The diagnosis of borderline conditions in adolescence.
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Adjustment Disorders↗
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Results for “Reality Testing”
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Research on family dynamics: clinical implications for the family of the borderline adolescent.
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Adolescent↗
Regression: some general considerations.
Regression is a concept involving development as well as structural considerations. Clinically speaking, it refers both to psychopathology and to potentially therapeutic phases of the psychoanalytic process. Regression, a movement backward, reverts to more or less primitive stages of psychic organization which deviate from a norm, while at the same time these stages are enduringly active in the continual integration of psychic life. Regression and progression are necessary and complementary phases of this organizing activity. Certain theoretical and clinical aspects are discussed in some detail. The normative implications of regression, in the context of modern Western rationality as the standard of normal mental life, are briefly considered.
Humans↗
Blow up: the "I" of the camera.
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Female↗
The ideal of the anonymous analyst and the problem of self-disclosure.
The principle of analytic anonymity is critically reviewed. A connection between the technical stance of nondisclosure and idealization of the analyst is proposed. Some preliminary suggestions are offered concerning what kinds of information about the analyst are useful to communicate to a patient.
Defense Mechanisms↗
[Violence--an element of the psychiatric profession].
In an article on principles it is shown that violence plays a significant part in psychiatry: The patients bring violence into the psychiatric institution as a symptom as well as an origin of their disorders. The institution itself can again not be free of structural violence. Add to this a resonance in the personal aggressive emotions of the professionals. In this way violence becomes an element of the psychiatric profession. In the centre of this appears the specific competence of the psychiatrist to judge about the ability of judgement ("reality-control") of other people in an authoritarian manner. This competence which cannot be eliminated from the psychiatric work gives power and has a latent totalitarian aspect. Thus taking over the responsibility to limit the violence that is set free through psychic disorders we have to limit this responsibility in the same time.
Adolescent↗
[Therapeutic reflections on violence in schizophrenic patients].
A model for a psychotherapeutic access to the violence of schizophrenics is presented. The theory bases on three schizophrenic operations: The loss of thinking correlated to the absence of the psychical representative for the act of violence. The splitting of the ego by which the patient knows of his violence but does not remember it. The paradoxon of speaking and not speaking about violence in the same time. The active use of these psychotic mechanism in the therapy and technique is showed by casuistics. Special problems are discussed.
Adult↗
[C. G. Jung's concept of schizophrenia].
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Ego↗
Orphans of the 'Real': I. Some modern and postmodern perspectives on the neurobiological and psychosocial dimensions of psychosis and other primitive mental disorders.
To understand and treat patients suffering from psychoses (especially schizophrenia) and from other primitive mental disorders, it has become increasingly important to integrate the "soft science" of psychoanalysis, including its derivate, psychotherapy, with the "hard science" findings of neurobiology, infant development research, and newly emerging trauma research. The author presents such an integrated perspective, and also discusses a paradigmatic change within psychoanalysis itself, one that can be described as a transformation from the one-person ("modern") model to the intersubjective ("postmodern") model. This change is also characterized by a shift from drive theory to that of semiotic meaning and hermeneutics. In light of this transformative change and integration, the author formulates the concept of a generic type of patient, "orphans of the 'Real,'" whose illness can be described as the result of a premature awakening from the protective blanket of innocence because of hypersensitivity and/or traumatic abruption. These patients experience the "Real" without the protective blanket of imagination or symbolization.
Arousal↗
Orphans of the 'Real': II. The future of object relations theory in the treatment of the psychoses and other primitive mental disorders.
Objective relations theory is a broad, multifaceted concept that covers a number of differing paradigms. The author highlights the historical development of this concept. Originally developed by Freud and Abraham, it gradually became a shibboleth that identified both the Kleinian and the Independent schools in Great Britain and the object relations school within the American school of ego psychology. The two British schools differed between each other and from the American school. Among these schools of thought, two major paradigms have emerged: (1) the one-person psychoanalytic model, and (2) the two-person model. More recently, derivatives of the two-person model have emerged as the schools of relationism, self psychology, and intersubjectivity. In addition, the contributions of the Lacanian school have altered concepts about the fundamental nature of object relations. What is consequently at issue in terms of the psychoanalytic conception and treatment of psychoses and primitive mental disorders (with patients suffering from being "orphans of the 'Real'") is (1) the differing conceptions of what is meant by internal objects, part-objects, selfobjects, and object-representations, and (2) the differing conceptions of unconscious mental life.
Freudian Theory↗
Schizophrenia and oxymorons.
From the viewpoint of character structure, patients with schizophrenia can be seen as the diametric opposite of persons with a nonpsychotic organization. They construct adaptations and defenses to deal with an externalized primitive mental orientation, whereas nonpsychotic persons tend to develop defensive mechanisms to render these primitive parts inactive. Patients with schizophrenia do not have a continuum between primary process id levels and secondary process reality operations. Thus polarities are not differentiated, leading to a series of paradoxes and oxymorons. These patients may view themselves as omnipotent and grandiose, yet at the same time lead a miserable, drab existence. Primitive parts of the personality may feel alive and powerful, whereas the ego is viewed as dead--the fundamental oxymoron of the living dead. The author presents several illustrative case vignettes of these features.
