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PubMed1984

[Sigmund Freud's ambition and Alfred Adler].

Freud never admitted to himself that he possessed a greater-than-average sense of ambition, which manifested itself in dreams, malachievement and priority problems. A completely new picture of Freud arises from such a perspective. Freud experienced childhood trauma in the form of his relationship with his nephew, John, in whom both an intimate friend and hated enemy were incorporated. This experience left a life-long impression which predetermined the neurotic element in Freud's relationship with men. Freud's own interpretation being that he had been betrayed by Breuer, Fliess, Adler and Jung. That is why the sentencing of his Uncle Joseph to a term of imprisonment had such far-reaching consequences for Freud. A further noteworthy observation is the close connection between ambition and death wishes and also between ambition and guilt feelings. Who, after all, likes to admit to harbouring such feelings? It appeared necessary to investigate the extent to which Freud's excessive ambition influenced his relationships with Breuer, Fliess and Adler. Freud was never prepared to recognize that Adler's contribution consisted of revealing the importance of the natural laws governing those layers of the psyche nearer to the conscious. The picture of the whole person emerges only by a combination of psychoanalysis and individual psychology.

Emotions↗
PubMed1984

Reflections on Dora: the case of hysteria.

It is with Dora that psychoanalysis becomes what we know it to be: the problem of the transference is introduced for the first time in her case. Although the number of papers written on this case is astonishing we still want to know more and more about her. Maybe this is a characteristic of the hysteric: it tantalizes us, waving a cape--like a bullfighter--that hides nothing behind it. In the second part of this paper, I refer to certain changes in psychoanalytic theory which would account for the apparent 'disappearance' of hysteria. In the third part, I relate hysteria to femininity. I suggest there is an hysterical stage in the development of women, characterized by divalence. Whilst ambi-valence describes a situation in which the subject has to decide whether he loves or hates his object, divalence would describe the situation in which the subject is confronted with the choice between mother and father, within the context of the oedipal drama. This is specifically feminine because it is the woman who has to change from one to the other in her development. When the subject gets 'fixed' to this stage, we find an hysteric who cannot determine the object of her desire, and she will always remain in the middle, unable to choose between mother or father, incapable of defining herself as a woman or a man--in spite of her apparently sexualized 'feminine self'.

Female↗
PubMed1978

Capgras syndrome: case report of an adolescent and review of literature.

Case report of an adolescent with Capgras Syndrome in the absence of organic brain syndrome is presented. Four cardinal features associated with Capgras Syndrome--(1) moderate-to-severe anxiety or stress, (2) ambivalent love-hate relationships with important love objects, (3) body image distortion, and (4) rejection-abandonment phenomena--were developed vis-a-vis the developmental tasks of adolescence. The literature consisting of 75 case reports is reviewed from the standpoint of differential diagnosis especially with respect to organic brain syndromes and schizophrenia.

Adolescent↗
PubMed1982

[Mother-child relationship and psychosocial dwarfism].

Results of a study of 11 children presenting what is known as psychosocial dwarfism are discussed. Clinical observations and projective tests (Rorschach) show the crux of the problem within the mother-child relationship to originate in reciprocal feeling of hate between mother and child. This hatred constantly manifests itself in daily life through acts and behaviour rather than through verbal expression. These results are in agreement with our findings in the psychotherapies of one child and one mother. Characterizing the mother-child relationship as ont of aggressiveness and hatred fits with other author's findings who describe the mother's neglect and rejection. However we think it is more adequate as it applies to both ends of the relation: mother on one hand, child on the other.

Adolescent↗
PubMedDate not supplied

Expiation as a defense.

This paper presents a specific defense mechanisms that leads not only to the stagnation of the analysis but also makes it difficult to terminate analysis. The predominance of what I call "expiation" demands continual punishment of the self and of internal objects in contrast with reparation. It is essential for the patient to maintain the immobilization of the analyst and of the analytic work. This defensive constellation aims at protecting the patient from the pain that comes from the guilt brought from the realization that his good and loved object is the same one that he hates and has attacked. Expiation is to be distinguished from the negative therapeutic reaction as well as from other problems in psychoanalysis. A case is presented. There is also a discussion of the relevant psychopathology and of the technical problems expiation poses, with particular attention to countertransference.

Adult↗
PubMed1994

[Phenomenological exploration of suicidal ideation].

Death fuels the idea of suicide with a strong emotional charge that often turns suicidal tendencies and suicide into one and the same. The idea of suicide, at times linked with depression and personality disorders, is nonetheless full of a meaning which deserves further research. Suicide can appear as a solution to a problem which the idea of suicide helps to identify and resolve. When it is a conscious realization, the idea of suicide can lead the patient to consult. As a danger signal, it allows to determine whether the individual's defense mechanism functions. Also, it attracts attention to a situation, reveals a form of repressed self-hate and even helps in passing from one life state to another, as in transition rituals described by anthropology.

Attitude to Death↗
PubMedDate not supplied

[The Dualism drive in Freudian theory].

