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Implications of psychopharmacological studies for the practice of psychoanalysis.

Over the past 35 years psychopharmacological developments have fueled major changes in the care of psychiatric patients. The most obvious of these are in two areas: (1) the control of symptoms not heretofore consistently treated effectively, such as the benefits of lithium in bipolar disorder, and (2) the shift toward reliance on medications rather than other forms of treatment. In this article I shall cover some of the implications of the second point, but will focus principally on other, less direct consequences of the development of specific pharmacotherapies for the practice of psychoanalysis. These areas are the enhanced importance of accurate diagnosis, the expansions of categories for which drugs are helpful, and the point, or framework, from which dynamic psychotherapies have their main indications.

Brain↗

Intergenerational work as an adjunct to psychoanalysis and psychotherapy.

Psychotherapy and psychoanalysis are opportunities for individuals to repair faulty aspects of their development that have resulted in symptoms or other difficulties in living. Although transference is the major therapeutic tool in this work, it is not the only one. The potential resources for healing that exist in family relationships is great, especially as these relationships go on long after therapy has ended. We are all living longer; families of three and four generations are no longer uncommon. There are many adult patients who have one or both parents alive and well. Intergenerational work can be a useful adjunct where there is no severe narcissistic pathology or psychosis in either patient or parent. It is especially helpful in cases where there is severe resistance and insight is not effective in promoting change. "By focusing constantly on the patient's transference distortions and ignoring reality elements we undermine self-esteem and make him feel he is always wrong, sick or crazy" (Greenson, 1978b,p. 434). The addition of intergenerational work in the course of psychoanalysis/psychotherapy can shorten the time of therapy and be another tool for dealing with resistance. This work has theoretical implications for the modification of the place that transference has in psychoanalytic therapy. By placing greater emphasis on the patient's real relationships in influencing intrapsychic change we pave the way to exciting clinical and theoretical possibilities.

Adult↗

Toward a "new" paradigm of therapeutic action: neuro-psychoanalysis and downward causation.

Freud's metapsychological assumption, which split the mind from the brain, is increasingly recognized as limiting the growth of psychoanalysis and its integration with other fields, including psychiatry. The dual-aspect monist position, sometimes used to rationalize the mind/body split, is seen to contain a mereological (category) error, which can be avoided by the introduction of the paradigm of psychodynamic science, and by the use of a nondualistic, symbiotic mind/brain formulation, well justified by the study of cultural and organic evolution. Therapeutic action may now be seen as a special case of development that occurs within the interactional context of cultural evolution, personal history, and the genome. Human evolution is increasingly dominated by culture operating on the mind/brain through downward causation. This concept refers to the influence of higher organizational entities (e.g., mind) upon lower ones (e.g., brain). Although little recognized, downward causation is tacitly assumed in psychotherapeutic interventions, and is illustrated in recent fMRI studies. The clinical integration of the downward causation concept links therapeutic action to the power of cultural evolution, and facilitates reunion with traditional science.

Biological Evolution↗

The essentials of psychoanalysis.

Psychoanalysis, as procedure, theory and therapy, is a unique activity centred around a special approach to a formalised intersubjective relationship. The phenomena of transference and counter-transference between analyst and analysand allow the emergence of a generative interplay between creative impulses struggling for expression and a persistent search for clarity by appropriate analytic interpretations and synthetic constructions of what takes place.

Freudian Theory↗

On the interpretive process in psychoanalysis.

The concept of interpretation and its function in the psychoanalytic process is updated by emphasizing the analyst's contributions to the psychoanalytic treatment process through his interpretations of resistance and transference. By incorporating Kohut's recent contributions to the psychoanalysis of narcissistic personality disorders into our general considerations regarding the process of interpretation, we have been aided in our effort to unify the theory of the psychoanalytic treatment process. We offer a broadened definition of the interpretative process and stress the added "interpersonal" dimension of resistance and transference, namely, those elements in the development of both, which are affected by the analyst;s personality and the manner of his interpretive and noninterpretive interventions. This makes the artificially sharp dichotomy between verbal and nonverbal interpretations or between interpretations and noninterpretive interventions unnecessary. The recognition of the "self-object" role of the analyst in the narcissistic transferences not only lends more precision to our understanding of archaic narcissistic experiences (whishes, demands, fantasies, etc.), but makes their interpretation within the transference our preferred analytic response. The need to foster the so-called "real relationship" between patient and analyst and the need to deal with such "nontransference" aspects of the relationship noninterpretively is thus replaced with interpretive interventions. To underline our emphasis on the analyst;s contributions to the analytic process, clinical samples and brief vignettes illustrate the manner in which interpretations may retard or promote the analytic process.

