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Sabina Spielrein: out from the shadow of Jung and Freud.

Since the 1982 publication of Aldo Carotenuto's book, A Secret Symmetry: Sabina Spielrein Between Jung and Freud, there has been renewed interest in the life and work of Sabina Spielrein. She was Jung's first psychoanalytic case at the Burghölzli Hospital in 1904, and was referred to several times in The Freud/Jung Letters. Spielrein recovered, enrolled in medical school, and went on to become a Freudian analyst. Her most famous paper, published in 1912, 'Destruction as a cause of coming into being', was referred to by Freud in 1920 in relation to his Death Instinct theory. In the few Freudian publications on this controversial theory since 1920, Spielrein's contribution is consistently omitted. Jung also neglected to refer to her 'Destruction' paper in his early 1912 version of 'Symbols of transformation', even though he had edited her paper and had promised to acknowledge her contribution. He did refer extensively to Spielrein's first paper, her medical thesis, 'On the psychological content of a case of schizophrenia', published in 1911, as yet unpublished in English. In her paper Spielrein sought to understand the psychotic delusions of Frau M, a patient at the Burghölzli, much in the style of Jung's 'Psychology of dementia praecox' (1907). The purpose of this paper is to explore to what extent Spielrein's Frau M paper, and its companion 'Destruction' paper, make an original contribution to both Jung and Freud's emerging theories on the possible creative versus destructive outcomes of neurotic or psychotic introversion, culminating in Jung's concept of the 'collective unconscious' (1916) and Freud's concept of a 'Death instinct' (1920).

Female↗

The mystical effects of dermatological vehicles.

Topical treatment of the skin is as old as the evolution of man. Instinctively, we try to treat a skin injury or irritation with cooling or soothing substances. Even animals lick their wounds, trusting instinctively in the healing power of saliva. When did this archaic pattern of treatment take the gigantic leap from folk medicine to modern drug therapy? This text illustrates the evolution of topical dermatological vehicles, their application (guidelines) and future use. In particular, a phenomenon that has so far been ignored in product development and clinical testing is the vehicle metamorphosis. In clinical and experimental situations, most dermatological vehicles undergo considerable changes after they have been removed from the primary container and are applied to the skin. Subsequently, the initial structural matrix, and the quantitative composition of the vehicle, will most likely change during and after the mechanical shear associated with application of the product and/or evaporation of ingredients. This natural, but highly dynamic process will generate mini-environments for the active moiety that are difficult to predict and that are crucial to the fate of the active moiety. Despite the reasonable wishes of formulators, clinicians, patients and customers, there are still no universal vehicles. Each drug, at each concentration, requires a different vehicle for optimized therapy. Stability and compatibility of excipients and active moiety are crucial for any commercially available pharmaceutical or cosmetic formulation, together with local and systemic safety of all components. Nonetheless, more diverse and molecularly complex classes of new dermatological vehicles are continuously being researched and refined. The scientific progress has been remarkable when one considers the simple emulsion mixtures that were commonplace in dermatological therapy and still persist to this day in commercial products. It is to be hoped that the result of these research endeavors will be the emergence of more innovative topical formulations, applying engineered bioavailability control systems, with broader applications in topical therapeutic and cosmetic vehicles.

Administration, Cutaneous↗

The experience of therapeutic touch from a nursing perspective.

This article describes the phenomenon of therapeutic touch (TT). Similarities and differences in the experience of the phenomenon from the perspective of a novice practitioner and healthy volunteers are highlighted. A qualitative analysis of findings indicates that the experiences of giving and receiving TT can be classified within two categories: the cognitive (knowing in the widest sense); and conative (instinct and feeling). The key constructs which emerged in this study are associated with feelings such as tingling, warmth, coolness, comfort, peace, calm and security. Formulation of the two main categories, cognitive and conative, emphasize the relationship associated with what is known by the mind and instinctively felt by the body. The holistic aspects associated with the phenomenon of TT are confirmed in the therapeutic relationship which can be formed between the practitioner and recipient during the administration of TT. It is suggested that TT, when provided by the nurse in the clinical setting, can promote feelings of comfort, peace, calm and security among patients.

Adult↗

Laughter: nature's epileptoid catharsis.

