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PubMed2006

[Post-traumatic psychosis: the contribution of an acute post-immediate trauma to a dynamic theorization].

SUMMARY: In his recent publication (2004), in which he favors the psycho-dynamic approach, M. Bertrand underlines the importance of traumatic matter at the heart of new clinical, methodological and epistemological challenges of psychopathology. TRAUMATIC PSYCHOSIS CONCEPT: Our contribution ("post-traumatic psychosis") comes within that prospect in reference to the semiology of traumas generated by extreme situations, such as the tsunami in South Asia (December 2004), the terrorist attacks in Madrid (March 2004) or the hostage taking in North Ossetia (September 2004). Four principle sets of themes lead us to suggest a traumatic psychosis when the person shows symptoms of a neurotic psychic structure: 1. There's no traumatic representation or psychic inscription of the event. Sideration (and its stupor-like confusion symptoms) or panic flight (together with hallucinations or acute delirious fits) often illustrate this first clinical aspect. 2. According to the psychodynamic frame of reference, psychic processes tend to ignore the pleasure/displeasure principle. They are governed by the "invasion" of affects of pain and compulsion to repeat. 3. The models of neurosis and psychic conflict are not efficient in the management of the "quota of affect" and the drive influence. 4. It would be necessary to add, from a psychopathological point of view, the appearance of temporary fits of mental confusion, self-destructive and autolysis behavior. CLINICAL FEATURES: The frame of reference of a DSM IV type "descriptive" psychopathology (ie acute Stress Disorder) seems to de inadequate to convey the implemented post traumatic stakes. If trying to soothe the symptoms is undeniably important, psychic disorganizations that generate a semiology that is essentially present in the symptomatology of the psychoses cannot be ignored. A first clinical approach makes it possible to specify the argumentation of our proposal: "a post-traumatic psychosis". It is supported by five main syndromic classes: 1) the symptoms are often more or less temporary delirious fits (delirious ideas or perceptions of a persecutory, cenesthetic or hypochondriac nature), mental confusion (oneiroid state, anxiety and stupor), phases of depersonalization and derealization, severe death pangs, serious physical disorders, divides close to schizophrenic-type dual personalities; 2) the adhesiveness marks the impossibility for the victims to keep away from a trauma. The objects are bound, persecuting and adhesive; 3) traumatic temporality imposes a factual and current omnipresence of the trauma. It destroys the temporal projections of the patient as well as an anamnesic reconstruction; 4) the "traumatic body" is not that of hysterical neurosis conversions. The somatic semiology marks operational-type functioning (P. Marty); 5) traumatic compliance doesn't work on the level of facilitations that lead to the formation of symptoms. The identity structure appears disorganized by the dismantling of the primary psychic envelopments. PSYCHOPATHOLOGICAL ASPECTS: A second theoretical approach makes it possible to promote this immediate psychotic-type post-traumatic psychopathology. Four considerations of fundamental psychopathology support our contribution: 1) Pictogramic inscription. The severe traumatism does not produce the polarity required for the process of "self-fathering" described by P. Aulagnier in connecting with original processes. Traumatic adhesiveness does not separate the victim from the trauma. It splits the necessary mediation spaces and distance for the emergence of representation processes. 2) Pain affect. The pain affect generated recalls the first experiences of the newborn, primitive agony and anaclitical collapse; the "narcissistic contract" is broken and the patient lives without a secure base or a sufficiently good and supporting psychic container (D.W. Winnicott). 3) Anxiety status. The anxiety is not of neurotic nature but truly annihilating. It is often similar to anxieties caused by disasters, psychoses due melancholy (H. Ey) or more "archaic" anxieties that have been observed in hebephrenic pathologies. 4) Body dismantling. The trauma results in "mute somatizations that cannot be symbolized" (M. Bertrand). They appear in sensory outward signs such as dermatosis, pruritus, diarrhea, hemorrhagic periods or persistent headaches for example. These two clinical and theoretical aspects of the severe forms of trauma confirm the unconscious traumatolytic aim of the victim's psychological destruction. The semiological forms most impervious to therapeutic processes seem to be, in reference to hostage-takings or terrorists acts, those where the patient was conformed with a trauma "that was not carried out" like mock hangings or executions. Suicidal dimension seems to be the ultimate recourse so as not to sink into insanity and to keep a subjective position when faced with barbarian figures.

