Biomedical subjects
Publications and source records attributed to S J Coen.
To avoid the passions of love and hate between them, therapists and patients construct and preserve negative barriers of angry criticism, dissatisfaction, and sadomasochism. This review aims to help therapists tolerate and work with loving feelings between patient and therapist for the benefit of the patient.
The author reconsiders Erikson's 'Dream specimen' paper as a forerunner of subsequent reader-response criticism, constructive writings on the exploration of countertransference and our contemporary debates about the constructions of meaning in the analytic and literary situations. He regards Erikson as deconstructing our interpretive efforts with texts and with patients; we are to move away from an interpretive process in which we pin down meanings towards opening up the ongoing exploration of multiple meanings. By emphasising self-reflexive questioning and joyful play between texts and readers and analysands and analysts, Erikson contributed to opening up the pleasures of both psychoanalysis and literary criticism. Although he wonders whether Erikson may have wished to move his own creativity beyond conflict, the author heartily endorses his encouraging us to enjoy playing with our materials--texts, dreams and analyses.
Analysts tend to avoid the full range and force of love and hate in themselves and in their analysands. Such affective constriction in the analyst interferes with full analysis of patients' defenses against passionate feelings, loving and hating. I contend that our analytic ego ideal tends to encourage constriction and discomfort with our loving feelings for analysands. My intention is not to advise analysts to love their patients, but to focus carefully on mutually constructed barriers that serve to prevent loving feelings in the analytic setting. I describe some of my loving feelings toward two analysands and some of the obstacles with which I had to struggle in order to preserve such feelings for the sake of these patients' analytic growth and change.
A type of patient is described, who has marked intolerance of taking responsibility for his internal conflicts so as to confront them, analyze them, and change. Defensive repetition in pathological object relations aims to avoid what is wrong within and to engage another so as to protect oneself. Genetic, dynamic, and technical aspects of such defensive, dependent relating are considered. Responsibility for oneself and for what is within oneself is held to be terrifying--more than anyone can bear on his own. How destructiveness has become, and remains, so terrifying is discussed.
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Dynamic conflict among feelings of entitlement, defectiveness, and deprivation is discussed from the perspective of superego defense against dangerously aggressive (and sexual) wishes. These negative feelings and negative self-images are exploited so as to appease the superego in the face of one's hostile aggression: that one is justified, that there are extenuating circumstances for one's hatred and destructiveness. The "oral" clamor of deprivation and entitlement, together with dependency, submissiveness, and defensive uncertainty, serve a screening function for hostile aggressive wishes, from any developmental level. Typically, attitudes of entitlement are contradictory, unclear, and wavering, because of conflict between differing ego ideal images, and conflict between superego, and ego and id, about the sadistic extractiveness in these attitudes. Attitudes of entitlement are contributed to by past trauma, deprivation, abuse, teasing overstimulation coupled with neglect, or alternating indulgence and deprivation, as well as identification with certain parental attitudes--exploitation and extractiveness--and denial of the need for the superego to assess reality accurately.
The behavioural enactment in pathological jealousy is a substitute for and defence against full, loving and sexual, intimacy with a single, live person. It is a masturbatory equivalent, sometimes a masturbatory prelude, a perverse form of sexual relatedness. The cast of characters includes at least four roles: male and female sexual protagonists, an observer, and an audience witnessing the interaction between the three. The need for concrete evidence relates to denial, mistrust, and guilt, especially about feared destructiveness, as well as masochistic and narcissistic enhancement. The object choice in pathological jealousy involves a fantasied protector, and is basically homosexual, narcissistic. These defend against the dangers of passive needs of another person different from oneself, as well as of aggressive destruction.
The sense of defect, physical or psychological, is here regarded as a fantasy, a compromise formation, rather than an actual defect existing somewhere in the body, or in some psychological structure. It need not correlate with the reality to an external observer of physical or psychological disability. Psychoanalytic emphasis is directed to the motivations for the persistence of this sense of defect, rather than primarily to etiology (trauma) or genetic history. Accurate perception and evaluation, having been interdicted during childhood, is avoided with the magical hope that thereby one will be acceptable and what is wrong will disappear. The interaction between self and parents, real and fantasied, cannot be clearly known. The patient remains uncertain as to what is wrong, in whom it is located, and how it has come about. The sense of defect, physical or psychological, becomes the nidus around which much is crystallized. This is then offered up to a parent (and the superego) as an appeasement and seduction, aiming to help this parent feel better by agreeing that the child is indeed the cause of what is wrong. Dangerously destructive (and sexual) wishes are defended against and atoned for by emphasis on one's defectiveness.
