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PubMed1981

Brief psychotherapy for unresolved grief in an 82-year-old-man.

This man experienced in old age the torment that occurs when early fantasies that underly anxieties are enacted in real life. His elderly wife, when she became confused, ordered their son to drive him from the marital home. When the wife died, the son kept the news from the husband until after the burial. These acts created in reality the fantasy of a reversed oedipal situation, with the son succeeding as a competitor for his father's wife. If the father had resolved his own oedipal strivings satisfactorily, presumably he would not have feared such competition. But there seemed to have been some early environmental failure that had prevented him from integrating in the process of maturation his own wishes for his mother and his fears of his father. Yet, despite the patient's advanced years, the early failure situation seemed to fade as he used the therapy not only to work through his grief, but also as an opportunity to experience anew in the transference a more facilitating environmental adaptation to his needs.

Adaptation, Psychological↗
PubMed1980

[Suicide and adolescence. II. Psychosocial factors and clinical aspects].

In this study, that follows another one, where the normal characteristics of adolescence that may influence suicidal behavior were focalised, a critical review of the psycho-social elements involved in the matter is done; attention is also given to the clinical picture. The family influences are very important and frequently we find antecedents of suicidal behavior in parents or in near relatives. The homes are usually unhappy with a father absent or "feeble". It is not rare the presence of a dominant-rejecting mother. The home is poor in love expressions, and the intra and extra family reactions tend to lead to the youth social isolation. With the changes that normally happens in adolescence, the repressed aggressive impulses increase and tend for discharge at this phase, but usually the youth turns them against himself. The emergent genital sexuality is also perceived as threatening by the parents. Though lacking more detailed studies, it seems that families of suicidal adolescents are very similar to the families of depressive ones. In females, cultural influences such as greater tolerance to suicidal attempts behavior, perhaps explain the higher incidence of this behavior. Men usually use violent methods for consumating the suicide, and often their mental status is more severe than in females. The precipitant factors vary a lot but they usually give evidence of a conflictive situation. It is suspected that often the patient unconsciously puts himself in the difficult situation. The influence of mental illness in the suicidal behavior of adolescents is complicated by several classificatory systems and the possibility of considering abnormal aspects that normally occur during adolescence. In the clinical picture is important to consider the patient report about his suicidal thoughts. The evaluation of the defences, the intensity of the conflict and the suicidal ideas involved, will determine our conduct. An important feature is that, in adolescents, depressive symptoms usually occur as "equivalents". The prognostic is worse when it is impossible to modify family relationships and when social life continues unpoverished. In 40% of the cases a new suicide attempt is done, and the risk is greater during the year that follows the first attempt. Prevention may be done by trying to understand and discuss adolescents problems with them in their peer groups. Public campaigns and courses with moral appeals should be avoided because they increase feelings of guilt. Special attention has to be given in each case to social and family situations. An early diagnosis by pediatricians, clinicians, teachers and law authorities is very important. To do this work they need to have instruction about the adolescence developments.

Adolescent↗
PubMedDate not supplied

Oedipus was not the son of Laius and Jocasta.

Neurotics have family-romance fantasies, which they sometimes take to be real and which make them think that their parents are not really their parents. They have other unconscious fantasies in which they feel that their sexual objects are really their parents and in which trivial acts acquire the value of incest and parricide. From these psychoanalytic findings we can interpret the Oedipus legend as a special manifestation of the family romance which has arisen from guilt feelings and an intense desire for punishment. Oedipus fantasies the rulers of Thebes to be his parents and takes his behavior toward them as both incestuous and parricidal. As a displacement on the adult level, the Oedipus legend symbolizes the genital situation of the child both before and during the creation of the superego. As Oedipus was happy in his love life before the plagues afflicted Thebes, the child enjoys, during his infancy, sexual pleasure with his mother and rejects his father as his rival. Later just as Oedipus did, the child learns from his parents and from the rest of his environment, that his incestuous and parricidal behavior is dreadful and that he must feel very guilty and be punished severely. The child also learns this must be repressed: He must no longer perceive these things. In the legend this is symbolized by Oedipus blinding himself. The usual interpretation of the Oedipus legend, which wrongly believes that he really committed incest and parricide, does not take into account the distortions of judgement and preception which guilt feelings can give rise to.