Attitude of Health Personnel↗

["Lump them all together?" Critical remarks on the psychoanalysis of so-called "destructive cults"]

Contributions to the psychoanalysis of so-called "destructive cults" are reviewed and criticized for several overgeneralizations. In order to gain a full understanding of religious feelings and commitments it is necessary to distinguish between different qualities of regression in a religious context. Religious groups differ in their "psychological offers" and therefore tendencywise in their members' personality structures, too. With regard to destructive developments of religious groups we must consider that collective projective identification with these groups can encourage such trends. Empirical results concerning commitments to so-called "destructive cults" are highly dependent on paradigms and research methods. In their entirety they rather contradict the assumption that the majority of these groups' members has severe personality disorders. As a consequence of the current status of research and discussion, religiosity should be respected as a complex domain of human experience that, despite the possibility of mixing with psychopathological tendencies, should not necessarily lose its creative potential.

Journal Article↗

[Time problem in Freud's psychoanalysis].

The influence of Freuds' work on the formation of psychological theory is especially based on the biographical system of Psychoanalysis. The aspect of historical order distinguishes his system of theoretical relations. The inspection of Freuds' scriptures shows that he through all his research was confronted with the problem of psychological time (in opposite to the term of "physical time"). The contrast between the time of existence and the identity of person clarifies the principle of the lack of temporality of repressed experiences as denied personal history.

Adult↗

The dialectically constituted/decentred subject of psychoanalysis. I. The Freudian subject.

Central among the irreducible elements that define a psychoanalytic understanding of man is Freud's conception of the subject, and yet this theme remained a largely implicit one in Freud's writing. The Freudian conception of the process by which the subject is constituted is fundamentally dialectical in nature and involves the notion that the subject is created and sustained (and at the same time decentred from itself) through the dialectical interplay of consciousness and unconsciousness. The contribution of psychoanalysis to a theory of subjectivity involves the formation of a concept of the subject in which neither consciousness nor unconsciousness holds a privileged position in relation to the other; the two coexist in a mutually creating, preserving and negating relationship to one another. The principle of presence-in-absence and absence-in-presence subtends the dialectical movement between conscious and unconscious dimensions of subjectivity.

Freudian Theory↗

[Some dimensions of the forgotten body in psychoanalysis and psychosomatic medicine].

Bodily Experience is well reflected in psychoanalysis and psychosomatic medicine, the body is not forgotten. The first part of the paper summarizes the general and clinical knowledge on bodily experience. The second part deals with some still neglected dimensions of bodily experience. The first two dimensions are clinical perspectives. 1. The (ill) body can be functionalized as a help to stabilize fragile body boundaries. 2. The body is determined not only by intrapsychic conflicts but also by social influences, so that bodily behavior might not necessarily reflect intrapsychic attitudes but social (hyper-)adaptation. The following two dimensions may be important for psychosomatic research. 3. Causal and unidirectional models of body-soul influences lack complexity and should be replaced by differentiated interactional models. 4. Empirical studies on body experience have to take into account its subjective and unconscious character. Qualitative methods might be very helpful here.

Body Image↗

[Anxiety, nostalgia and melancholy. A few remarks on psychoanalysis and tango].

