materialism that characterizes our historical era. A hermeneutic psychiatry offers us the best hope of not losing sight of the methodological horizons that delimit our clinical work, and of widening these horizons so as to provide further understanding of our patients.

Humans↗
PubMed1990

Self-analysis: a fool for a patient?

In this paper I first reviewed the scanty publications on the subject of self-analysis. Although it was recommended by Freud as early as 1910 for every analyst, self-analysis turns out to have many pitfalls and to be quite a complicated and controversial procedure. There is no agreement on the proper technique of self-analysis in the literature, nor is there any discussion of the determinants of the particular choice of technique of self-analysis that is employed, nor even of the reasons why some analysts do not engage in it at all. Using clinical data gathered from written material of many years of self-analysis following the termination of a successful training psychoanalysis, I have attempted to elucidate some of the problems posed by this procedure. These problems are in some ways similar to formal psychoanalysis, but are in some ways contingent on the fact that it is basically a different technique. It is a solitary occupation and therefore suffers from the dangers of disintegration into autism, narcissism, and obsessional rumination. There is no living presence of an analyst to serve either as a transference figure or to make interpretations and stimulate the production of material. The identification with the analyst's analyzing function is far from simple in self-analysis because of the complex nature of the various internalizations of the analyst that take place over years of a formal training analysis. Thus, Ticho (1967) is correct when she claimed that self-analysis is a skill that the analysand has to acquire by himself or herself. An important phase of the beginning of self-analysis involves the working through of the separation from the psychoanalyst and the re-evaluation of the analyst and the analytic process. This results in a heightened sense of independence and autonomy, increased cohesion of the self, and maturation--which is manifested by greater autonomous ego functioning, a more mature sense of identity, and continued transformations of narcissism which highly valuable goals, on the basis of the data I have presented, can be approached through the process of self-analysis. Above all this stands the most important goal of self-analysis, the understanding of one's countertransference reactions. This is especially important in the treatment of seriously disturbed patients who become disruptive, and thus get labeled borderline, often as a response to unconscious countertransference manifestations from the analyst which are then experienced in the self-object transference as failures in empathy.(ABSTRACT TRUNCATED AT 400 WORDS)

Conflict, Psychological↗
PubMed1989

The death instinct and the future of humans.

Freud's notion of the "death instinct" has been conceived of by many subsequent authors in many ways. One of the misuses of it is as an excuse for passivity in the face of the current crisis in human affairs. This paper reviews the "death instinct" concept and attempts to understand the disavowal of the dangers to our species and our planet on the basis of our current narcissistic cultural orientation. It examines the use of praxis by a variety of continental thinkers to counter this disavowal and emphasizes the obligation of all mental health professionals to participate, through direct action and through educational contributions, in the elimination of these evils.

Aggression↗
PubMed1988

Thirty unresolved psychodynamic questions pertaining to feminine psychology.

The psychoanalytic view of feminine psychology is rapidly changing. This paper organizes and presents thirty areas of currently unresolved questions on this controversial topic, as they have appeared in the literature of psychoanalysis and psychotherapy beginning with Freud's original publications, for consideration for future research, study, and discussion.

Body Image↗
PubMed1988

On the unique impact of Richard Strauss's Elektra.

The unique and remarkable impact of the opera Elektra is explored. This opera rests not only on its dramatic portrayal of the oedipal theme, but also on an inspired expression of archaic emotions, prelogical thought, and preoedipal concerns. This accounts for its unique impact, and serves as a warning to clinicians confronted with manifest oedipal material to be sensitive to the diagnostic implications when oedipal material is permeated with more primitive expressions, producing a curious and eerie ambience and much disquiet in the therapist.

Culture↗
PubMed1987

Lacan's practice of psychoanalytic psychotherapy.

Lacan's efforts in the psychoanalytic psychotherapy of patients with structural deficits aim at separating truth, desire, and ideals from each other so that the analysand is freed up to find or create the desire that gives him or her "joy." This paper presents Lacan's use of the "bridge metaphor" towards that purpose, and illustrates the application of Lacan's early concepts in actual clinical work.

Communication↗