Adult↗
Multiplex developmental disorder.
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Autistic Disorder↗
[Qualitative research in social psychiatry--exemplified by a research project on daily life of chronic psychiatric patients outside the psychiatric hospital in an East and a West Berlin sector].
Qualitative research methods give an opportunity to investigate the everyday reality of dealing with and understanding of chronic mental illness as a social reality in local context. By the reconstruction of the perspective of the mentally ill, their relatives and their professional caregivers we analyze the cultural and social side of chronicity. This approach is illustrated by a still running study in which we compare the situation of chronic mental patients in an east- and west-district of Berlin after the fall of the wall. The research method and the steps of generalization of results are demonstrated by an case example.
Activities of Daily Living↗
The psychoanalyst's mind: from listening to interpretation--a clinical report.
Freud's delineation of 'psychical reality' as our investigative domain poses compelling epistemological and clinical challenges, which must profoundly affect our understanding of what is meant by what is real. Exploring the patient's inner reality as our central database, we are given a remarkable, but elusive opportunity for discovery and recognition, holding a pervading mutative power. It is elusive, for, despite our intentions otherwise, there is a continuing pull towards a belief in the greater 'wisdom' of our own assumptions and predilections, a blurring of the boundaries between our and our patient's vantage points, leading us away from essential, if subtler dimensions of the patient's experience. Utilising a clinical example, the author tries to illustrate some of her efforts to listen to her patient, and the difficulty she encountered. Her struggle was one which, she believes, has more far-ranging, even ubiquitous ramifications. Further consideration is given to some of the theoretical underpinnings in this mode of analytic listening.
Adult↗
[Treatment of psychotic patients with music therapy].
The present contribution describes the experience taken from music therapy of psychotic patients. The emotional and cognitive music perception and its possible influence on self perception and strengthening of ego are discussed. Since exercise instructions were limited the observed improvement of communication seems rather due to intra- and interpersonal effects of active improvisation than to a training process. With regard to schizophrenic patients possible effects of music therapy are discussed in the light of self-object-differentiation.
Adult↗
Understanding delusions.
Delusions traditionally have been considered as fixed, false beliefs, born of morbidity. Whereas this definition serves to orient the clinician to the phenomena at hand, each element breaks down under scrutiny. It has been shown that delusions are not necessarily false, although in some sense they are discordant with reality. When delusions coincide with actual events their judgements can be shown to be independent of this evidential basis; when they refer to disorders of experience, such as first rank symptoms, the experience usually contains a distorted meaning. The supposition that delusions are a variety of belief has itself been questioned. On the one hand, they do not always refer in a meaningful way to anything, or when they do they fail to function as evaluative judgments; instead, delusions are experienced subjectively in ways that are characteristic of knowing rather than believing. On the other hand, delusions are not ascertained clinically by surveying the patient's belief system; rather their failure to achieve the status of objective knowledge leads to the post hoc relegation of delusions to the epistemologic waste basket of beliefs. To treat delusions as necessarily the product of morbidity is essentially tautologous insofar as delusions are, by definition, pathologic; that is, as defective judgments delusions are not simply erroneous, they are disordered. Finally, the fixity of delusions is an empirical matter and varies widely. Underlying this perceived intractability, however, are the subjective certainty and incorrigibility that Jaspers identified and which Spitzer has recast in the form of "epistemological asymmetry" misapplied to external reality. Although delusions typically have been recognized and categorized according to their manifest content, these formal considerations are crucial to understanding the nature of delusions.
Delusions↗
Evolutionary perspectives on paranoid disorder.
Certain subtypes of DD may represent abnormal forms of previously well-characterized, content-specific behaviors that represent evolved adaptations to challenges of social interaction and mating. Such rare delusional states may be manifestations of an adaptive hypersensitivity to important environmental threats or opportunities, or may be a byproduct of behavioral misfiring triggered by unfamiliar environmental cues or perceptions.
Adaptation, Psychological↗
Culture-specific delusions. Sense and nonsense in cultural context.
It can be said that a definition of delusions requires the invocation of cultural understandings, standards of acceptability, as well as conceptions of reality and the forces that animate it. For these reasons, the determination of delusional or normative ideation can only be effected properly within particular cultural contexts. The cross-cultural record suggests that it is difficult to separate the delusional from the cultural; a belief that is patterened and culturally specific is, by definition a cultural, not a delusional belief. One must rely upon particular, relevant local cultural understandings to ascertain when the bounds of culture have been transgressed and meaning has given way to unshareable nonsense.
Cross-Cultural Comparison↗