Our work is based on the application of psychoanalytic techniques, in order to unveil this cultural phenomenon called tango, related with sexuality and unconscious processes. As a way of introduction, it deals with a brief theory of the birth of tango, the possible terminological source of its name, its main creators and interpreters, as well as the chronological classification into the first wave tangos, Guardia Vieja, and the newer wave tangos, Guardia Nueva. The former ones were awash with festive themes of the centennial years, expressed in behaviors that denote sexuality and love, whereas the latter ones, expose the great bewilderment of the thirties' crisis, due to the imminent downfall of the country, the denunciation of materialism, the crumbling of ideas; which led up to feelings of utter pessimism, loneliness and abandonment. From this point onwards, through the use of techniques provided by psychoanalysis applied to tango lyrics, we are able to unravel the unconscious processes of the drama of its characters; the immigrant, hopeful and at same time nostalgic for the loss of his mother country; the porteno -urban man from Buenos Aires city- who, overwhelmed by immigrants, has to give way to the new compatriots; the inland inhabitant, who was dragged to the city because of the new conditions of rural work; and finally the conventillo, tenement house, as a melting pot that fulfilled the integration of these groups. Like in a painter's palette, which contains various colors and shades, the interpretations about nostalgia, grief and loneliness become apparent, along with the father-son rivalry, the conflict with the absent mother, the relationship between sexes, male chauvinism, infatuation, identity, the fear of death, the rebirth to a new life, the passage from gaucho to guapo, from a shrewd horseman to a daring, bullying braggart.

Anxiety↗

The Oedipus complex in the contemporary psychoanalysis.

In this article, authors have tried to answer the question: "Where is the place, and what is the meaning of the Oedipus complex in contemporary psychoanalysis?" The review of different theoretical standpoints was given, according to meaning and place of the Oedipus complex in human development. Although it depends on the resolving of preoedipal conflicts, the conflicts of phallic phases of the psychosexual development are universal to all human being, no matter how we call them--Oedipus, Electra or Persephone Complex.

Adult↗

Psychoanalysis as cognitive remediation: Dynamic and Vygotskian perspectives in the analysis of an early adolescent dyslexic girl.

The interface of neurocognitive problems and dynamic concerns are examined in the treatment of an early adolescent dyslexic girl. Despite previous intensive remediation, she had been unable to master reading and spelling, but made remarkable progress after a relatively brief period of psychoanalysis. Psychoanalytic and Vygotskian perspectives are integrated to provide a model of how play, within the analytic context, is mutative for learning disabled children. Through the process of reexteriorization in the transference, play allows for the interpretation and resolution of traumatic situations which have become associated with learning. As the act of learning becomes separate from the personal and affective context in which it took place, the child gains access to other, more normative, functions of play. These functions include the development of the capacity to separate meaning from action and the ability to understand words as generalized categories which represent objects, rather than being part of the specific object named. These two capacities, fundamental to the development of abstract thought, will support reflective awareness and help modulate affective states. The abilities furthered in play also act to remediate one component of dyslexia-the difficulty separating context from more abstract bits of knowledge. Finally, the child learns to "play at reality, " often trying on the new role of "student". As Vygotsky notes, play is essential in allowing the child to become aware of what she knows. For a dyslexic child, for whom reading may never become completely a part of procedural memory, becoming conscious of what he knows may also enhance mastery of the skills of phonological processing, albeit more slowly than normally developing readers. The pleasure in play and the repetition it generates aids the internalization of the task and the development of automaticity.

Adolescent↗

[Psychoanalysis and treatment of psychotics.].

The psychotic person who is undergoing transference reacts differently to treatment. The ethics of psychoanalysis require that that person become responsible for the treatment. The person then has a long fit directly linked to the treatment ; the only way out is through recognizing their symptoms. The treatment and the analysis of symptoms bring the psychotic to a particular time of "reconstruction" (reconstitution du corps) ; this is when producing an object allows them to leave behind their psychotic phenomena. This path is unforeseeable yet for those who choose to follow it, at grips with a structural rather than symptomatic illness, there is at the end of the tunnel society's total failure in properly recognizing their place in the world.

English Abstract↗

The wish for a sex change: a challenge to psychoanalysis?

This paper approaches different facets of male transsexualism from the point of view of different current psychoanalytic theories and the criticisms to which some of them give rise. On the basis of the author's observations, the determining psychological factor is stated to be the hatred of masculinity. The central thesis is that the clinical challenge made to psychoanalysis is an integral part of the pathology and that it highlights the working of this disorder, just as the 'reflection theories' of the manifest content of what the patients say represent in their objectifying reification a fundamental aspect of this disturbance. Based on two clinical vignettes, an attempt at reconstruction is proposed, in which the narcissistic aspects of this pathology are emphasized. Current theory tends to stress the concepts of deficit and developmental arrest, which are generally inconsistent with those of conflict and defence, but they are here linked organically together.

Drive↗