From the widely diverse category of so-called mirror dreams, we have differentiated the most frequent, which we have designated the common mirror dream (CMD). It is one in which the dreamer at some point looks into a mirror and reports seeing himself, a part of himself or a distorted though recognizable version of himself. Mirror dreams, including CMDs, are distinctly uncommon. Every dreamer of CMDs in our series had felt enjoined by the mother (in most cases with the father's collusion) not to see and regard her clearly and not to be an accurately reflecting mirror for her. The intensity with which the maternal injunction against accurate visual perception and evaluation was feared was an important distinguishing feature in our patients with CMDs. The essence of the CMD has been hypothesized to be a reciprocal, reverberating, visual-exhibitionistic dyad representative of the mother-child relationship. The dream mirror may represent the wish that the analyst-mother counter a feared parental injunction against accurate visual perception and evaluation so as to correct the distorted perceptions of self and objects and provide visual affirmation of the value and integrity of the self-representation. For some patients, defense against the dangers of castration and loss of maternal love was accomplished by the mirror mechanisms of magically transforming images in the mirror, the ease of creating illusion in the mirror, and a fetishistic mechanism of visually reintrojecting a phallic symbol from the mirror. Our data failed to confirm many of the hypotheses of previous contributors as to specific symbolic meanings of the dream mirror. More relevant than the symbolism of the dream mirror are the many functions of the dream mirror for the dreamer. These are analyzed and discussed.
A case is presented of an analytic patient who reported adolescent and adult mirror masturbation in the context of a struggle for psychic differentiation and separation from his mother. A model is elaborated in which magical manipulation and transformation of the self- and object images are facilitated by masturbatory mirror play. The role of impersonation and transformation as another man or woman is explored. Visual hunger, traumatic overstimulation, incestuous games, and fear of actually committing incest with a seductive parent are proposed as genetic contributants . Mirror masturbation is understood as a dramatic play which defends against castration anxiety and attempts to master childhood sexual overstimulation by active repetition and re-creation.
This paper explores the meanings and functions of a transference paradigm of a fantasied twin relationship with the analyst. Twin transference in the analysis of nontwins has been reported infrequently in the psychoanalytic literature, except recently by Kohut and his co-workers, who refer to twinship transference as a variant of narcissistic mirror transference. We suggest that such narrow definition tends to reduce the complexity of the wish for a twinlike relationship with the analyst. Analytic data are used to show the advantages of examining twin transference within structural theory, in terms of the multiple functions served by this rather primitive transference paradigm, rather than reducing it only to one variant of the need for certain mirroring functions. We suggest that twin transference, together with all twin fantasies, subserves multiple functions, of which we highlight gratification and defense against the dangers of intense object need. In this formulation, the twinlike representation of the object provides the illusion of influence or control over the object by the pretense of being able to impersonate or transform oneself into the object and the object into the self. Intense object need persists together with a partial narcissistic defense against full acknowledgment of the object by representing the sought-after object as combining aspects of self and other. Further analytic attention needs to be directed to the specific representation of the needed object in certain primitive transference paradigms instead of exclusive emphasis on the functions required of the object. Our analytic data are used to argue that intense early needs of an object are best understood analytically within a conflict model in which they are modified by multiple wishes, drives, fears, dangers, and needs for defense.
Kohut's (1979) paper, "The two analyses of Mr. Z.," is used to highlight difficulties in the maintenance of an analytic attitude toward certain preoedipal conflicts. It is suggested that two separate and distinct issues are confused in the concept of selfobject: the subject's needs for the object and the status of the object as not separate and distinct from the subject. This obfuscates the subject's relation to the object, neglecting attitudes, representations, feelings, and valuations of the object. Distinctions between "need-satisfying object" and "specific object" are used to clarify the status and multiple functions required of the selfobject. The author disagrees that it is useful to differentiate selfobjects from a more general class of preoedipal objects. The motivational forces presumed for selfobject relationships are criticized as experience-distant, nonaffective, metapsychological constructs. The position is taken that etiology in selfobject pathology is more complex than deficits in parental empathy. Interrelations between developmental deficits and psychic conflict are examined; they indicate that insufficient attention has been paid to the role of defense in the concept of selfobject relationship.
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Sexual fantasy in initial interviews and during psychotherapy and psychoanalysis is explored for its contribution to understanding psychopathology, both sexual and nonsexual. The focus is on distinguishing between the sexual and the seemingly sexual. "Sexual" behavior and fantasy are regarded as having sexual pleasure and orgasm as the predominant goal. Seemingly sexual behavior and fantasy have a predominant goal that is not sexual, even though a sexual mode is used. Predominant goals in the seemingly sexual are emphasized such as coping with intense aggression and problems of self-esteem, self-definition, self-cohesion, and the maintenance of object relations. Sexual fantasy and behavior can be especially useful for repairing negative self- and object images and the associated intensely negative affects. This does not imply that all more primitive patients are incapable of experiencing intense sexual pleasure and orgasm. On the contrary, borderline patients, with extensive use of splitting mechanisms at the level of dyadic object relating, may have intact sexual functioning.
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