The ability to laugh, like other favored behavioral traits, may have evolved over many generations in response to environmental stresses favoring reproduction among successfully adapted people. This speculative overview depicts laughter as a symbolically-triggered release mechanism that unleashes instinctive drive energies associated with survival, in the process lowering anxiety. The use of humor to trigger the laugh reflex has become a cultural activity in which unacceptable impulses are expressed in an acceptable manner. As this occurs, there is an emancipatory release of repressed energies and assorted conflicts are "resolved". An attempt is made to examine the neurological events of laughter; here, there is a suspension of cortical-diencephalic inhibitory control, and tensions are discharged from lower centers, the presumed custodians for some of the encoded programs of instinct and emotion.

Abreaction↗

When to trust your gut.

Many top executives say they routinely make big decisions without relying on any logical analysis. Instead, they call upon their "intuition," "gut instinct," "hunches," or "inner voice"--but they can't describe the process much more than that. What exactly is gut instinct? In this article, author Alden Hayashi interviews top executives from companies such as America Online and Johnson and Johnson to find out how they make decisions. Hayashi also presents the research of leading scientists who suggest that our emotions and feelings might not only be important in our intuitive ability to make good decisions but may actually be essential. Specifically, one theory contends that our emotions help us filter various options quickly, even if we're not consciously aware of the screening. Other research suggests that professional judgment can often be reduced to patterns and rules; indeed, truly inspired decisions seem to require an ability to see similar patterns across disparate fields. A CEO who possesses that ability can craft a perfect strategy by detecting patterns that others either overlook or mistake for random noise. But various traits of human nature can easily cloud our intuitive decision making. One potential pitfall is our tendency to see patterns where none exist. Thus, continual self-checking and feedback are crucial, and some organizations have made these processes part of their corporate culture.

Administrative Personnel↗

[Nightmares and behavior during REM sleep].

This study reports the current neurobiologic data on REM sleep including psychoanalysis, distinguishing between the "instincts of pleasure" and the "instincts of death" (Beyond the principles of pleasure, S. Freud, 1920). The award and punishment systems are also reported and current data related to nightmares and mainly dream behavior during REM sleep without atonia are presented underlining the frequency of parasomnia in ponto-cerebellous atrophy and Parkinson's disease. The author emphasizes the need for establishing discussions among the different neuroscientific fields related to these questions.

Atrophy↗

Beta-adrenergic stimulation modulation of heart rate via synchronization of ryanodine receptor Ca2+ release.

A robust "fight or flight response", largely mediated via acute beta-adrenergic receptor (beta-AR) stimulation to the heart to increase its beating rate and contractile performance, is an essential component of the vertebrate survival instinct. While it has long been recognized that activation of beta-AR increases the spontaneous beating rate of sinoatrial nodal cells (SANC), specific links between stimulation of beta-ARs and the resultant increase in firing rate have not been evaluated. Our recent studies employed imaging of subcellular Ca2+ release coupled with recording of membrane potential or current in single, isolated cardiac SANC, to seek novel links between beta-AR stimulation and ryanodine receptor Ca2+ release and heart rate. An overview of these recent results, which provides novel insights into mechanisms of cardiac reserve that underlie the "fight or flight instinct, is presented here.

Algorithms↗

Don't trust your gut.

Making high-stakes business decisions has always been hard. But in recent decades, it's become tougher than ever. The choices facing managers and the data requiring analysis have multiplied even as the time for analyzing them has shrunk. One simple decision-making tool, human intuition, seems to offer a reliable alternative to painstaking fact gathering and analysis. Encouraged by scientific research on intuition, top managers feel increasingly confident that, when faced with complicated choices, they can just trust their gut. The trust in intuition is understandable. But it's also dangerous. Intuition has its place in decision making--you should not ignore your instincts any more than you should ignore your conscience--but anyone who thinks that intuition is a substitute for reason is indulging in a romantic delusion. Detached from rigorous analysis, intuition is a fickle and undependable guide. And while some have argued that intuition becomes more valuable in highly complex and changeable environments, the opposite is actually true. The more options you have to evaluate, the more data you have to weigh, and the more unprecedented the challenges you face, the less you should rely on instinct and the more on reason and analysis. So how do you analyze more in less time? The answer may lie in technology. Powerful new decision-support tools can help executives quickly sort through vast numbers of alternatives and pick the best ones. When combined with the experience, insight, and analytical skills of a good management team, these tools offer companies a way to make consistently sound and rational choices even in the face of bewildering complexity--a capability that intuition will never match.

Administrative Personnel↗

[High immunization rates--how can they be achieved at all?].