Family↗
PubMedDate not supplied

Transsexualism and psychosis.

A discussion of "The Transsexual Wish in a Psychotic Character" by Katherine MacVicar, M.D. This paper reviews some of the major reports gradually emerging in the psychoanalytic literature which validate the belief that beneath the desire "to change sex" may lie serious, if not overwhelming, psychopathology-even of a psychotic nature. Transsexual wishes may arise from oedipal conflict, preoedipal fixation, or schizophrenic processes. This paper briefly describes the mechanisms involved in the development of psychotic reactions in those schizophrenics who desire and undergo sexual transformation surgery.

Follow-Up Studies↗
PubMedDate not supplied

Oedipal grief.

This paper concerns a common clinical picture, one that is seen particularly clearly in young men. It is a picture which, within a traditional psychoanalytic framework, has much to do with that set of mental structures referred to as the superego and with the patterns which follow from the oedipal period of development. Using two case examples, this paper suggests the outlines of a treatment strategy and looks at some of the theoretical issues involved (in particular, the contribution of an object relations emphasis to classical theory). It argues for the importance of grief in the oedipal dilemma and suggests that the role of grief in the formation and maintenance of morbid conscience can overshadow that more familiar explanation, the struggle with one's own forbidden wishes.

Competitive Behavior↗
PubMedDate not supplied

Oedipal grief: mourning or melancholia?

A discussion of "Oedipal Grief" by Robert May, Ph.D. A clinical syndrome seen in late adolescent men, oedipal grief refers to a depressive state sustained by a vengeful conscience and a pattern of self-punitive acting out. The psychopathology of this syndrome is clarified and differentiated sharply from the normal developmental process of grieving the loss of an idealized oedipal father. As a form of developmental melancholia, the repressed ambivalence and weakening of the ego in this syndrome is highlighted. May's reconceptualization of the structural-instinctual model of the superego and ego ideal is then critically reviewed; his tendency to reduce oedipal to preoedipal developmental phenomena is noted. A more developmentally differentiated theoretical model is suggested in terms of the incomplete internalization of the functions of self-control and self-esteem in the type of adolescent personality organization which underlies, and is perpetuated by, the psychopathology in the oedipal grief syndrome. The main task of brief psychotherapy is thus to promote the ego's capacity to tolerate increased inner conflict so that a developmental shift toward greater internalization can take place. The skillful treatment conducted by May is reinterpreted in these terms; and the therapeutic facilitation of adolescent grieving is placed in the context of structural-developmental change.

Child Development↗
PubMed1980

The organization of the self-representation and its influence on pathology.

Units within the self-representation provide the quality for ego activity. The ego selects and cathects the appropriate unit of the self-representation. Oedipal identifications internalize the ego capacity to maintain the self-representation and its stability. Conflict can promote instability within the self-representation requiring special defenses to deal with the narcissistic stress. Such narcissistic conflict can arise at all levels of maturity.

Acting Out↗
PubMed1980

Enuresis: a functional equivalent of a fetish.

