The diagnosis of hysteria: an overview.
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Freud built his model of the mind and his hypotheses about dreaming directly on the structure of his neurobiological model of the brain, which was developed in the "Project for a Scientific Psychology", written in 1895. Among the concepts modeled in this work were ego, somatic drives as motivationally critical, cathexes of psychic energy, wish fulfillment, and primary and secondary process. From the vantage point of more than 80 years later, the authors indicate the areas in which many of Freud's neurobiological assumptions are inacurrate. Revisions are needed in the neurobiologically derived psychoanalytic concepts, especially those of Freud's wish fulfillment-disguise theory of dreams.
Recent research in the neurobiology of dreaming sleep provides new evidence for possible structural and functional substrates of formal aspects of the dream process. The data suggest that dreaming sleep is physiologically determined and shaped by a brain stem neuronal mechanism that can be modeled physiologically and mathematically. Formal features of the generator processes with strong implications for dream theory include periodicity and automaticity of forebrain activation, suggesting a preprogrammed neural basis for dream mentation in sleep; intense and sporadic activation of brain stem sensorimotor circuits including reticular, oculomotor, and vestibular neurons, possibly determining spatiotemporal aspects of dream imagery; and shifts in transmitter ratios, possibly accounting for dream amnesia. The authors suggest that the automatically activated forebrain synthesizes the dream by comparing information generated in specific brain stem circuits with information stored in memory.
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In recent years dreaming has been characterized as an information-processing activity that functions adaptively to match new experience with representations of past events already stored in long-term memory. Nine patients who reported dreams in psychotherapy were asked expressly if the dream imagery recalled a specific event from early in their lives. Of 50 consecutively reported dreams, 46 were associated with early events whose imagery appeared in the dream. When questioning about the past was omitted in a later series of 34 dreams, the same patients spontaneously recalled early events represented in the dream imagery only 13 times.
A woman who had appeared suitable for psychoanalysis was persistently unable to develop an analyzable transference. Her history, as it unfolded during analysis, suggested a form of atypical depression linked to a neurochemical abnormality, which appeared to be related to her reluctance to take the emotional risk involved in examining transference phenomena. The analysis was modified by a trial of phenelzine. Changes within the analysis and in the patient's private life after the drug trial ended support the hypothesis that her affective vulnerability had inhibited her ability to engage in analysis of transference before the administration of the drug.
The authors present a brief written psychodynamic formulation that focuses on central conflicts, anticipates transferences and resistances, and helps guide all psychiatric treatments. After placing the presenting problem in the context of the patient's life and identifying nondynamic determinants of the psychopathology, the formulation explains the development of central conflicts and their repetitive effect on the patient's behavior. It concludes by describing how these conflicts will be manifested in treatment. Three sample formulations and their application are presented to illustrate the value of this clinical tool.
Some of the most important issues in dynamic psychiatry involve the mechanisms of action of and the distinctions between psychotherapy and psychoanalysis. Recent advances in developmental psychology and in clinical practice and theory provide new insights into these long-standing controversies.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Analysis of dreams is often used in group psychotherapy to explore common group tensions and individual internal conflicts. The author pays special attention to the first dream which a patient reports in the course of group psychotherapy. These first reported dreams clearly and accurately reveal the patient's basic conflicts and also reflect the progressive stages of group-as-a-whole tension from issues of dependency, advice-giving, and universality to explorative resolution of conflicts.
This paper attempts to indicate some of the strengths and weakenesses of primal therapy, some of the ways it is changing and how it can be incorporated within more traditional psychodynamic frames of reference.