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PubMed1991

Sadomasochism in the perversions: some thoughts on the destruction of reality.

The author summarizes and develops some of her viewpoints on the perversions (outlined in several of the books and articles she has written). For her all the perversions, whatever their content, develop against an anal sadomasochistic backdrop. Their aim is to destroy reality. Reality, from a psychosexual perspective, may be defined as resulting from the existence of the father separating the mother and the child. This may be formulated in another way: reality is recognition of sexual and generational differences. Or, yet again: mother and father have a procreative sexuality, whereas the child does not. This leads to the idea that the destruction of reality is equivalent to destruction of the paternal universe. Clinical case illustrations are provided, one of which centers on the assassination of an old man who, besides representing a paternal oedipal image, also represents reality itself. This case illustrates in concrete form the murder of the father, and hence of reality, accomplished by the pervert when he eradicates the paternal dimension of psychosexuality by regressing to the anal sadomasochistic dimension.

Fantasy↗
PubMed1995

[Psychoanalytic aspects of crisis and crisis intervention].

"Crisis" is defined as the lack of the development of defense- and/or coping-mechanisms in the conflict between drive-claims or narcissistic needs versus the influences of the super-ego and/or conditions of outside reality. The term crisis, introduced by Erich Lindemann (1944), characterizes a state which was already known to Sigmund Freud. Central to his thought was an antagonism between the pleasure principle dominating the unconscious and the reality principle being directed toward the outside world. Different possible causes of crises are for example sudden and unexpected intrusions in a life situation which was previously experienced as stable, or a narcissistic trauma and loss that could not be worked through as grief and that lead to a reactive-depressive state, or a shock resulting from demands of the super-ego during inner or outer experiences. Principles of a psychoanalytically oriented therapy are discussed, the outcome of which is the better, the more there is a good working alliance and good development of insight.

Adaptation, Psychological↗
PubMed1987

Effects of oedipal triumph caused by collapse or death of the rival parent.

It is suggested that the threat of castration at the phallic-oedipal phase results in repression, effecting no change in the unconscious fantasy, that the resolution of the Oedipus complex depends on developments during latency and adolescence, and that during this period one of the determinants impeding the resolution may be the collapse or death of the rival parent. Death of the oedipal rival results in a confusion of the unconscious wish with an external happening. The child, unable to cope with the consequent guilt, resorts to repression. Thus, the critical aspects of the oedipal triumph remain potentially operative in the unconscious, hindering the patient's functioning in all closely associated areas. Three clinical illustrations of oedipal triumph are described to indicate some of the psychodynamic issues that arise in the analysis of such patients. Of particular importance are: the concept of reality testing; differential adaptation to the unconscious sense of guilt; the varying degrees of resistance evidenced in the analysis of such patients; and the impact of oedipal determinants in differential outcome of bereavement.

Adult↗
PubMed1988

The psychoanalysis of time.

The experience of time has been studied psychoanalytically largely through the conceptual frameworks of ego psychology and classical analysis. The implications of self psychology and Lacanian theory for understanding time experience have been relatively little explored. These implications would develop, on the one hand, from Kohut's investigations of fragmentation phenomena and, on the other, from Lacan's concept of the ego and his use of the short session. But time experience cannot be understood entirely in terms of individual histories and the psychoanalytic situation. A preoccupation with time is central to Western culture and is traceable to the social context--thirteenth-century monasticism--in which the clock was first invented. Time enters the analytic session especially in the handling of beginnings and ends, reflecting divergent notions of the purpose of treatment. The standing of time-frame rules in the different systems defined by ego psychology, self psychology, and Lacanian theory are examined together with their underlying assumptions about the nature of reality. These metaphysical issues--no longer academic but made concretely meaningful in each session--go beyond illuminating the concept of time. Our response to them will determine both the direction of each patient's treatment and the course of psychoanalysis itself.

Adult↗
PubMed1991

Internalization of the absent father.