Affect↗
PubMedDate not supplied

Childhood "screen memories." Are they forgotten?

In the past few years, much has been written on childhood sexual abuse. However, there is an absence of any mention of screen memories. Freud introduced the term "screen memory" in 1899. He repeatedly returned to the subject of childhood memories and concluded all childhood memories are "screen memories" and as such, "show us our earliest years not as they were but as they appeared in later years when the memories were recovered." Childhood memories are important in what they reveal and what they hide, and most important is the affect, not the event.

Adult↗
PubMed1993

Epileptic seizures and infantile states: some thoughts from psychodynamic therapy.

A brief introduction to psychoanalytic thinking around epileptic seizures is given. It is notable how little attention has been paid by psychoanalysis to the psyche-soma links present in epilepsy. The psyche-soma world of the early infant is outlined, along with the impact of impingements on this fragile world. It is postulated that for certain individuals with epilepsy, the seizure state may generate a regression to an earlier developmental state of being involving a change in emotional state and the emergence of unconscious phantasies. Single case study material from the psychodynamically orientated art therapy of 'Gordon', a man with epilepsy and learning disabilities, is used to illustrate and support this hypothesis. This work took place in a specialized centre for epilepsy.

Adult↗
PubMed2000

The products of the imagination: psychoanalytic theory and postmodern literary criticism.

This article considers some of the affinities between postmodern literary theory and the psychoanalytic theories concerned with intersubjective phenomena. Postmodern literary theory is described briefly, and it is argued that one of its major concerns is the nature of, and the political and cultural influences on, subjectivity and identity. Despite that, postmodernism generally, and literary postmodernism in particular, can be said to lack a theory of the psychological and interpersonal dimensions of the experience of self. This article contends that the more relational schools of psychoanalytic theory can provide an example of the construction of selfhood that is of importance to contemporary and postmodern literary criticism. The academy has, to a considerable extent identified 'psychoanalysis' with the work of Jacques Lacan, but since the 1980s the work of such theorists as Jane Flax and Jessica Benjamin, building on the work of Nancy Chodorow, have increasingly opened up the possibilities of relational and object relations theory for literary studies. The relational psychoanalytic theories operate in the same epistemological universe as postmodern literary criticism, congruent with the postmodern idea of 'truth' as constructed and relational, and selfhood as shifting, contingent, and always-in-process. Particular attention is paid to the work of Wilfred Bion, whose understanding of self provides an account both of the failure of meaning, and of the development of mind. Some examples of a relational approach to literary analysis are provided.

Humans↗
PubMed2001

Psychological trauma in adolescence: familial disillusionment and loss of personal identity.

This article presents trauma theory and characteristics of traumatized adolescents. A case vignette demonstrates the considerations regarding assessment and treatment strategies in clinical work with an adolescent girl who suffered profound trauma, loss of personal identity, and self-esteem due to familial disillusionment. In contrast, the author presents the case of a female Holocaust survivor, documenting catastrophic loss, also during adolescence. Irrespective of the nature and magnitude of trauma, the single most outstanding predictor of future positive adjustment and resilience was the nature of the parent-child tie.

Adolescent↗
PubMed2002

"Living turned inside out": the musical expression of psychotic and schizoid experience in talking heads' Remain in light.

The rock album form, advantageously suited for the artistic expression of intrapsychic experience, has been virtually ignored by analytic writers. Remain in Light by Talking Heads is presented as an example of an album that effectively utilizes the potentialities of this form to give powerful and disconcerning musical expression to a variety of psychotic and schizoid experiences, bringing to life the formulations for these phenomena of Bion, Winnicott, Guntrip, Ogden, Grotstein and others. The album suggests a variety of mechanisms by which sound and music may serve both defensive and compensatory functions in relation to these phenomena.

Creativity↗
PubMed2002

Michael Balint: an overview.

Balint's important work extended over a period of 40 years in two directions; firstly the development of individual sexuality, and secondly, the development of object relationships, together with their relationship to psychoanalytical technique. He introduced the concept of primary love and was one of the pioneers in the thinking of the interdependence of mother and infant. He extended Ferenczi's work on therapeutic regression, introducing the concepts, among others, of benign and malignant regression, the basic fault, and the states of ocnophilia and philobatism. His applied psychoanalytic work is world famous, particularly the Balint groups for general practitioners and similar groups for marital therapists, social workers, and psychosexual counselors.

History, 19th Century↗