The split in the ego between consciousness and unconsciousness which sometimes eventuates in fetishism can also be clinically manifested in sleep disturbances, depersonalization, dejà vu and a variety of alterations in the sense of reality. It is suggested that this same split comprises the central dynamic mechanism in enuresis. The sleep disturbance which accompanies enuresis involves a confusion between waking and sleeping, sometimes taking the form of a dream that one is awake. Three patients(adult males) revealed in the course of their analyses that they suffered from childhood enuresis accompanied by a sleep disturbance. Milder forms of sleep disturbances persisted into adult life. In these analyses, certain perceptual distortions, difficulties in the sense of reality, and between fantasy and reality, confusions between waking and sleeping, could all be linked to the functional split between consciousness and unconsciousness and eventually to disavowal of the female genitals. The enuresis represented a functional equivalent of the fetish (and it may be that the urinary stream itself actually served as a fetish). Psychological test data from nine enuretic boys were examined as well. This material clearly demonstrated that these boys wished to deny the differences between males and females, that they suffered from sleep disturbances and that they confused reality and fantasy, sleeping and waking. The combined data suggest the existence of a functional split in the ego used in the service of defence, the product of a regressive fixation and a reinstatement of an archaic mode of thought.

Adolescent↗
PubMed1995

A childhood gender identity disorder. Analysis, preoedipal determinants, and therapy in adolescence.

This paper is about a four-year-old boy's wish to be a girl. This wish was a compromise formation, the consequence of intrapsychic conflict. Using reconstructive inferences and research findings, I suggest a line of development in the boy's femininity, beginning with constitutional and maturational factors, with being shaped in a feminine direction by his environment, and with shaping himself internally in the form of a compromise formation in that direction by the time he was two to three years of age. The disorder began to acquire a persistence and stability during the preoedipal phase and, with minor changes in its components, remained operative during the oedipal phase, latency, and adolescence.

Child, Preschool↗
PubMed1995

The nature and function of a pathological oedipal constellation in a female patient.

The first analysis of a female patient dealt essentially with separation-individuation and narcissistic issues. During the second analysis a dynamic constellation of narcissistic character pathology, some psychopathic tendencies, perverse fantasies, and enactments emerged. Prominent was an unconscious fantasy of stealing the sexual organs of one parent to sexually satisfy the other parent. The etiology of this constellation and its transmutations in analysis are described.

Adult↗
PubMed1994

Publication anxiety: conflict between communication and affiliation.

The author suggests that publication anxiety is ubiquitous and natural; it can produce inhibition, symptomatic disorders of the text, or simply overt anxiety. Anxiety-free publication occurs where anxiety is denied as part of a manic defence which produces complacent orthodoxy, triumphant iconoclasm, or an illusion of originality. A discriminating journal usually detects this and publication fails. If the anxiety is excessive, there may be an inhibition of publication such as afflicted Darwin. Lesser degrees of anxiety may result in distraction or distortion due to a compromise between the urge to communicate an idea and the desire to consolidate affiliation with a significant group through shared language, common belief systems, totemic figures or ritual utterances. The author sees this conflict as internal to the individual. It is shaped by Oedipal anxieties which are given different emphasis and intensity by the scientific contexts current at the time. If the 'paradigm', under the influence of which the analyst is writing is in the ascendant, publication is relatively free of anxiety for most writers who are content to add to its application. Some, however, suffer 'anxiety of influence', fearing that their existence as originators of ideas is threatened. When the stability of the paradigm is threatened, due to the accumulation of anomalies, publication anxiety, with both persecutory and depressive elements is intensified. This increases the conflict between the need for affiliation and the desire for communication and may result in defensive writing or distorted texts.

Anxiety↗
PubMed1995

Triangular space and the development of a working model in the analysis.

Two clinical examples are presented in order to demonstrate how the analyst uses what he perceives to be the patient's impact on his ability to think, in constructing an effective psychoanalytic working model. The two clinical cases, very different in character and in the countertransference difficulties they cause, lead to the construction of quite diverse working models, although an oedipal illusion plays a central role in both. The presentation is based on the premise that psychic space exists and that the shape of the psychic space of one individual affects by way of projection the shape of the psychic space of another. In the discussion the author traces Bion's concept of the working model and the abstractions which can be developed from it, as well as the use of Bion's theory in Britton's discovery of the effect that a patient's personal model of the oedipal situation can have on the mind of the analyst.

Depressive Disorder↗