The analysis of a woman, born of an unmarried mother, is presented. Her mental representation of the fantasized father was derived partly from her own wishes and fears, partly from what she was told by her mother, and partly from what she discovered through her own observations and enquiries. The revival in the transference of the split-off parts of her self and of the related bipolarity in her representation of the absent father, the search for their origin in her childhood, the discussion of their operation in her present and past relationships, and the working through of her resistances to change, enabled her to integrate the split-off parts of her self, and to maintain stable relationships. The child's need to internalize a father, whether or not the latter exists in reality, raises the question whether human offspring have an innate propensity to relate to a father, or a father introject, even when the latter is derived from fantasy alone.

Adult↗
PubMed1996

Playing with reality: I. Theory of mind and the normal development of psychic reality.

The authors of this paper discuss changes in the child's perception of psychic reality during normal development, highlighting a major shift in the child's understanding of minds ('theory of mind') at the oedipal stage. They illustrate this transition with material from the analysis of a 4-year-old girl. They maintain that the very young child uses two forms of psychic reality, which they have called 'psychic equivalent' and 'pretend' modes, which differ primarily in the assumed relationship between internal and external realities. The integration of the dual modes into a singular reflective mode is normally completed by about the age of 4, with affect leading cognition: the child first understands that people have different feelings, then that they may have different thoughts about the same external reality. The authors describe normal psychological growth and neurotic pathology, in which the integration of these two modes of functioning has been only partly achieved.

Adult↗
PubMed2000

Adjuvant therapy for gastric cancer: a reality at last.

Gastric cancer remains a significant healthcare problem throughout the world and is usually diagnosed at a fairly advanced stage in the West. Despite complete resection of the primary tumor, most patients eventually experience a relapse and die of recurrent disease. Extended surgery has not been shown to improve survival in Western studies. There have been a large number of adjuvant chemotherapy trials over the past several decades, most with negative results. More recently, there is hope for improving these dismal results with a meta-analysis showing a benefit for adjuvant chemotherapy and a large randomized trial, INT-0116, which has just reported a significant survival advantage with combined chemoradiation. These results make adjuvant therapy for completely resected gastric carcinoma the new standard of care, except in the uncommon setting of early intramucosal cancers.

Antibiotics, Antineoplastic↗
PubMed1994

Phantasy and reality.

To mark the fiftieth anniversary of the Controversial Discussions the author has selected the interplay between phantasy and reality for further consideration. Basing her thinking on her reading of Klein and Freud she reviews her own contribution to symbolic forms of expression--the distinction between a symbol and a symbolic equation--which combine phantasy and reality and articulates this with the recent work of the philosopher Wollheim. She restates her argument that the early processes of symbol development and their pathological variations are analysable through an understanding of the patient's relationship to the analyst, offering as it does an opportunity to explore and analyse the influence of phantasy and reality in influencing how the patient perceives the analyst and acts towards her. This view is illustrated with material from several cases leading on to a discussion of the nature and function of phantasy, delusion formation and phantasy-testing leading to thought.

Defense Mechanisms↗
PubMed1997

The intuition of the negative in Playing and reality.

The author draws some parallels between his own conceptions on the work of the negative with some ideas presented by Winnicott in the ultimate version of his paper on 'Transitional objects and transitional phenomena'. He underlines the germs of the intuition of the negative in Winnicott's general theory ('not me possession', transitional object as not being the breast, the decathexis of the representation of the object). He then goes on to examine in detail the clinical material of a patient, in the last part of the paper, which has been published posthumously. In this last part the negative is mentioned explicitly and the idea is openly presented. We have here a concept of which Winnicott had the intuition without having the possibility of considering its full development and implications. It so happened that the patient whose clinical material is published in 'Playing and Reality' came to the author to continue her analytic experience. One can compare the material presented in these two analytical relationships. The author comments about his relationship with the patient and of the way she meets his own hypotheses.

Adult↗
PubMed2000

Love in the therapeutic alliance.

