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Biomedical subjects

R D Chessick

Publications and source records attributed to R D Chessick.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1986

Heidegger for psychotherapists.

"Philosophical anthropology," and a powerful continental movement in philosophy and psychology have greatly influenced the practice of psychiatry in Europe. Martin Heidegger brought this approach to a position of prominence and wide attention and I describe his views pertinent to modern psychotherapy on (a) human living and (b) the epistemological foundation of psychiatry and psychotherapy.

Culture↗
PubMed1985

Psychoanalytic listening II.

This paper employs a rhetorical form designed to clarify and sharpen the focus of the very special stance required--which must be painstakingly learned under careful supervision--in order to effectively tune in to communications coming from the unconscious of the patient. This is the hardest task that must be mastered to become truly empathic and sensitive in dyadic relationships, a unique expertise that marks the psychiatrist as a genuine specialist in medical practice. Regardless of theoretical orientation, neither the form or content of any therapeutic intervention can be appropriate unless it is empathically based. Clinical vignettes illustrate the lack of such empathy, and readings are suggested that enhance our approach to learning this skill, borrowing especially from Kohut and Bion. The great importance of the often ignored "background" of the patient's communication is emphasized, and is illustrated from the field of music in the work of John Cage and Anton Webern. The congruence between this clinical psychiatric problem and the main thrust of Continental philosophy, which attempts to put man back in touch with himself, is described. Suggestions are offered to supervisors how to develop these skills in the novice. Finally, a discussion is presented of the effect on the professional and personal life of the therapist who has not developed these skills, emphasizing the dangers of "burn-out" in therapists and the implicit philosophy of life in a money-oriented practice of psychotherapy. The dangers of not attending to such matters even during residency training are pointed out, in an attempt to raise the consciousness level of the therapist to the extreme importance of background practices both in the patient and the therapist.

Communication↗
PubMed1984

Sartre and Freud.

The approaches to understanding a person's life represented by Freud's psychoanalysis and Sartre's "existential psychoanalysis" are fundamentally opposed. Starting from entirely different epistemological premises, they reach irreconcilable views on the nature of man and psychopathology, and lead to quite dissimilar and opposed formulations for psychotherapy.

Awareness↗
PubMed1982

Intensive psychotherapy of a borderline patient.

A detailed case report of the long-term intensive psychotherapy of a borderline patient illustrates my approach to such patients. It also raises questions about the value of interpretations in the early phases of therapy of such patients, regardless of which conflicting theories are chosen as the basis of these interpretations. Stress is placed on the value of empathic attunement to the patient, staying with the patient through the many vicissitudes of long-term treatment, and the developmental use the patient made of a long treatment, reliving certain phases of development in the transference. Acquisition of internalized controls may need to occur in this way before the patient is ready to utilize interpretations. Also illustrated are the difficulties in convincing insurance companies and other third parties to support long-term psychotherapy and the effects of such intensive interaction over the years on the psychotherapist.

Adult↗
PubMed1982

Current issues in intensive psychotherapy.

Seven current critical areas in intensive psychotherapy are discussed. (1) Social polemics, centering around the conflict between the humanistic and individualizing thrust of intensive psychotherapy, and the dehumanization of our current dark age; (2) training, where the resident is caught in a dilemma between techniques stressing fast relief and the possibilities of longer intensive therapy that stand in stark contrast to these techniques; (3) fundamental philosophical choices on the part of every practitioner that various types of therapy require; (4) delineation of intensive psychotherapy primarily defined as a modified form of psychoanalysis; (5) establishing the methodology of psychoanalysis and its derivative discipline, intensive psychotherapy; (6) use of intensive psychotherapy as the treatment of choice for pre-Oedipal disorders, severe character disorders, borderline patients, and certain others, such as some schizophrenic patients; (7) the collision between certain irreconcilable views such as those of Kohut and Kernberg that forces further choices on the therapist. This latter unresolved area could be placed in perspective by appeal to ego psychology which, as in the work of Blanck and Blanck, and others, is still a viable alternative and forms a critical area of investigation.

Borderline Personality Disorder↗