The author discusses Freudian dualistic conception of drives and contends that it can be reduced to a monistic one, on the basis of modern conceptions of Biology, and after scanning the original writings of Freud on the subject of drive and instinct. The word Trieb (drive) is used by Freud as compared with Instinkt (instinct); in 1915 the concept is defined through its attributes: thrust, source, objet and goal; being object and goal contingent for the drive and fixed for instincts. The first dualism is love vs. hunger; the drives are either sexual or autoconservative. But Biology demonstrates today that all life movements are autoconservative. The second dualism, love vs. hate, and the third one, Eros vs. Thantos, interpreted through Biology, show that there is always a prevailing therm, the first one. In this view, instinct should be but one successful drive, "frozen" through time because of its very success, and transmitted through philogenetic channels, in order to be enlivened in each ontogenetic process.

Austria↗
PubMed1994

Splitting as a consequence of severe abuse in childhood.

Clinical data suggest that Kernberg's description of splitting as a defense mechanism is useful in conceptualizing the psychological consequences of abuse in childhood in certain patients. The splitting in these patients is similar to his description of splitting in borderline patients in that it compartmentalizes and sequesters certain overwhelming and painful ego states accompanying negative introjects of the betraying primary object and the betrayed self. These sequestered introjects, furthermore, act as automatons, generating behaviors that arbitrarily re-enact their content even though the patient remains consciously unaware of their historical meaning. Another consequence of the sequestration of these traumatic introjects is that their affects retain their initial power and primitive quality, unmodulated by the usual homogenizing process that is a part of the synthesis of part-object introjects into whole-object introjects; the sequestration, therefore, often painful in itself, must nevertheless be rigidly maintained lest traumatic anxiety in the face of overwhelming affects be re-experienced. Shengold calls the sequence of events that results in this brittle but stubborn painful constriction of the personality "soul murder." He borrowed the phrase from Freud who used it to refer to what Schreber had suffered at the hands of his sadistic father. That phrase--"soul murder"--may sound melodramatic, but it powerfully conveys what these patients communicate of their experience of themselves. As with Kernberg's patients, the defensive splitting serves to protect the positive introjects. These patients fear their negative introjects, even more than they feel uncomfortable about the split. They fear their desperate rage will destroy their love objects, and leave them feeling abandoned and hating themselves. As one of my patients put it: "I fear that my destructive anger will leave me all alone in a sea of rubble of my own making." In the transference, he feared destroying me and our positive bond. In these cases it would seem that the turning to splitting occurred at a later age than it does with Kernberg's borderline patients. His proposition is that the developmentally normal "splitting," related to the undifferentiation of the infantile ego, persists as a defensive splitting, perhaps as a consequence of a consistently derailed mother-child dialogue; whereas in my patients it would seem that the normal developmental splitting had waned as ego differentiation proceeded, but that in the face of overwhelming traumata at perhaps 3 or 4 years of age, the primitive defense was invoked regressively.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[Brief analytic essay on unconscious forces facilitating transgenerational repetition of physical or sexual abuse].

Transmission of abusive conduct is mainly determined by unconscious guilt and identification with the aggressor. The abused child is bound to split the parental object. The hostile side is eclipsed due to dependence and regression. Therefore deprived of the hated object, the guilt surges forcefully with the role reversal of the following generation. The former victim, whose identifications with the aggressor are actuated, discharges his guilt by projective identifications with the new victims. The ongoing splitting perpetuates the pathology of the relation.

Adult↗
PubMed1994

Destructive hostility: the Jeffrey Dahmer case. A psychiatric and forensic study of a serial killer.

We were involved as forensic experts in the case of the serial killer Jeffrey Dahmer. We discuss the scene and victim autopsy findings, with a brief consideration of the basic emotion of hostility. These findings support the thesis that at the basis of this serial killer's behavior were primary unconscious feelings of hate that he had channeled into a sadistic programmed destruction of 17 young men. The interview of the serial killer, the photographic scene documentation, and the autopsy findings stress the ambivalent homosexuality of the killer, his sexual sadism, his obsessive fetishism, and his possible cannibalism and necrophilia.

Adolescent↗
PubMed1994

The computerized medical record in action.

Before the advent of the IPS computerized medical record at Burlington, Zallen did not own a computer. Although he learned touch-typing in high school, he emphatically states that he hated it. The average age of the physicians on staff at Burlington is about 40, but few had extensive previous experience with computers. According to Zallen, all have adapted to the CPR with few tears or tirades. The physicians continue to "tweak" the system to customize their own scrapbook and templates. Lahey physicians who work at Burlington part time are using the system, although with more staff help. The CPR is alive and well at Burlington Health Center. HCHP physicians can and do use computers in their daily work, producing quality medical records that are readable and retrievable. Nonetheless, promises that computers will make records more complete and accessible and will improve quality measurement will be mere blather if the CPR doesn't make users' lives easier. My last question to Zallen was "How has this system made your life harder?" After one pensive second, he replied, "I really can't think of anything." To me, that is potent testimony that the CPR is not a techie's fantasy, but rather, a pragmatic, workable answer to the needs of 21st century medicine.