Volumes have been written about the patient's love for the therapist, but there has been relatively little discussion of the therapist's love for the patient. In an attempt to create a theoretical and technical space for discussing the appropriateness and role of love in the therapeutic relationship, a revised concept of the therapeutic alliance is applied to provide technical guidelines and understanding of two kinds of love between patient and therapist, corresponding to two systems of self-esteem regulation: an open, reality-oriented system and a closed, sadomasochistic system organized according to omnipotent beliefs. Examples of the role of love through the phases of treatment illustrate the interrelationship of love and the accomplishment of therapeutic alliance tasks.

Adult↗
PubMed1993

Concepts of reality and psychic reality in psychoanalysis as illustrated by the disagreement between Freud and Ferenczi.

In this paper, the concepts of reality and psychic reality are discussed in relationship to a number of controversies about the therapeutic and scientific aims of psychoanalysis, as illustrated by the disagreement between Freud and Ferenczi. Because the nature of psychic reality is necessarily incomplete and indeterminate, there are inherent limitations and dangers to any psychoanalytic attempt to discover historical and experiential truth. Modell's interpretation of Nachträglichkeit ('deferred action') as 'retranscription' expresses the ambiguity of psychic reality in analysis, which is not fixed or foundational but part of an evolving inner and outer dialogue in relation to new experience. It is argued that Freud accepted this ambiguity, while Ferenczi sought to overcome it through modifications of technique.

Freudian Theory↗
PubMed2005

Guidelines for the treatment of Alzheimer's disease from the Italian Association of Psychogeriatrics.

A committee of experts from the Italian Association of Psychogeriatrics compiled the following report, which was then approved by a Steering Committee (comprising 20 specialists in neurology, psychiatry or geriatrics) from the Association and by two Alzheimer associations representing patients and families: the Italian Association for Alzheimer's Disease and the Italian Federation for Alzheimer's Disease. The report is based on a comprehensive review of the scientific literature on the treatment of Alzheimer's disease, discusses methodological aspects of dementia management, and details the limitations of current therapies. These guidelines are, in general, consistent with the principles of evidence-based medicine; however, for some controversial or poorly investigated issues, the guidelines integrate scientific evidence with experience and opinions from experts working in the clinical setting. In particular, the clinical experience of experts has been used to define recommendations for starting and interrupting pharmacotherapy, and to critically review evidence about the efficacy of non-pharmacological interventions. The principal pharmacotherapeutic interventions covered in the guidelines are acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine, and tacrine) and memantine. The main non-pharmacological interventions reviewed are memory training, reality orientation therapy, and combined non-pharmacological interventions. Other issues covered are opportunities for Alzheimer's disease prevention, various modalities of care, and the treatment of comorbidities.

Aged↗
PubMed2003

Stem therapy for ALS: hope and reality.

All are agreed that there is pressing need for an effective treatment for Amyotrophic Lateral Sclerosis (ALS; MND). Such treatment may derive from a combination of therapeutic strategies aimed at different aspects of the disorder, and might include drugs directed at the initial, intermediate or terminal cascade of events leading to cell death, as well as the use of stem cells to replace dead motor neurons, or to protect those that remain. The attraction of cell implantation or transplantation is that it might help to overcome the inability of the CNS to replace lost neurons. It is also clear that neural implantation will yield little benefit if the donor cells fail to integrate functionally into the recipient CNS circuitry. In this respect, ALS poses an especially difficult problem. The recent breakthroughs in stem cell research might nevertheless provide possibilities for neural implantation and cell replacement therapy for patients with ALS. The potential impact of these new approaches to neurodegenerative diseases has been emphasised by the many experiments using human foetal cell grafts in patients affected by Parkinson's and Huntington's disease. Clinical benefits in Parkinson's disease seem to be associated with integration of the donor cells into the recipient brain. Despite promising results, however, significant constraints have hampered the use of foetal cells for neural implantation and transplantation. Besides ethical concerns, the viability, purity, and final destiny of the foetal tissue have not been completely defined. Foetal cells are, in addition, post-mitotic and cannot be expanded or stored for long periods, necessitating close synchronisation of tissue donation and neurosurgery.