High rates of immunization are achieved not only by compulsory vaccination. Strict discipline is necessary as well as motivation of medical assistants and of patients in their social environment. All people have a natural instinct for protecting themselves against risks of life. This instinct can in fact be stimulated by repeated motivation and can be enforced by propaganda. The process of propaganda alone cannot stimulate urges. Strategy of immunization must be standardised in all districts of the Federal Republic. This means: immunisation schedule, information of patients, children and of their parents. This is part of discipline of vaccination, same as is the permanent training of medical staff. They should be sent to seminars and training workshops. Specialist opinions must be differentiated as to whether they are scientists or articulate their own and personal opinion or whether their attitude is conditioned by general medical considerations. Any legal claims arising from vaccination accidents would be decided 'in dubio pro aegroto'.

Child↗

The Eros of dreaming.

This paper examines the aspects of dreaming derived from the principle of Eros, the life instinct as described by Freud in Beyond the Pleasure Principle. The life instinct is interpreted in information-processing terms, as the inverse of entropy. The paper emphasizes the role of condensation as a mechanism that binds together the representations of present and past events in the imagery of the dream. This distinguishes it from displacement, which appears to be a mechanism whose function is solely defensive. The role of the dream in finding a common ground between current and past experience (Galton's method of comparison by superimposition) is discussed in detail. It is suggested that condensation is a primitive cognitive mechanism at work in many kinds of mental activity. The implications of this idea for psychoanalysis and for the creative process in general are explored in brief.

Dreams↗

Strategic intensity: a conversation with world chess champion Garry Kasparov.

It's hard to find a better exemplar for competition than chess. The image of two brilliant minds locked in a battle of skill and will-in which chance plays little or no apparent role-is compelling. Even people who have scant knowledge of the game instinctively recognize that chess is unusual in terms of its intellectual complexity and the strategic demands it places on players. Can strategists learn anything from chess players about what it takes to win? To find out, H BR senior editor Diane L. Coutu talked with Garry Kasparov, the world's number one player since 1984. Kasparov believes that success in both chess and business is very much a question of psychological advantage; the complexity of the game demands that players rely heavily on their instincts and on gamesmanship. In this wide-ranging interview, Kasparov explores the power of chess as a model for business competition; the balance that chess players strike between intuition and analysis; the significance of his loss to IBM's chess-playing computer, Deep Blue; and how his legendary rivalry with Anatoly Karpov, Kasparov's predecessor as World Chess Champion, affected his own success. Kasparov also shares his solution to what he calls the champion's dilemma, a question for all world masters, whether they are in business, sports, or chess: Where does a virtuoso go after he has accomplished everything he's ever wanted to, even beyond his wildest imagination? If you are lucky, says Kasparov, your enemies will push you to be passionate about staying at the top.

Commerce↗

[A reminder of the legacy of Sigmund Freud].

In September 1989 fifty years elapsed since the death of Sigmund Freud, the founder of psychoanalysis. The authors recall selected topical ideas from the work of Freud. At the same time they draw attention to the importance of his studies for the left-wing student movement in Czechoslovakia between the two world wars. Initial attempts of a close association of psychology with the nervous substrate did not succeed but led later to the original explanation of converse mechanisms. In his own way Freud anticipated contemporary bio-psycho-social concepts. Gradually subconsciousness was conceived as Freud's most important discovery. Energy for mental life was sought in the sphere of instincts, in particular the sexual instinct, Freud extrapolated his reflections into the social sphere and elaborated his understanding of group psychology, using mechanisms of the individual psychic make-up. From this he derived regulatory mechanisms of civilization. Freud believed in reason represented to him by science. He considered religion illusionary happiness and warned also against the so-called chemical path. He denounced war unequivocally and had his own ideas how to reduce its probability.

Austria↗

The devil or the sea? Transfer regs create a dilemma.

With the advent of strict federal regulations, physicians considering whether to transfer patients seeking emergency treatment can find themselves between the devil and the deep blue sea. Do they spar with the diabolical guidelines and follow their best medical instincts and training? Or, do they abandon their instincts and training and depend on a regulatory life preserver to keep their heads above water? Victoria obstetrician/gynecologist Michael L. Burditt, MD, embodies this unenviable dilemma. After he ordered the transfer of an indigent pregnant patient from Victoria to Galveston, the federal government accused him of knowingly making an inappropriate decision to transfer. Dr Burditt appealed the government's ruling, and the confrontation eventually led him to the courtroom in the nation's first test of the 1986 law that prohibits patient "dumping." Dr Burditt came close to settling the case, but, with assistance from the Texas Medical Association, the Victoria-Goliad-Jackson County Medical Society, and the American Medical Association, he's still in the fight. At the heart of the case is the issue of guaranteeing physicians due process in the review system for transfers. (Due process, the physician's right to be heard before fines or sanctions are imposed, is guaranteed in Medicare's quality review procedures, but not in transfer reviews). The case is in the hands of an administrative law judge, who is expected to hand down a decision in June. This article examines Dr Burditt's case in light of developments that brought hospital transfers under federal scrutiny.