Computer Systems↗
PubMed1994

[Adolescence: viewpoints from adolescent psychiatry].

Adolescence is a phase of human development which is marked by a high vulnerability due to the ongoing psycho-physiological transformations. The regulation of the self-esteem is especially in danger in youngsters who went into adolescence with a marked burden of conflicts or who lived in families with disturbed intrafamilial dynamics. To be present as a partner and not to find the solutions for the adolescents' conflicts, to accept their questioning of what is established and to recognize their movements of reconciliation are the quite complex demands put on to the world of the adults. Adolescents urge us to a review of our own adolescence, to a balancing of hate and love, openness and rigidity, and to dialectic movements between disintegration and reintegration as well as between the generations. Any help, be it on the physical, the social or the psychic level, should be directed toward a restitution of the intrapsychic, intrafamilial or intergenerational balance; sociocultural factors have also always to be respected. The helpers--especially in a culture with rapid change--are often confronted with their own adolescence, which took place a generation before and mostly under totally different conditions.

Adolescent↗
PubMed1993

Doing obstetrics and staying alive.

Many family physicians have a love-hate relationship with childbirth care and struggle to balance their personal and family needs with the need to provide high-quality personal care during labour and birth. Many false assumptions undermine family practice obstetrics. Strategies are presented to simplify obstetric care for women and families while promoting reasoned self-care for physicians.

Adaptation, Psychological↗
PubMedDate not supplied

["Ageism": prejudice against age].

Prejudices against the aged are called ageism. A case demonstrates its obscure effects. Ageism is seen as antipathy or hate, too. But a common societal reality of ageism is not being able to take different perspectives. Seeing the challenge of a concrete clinical situation means varying the ethical perspectives both care and fairness. According to that, "multidimensional" assessment characterizes geriatrics. Examples for not being able to take varying perspectives are given when adults are confronted with suicide, sexuality/tenderness, convictions, depression, religiosity, reduced memory capacity, quality of life, incontinence, dying etc. of the aged. The paper shows three ways of controlling cognitive and affective dimensions of prejudices in general.

Activities of Daily Living↗
PubMed1993

Human immunodeficiency virus infection confronts the law, ethics and society.

The full panorama of the AIDS problem is filled with contradictions. There are those who consider the AIDS sufferers--primarily gays and intravenous drug abusers--as "the bad group". Yet, there are also innocent victims: recipients of blood and blood products and the unknowing sex partners. Regardless of the circumstances under which they contracted the disease, many AIDS sufferers are hated because they are perceived as menaces. Such feelings are triggered by raw emotions, hysteria, anxiety, insecurity, fear, even phobias and paranoia in those who do not have, and who often do not understand the disease. This frequently results in discrimination and bias that may be aggravated by scientific and societal ignorance. Education of those who do and do not have AIDS is hampered by underlying economic problems: poverty, indigence and low social status, as well as taboos regarding discussion of sex and contraception. No disease in this country has created a greater dilemma among the public or the professions concerned with and involved in its care and management, as AIDS. A study of the magnitude of the problem and its impact reveals that it is beset by a "damned if you do, and damned if you don't" result, with the bottom line ultimately involving the benefit versus risk rule. An overview of the AIDS problem reveals particular areas of medical, societal, legal and ethical-moral concern that frequently overlap.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Northern Ontario MDs seek solution to region's huge accidental-death toll.

A recently published study discussed the trauma-related death toll that plagues northeastern Ontario, which has a much higher death rate from nonintentional trauma than the rest of the province Dr. Gary Bota, one of the study authors hates calling these tragedies accidents because that implies a random, act-of-God nature that he does not accept. "They're not accidents," he maintains. "They're patterns, just like infectious diseases."

Accidents, Traffic↗
PubMed1996

An adopted analysand's transference of a 'hole-object'.

The author describes the vicissitudes of the transference and countertransference in cases where the internal object transferred by the patient on to the analyst is experienced by the former as non-existent. A case history involving a 'hole-object' of this kind is presented, the patient concerned having been adopted at the age of six months and having the fantasy that she did not exist before her adoption. The hole-object is created by the patient to defend against psychic suffering and aggressive drives towards the object. A careful distinction is made between the hole-object, which is defined in terms of its non-existence, and the absent object, the 'psychic hole', the melancholic object and the bad-breast feeling, all of which exist or have existed at some time. The author describes the 'double transference', in which she represented both the idealised albeit well cathected adoptive parents and the disavowed, abandoning biological parents; in the latter case indifference took the place of love and hate in the transference. The analyst in this situation must in the author's view interpret his transference role as a hole-object so as to confer existence on this object and make it representable, and for this purpose a vital role falls to the countertransference. The split between the abandoning and the adopting aspects of the parents can then be resolved, giving rise to a single identificatory parental image.

Adoption↗