Amyotrophic Lateral Sclerosis↗
PubMed1995

Trauma and symbol. Instinct and reality perception in therapeutic work with victims of incest.

With the help of the conceptualizations of Amati and Bleger, and of Jung, the loss of instinctual experience and reality sense in the victims of incestuous abuse is described as an extreme regression to a primary undifferentiated stage of development: that of 'ambiguity' and 'identity'. At this stage the identity of the victim is taken over by that of the aggressor and becomes petrified in a form of mimicry. Differentiation processes are partially blocked. Through the therapeutic work with a woman who was sexually abused as a child, and whose daughter was also being incestuously traumatized, it is demonstrated how, through the use of fantasy, the instinctive reaction of thanatosis can be given up, together with the attempt to find meaning through self-sacrifice, which continually places the victim in renewed danger. By means of activating the transcendent function, the positive pole of the archetype can be set up as a counterforce in the internal world which was once feared like an abuser, and thus as a balance to the images of actual historical violation. The positive pole of the archetype then allows the inner world to loosen itself from the tangled aggressive and auto-aggressive layers of identity. This leads to a revival of protective instinctual reactions and to an improvement in reality functioning. It is emphasized that it is not the recall of actual abuse that promotes therapeutic progress but the evolving symbolizations. The analysis of the symbolic experience leads to the following conclusion: the hypothesis that, on the grounds of positive feelings, the children 'have also wanted' the incestuous activity, cannot be upheld.

Adolescent↗
PubMed1985

Three principles of mental functioning in psychoanalytic theory and practice.

In this essay I have reformulated the relationship of the pleasure principle, reality principle, and Nirvana principle. I have linked this conception of the three principles of mental functioning to the idea of the paranoid-schizoid position. And I have attempted to demonstrate the utility of these various notions for illuminating the analyst's sleepiness during analytic sessions.

Adult↗
PubMed1994

Cognitive therapy as a tool for caring for the elderly confused person.

With the increase in the numbers of elderly people, methods to improve the quality of life for this population has never been more relevant. As the primary carers for this group of people, nurses are likely to be faced with this task. Cognitive therapies such as reality orientation, validation, reminiscence and life review, can help to maintain or improve aspects of cognitive or behavioral functioning for the elderly confused. If this in turn can increase life satisfaction for those elderly suffering from dementia then cognitive therapies must be addressed as means to improve individual quality of life. Existing research offers contradictory evidence as to the practical application and usefulness of such therapies. More substantial research must be undertaken in the area, addressing nursing perspectives with regards to the implementation of cognitive therapies. The author maintains that the cognitive therapies discussed in this paper have great potential for use within care of the elderly and despite controversial research results, can help to maintain or improve the quality of life for the elderly confused.

Aged↗
PubMed1984

[Value testing in psychoanalysis--reflections on an ego psychologic concept coined by Heinz Hartmann].

We have attempted to demonstrate the importance of the concept of value testing set forth by Hartmann in 1960 in terms of both clinical practice and the theory of psychoanalysis. We use a case study to illustrate the way in which this subfunction of the inner reality testing ties in with the subfunction of signal guilt (the function of affect differentiation as one of the subfunctions of the perception of internal reality) and with the anticipation of the interpersonal effect of one's own behavior and the appropriateness of this behavior as subfunctions of judgment. In conclusion we discuss the suitability of the concept of value testing as a way of relating the psychoanalytic idea of the moral organization of action to the ethics of utilitarianism.

Ego↗
PubMed1995

[Fragmented psychotherapy of a boy returned from Bergen-Belsen].

Like an artist giving expression to his vision of reality, the psychoanalyst is also guided by a certain vision of psychic reality. With reference to the case of an orphan boy who survived Bergen-Belsen, the author traces the difficult process of attaining empathy with a vision of reality marked by the years spent in a concentration camp and the world of unimaginable horrors experienced there. After a long period of silence in which a relationship of trust was gradually built up, the young man found it possible to find expression for his un-utterable experiences, his unrest in the unconscious. The word Bergen-Belsen had become utterable.

Child↗