Female↗

Analysis terminable and interminable: a half century retrospective.

Elucidating issues of profound importance, 'Analysis terminable and interminable' stimulated the advance of psychoanalytic thought while in some respects paradoxically reactivating antiquated ideas. Soberly realistic about analytic outcome, Freud indicated that conflict could not be permanently resolved or the ego definitively strengthened. He emphasized some important aspects of constitution, such as strength of the instincts, libidinal adhesiveness, free aggression, and psychic fluidity or rigidity. Considering the influence of experience, he regarded the more accidental traumatic neurosis as having an unusually favourable prognosis. While concurrently advancing dual drive theory and ego psychology, Freud also paradoxically returned to concepts of ego instincts. His proposals concerning the bedrock of bisexuality have been extended and deepened, but the 'repudiation of femininity' requires theoretical qualification. Problems of termination thread through the entire essay. Freud pondered the nature of termination as well as incomplete, completed, periodic, and interminable analysis. His observations both preceded and contributed to the subsequent formulation of a terminal phase. He recognized that analysts might require re-analysis and hoped that the analytic process would continue after termination in the analyst's self-analysis.

Ego↗

[Psychodynamics of psychogenic somnolence (secondary narcolepsy). Case report].

The therapy of a patient suffering from secondary narcolepsy is described. The illness and the function of the symptom as a defense-mechanism are analysed. Sleep appears to be an ontogenetically archaic reaction to extreme--real and neurotic--dangers, which there is not possibility to escape from. The defense against extreme dangers is the withdrawal of all object-cathexis; following Freuds explanations this means: Sleep. In the patient the danger consisted of a regression to a narcisstic position: The symptom helped to avoid a separation of instincts in form of on the one hand narcisstic rage, on the other hand symbiosis. Taking into account the ideas of Spitz, the concept of fusion and separation of instincts is discussed.20

Adult↗

The amygdala: historical and functional analysis.

The amygdala, part of the limbic system, is a small collection of neurons located in the ventral temporal lobe, and can be divided into two morphologically and functionally distinct nuclei - the corticomedial, a phylogenetically old group, and the basolateral, a phylogenetically more recent group. Both divisions of the amygdala have extensive interconnections with the hypothalamus, the corticomedial nucleus via the stria terminalis and the basolateral nucleus via the ventral amygdalohypothalamic pathway. The amygdala receives input from the orbital frontal cortex, the piriform cortex, the hypothalamus, the thalamus, and all sensory modalities as well as from the other structures of the limbic system. Early theories positing strictly emotional, olfactory, or visceral functions for the amygdala are at best incomplete. An intact amygdala seems to be essential for the successful performance of behavior patterns such as instinctive food getting and instinctive defensive reactions that are necessary for the survival of the individual organism and the species. Ablation of the amygdala produces many behavioral deficits that center around the inability to integrate changes in reinforcement contigencies into new behavior patterns.

Amygdala↗

[Phlegmatic temperament from the psychiatric angle].

Unlike the other five deadly sins of the Church, sloth is not attributed to an instinct or an impulse but to an anancastic form of reaction. A phlegmatic person is characterised by a lack of egoistic or altruistic instincts while feelings of nausea or fear are increased. Among phlegmatic persons those of clinical importance are epileptoid psychopaths, oblomovists and those exhibiting (forms of) phlegmatic temperament combined with obsessional or hysterical neurosis.

Antisocial Personality Disorder↗

War, revolution, and psychoanalysis: Freudian thought begins to grapple with social reality.

Psychoanalytic theory and practice have been affected by external events as well as by internal development. Specifically, the period of the Great War and its aftermath was a turning point in the history of psychoanalysis. These experiences emphasized the inadequacy of the libido theory alone, accelerated Freud's impetus toward metapsychology, and encouraged the articulation of theories of innate destructive urges, of ego instincts, of the superego, and of social interaction. Discussions of war neuroses, of aggression and the death instinct, of the reality principle, and of the mechanisms of social psychology undermined Freud's original biologism in favor of a social-scientific approach. Psychoanalytic theory began to take more account of social experience and was profoundly changed in the process.

Austria↗