PubMed · 13528221
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C H NODET. [Psychoanalysis & guilt feeling].. https://pubmed.ncbi.nlm.nih.gov/13528221/
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Hans Loewald's work was relatively marginalized in its day and it is little known outside the United States. It is, however, assuming increasing importance in American psychoanalysis. Loewald's attractiveness as a theoretician is due, in no small part, to his rigor and synthetic reach. He is able to accomplish the difficult feat of remaining non-sectarian and systematic at the same time. Indeed, Loewald's work contains an integrative vision that is unusual in today's fragmented psychoanalytic world. This author tries to show how Loewald attempts to reconcile many of the rigid oppositions that often become reified in analytic controversies: structural theory versus relational psychoanalysis, traditionalism versus revisionism, oedipal versus pre-oedipal, modernist versus postmodernist and hermeneutical versus scientific. The article examines how Eros, understood in terms of the psyche's synthetic strivings, plays a major role in Loewald's theory. The author also situates Loewald's position within contemporary psychoanalytic discussions of epistemology. These discussions tend to criticize the objectivism of modern science-and analysis in so far as it models itself on science-and stress countertransference and the subjectivity of the analyst. Loewald's argument, however, runs in the opposite direction. Because of his concern with the autonomy and individuality of the patient, he is concerned with the clinical dangers rising from an overemphasis on the subjectivity of the analyst.
The underlying positivist philosophy of medicine and the emphasis on 'knowing' can induce a shame response when doctors perceive they have failed. In contrast to guilt, shame affects the whole of the self and may diminish the doctor's ability to accept his or her own illness, respond to a disciplinary complaint, or consider clinical supervision. Consideration of the polarities of practice can help doctors respond to mistakes, errors, or wrongdoing with guilt rather than with shame. This places a perceived failure outside the self of the doctor, enabling restoration of relationships and learning from clinical experience. This will benefit both doctors and patients.
Post-traumatic stress disorder is currently classified as an anxiety disorder with fear as the predominant emotion. This has led to the development of treatment techniques such as exposure aimed at alleviating fear. This article highlights the need to address other emotional responses, in particular shame and guilt, when assessing and treating PTSD. Hence, it presents two clinical models of shame-based PTSD and guilt-based PTSD. These models are offered as aids to clinicians in assessing and formulating cases of PTSD where shame and guilt are salient issues. The models highlight the importance of assessing meaning in the context of pre-existing schemas and address two pathways to the development of shame and/or guilt: schema congruence and schema incongruence. Several treatment implications are drawn from the models.